If you are responsible for the care of a loved one, and you are thinking about trying to manage their home care yourself, there are some important things you need to consider.
It may seem cheaper and maybe even easier to just hire a good home health aide and let them go to work; but nothing in life is quite so simple. In fact, it may not even save you money.
Whether your loved one needs “just” a companion, skilled nursing, caregiver, or non-medical care, there are many, many good reasons to work with a quality home care agency instead of hiring private home care all on your own.
As with anything in life, there is no substitute for experience. Although your and your loved one’s journey will be unique, there is much about it that will be very much the same as others who have traveled this path before you. Home care agencies have almost “seen it all”. So not only will you have the experience of their carefully selected staff to support you, but you will have the experience of the entire agency, including medical and nursing staff, administrators, and clinical directors to fall back on, too.
2. Vetting caregivers
The ability to thoroughly vet and check the background and references of other people is not a common skill for most people. Unless your own profession has required this of you, you would have no cause to know how to check a person’s background, experience, references, and credentials. It would be difficult for a lay person to know where to start; to know how to trust the information that is provided; to know what to look for, where to look, and how to sort through it all.
This is part of the work that home care agencies perform on a regular basis. In addition to their own in-house standards and protocols, they will also know what regulatory considerations, certifications, and licenses are required, where to look for them, and how to verify them. There is also the issue of updates to those licenses and certifications and knowing what is required. Remember that compliance and current licensure, to whatever degree it is required, is an ongoing responsibility of both the employee and the employer.
3. Payroll and Human Resources
Regulatory compliance and licensing are only one part of managing home care workers. There are many other aspects of hiring and management. A home care agency will already have staff assigned specifically to this role. That staff will be well-versed in their legal responsibilities and will be experienced in human resources management.
This is, in fact, an extensive consideration.
Payroll laws, employee tax law, wages (minimum and industry standards), overtime laws and overtime pay, paid time off, sick and personal time, benefits, fair employment practices, employer responsibilities…these are all a part of what you will be responsible for as the direct employer. Remember, too, that there are both state and federal regulations that must be followed.
There is also the issue of job description. This includes the work that you expect of the caregiver, but you also must be aware of what you legally can and cannot ask the caregiver to do. Everything you need may not fall under the legal scope of practice even for certified caregivers. You might be surprised to find some of the things that your state does and does not allow trained workers to do. Medication administration, for example, is a very gray area for certified caregivers.
An agency that has access to higher-level certified or licensed individuals may be able to provide some of the services that you cannot ask of non-medical caregivers. Either way, it would be unfair to expect services from your caregiver that are above their licensure. More importantly, it may be unsafe for the care recipient. It would also put the certification of the caregiver at risk. You may hold a level of responsibility as well.
In a perfect world, liability would not be something to worry about. The world is not perfect.
There is always a possibility that something might happen and that you or your loved one might be held liable. Accidents happen. People get hurt. It could be the care recipient who is injured, or it could be the caregiver. If so, what then? Employers bear responsibility for worker care and compensation when injuries occur at work.
Will you carry a liability insurance policy to protect you or your loved, as a licensed home care agency would? Will you increase coverages on an existing homeowner’s policy? Will it cover such eventualities? Do you need additional insurance to cover worker compensation? What is the cost of obtaining or extending insurance to cover you? How does this compare to the cost of services provided by a home care agency? What would be the personal toll of managing such a situation and its implications?
Accidents and injuries are not the only liabilities to consider. Though it is difficult to think about, the risk of abuse and neglect is real. Abuse or neglect could be physical, sexual, medical, emotional, or financial. The risk of fraud, theft, and exploitation is real, too. Risk is a consideration for care recipients, but caregivers take on the potential for risk, too. You also bear a responsibility to protect your workers.
5. Coverage and scheduling
Caregiver coverage and scheduling might seem like one of the easier aspects of managing your loved one’s home care. It’s another of those things that is a non-issue in a perfect world. You decide the number and time of care to be covered, you assign those schedules to one or more care providers, and you go on with the demands of your life.
In the real world, it doesn’t work that way. In the real world, people call out. They get sick. They may turn out not to be as reliable as you’d thought they would be. They may ask you to change their schedule. They may complain and argue their responsibilities. They may call you at work or at times when you cannot be disturbed. They may quit. And they may not give you notice when they do.
When these things happen, are you prepared to handle them? How will you handle them? Who will fill the vacant shift? How will the care be covered?
6. Plan of care development and implementation
A plan of care is an important document. It defines the needs and services for your loved one. It also serves as a set of clear instructions to care providers. It defines the condition(s) of the recipient and how their needs are to be met in very specific terms. It also defines who is responsible for the various tasks and responsibilities, and when.
A care plan may remain stable for a time, but it also needs to be updated regularly. Updates mean assessment. Assessment means revision and possibly modification.
This is a primary function of a home care agency. Skilled medical personnel and Clinical Directors will construct, evaluate, change, and modify care plans. They will regularly communicate with care staff, and they will oversee that staff to make sure all the pieces of the plan are completed. They will make sure the needs of the care recipient continue to be met. They will also communicate with you as the family advocate or proxy so that you know what the needs are and that they are being seen to and performed.
Without a home care agency, this is work that you will need to perform. It will take many hours.
7. Liaising with vendors and insurers
Clinical Directors and home care agency administrators bring with them the benefit and experience of regularly dealing with outside providers. This includes (but is certainly not limited to) vendors and suppliers of durable medical goods and medical supplies as well as insurance companies.
This access and experience comes with them when you contract with a home care agency. An experienced, reputable agency can be a huge resource in securing goods, supplies, coverage, and services. These can be difficult to find and access if you do not have the background and organizational skills—or the time—in dealing with these services.
8. Access to services
You probably do not know all the range of services that your loved one will need now and in the future. You also probably do not know the providers of those services. You probably do not know who the better and best providers are, either. Asking around can sometimes get you some answers, but it can sometimes get you very contradictory answers, too.
From specialists to custom medical garment suppliers, to occupational therapists, physical therapists, and all the other types of therapists, there are many, many services and providers. You may not know where to start, or how to work with insurers and providers to secure those services. You may not even know what your loved one’s coverages or rights to services are. A good home care agency will, though.
9. Consolidated care and services
Some home care agencies will be very focused in their service roster, while others will have a much wider menu of services to choose from. For example, some home care agencies may also offer case management. Some may have in-house or partnering service providers for things like physical therapy, visiting nurses, or specialty medical care like trachea care, wound care, or catheter care.
Don’t underestimate the value of care and services that are consolidated under one administrative umbrella. This doesn’t just make life easier for you—it also makes life better for your loved one.
Why? Because consolidated care means streamlined care. It means that one body is in charge of all the services that your loved one needs—and all the services you need as their advocate and healthcare proxy. It also means that the care overseer—the Clinical Director, Case Manager, and her administrators—have the full picture of services. They’ll know what services are and are not working, which gaps in services need to be filled, and they’ll get to work filling them. They’ll also help you understand them.
They’ll have a picture of your loved one as a whole and the ability to approach their care wholistically, not in part. Such an approach can make all the difference in quality of life, comfort, safety, and achieving the best outcome.
When you weight the time commitment of personally managing home care, consider it in both the short and the long term. Think not only in terms of the hours in a day, but in the days you have left together. Now think of how you want to spend that precious resource together.
You also must view and consider time through your own personal lens. It is not selfish to do so. It is realistic. It is imperative.
Think of preserving time and space to live a life of your own, and time and space to share your life with your family, significant other(s), and your loved one. Put real thought and weight into allowing for quality time that is not focused on issues of health, decline, and stressors. Save time to enjoy each other’s company and spend that time doing things you both enjoy—even if what you enjoy is a quiet afternoon sitting on the couch together.
Your time has a value, too—both emotionally and financially. It’s not enough to consider only the bottom line of caregiver expense. Think about all the different scenarios that could play out. The impact to you financially if you lose work or have to cut back to manage care.
Consider the true financial value of your time. Think about how best to mitigate risks, of all sorts, for all involved. Think about all the potential costs and then compare them to the costs and benefits of hiring a private home care services company. On the balance, the cost of agency-managed caregiving may be much more equal, and quite possibly more in your favor, than you would initially think.
Some To-Do’s Before You Hire Home Care Yourself
- Contact some reputable home care agencies before you do it yourself. You may still decide to go it alone, but you should at least look into the costs and services that are available to you. You may also find that the costs are not as high as what you initially might have thought.
- Count yourself into the equation. The toll that stress can take on a family advocate or caregiver cannot be understated. There are certain things that will be very difficult for you as a loved one to separate, compartmentalize, and address objectively.
- Do all the math. Don’t just look at the cost of a non-agency versus agency hire. Look at the expenses that you and your loved one will incur if managing home care yourself. Look at the cost of potential loss of work, liability claims, services not covered by insurance, and potential negative health impacts.
- Check references. This goes for both the home care agency(ies) you are considering and any and all caregivers or workers you are considering. Private hires must be able to provide verifiable good references. Reputable agencies will have references from a several different resources—client and family reviews, business reviews, and references from past or present clients/family advocates that they may share with the permission of the client (this can be arranged legally and ethically upon request).
Of course, these are only the beginnings of the things that you need to do to safely, responsibly, and confidently to arrange home care services for your loved one. They are a place to start. If you start with these four objectives, it is quite likely that you will come away with a better idea of your own level of comfort with the options as you move on to the next phase in your decision-making process.