If you are considering home healthcare in any capacity, or if you have home healthcare services in place already, it helps to know who the different “players” are who will be involved in your care. Like many healthcare services, home care can involve a lot of moving parts; a number of different people might be involved.
Here, we take a look at the people you might meet on your journey with home healthcare services.
The Clinical Director in a home care services agency oversees the work of the medical staff (nurses) and non-medical personnel (aides, caregivers, and companions) who are working directly with the client or patient. The Clinical Director may also meet and contact the client, patient, or their family (and in the best situations they will), but this will be on a less frequent basis. Whereas certified aides, caregivers, nurses, and companions may be in the home with the care recipient daily depending on the need and scheduling, the Clinical Director will meet and/or check in regularly in a supervisory role.
The Clinical Director wears many hats and also oversees regulatory compliance, care plan implementation and modification, and ensures that the care plan is being carried out. You might think of the Clinical Director as the “boss” of the nurses, caregivers, and service providers that are working directly in the home.
Administrative Director, Administration, and Administrative Support Personnel
To allow the Clinical Director, medical staff, and caregivers to perform their duties, additional support is needed. As you can imagine, the work involved in billing, dealing with insurance companies, human resources and personnel management, scheduling (for both employees and clients), accounts and payroll, hiring, and continuing education and staff training, is large. A lot of work also goes into logistics and planning, ordering supplies and durable medical goods, and simply ensuring that all clients and patients have all that they need to live well, live comfortably, and have successful experiences and outcomes.
This “behind the scenes” work is the responsibility of the people in administration. You may or may not get to know these people and you may or may not hear from them very often, but rest assured they are there, supporting the front-line workers, the Clinical Director, and other staff. They are dealing with a lot of the “outside” influences and liaising on your/your loved one’s behalf. Truth be told, administrators take a lot off your plate and a lot off the plates of the frontline care providers and the Clinical Director, so they can focus on the most important work–client care.
Nurse Case Manager
A Nurse Case Manager may or may not be a part of your private home care team. We often see Case Managers (or Care Managers/Nurse Care Managers) working in hospital settings or social services settings. There are Nurse Case Managers who work in some home care agencies, too. The outcomes with such community-based case managers can be very good, due to their familiarity and participation in the local healthcare community (and beyond).
A Private Nurse Case Manager is a medical professional who manages the intricacies of a client/patient’s care. They write care plans for the caregivers to follow, outlining all the different services the care recipient needs. They oversee the implementation of this plan, working closely with the Clinical Director and the caregiving staff. They schedule all appointments and services, help find services and providers, and coordinate all the different facets needed to follow through with the care plan. Your case manager will also attend appointments and services, translate and educate both client and family regarding conditions and treatments, etc., and communicate and liaise with family members and care partners. Your case manager will also reassess and change or modify care plans as needed.
A Registered Nurse (RN) or Licensed Practical Nurse (LPN) may be assigned to your/your loved one’s case depending on their condition, care, and needs. In more critical cases, a nurse may be assigned to full-time duty if the needs are more medical than they are activities of daily living and companionship.
If the medical needs of the client/patient do not require full-time nurse staffing, nurses may come in for such matters as wound care, assessments, or other medical treatments. In this case the nurse would visit on the schedule described in the care plan. It may be daily, every two or three days, weekly, etc. Think of the care that a home care nurse provides as being similar to the skilled medical care that a nurse in a hospital, skilled care facility, or medical clinic might perform.
Certified Aides and Companions
These are the people you are most likely to get to know the best, because for many homecare clients, the certified aide staff are the people you will spend time with on a daily basis. Aides and companions may be referred to as Certified Nursing Assistants (CNA), Personal Care Attendants (PCA), Caregivers, Companions, or Home Health Aides (HHA). These are very much front-line, “on the scene” personnel and make up a very large percentage of the caregiving and hours that go into a person’s care.
Even if other skilled medical services such as physical therapy, registered nurse care, or case management are involved, the care of a certified aide, caregiver, or companion is likely to be present. Where nursing is on more of an as-needed medical basis, for many elderly persons and people with chronic conditions the care of an aide or companion is needed for the other very important tasks and activities of daily living, safety, and companionship.
“Activities of Daily Living” is a term that you/your loved one will become more and more familiar with when working with private home care services. The goal of such services it to keep people in their homes where they are happiest, most comfortable, and where their healing, wellbeing, and quality of life is best accomplished. There are many routine activities that we take part in daily to keep ourselves happy, healthy, and thriving. It is easy to overlook them and for them to be taken for granted—at least until you or a loved one is unable to safely do them on their own.
Home health aides (no matter what their title or letter abbreviations) are trained care providers whose skills and experience are directed toward aiding in the completion of these “Activities of Daily Living” (ADL’s in the lingo of medicine and insurance). Their focus will be to provide the non-medical portion of care. This may include such things as meal preparation, housecleaning, bathing, overseeing exercise, medication reminders, dressing, feeding/eating, toileting, grooming, errands, shopping, and more.
These hardworking front-line workers are easy to mistake for friends and family because over time, they often become quite invested in their clients.
Are Players the Same in Every Home Care Agency?
Though the titles of the staff and administration may be the same or similar across agencies, the delivery of services, roles, and responsibilities that are assumed by the staff and agency are not always the same. You will likely see the starkest differences between corporate agencies and small to medium-sized home care agencies.
As you can imagine, the larger and more franchised a homecare agency is, the more detached and distanced much of the staff and the “players” are. Corporate-style companies will have additional layers of administration and direction, and in those cases, these are often people with whom you will never come into contact and never get to know personally. There will probably be many people involved with your case who you will never even know about.
Small to medium-sized home care agencies operate on a much more personal level. In agencies of this size, you will likely know or be known to all members of your care team, including administration and support. Directors will be personally involved in the management, assessment, and review of your case and your needs. The only people you may not get to know are those who are not assigned to your care or those who represent services that you do not need. At least, this is the way of things in quality home care companies. If this is not the level of care you are experiencing, you might consider whether the company you are working with or interviewing is the right home care company for you.
What Is the Background Behind the Care?
Another aspect to consider when working with or choosing a homecare company is the background of the players. For instance, do directors and administrators have a background in the medical professions? Is your Clinical Director a nurse? Is there a longstanding stream of experience in both medical settings and (more importantly) home care behind the running of the business?
Certainly not every player in the administrative layer needs to be a former nurse or health professional, but when you find a home care agency in which one or more are, you know that that agency is one whose leaders understand both their personnel and their jobs. They are well-versed in the support their staff needs as well as, most importantly, the needs and supports needed by you, the client and client’s family.
Finding a private home care company that has experienced nursing staff at the helm is of great benefit all around. So, too, is working with a company that offers more in-house and consolidated care. The more services and types of home care professionals that a home care agency can offer, the more streamlined the care can be. This in turn results in a care team that has more knowledge of the full picture of care for the person who is being cared for, more cross-coverage for when a care provider is unavailable, and an overall better coordination of communication and understanding of the person who is at the heart of the care.
Private Home Care Services is based in Brookline, Massachusetts and provides quality home care services in the Boston Metro area, surrounding communities, and throughout the state of Massachusetts. PHCS is owned and operated by Danielle Hannigan, RN CNM, a registered nurse with decades of experience in both clinical and home health care.
Danielle is the Clinical Director of her agency, Private Home Care Services, LLC, but is well known to go above and beyond and don the hats of nearly every position in her company, from caregiver, to nurse, to case manager, administrator, to family liaison. Her level of care, compassion, and involvement in each case has earned her a reputation that precedes her and her company. PHCS has worked hard and earned their reputation as a caring, compassionate, full-service private home care provider with a focus on streamlined, consolidated care, cost containment, and achieving the best possible outcomes for clients and their families.