Full-service agencies, like Hillendale Home Care, provide care by employees that are screened, trained, monitored, bonded, and insured. There is far more safety in this model, and far less potential liability for the care recipient than with a nursing registry or an independently hired in-home caregiver.

Nursing Registries/Healthcare Registries act as “matchmaker” services, assigning workers to clients and patients who need home care. However, registries place the responsibilities of managing and supervising the worker on the patient, a family member, or a family advisor. Supervision, monitoring, government-mandated taxes, and workers’ compensation coverage usually fall on the consumer and, quite often, the workers are neither trained nor pre-screened.

With independent contractors, the same responsibilities of managing and supervising the worker as well as paying government mandated taxes and workers’ compensation coverage fall on the consumer. The additional responsibilities of interviewing, screening, and payroll also fall on the consumer.

For further information on the differences between a professional home care agency, such as Hillendale Home Care and a registry or independent hire, please visit www.hillendale.net or call 925-933-8181.

Not all home care is created equal. To assist with understanding the differences between a professional home care agency and a registry or independent hire, Hillendale Home Care has put together the following list.

Skip the laborious search for a qualified caregiver. It is difficult to find a caregiver that is not only well qualified, but is a good personal match for the client as well. An agency not only checks references, performs thorough background and driving record checks, but also takes care to find the perfect caregiver match for each client, taking into account personality, hobbies and common interests in addition to requested schedule and geographic accessibility.

1. With a professional home care agency, clients can be assured of their chosen caregiver’s competency for the job. An agency often provides ongoing caregiver training as well as an orientation. Ongoing monitoring means that any needed changes or assistance can be identified and corrected.
2. If a client hires a home caregiver through a registry or independent hire, the client is responsible for the caregiver’s payroll taxes (which oftentimes is not disclosed). Alternatively, because all caregivers from an agency are employees of the agency, all payroll taxes are paid for by the agency.
3. It is inevitable that at some point a chosen caregiver will become ill or desire to take a vacation. An agency provides a backup caregiver if your regular caregiver is ill, on vacation or does not show up for work. Additionally, an agency handles all worker discipline, to assist with situations such as showing up late for work.
4. An agency provides supervision of all caregivers by a qualified individual. With a registry or independent hire, there is no oversight of care, opening up a client to potential financial, mental or physical abuse.
5. A home care agency carries liability insurance. This means that if something happens for which a liability is incurred, the agency’s insurance policy will likely cover it.
6. It can be cumbersome and confusing to handle a worker’s invoices and payroll. With an agency, all of the worker’s timesheets, as well as billing and payroll, are taken care of for the client.
7. A home care agency takes care of carrying and covering workers’ compensation and unemployment insurance.
8. If a worker is injured on the job, or is suddenly unable to work due to medical reasons, the agency’s policy will cover the medical bills and any incurred expenses. Additionally, if a worker is laid off from a job, the worker may file for unemployment. With a registry or an independent hire, the client would be responsible for not only the medical bills and potential disability payments, but the unemployment payments as well.
9. An agency provides a detailed plan of care which is developed by a qualified individual. The plan of care details a client’s needs and lists ways to meet those needs. This care plan is reviewed regularly and changes are made as deemed necessary.
10. An agency performs an initial assessment in a client’s home by a qualified individual to make sure all necessary care services and safety items are in place.

Risks when Hiring an Independent Contractor – Abuse and Exploitation

Most workers who enter the home care industry are caring, giving people. Unfortunately, there are also those who know that it is very easy to take advantage of frail, functionally limited, often cognitively impaired clients.

Registries or independent contractor agencies usually do not perform background investigations on their caregivers, and, by law, they are not allowed to monitor or supervise since the worker is not an employee of the registry. This could subject clients to physical, psychological or financial abuse.

Supervision of the Worker

Because of Internal Revenue Service regulations, registries and independent contractor agencies cannot provide supervision, scheduling, or training to workers in home care without becoming employers. A home care agency does provide supervision, scheduling and worker training to their caregivers. Plus, the agency provides ongoing monitoring in the home as an additional safety measure.

Reliability

What would happen if a consumer’s registry caregiver or independent contractor did not show up for work, or wanted to take a vacation, or was sick? With an agency, consumers do not need to worry, because the agency will provide a replacement caregiver for the consumer.

In short, it is very important to understand the risks and liabilities associated with hiring an independent contractor or a registry before making a decision for care. This knowledge may well save you and your loved ones from an unfortunate experience.

For further information on the risks and liabilities associated with hiring home care, please call us at 925-933-8181

or visit

www.hillendale.net

Benefits of
Home Care

Why and when it is better than
assisted living or nursing home care

A 2006 AARP report revealed that when given a choice, 89% of all people surveyed want to remain at home. There IS no place like home, and understanding when home care is an appropriate option will make facing the daunting choices of long term care easier to navigate.

13% of homeowners age 62 and older need help with activities of daily living. 16% have difficulty with these everyday activities, but can still do them on their own.

— NCOA 2005

More than two-thirds of all older people who need help with everyday tasks live at home, including more than 70% of those with Alzheimer’s disease.

— U.S. Dept. Health and Human
Services 2003, Alzheimer’s
Association 2005

The Aging in Place Initiative reports that, contrary to popular belief, only a small minority of seniors move to warmer climates upon retirement and fewer than 5% of the 65+ population reside in nursing homes.

Instead, most Americans choose to age in place, within the same communities where they have long lived.

In fact, homeownership rates among adults age 65+ (more than 80%) are higher than the national average.

AARP knows there’s no place like home and reports these top three reasons why most people want to stay home as they age:

•           Comfort
•           Control
•           Independence

About.com Senior Health reports that seniors who go to nursing homes or other assisted type facilities are usually not in need of complex medical care, but rather are having difficulty taking care of their personal needs.

Unfortunately, many seniors become depressed and discouraged when they move to nursing homes. Many see nursing homes as just a place to wait for death. Loss of independence is often their greatest fear.

Staying in their own homes as long as possible can mean a great deal to many older people. Familiar surroundings can be therapeutic. Fortunately, with today’s in-home services offered, many seniors can stay in their own homes.

Things to consider when faced with recuperative care needs:

Receiving care at home allows people to get the help they need without having to move.

Help in the home can include:

• Home Care Agencies
• Home Health Agencies
• Choices in Privately Paid Home Care Services Agencies
• Quality Care Versus Cost

Other Types of
Available Help at Home

Almost any type of help is available in a person’s home. The following list includes some common services people need.

When Is In-Home Care Appropriate?

Francis is 84 years old and recently had a stroke. She was hospitalized briefly and then discharged to continue recovering at home. To enable her to return home, her doctor called a home health care agency, and the agency gave Francis a complete home health care plan for six weeks. Since the doctor ordered the home care for Francis, Medicare paid for it.

For the first week after Francis went home, a nurse visited her every day

The nurse met with Francis’ family to discuss her special dietary needs and to arrange for exercise therapy to help Francis regain her strength.

Once that was done, the nurse visited Francis twice a week to check on how well she was recovering.

The home health care agency also sent a physical therapist and a home health aide to visit Francis a few times during the week.

The home health aide would help Francis bathe, get dressed and walk.  The physical therapist would keep Francis moving and see to it that she got some exercise to aid in her recovery.

When Medicare coverage was exhausted, the family chose a private duty agency to continue providing the ongoing daily care that Francis needed.

To get help with your Medicare questions, call 1-800-MEDICARE (1-800-633-4227),

TTY/TDD: 1-877-486-2048 for the speech and hearing impaired or look on the Internet at http://www.medicare.gov.

In-home care helps seniors live independently for as long as possible, given the limits of their medical condition.

It covers a wide range of services and can often delay the need for long-term nursing home care, or it can serve as an aging-in-place solution so a senior does not have to move out of the home.

It is important to understand the differences between home health care and home care services.

Although they sound the same (and home health care may include some home care services), home health care is more medically-oriented.

While home care typically includes chores and housecleaning services, home health care usually involves helping seniors recover from an illness or injury.

Thus, the people who provide home health care are often licensed practical nurses, therapists or home health aides.

Most work for home health agencies, hospitals or public health departments that are licensed by the state.

“Private duty services are basically any supportive type of services. They run the gamut of errands and transportation, to companionship, to personal care, to nursing. Basically, whatever services someone needs to stay at home, or to supplement care in a facility for which they have the resources to pay, can fall under private duty or privately paid services. There is not usually a doctor’s order needed, nor is there necessarily even a medical component to the services. The definition of private duty is therefore hard, as it really can be any type of service that is provided to someone who is frail or elderly to allow that person to have more independence in his or her lifestyle or choice of living situation.”

Excerpt from Caring Magazine, August 2008, Merrily Orsini, MSSW, Author.

As with any important decision, it is always a good idea to talk with friends, neighbors and trusted advisors or professionals to learn more about the in-home care agencies in the community.

In looking for an agency, the following questions can be used to help guide the search:

• How long has the agency been serving this community?
• Does the agency have any printed brochures describing the services it offers and how much they cost? If so, get one.
• Does the agency have a current license to practice (if required in the state where you live)?
• Does the agency offer seniors a “Patients’ Bill of Rights” that describes the rights and responsibilities of both the agency and the senior being cared for?
• Does the agency write a plan of care for the patient (with input from the patient, his or her doctor and family) and update the plan as necessary?
• Does the care plan outline the patient’s course of treatment, describing the specific tasks to be performed by each caregiver?
• How closely do supervisors oversee care to ensure quality?
• Will agency caregivers keep family members informed about the kind of care their loved one is getting?
• Are agency staff members available around the clock, seven days a week, if necessary?
• Does the agency have a nursing supervisor available to provide on-call assistance 24 hours a day?
• How does the agency ensure patient confidentiality?
• How are agency caregivers hired and trained?
• What is the procedure for resolving problems when they occur, and who can I call with questions or complaints?
• How does the agency handle billing?
• Will the agency provide a list of references?
• Who does the agency call if the home care worker cannot come when scheduled?
• What type of employee screening is done?

An agency plan of care should cover the following prior to the caregiver being scheduled in the home:

• Illnesses/injuries and signs of an emergency medical situation;
• Likes and dislikes;
• Medications, and how and when they should be taken;
• Need for dentures, eyeglasses, canes, walkers, etc.;
• Possible behavioral problems and how best to deal with them;
• Problems getting around (in or out of a wheelchair, for example, or trouble walking);
• Special diets or nutritional needs; and
• Therapeutic exercises.

The agency personnel should spend some time preparing the person who will be providing the in-home care.

• In addition, this information is helpful to the in-home care worker:
• Clothing the senior may need (if/when it gets too hot or too cold).
• How you can be contacted (and who else should be contacted in an emergency).
• How to find and use medical supplies and medications.
• When to lock up the apartment/house and where to find the keys.
• Where to find food, cooking utensils and serving items.
• Where to find cleaning supplies.
• Where to find light bulbs and flashlights, and where the fuse box is located (in case of a power failure).
• Where to find the washer, dryer and other household appliances (as well as instructions on how to use them).

A Word of Caution…

Although increasingly more states are requiring some form of licensure for private duty services, those regulations vary widely by state.

While most licensed states require that in-home care agencies perform criminal background checks on their workers and carefully screen job applicants for these positions, the actual regulations will vary depending on where you live.

Therefore, before contacting an in-home care agency, find out what laws apply in your state.

How Can I Pay For In-Home Care?

Costs

Nursing home care can be very expensive, and many times home care is a more cost-effective alternative.

The cost of in-home care varies across states and within states.

In addition, costs will fluctuate depending on the type of caregiver required for the situation.

There are many ways to pay for in-home care:

• private funds
• family funds
• long term care insurance
• veteran’s benefits
• worker’s compensation
• Medicaid waiver programs
• charitable organizations
• religious organizations
• reverse mortgages.

Generally speaking, it is less expensive to stay at home with 8 hours of care or less per day than it is to move to another location.

Medicare Home Health is generally called “Home Health Care” and is a term used to refer to Medicare-certified agencies that provide services which are paid for by Medicare.

Medicare is not, and was never intended, to provide long term in-home care.

Home Health Care is skilled nursing care and certain other health care services one receives in a home setting for the treatment of an illness or injury. Medicare covers some home health care if all the criteria below are met:

A doctor decides medical care at home is needed and makes a plan for that care at home; and

At least one of the following: intermittent (and not full time) skilled nursing care, or physical therapy or speech language pathology services; or a continued need for occupational therapy is needed; and

The patient is homebound – meaning being normally unable to leave home and leaving home is a major effort. If one does leave home, it must be infrequent, for a short time.

The patient may, however, attend religious services or leave the house to get medical treatment, including therapeutic or psychosocial care.

Receiving care in an adult day-care program that is licensed or certified by a state or accredited to furnish adult day care services is also permitted while receiving home health benefits paid for by Medicare, and

The care must be medically reasonable and necessary.  It must be related to problems encountered by the illness or injury and the care plan must address realistic outcomes.

The plan and care needed has to show potential for an improvement in health/activities of daily living; and

The home health agency providing the care must be approved by the Medicare program.

A Certified Home Health Agency is an agency that has been surveyed and certified by a state agency to assure all Medicare Conditions of Participation have been met. These include clinical services, operational, financial, billing and other organizational issues.

Certified agencies can also be accredited by the Joint Commission for Healthcare Organizations (Joint Commission), the Community Health Accreditation Program (CHAP) or the Accreditation Commission for Health Care (ACHC)—any of the three have “deeming authority”.

If an agency meets the criteria for accreditation, it also covers the Medicare certification.

Hospice Care is a special concept of care designed to provide comfort and support to patients and their families when a life-limiting illness no longer responds to cure-oriented treatments.

Hospice care neither prolongs life nor hastens death.

Hospice staff and volunteers offer a specialized knowledge of medical care, including pain management.

It is generally depicted as end-of-life care and can be in a home or a hospital setting, but one requirement is that someone be with the dying patient at all times.

Most hospices accept patients who have a life expectancy of six months or less and who are referred by their personal physician.

The goal of hospice care is to improve the quality of a patient’s last days by offering comfort and dignity.

Hospice deals with the emotional, social and spiritual impact of the disease on the patient and the patient’s family and friends.

Hospice coverage is widely available—offered by most private insurance providers and through Medicare nationwide as an optional Medicaid service covered by 47 states (excluding Connecticut, New Hampshire and Oklahoma).

Some types of help could cost a lot. Others may be free. Some services may be covered by Medicare, private “Medigap” policies or other private health insurance, Medicaid or long-term care insurance. Some may not.

Check with your insurance provider(s). There is a chance that paying for just a few services out of pocket could cost less in the long run than moving into an independent living, assisted living or long-term care facility.

Once you have thought about which services you need, you can find out about Federal, State and local government benefits at www.govbenefits.gov. If you can’t get to a computer, call 1-800-FED-INFO (1-800-333-4636) for the same kind of help.

Another Web site to search for benefits is www.benefitscheckup.org from the National Council on Aging. By typing in general information about yourself, you can see a list of possible benefits for which you might qualify. You don’t have to give your name, address or Social Security number in order to use this service.

Are you eligible for veteran’s benefits from the Department of Veterans Affairs?

The VA sometimes provides medical care in your home. In some areas, they also offer homemaker/home health aide services, adult day health care and hospice.

You can learn more by going to www.va.gov, calling the toll-free VA Health Care Benefits number (1-877-222-8387) or contacting the VA medical center nearest you.

If home care is provided under Medicare, the cost of services is covered completely.

Equipment is paid for under Part B and is covered at 80%.

Homemaker and aide services provided under state programs are generally covered at 100%.

There are several national organizations that can provide additional consumer information about in-home care services. These include the following:

National Association for Home Care and Hospice
228 Seventh St., SE  •  Washington, DC 20003
202-547-7424  •  www.nahc.org

Visiting Nurse Associations of America
900 19th St., NW  •  Suite 200  •  Washington, DC 20006
202-384-1420  •  www.vnaa.org

National Private Duty Association
941 East 86th St.  •  Suite 270  •  Indianapolis, IN 46240
317-663-3637  •  www.privatedutyhomecare.org

To find out more about in-home care options here in California, contact Hillendale Home Care.

Hillendale Home Care
1777 N. California Boulevard Suite 210
Walnut Creek, CA  94596

925-933-8181

serviceinquiry@hillendale.net

www.hillendale.net