What is Home Care?
Guide to Understand Home Health Care & Non-Medical Home Care

Home care is a popular option for long-term care. Most seniors want to age in place at home, which contributes to familiarity and comfort, yet in order to keep a loved one safe at home, it requires planning and evaluation. This guide gives you a detailed understanding of in-home care options, what needs to happen to create e a dramatic, positive impact on you and your entire family.

If you're a family caregiver, in search of additional senior care, you are among 70 million people who deliver care for a loved one at home. the research concludes by 2050, over one million centenarians - individuals over the age of 100 will live in North America.

With the recent advent of Accountable Care (informally known as ObamaCare), in-home care is a critical post-hospitalization piece to the care transition. Today, discharged patients go directly home.

Even hospice care is at home. If you or an aging loved one has a terminal illness and depleted other treatment options, consider hospice care at home. It gives a loved one and family members comfort and support.

Recent studies, like the Archives of Physical Medicine and Rehabilitation (May 2011) concluded that after certain hospital-based operations, joint replacement, home is an effective strategy over discharge to a rehabilitation facility.

What is Home Care?

Receiving care at home

Home care is an option allowing older adults the choice to age in place at home with a specified level of care they need for safety, comfort and independence.

Simply described, home care means help with activities of daily living and household tasks. It includes meaningful companionship for older adults. In-home care is the oldest form of healthcare. Today, home care serves as a comprehensive alternative to institutional living.

Home care is commonly presented as a service to assist aging seniors, its a valuable resource when a person at any age has an injury, accident or surgery or is suffering from a chronic illness.

Types of Home Care

Non-Medical Home Care

Trained caregivers give support to individuals with basic activities and functions needs: Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living.

Activities of Daily Living - Measures the Overall Wellness

• Bathing
• Dressing
• Toileting
• Transferring
• Continence
• Feeding

Katz Index

Instrumental Activities of Daily Living

While the Katz Index measures Activities of Daily Living, Lawton Instrumental Activities of Daily Living Scale (IADL) assesses independent living skills and most useful when identifying improvement or deterioration over time.

• Ability to Use Telephone
• Shopping
• Food Preparation
• Housekeeping
• Laundry
• Mode of transportation
• Self-direct medications
• Ability to Handle Finances

Lawton Instrumental Activities of Daily Living (IADL) Scale

Respite Care

In-home respite provides a family caregiver a break from care in one's home. It's usually offered by a friend of the family, a respite worker or a hired caregiver and provided at home or in a care setting, like adult day care or an assisted living residential facility.

It's a good way for the family member to get away and relax.

Senior in-Home Companionship Care

Companionship services allow healthy interaction and activity that's important for seniors, especially those living with cognitive and physical health issues. Companionship care provides care needs, fun and creative activities in the home and community, so families get a break. It's offered on an hourly basis.

Hospice Care at Home

Hospice care services, delivered by health care professionals to enhance comfort for a terminally ill person by reducing pain and attend to the physical, social, spiritual, and psychological needs. Hospice care gives counseling, respite care and practical support.

Hospice care is available at hospitals, nursing homes, assisted living facilities and dedicated hospice facilities.

Medical Home Health Care

Home health care is a wide range of health care services delivered at home by licensed medical professionals. It's less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility.

Home health services include:

• Wound care for pressure sores or a surgical wound
• Patient and caregiver education
• Intravenous or nutrition therapy
• Injections
• Monitoring serious illness and unstable health status

Options within Home Care

Non-Medical Home Care Agency

• Not a Medicare option - Out of pocket only
• An agency is the employer of caregivers and manages taxes, insurance, liability, etc.
• Provide caregivers with training.
• Current on trends in health and wellness.
• Well developed scheduling and backup procedures for monitoring and care management.
• Out of pocket costs are higher.

Medicare-certified home health agency

Home health care, the Medicare option and generally considered for short-term treatment lasting approximately six weeks. The home health agency must continue to prove to Medicare that the patient has a need for skilled care. Home health care gives on average less than 28 hours per week.

• Applies to Medicare rules and regulations.
• A patient is homebound.
• Co-payments apply.
• Durable medical equipment like wheelchairs and oxygen concentrators, medications are partially paid for by the home health agency.

Family member

• Knows the older adult and the individual feels most comfortable having a family caregiver.
• Time and responsibilities add to heavily taxed family member schedule; job, children, and spouse.
• Stress-related physical and emotional impacts like depression, isolation, and physical symptoms such as back pain.
• No formal training.

Private Hire

• Costs are lower
• The family or older adult is responsible as employer for the private hire and must follow local employment laws; pay unemployment wages to dismissed caregivers.
• Not bonded or insured.
• If one does not show up for work, back up care falls on the senior of family.
• May not have training.

Hiring a Caregiver

Stay Safe

Things to know before hiring a caregiver; privately or through an in-home care agency. Information and planning ahead improve the results. This will help you arrange for home care. Always use caution when hiring a stranger and consider the following questions in home care planning.

You hire a private caregiver

• If you do not use a home care agency, how will you screen them?
• What's the caregiver's experience?
• Do you need someone with experience working with memory impairments or other disabilities?
• Any language skills or other special skills needed?
• What types of training does the caregiver receive? In training, what are the topics covered?
• Will the caregiver need to lift the care recipient and/or operate any special equipment?

You hire a home care agency

• If you do use a home care agency, ask how they screen caregivers and do you complete a background check (criminal, driving, work permit status and past references)?
• What is the ratio of the applicants you hire to the applicants you interview?
• What types of training does the caregiver receive? In training, what are the topics covered?
• Will the caregiver need to lift the care recipient and/or operate any special equipment?
• Do you offer continuing education training for your caregivers?

Questions to Ask when Hiring Help at Home

• Why are you in this line of work?
• What kind of special training, if any, have you had?
• What types of work do you enjoy? Do not enjoy?
• Do you have any physical or emotional problems that would hinder you in this job?
• Have you ever been convicted of a crime? What? Where? When?
• Do you mind being around someone who smokes or drinks?
• Will it bother you to work around a cluttered house?
• Would you be willing to transport the care recipient to doctor's appointments or other outings?
• Is there anything on my "list of needs" that you can't or won't do?
• How long do you plan to stay on the job? Will you provide at least two weeks notice before resigning?
• Would you ever have any occasion to bring someone with you?
• Are there any problems with the days or hours that I need you to work?
• Can you work on weekends and/or holidays?
• What are your salary requirements? Is it negotiable?
• Would you agree to a trial period for training and getting acquainted?
• Are you familiar with special diet s (i.e., diabetic, low sodium, low cholesterol)?
• Do you have reliable transportation?

Resources for Hiring In-Home Help

Family Caregiver Alliance

AARP

H.E.L.P.

Adult Protective Services - How to Hire a Home Care Agency

Washington State Department of Social and Health Services Tips on Hiring Family and Friends

Search our Home Care Directory

Referrals for Agencies

Doctors, social workers and discharge planners

Recommendations from family and friends

Your local Area Agency on Aging

National Association for Home Care and Hospice

Medicare Approved Agencies

How to Hire a Caregiver? General questions and procedures from the State of MI.

Evaluate the Care Received

• Coordination of schedules to meet the older adult's needs
• Quality of service
• Services as promised
• Response to problems
• Effective communication
• Confidence in caregiver
• Timeliness
• Work ethic
• Appropriate appearance and cleanliness
• Compatibility
• Compassion of caregiver
• Knowledge and training

Questions to ask applicant's references:

• How long have you known the applicant?
• What was their position with you? What were their job responsibilities?
• What were your impressions of their work?
• Was the applicant reliable? Dependable? Courteous? Trustworthy?
• Were there any problems?
• Why are they no longer working for you?
• Would you rehire this individual?

Criminal Record Check

For $10 to $25 you can order a background check on another individual by contacting the Criminal Justice Information Center in your state.

It is a simple process that requires the name, race, sex, and date of birth of the person for whom you are requesting a search (asocial security number, maiden name, or previous married name is helpful, but not required). It generally takes several days to process. It's critical. Do not skip this step.

Request a sex offender check at no additional charge but must specify in what capacity or setting the individual would be working.

Other Services Provided at Home

The non-medical peer-level companionship for social companionship (playing card games and sitting and visiting) includes:

• transportation
• errands
• light housekeeping
• meal preparation
• medication reminders
• assistance with activities of daily living
• respite care for family members
• skilled nursing care
• hospice care

Home health care agencies, specialty services, offer wound care or infusion (IV) therapy for intravenous therapy, including chemotherapy and antibiotics, to patients in the comfort of home. While those services will cost more, they will still be less expensive than if offered during an overnight hospital stay.

Home Care offered in Senior Care Facilities

In some cases, home health care workers provide one-on-one care to a client in a nursing home, assisted living facility, rehabilitation unit or hospital. The staff person, hired and paid for by the client, and provides the personal care that larger health service organizations are not able to give.

Most hospitals and other residential health organizations have specific rules and guidelines regarding outside staff, and you may want to check with the director of nursing before hiring a home health agency. As long as the home health care staff person does not interfere with the care of any other patients, it's permitted to use an outside agency. They will not, however, deal with any staffing issues.

Personalized Care

You can request a free initial assessment plan with a staff social worker or nurse coordinator. Generally, a social worker or other staff member of a home health care agency will visit the client's home and work with the client, and their families and physician, as needed, to develop a written care plan which includes the services the client needs to maintain his or her physical, mental, and social well-being.

Regulations

Home health care agencies regulated by state laws, which may determine what services performed and by whom. Typically, laws require that home health care staff not perform services beyond those which they are licensed to do. In other words, a companion could help with meals, but not give injections.