Tag Archives: In Home Care

Who Helps in Home Health Care

With the ever increasing complexity in the healthcare system in America, we though an outline of the types and titles of individuals would be in order when you finally need to have in home care. Below is an outline of the roles and responsibilities of individuals you may be dealing with then care is delivered in your home.

When a physician orders in-home care services to a home-bound patient with verified skilled clinical needs, there can be a variety of support personnel who come into the home to address each of the specific needs. Numerous caregivers can be wonderful, but also confusing. It is important for patients, families, and caregivers to know the role of each discipline and who to call for which services.

Ongoing changes to the allowances for in-home care by insurance companies, Medicare, and Medicaid have made it challenging for people to get the care they need at home when they are ill or injured. In fact, adult children are often considered the sandwich generation as they are caring for their aging parents, their own children, and even their own grandchildren at the same time. While some physician practices have a nurse liaison or care coordinator to assist patients with navigating the challenges of services, families need to strongly advocate to get their loved one the care that is needed to rehabilitate or to be safe in their home.

Once services are ordered, it is imperative for patients, families and/or caregivers to know the focus and tasks of each role:

Registered Nurse: A Registered Nurse, or RN, is a person who will usually get the in-home care started by meeting with the patient, family and/or caregiver (usually a family member) to collect a lot of information in order to create a plan of care for your visits. Even though your doctor may have all of the same information, the RN must still ask these questions in order to correctly capture all of the information. Be sure to have all of the medications and supplements available for the nurse to record.

Licensed Practical (or Vocational) Nurse: Also a nurse, the role of the licensed practical nurse (LPN or LVN) is to provide skilled tasks such as wound care, administering medications and/or patient education. The LPN carries out the tasks related to the plan of care created by the RN.

Home Health Aide: The role of the Home Health Aide (HHA) is to provide direct-care services such as bathing, showering, transferring to a chair or bed, and basic grooming chores. As the HHA is not a licensed caregiver like the RN or LPN, they cannot give medications or advise patients on healthcare issues or concerns.

Social Worker: Many times, patients and families need additional community support and resources to care for someone at home. The role of the social worker (SW) is to connect patients with resources such as applications for financial assistance or respite care. Licensed Clinical Social Workers (LCSW) can assist patients with mental disorders such as depression or anxiety and can help patients and families deal with life-changing events such as a terminal illness. See Social Work

Physical Therapist: Patients who require physical rehabilitation will mostly likely have a physical therapist (PT) providing care in the home. The PT will conduct an extensive interview, similar to the RN interview, along with a physical evaluation to create a plan of care to restore physical function to the patient. The PT’s plan of care will include a list of exercises that the patient, family or caregiver can administer between visits.

Physical Therapy Assistant: The physical therapy assistant (PTA) is a trained individual who helps patients with the exercises that are ordered by the PT. Although the PTA is not licensed, most have received degrees from programs specializing in rehabilitation services and exercise physiology.

Occupational Therapist: Patients who have lost the ability to care for their personal needs such as dressing or eating will need the support of an occupational therapist (OT). The OT provides patients with rehabilitation skills to return to optimal functioning after illness or surgery. The OT can also teach families and/or caregivers how to reinforce these skills in between visits.

Speech and Language Therapist: The speech and language therapist (ST) provides pathology services to patients who need to improve or regain speech and language skills. This specialist also provides evaluation services for swallowing to ensure patients are able to eat and drink safely without the risk of choking.

Over the past decade, Medicare has changed many of the qualifications for home care services which are often reflected in the private insurance world. Now that the question of who is providing the care that is ordered has been answered, which additional services are available and covered may require a bit more digging by the patient’s family and/or caregivers.

About the Author
Catherine Burger, BSN, MSOL, RN is a board-certified nurse executive and contributing writer for www.registerednursing.org

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com. The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

Common Problems with Private Duty In-Home Care Agencies

While the private duty industry has just released a report indicating that their turnover rate has reached an all-time high of 82% according to the 2018 Home Care Benchmarking Study by market research firm Home Care Pulse, a review of the common problems of the home health private duty care agencies is in order. Traditionally, hiring a private duty in-home care agency was seen as the only avenue for people looking to care for those with elderly parents who need assistance.  Through out the history of private-pay, private-duty care, working with caregiving agencies is often a daunting task that can be difficult for both elderly parents and their adult children. Part of the problem is that to date, getting a reliable, dependable, affordable caregiver is usually an exception rather than the rule and this situation is only getting worse.

For adult children looking to hire a caregiver or private duty agency to care for the elderly parents, there are many pitfalls that get covered up by private duty agencies. Most people believe that an agency is going to get a matched caregiver to you or your parent’s needs and pay them a decent wage, when in fact most agencies just field the next available caregiver in roster. They are more about making money than servicing the clients.  In case after case we hear about how caregivers at agencies often do not show up, are sleeping on the job, are not trained, or more seriously, sometimes abuse their charges.

In order to save individuals frustration and regrets, it is beneficial to review some of the most common problems with private duty in-home care agencies and how to avoid them. Below is a listing of the top client complaints concerning private duty home care agencies.

  • Lack of consistency of caregiver
  • Caregivers not showing up or consistently late
  • Communication Problems Between Client and the Agency
  • Insufficient Caregiver Training
  • Caregivers focused on technology not the client
  • Unwanted caregiver behavior
  • Cultural differences / not accounting for cultural needs

The most common problem with private duty home care is that either caregivers do not show up, or there is a new caregiver showing up ever other week.  These issues have been a chronic and persistent problem in private duty home care since its inception. While the industry has known about this situation for some time, the problem persists due in a large part to the inadequate pay afforded caregivers, and the fact that agencies tend to hire anyone who applies for the open job, instead of doing a real match to a client’s needs and the caregiver’s personality and skills. The bottom line is that agencies are more concerned with maximizing their profits rather than really taking care of a client’s needs.

Another common problem lies with poor communication from the private duty care agency and/or their caregivers. While you believe hiring a caregiving in-home care agency will give you some relief for people looking to take care of parents who are no longer able to adequately take care of themselves, it is amazing how even acknowledging that the basic activities of daily living (ADLs) are being performed do not get communicated to those who might be paying for those services. This is even more compounded if special needs are involved, or if the elderly client needs to be taken to the doctor or requires some form of clinical therapy.

On top of not paying caregivers adequately, another challenge for the industry is the fact that there is insufficient training for caregivers. In some instances, caregivers are not allowed to provide services in the home due in a large part to the Stare restricting what services a private duty agency can offer. On the other hand, it goes back to in home private pay care agencies just trying to get billings, knowing adult children are desperate to get care for their needy parents and are unable to personally attend to that need. Sadly, even basic skills such as cooking and cleaning, may go lacking with many of the caregivers private duty agencies hire, and should be questioned and evaluated before hiring a potential caregiver.

Technology can be a great tool for delivering care, but at the same time, many caregivers are distracted with their phones, social media and the internet in general, and this distracts them from performing their caregiving duties. While you may not like it, it is very difficult for home care agencies to police their caregivers on the use of their smart phones as a distraction to caregiving.

While the best-case scenario is when a caregiver feels like they are part of the family, it is vitally important to maintain some boundaries with the caregiver. This is especially true if they start to display some irresponsible behaviors. Occasionally, everybody is late, but with private duty home care agencies, this tends to be a chronic condition, and when you start to see a caregiver not show up for care, or have a substitute being called in frequently, it is time to reevaluate the use of this agency. The problem gets worse if the caregiver seems nice, but in actuality is just taking advantage of the situation. Remember, you are relying on a 3rd party to bring someone you do not know of have not vetted or chosen into your home. Too often people make the assumption that a private duty agency takes as much care as they would in choosing a caregiver, but most of the time, that is not the case.

Finally, there are the differences in cultures, likes and dislikes. Some of these are straightforward like language and ethnicity, but others deal with diets, foods, music, cleanliness, and religion. It is important that you address possible language and cultural barriers first. There are some cultural differences between hygiene and eating habits that may pose a surprise problem later on. Laying out expectations from the beginning can eliminate these problems. Working with private duty in-home can be difficult, but it does not have to be. There are new alternatives being offered, like Well Beyond Care, that allows people to how hire your own caregiver and steer clear of the frustrations of working with private duty and at the same time saving a substantial amount of money and letting you choose your own perfect caregiver.  Well Beyond Care teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover. The platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. This solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

About Well Beyond Care
Well Beyond Care is the only company that teaches families and individuals how to find and manage affordable non-medical in-home care, while solving the chronic problems of caregiver truancy and turnover through the web application, WellBeyondCare.com. The Company’s platform combines the power of the internet with the personal touch of nurses to offer families a pathway to transitional care, allowing our elderly parents to safely age-in-place. Their solution lowers stress in hiring a caregiver and saves families tens of thousands of dollars per year in care costs.

CMS Adds Non-Skilled In-Home Care to Medicare Advantage Benefit

Beginning in 2019, non-skilled in-home care services will be allowed as a supplemental benefit for Medicare Advantage (MA) plans the Centers for Medicare & Medicaid Services (CMS) announced in a final rule issued Monday, April 8th. This ruling, originally proposed in February, was met with enthusiasm from both the home health and private duty home care industries.

This marks the first time CMS has allowed supplemental benefits that include daily maintenance in Medicare Advantage. “CMS is expanding the definition of ‘primarily health related,’”the agency stated in its announcement. “Under the new definition, the agency will allow supplemental benefits if they compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.”

In 2015, 35% of Medicare beneficiaries were participants in MA, according to CMS data. And that figure is expected to grow quickly over the next several years. Home care providers are not the only ones welcoming this change, as many also believe MA payors are ready and willing to pay for non-skilled in-home care services but as of yet did not have a mechanism to do so.

“The Medicare Advantage plans have a very different payment environment [than fee-for-service],” Tracy Moorehead, CEO of industry group ElevatingHome, told Home Health Care News at the association’s National Leadership Conference in March. “They have greater flexibility than the fee-for-service providers do. They do not have a home bound requirement in many cases. So they are tasked with full capitation, where they have an amount they are provided [with] to care for a patient and they will do whatever they need to make sure that patient doesn’t cost them more money than necessary. And if that [includes] private duty services, then I’m sure a plan is more than ready to pay for that.”

In fact, insurers and payors have been positioning themselves to better align with post-acute care services for years. As the focus also shifts toward the high-cost, high-needs dual-eligible patient populations of people who qualify for both Medicare and Medicaid, that has provided additional incentive to cover personal care services as well.

“What Humana, UnitedHealthcare, and Aetna have been saying for several years is that we’ve have a great relationship for skilled home health and hospice for quite a while,” Keith Myers, CEO of LHC Group (Nasdaq: LHCG), told HHCN. “In the last few years, they’re starting to focus more on dual-eligible population and have needed us to have a bigger commitment in personal services.”

In-Home Care: The Practical Choice

Many American adults today are facing the reality of caring or having to care for their aging parents who are no longer capable of living an independent life. Many are worried about what they can do to ensure that their parents may receive the kind of care they need at this point of their life, but few know what to do about getting care. So, if you are in this situation, it may be comforting to know that you are not the only one facing this challenge. According to recent statistics, “the oldest-old population (those age 85 and over) grew from just over 100,000 in 1900 to 5.5 million in 2010” (AgingStats.gov). There are millions of others like you thinking about how to get the best care for their aging parents and wondering how to do so at an affordable cost.

Without a doubt, the costs of healthcare these days can be crippling. And sadly, the hope of having these costs adjust favorably may be bleak. In spite of health care reforms, there is no guarantee as to whether or not they will work out well for American citizens or not – and this leaves you with the only option of working on your parents’ healthcare requirements using your own resources.

The Difficulties of Healthcare for Elderly Parents

The difficulties that your parents are experiencing as they feel the pangs of aging may be as overwhelming to you as them. The added stress you are feeling about having to provide them the best help they can get makes the situation even worse. Their health issues, along with the inconveniences of possible incontinence and inability to perform their daily tasks, like dressing, bathing, and cooking, call for your immediate attention.  Adding this urgent need to your own scheduling requirements to look after them as they progressively need more care, adds significant angst to you and your family.  What options do you have?

The Common Response

The most common response in this kind of situation would either to admit your parents to a full-time nursing home, or an assisted care facility if you can afford it. Though these options may be plausible, they may not be the most practical choice if you are considering your long term financial future.

To begin with, long-term outlay costs may be burdensome for you and your family; you may have other fiscal obligations, such as having to provide for your spouse and children, and your own daily living expenses. On the other hand, nursing homes and assisted care facilities may also be equally as expensive, with the costs estimated at up to $80,000 annually (CNN Money, 2013).

In-Home Care Options

Hiring your own In-home caregiver, on the other hand, may be a more practical choice. Unlike the other more common options, having this kind of care for your aging parents may mean not having to spend as much money while getting the same or better assistance they require and deserve.

These non-medical, private pay or personal care professionals, or caregivers, can do anything from preparation of meals, to bathing and grooming, to even administering intravenous medications. Depending on their specific qualifications, they may also offer other services as that your parents may need now or in the future.  The cost savings of hiring an individual caregiver can be substantial, sometimes less than half the expected cost of a nursing home facility.  The advantages of having a caregiver for your parents may be the best choice you make for them; and for yourself as well.

When hiring your own caregiver, you should look at companies like Well Beyond Care. Well Beyond Care offers an online caregiving matching application and more. While most in-home care is provided by private duty agencies, Well Beyond Care teaches and guides a Careseeker (a senior or their children) on hiring their own caregiver. Compared to traditional Private Duty Agencies, families can save $10K to $30K per year, and caregivers make an additional $3 to $4 per hour extra using our on-line service.  The Well Beyond Care system, combines the best in caregiver hiring (matching, screening, ratings & background checks) with all the back-office functions (verified time worked, payroll, scheduling, and documentation) to insure safe, reliable, dependable, affordable care is obtained.  Each careseeking member has access to their own local, personal nurse navigator to help guide them and give advice on healthcare options.  An user friendly, free service, the  Well Beyond Care system wants to make sure that there is a rightness of fit in the Care-Pair by empowering caregivers and those looking for care.

How Can I find the Best Caregiver for my Parents?

More than ever, we live in a long-distance society and finding the best caregiver for your parents requires a lot of consideration. To begin with, being far away and entrusting your aging parents in the hands of others may be a tough decision, but knowing that they are in the good hands of a trusted and qualified caregiver can lower stress, give you and your parents piece of mind, keep them out of the hospital, and actually prolong the length and quality of life for them.

Before making any decisions, it is important to know your options in choosing the best caregiving means for your parents. There are a number of live-in facilities offering caregiving, and it’s up to you to decide which option best suits your parent’s individual caregiving needs. It is vital that you get to know each healthcare facility and what they have to offer, which will allow you to decide whether or not you are making all the right decisions for your folks. It is advisable at this juncture to try and locate a healthcare professional who knows the good versus poor facilities in your area.  You might be shocked at the exorbitant cost of housing your parents in a healthcare facility, and may decide that hiring a in home private caregiver is actually the best option.

In-Home Care: An Excellent Health Care Option

In most cases, having to leave one’s home to move into a nursing home or assisted living facility gives elderly patients unnecessary anxiety and stress. Alternatively, hiring an in-home caregiver to come take care of your parent in their home where they are comfortable and familiar alleviates this stress. They can get the same health care and assistance they require from the comfort of their home through personalized home health care services.

There are a number of different levels of home caregiving at a varying range of pricing that you can choose from, depending on the particular needs of your parents. You can employ a geriatric care manager to help you determine which level of care or qualification your parents might need. Qualification levels include Registered Nurses (RN), Licensed Vocational Nurses (LVN), Skilled Caregivers, and Companions or Homemakers. Their qualifications and expertise may vary, but these professionals and skilled health care workers provide assistance to their elderly home care clients in their clients’ own homes.

The responsibilities that these home health care professionals provide range from assisting their elderly clients undertake their daily tasks of living, such as taking a bath, using the toilet and administering medicine, to other routine activities that aging patients may need help with, such as going to a doctor appointment, grocery shopping and doing laundry.

What You Need to Know About a Home Care Provider

As soon as you have decided to hire a home health caregiver for your parents, the next thing you need to do is decide which duties that caregiver will need to perform to effectively care for your parents. For instance, you may address the following points concerning your caregiver of choice:

  • Skills or qualifications
  • Recommendations from past patients or clients
  • Number of years experience in caregiving
  • Accreditations and licenses
  • Confidentiality and client privacy policies
  • Records of inspections, ratings, and client satisfaction
  • Criminal background check

Apart from these concerns, you should also consider your budget. Hiring an in-home caregiver is typically much more affordable than nursing home or assisted living facility care. But more importantly, it is all about looking for a caregiver that offers the service that your parents require, at a rate you can afford.

Hiring an individual skilled caregiver is an excellent way to save money while building a close personal relationship with a high quality care professional.  But in saving money, make sure you are NOT endangering your parents by hiring an unscreened or unqualified caregiver.

Well Beyond Care gives both caregivers and those who need care the tools to manage their in-home care online. Caregivers, registered nurses and geriatric care managers can use the website to be matched with Careseekers and their family members who are looking for care, set their wages and weekly schedule, receive weekly payment, and build their resume and portfolio with real experience. Careseekers, or family members looking for someone to help care for their parents or loved ones, can use the website to be matched with caregivers who best match their specific care needs, monitor their caregivers’ schedules, and make payment online and receive personal, local support from a local Nurse Care-Pair Manager. These Nurse Care-Pair Managers offer assistance in understanding what is available with care in your community as well as helping you navigate any issues you might run into using the Well Beyond Care website. Join for free today at WellBeyondCare.com.

Hiring A Caregiver: Direct Hire Vs. Agency Hire

Hiring A Caregiver: Direct Hire Vs. Agency Hire

If you or a loved one is considering hiring an in-home caregiver or private pay attendant to help take care of you at home, there are a lot of factors to consider. Many people choose to hire a caregiver through a private duty agency due to in part to the seemingly apparent ease of using one, but agencies tend to be very expensive. On top of having to pay your caregiver, you will have to pay fees for the agency’s services. In addition, you have little say on ‘what’ caregiver you get with an agency. On the other hand, hiring a caregiver completely on your own poses its own set of obstacles such as finding a trusted, qualified, reliable, quality caregiver.

 What Is the Alternative?

Using a fully integrated online service to hire a caregiver for yourself or a loved one is a new and revolutionary way to find top-notch and well matched caregivers who are verified, qualified and more affordable than using an agency. Sites like WellBeyondCare.com, make hiring a caregiver simple, easy and more affordable while allowing you to maintain control of your care needs.

When you use an agency, many elderly patients have trouble paying the agency fees, which can range from $10 to $25 per hour over what a caregiver is making. At the same time, private duty agencies will not always accept insurance or Medicare. Using an online resource, the individual who needs care is able to set their own price and still have the option of using Long Term Care Insurance or Medicare. This makes costs for the careseeker much lower and can relieve much of the stress of having to hire a private duty caregiver. A good online service should also be able to estimate taxes, do the automatic required deductions and provide the information you need to file tax reports when the time comes.

One other very important aspect of hiring a caregiver is ensuring that the person can be trusted and their work experience and references can be verified. Caregivers need to be reliable, show up on time, provide quality care and must be able to be trusted to perform the duties they say they can. A good online service will feature reviews and ratings for every caregiver who has worked for other careseekers provided by the careseekers themselves. They should also feature a system to get a background check and reference check, so you know the caregiver can be trusted coming to your home. This transparency gives careseekers and their family members peace of mind knowing that the caregiver they want to hire is dependable, reliable and meets their skill requirements.

One other feature that should be considered with an online service is the ability to remotely monitor the care from afar.  Families today are widely dispersed, and the ability to have multiple individuals be able to see what is being done with a care recipient by the caretiver is a crucial factor in reducing stress and providing superior service for any online platform.

With an easy-to-use website, helpful tools and personalized customer support, using an online resource such as WellBeyondCare.com to hire a caregiver is a new and great alternative to the old way of doing business. Save money and time by setting your own prices and managing all of your care needs from the comfort of your home.

WellBeyondCare.com gives caregivers and those who need care the tools to manage their in home care online. Caregivers, registered nurses and geriatric care managers can use the website to be automatically matched for caregiving jobs, set their wages and weekly schedule, receive weekly payment, and build their resume and portfolio with real experience. Careseekers, or family members looking for someone to help care for their parents or loved ones, can use the website to search for qualified caregivers, post a profile that outlines their specific care needs, monitor their caregivers’ schedules, make paymenst online, and receive personal, local support from the WellBeyondCare team of Nurse Care-Pair Managers.

When are Patients “Unsafe” for Home Care?

Reprinted by permission from Elisabeth Hogue, Esq.; (877) 871-4062; ElizabethHogue@ElizabethHogue.net

CaringForCaregivers-CGS-largeDischarge planners/case managers are likely to encounter instances in which home care, hospice, and home medical equipment (HME) providers state that they cannot accept patients because they are “unsafe” at home. The use of this term may be confusing to discharge planners/case managers. What is it about patients’ homes that make it unsafe for them to receive services there? Aren’t all patients appropriate for home care?

First, discharge planners/case managers may not have provided services in non-institutional settings. If so, it may be difficult to make a crucial distinction between institutional care and home health services. Specifically, in institutional settings the provider controls the “turf” on which care is rendered. In post-acute care at home, providers have little control over the environment in which services are provided. In fact, patients have almost absolute control over the “turf” in home care because services are rendered in their private residences.

Consequently, home care providers often confront barriers to the provision of services that many discharge planners have not experienced. Staff have, for example, encountered “attack geese” when they arrive at patients’ homes and risk the consequences of a serious pecking in order to reach patients’ bedsides! Or they have come eyeball-to-eyeball with a pet alligator, named Bubba, in a mobile home in Louisiana!

Although patients may not be adversely affected by pecking geese and may have a cozy relationship with Bubba, there may be other factors over which home care providers have no control that clearly jeopardize the well-being or safety of patients. These factors may make it impossible for providers to render services at home. Patients’ homes may, for example, be in such disrepair that both patients and caregivers are at risk. A home health nurse, for example, recently fell through the floor of a patient’s home as she approached the patient’s bedside. Patients’ homes may also be invested with roaches, rodents and/or vermin of various types and descriptions. Despite appropriate interventions from providers, patients may suffer repeated falls at home that make it risky or unsafe for them to remain there.

Despite these examples, discharge planners/case managers may still be unclear about why patients cannot be cared for at home when post-acute providers decline referrals on the basis that patients are “unsafe.” It may be helpful for providers to be more detailed in their communications. Specifically, providers could say, “The patient’s home environment will not support services at home for the following reasons….” When providers’ communications with discharge planners/case managers are vague, discharge planners might prompt clearer communication by asking: “What are the specific reasons why this patient’s home environment will not support home care services?”

Institutional care and home care services are fundamentally different models of care. Because the differences are so great, it is reasonable to expect that providers who practice primarily in institutions and those who work in home care may not always understand or account for important factors involved in different types of care. Clear, specific communication is, therefore, absolutely essential for the well-being of patients.

Well Beyond Care:

WellBeyondCare.com gives those who need care the tools to manage their in home care online. Careseekers, or family members looking for someone to help care for their parents or loved ones, can use the website to search for qualified nurses and caregivers, post jobs that outline their specific care needs, monitor their caregivers’ schedules, and make payment online and receive personal support, local support from their personal Nurse Care-Pair Manager. Caregivers can use the website to search for caregiving jobs, set their wages, post their weekly availability, receive weekly payment, and build their resume and portfolio with real experience. Join for free today at WellBeyondCare.com.