There comes a time in the lives of many senior citizens where they need a little assistance at home. Do you know that giving seniors just a little bit of help often makes it possible for seniors to live at home longer? In-home senior care is usually the least expensive option for health care for seniors that need care for less than a 40-hour work week.[a] Here’s what you need to know about how to hire a home health care agency
Setting up in home healthcare services doesn’t necessarily mean arranging for live-in or overnight care. Many seniors get along quite nicely with anywhere from a few hours a week or a few hours a day of assistance. Others only need to have some minor safety modifications in their homes and some supplemental help with home maintenance.
There are many terms to describe senior helpers. Some of the descriptions include home health aide, certified nursing assistant, and custodial care worker, depending on the type of home health aide services they provide.
It’s common for people to envision that they will go into their retirement years living a healthy and active lifestyle. Statistics on aging tell us that most people will need some level of assistance at some point in the later stages of life.
There is a lot to consider when entrusting someone to come into the home and provide caregiving duties. It’s a hard decision for many seniors and their families because the health and well-being of vulnerable seniors are at stake.
Learning more about how home healthcare agencies work will alleviate much of the concern about contracting with outside home health care services. It’s important to weigh the pros, cons, and risks for the senior and those who contract for services.
Senior home healthcare agencies have the knowledge and expertise to review current and future services with you so that you can make the best decisions now and later. Expanding on your knowledge of senior care will help you understand if a home healthcare agency is right for your family and fits within your budget.
How Do I Know If In Home Healthcare Is Right for Our Loved One and Us?
As most people near retirement, their thoughts turn to all the things that they didn’t have time to do when they worked full time. Pre-retirees start looking to complete household tasks, relax a bit, and maybe do some traveling. Few people at this stage of life anticipate needing any kind of help at home during the retirement phase of life.
What Data Tells Us About Healthcare Needs During Retirement
A 2011 study by the National Conference of State Legislatures and the AARP Public Policy Institute called, “Aging in Place: A State Survey of Livability Policies and Practices,” yielded some interesting facts about how retirees see their lives changing during retirement. [i] The report also highlighted some differences in how adult children saw their parents during later stages in life.
The study showed that 69% of pre-retirees thought about their ability to live independently as they got older, but only 14% of them expected to need day-to-day assistance or ongoing health care at any point during their retirement. Less than 27% of people approaching retirement thought they’d need their children’s help as they aged. The AARP report shows that 90% of people aged 50-65 years preferred to live in their own homes as they age.
By contrast, 75% of adult children who responded to the survey reported that they thought about their parents’ ability to live independently as they got older. About 54% of adult children said that they thought their parents would need their help after their parents retired.
Universally, the report made it clear that large percentages of seniors would eventually need some type of healthcare assistance and that they preferred to receive assistance right at home.
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Starting the Discussion About Hiring Senior In-Home Healthcare
Regardless of how well seniors and their adult children prepare for the later stages of life, it’s not always easy or pleasant to talk about bringing in outside help. Seniors and their children need to come to the point of accepting that help is necessary.
There are many different ways to divide duties to make sure that the needs of the elderly are taken care of. Setting up in-home health care doesn’t necessarily mean bringing strangers into the home around the clock. When seniors can no longer provide for all their needs adequately, and family exceeds their limits to help, it helps to have a candid discussion about what tasks aging parents can continue to do on their own. [ii] From there, other family members can decide what they can and are willing to do to manage the remaining tasks.
Areas Where Seniors May Need Assistance
Think through the types of services that your loved ones need. Take into consideration how much support there is, the senior’s general health and available finances. Can family members or friends help out in some areas? Are they willing and able to help?
You’ll have a better idea of whether you need to hire home health care services for a few hours, a full day or overnight. Seniors typically prefer getting help from family members when they need it, but that isn’t always possible. Getting help from home health aide services can be a bit of an adjustment in the beginning, but many seniors adapt fairly quickly and eventually look forward to seeing their home healthcare workers.
Here are some areas to think about.
Location, Location, Location
If location mattered during the working years, it matters much more during the retirement years. How easy is it for seniors to get to town to do their banking, shopping, and other errands? How easy is it for family members to get out to the senior’s home to help out with transportation, meals, home repairs, and other needs? For seniors that live in rural or remote areas, do you have a plan if they need help in an emergency?
In thinking through healthcare needs, you may consider bringing in outside help, arranging for transportation, or moving the senior closer to the services they need most.
Home Accessibility and Maintenance
Seniors may love their homes, but it’s important to consider whether their family homes work as well for them as they used to. Would adding ramps or stair lifts make it easier for the senior to remain living in their home? More importantly, is it possible to make those additions to the current home? Does the home have too many steps or too steep of an incline to get into the house? Is the senior able to keep up with lawn or home maintenance?
Many seniors can continue living in their homes by making a few minor modifications. [iii] Seniors that can take care of themselves may only need a few hours of lawn maintenance or access to an on-call handyman.
Managing the Household
There are many duties that go into managing a household—shopping, cleaning, laundry, gardening, paying bills, pet care, and managing doctor and other appointments. Find out which of these tasks the senior feels capable of handling and find resources to fill in the gaps. Some seniors will not want to give up tasks they enjoy. Getting help for other things may afford them the time to tend to the activities they enjoy most.
Elderly people that enjoy shopping may want or need a companion to go with them.
Seniors with chronic medical conditions like kidney disease, congestive heart disease, diabetes, or some other health issue may only need in home healthcare at regular intervals to give medical checks, administer medications, or provide treatments.
Other professionals also offer in home healthcare services. Occupational therapists, social workers, and home health nurses provide many services in the comfort of the senior’s home. You may also be able to find intensive home health care services like dementia care and hospice care.
Medicare, Medicaid, Veteran’s services, or private insurance cover many healthcare and social services.[iv]
As seniors age, their abilities to perform personal care and other activities of daily living tasks may decrease.[v] Many seniors find it very helpful to have a home health aide visit them for a few hours of the day to help with things like dressing, bathing, feeding, and meal preparation. Personal care aides also often help with things like medication management, taking blood pressure, caring for plants or pets, and performing light housekeeping.
Personal care services may extend to a full day or live-in care as the needs of the senior increase.
Alt text: Home health care aides help take blood pressure and manage medications
Availability of Transportation
It’s harder for seniors living in rural areas to get to town to do their banking, shopping, and other errands if they are unable to drive at night or not at all. It’s also more difficult for family members to take time from their busy schedules to help out if the driving distance is too far. Home health aides often provide transportation and assistance for grocery shopping, personal shopping, assistance with banking, medical appointments, hair and barbering appointments, and other errands.[vi]
Seniors that live in the city or suburbs may have access to public transportation, which may make things easier. Public transportation is not always accessible or handicap accessible. Many communities have designated transportation for senior citizens.
Putting Together a Budget for In Home Healthcare
As the needs for in-home health care services increase, costs can quickly add up. It helps to make a line-by-line budget with services, hours, and fees. If costs are getting out of control, home health care services may be able to help you get the most appropriate array of services that fits the budget.[vii]
Higher levels of care are costly in all settings, so it’s a good idea to periodically compare costs against in-home care, assisted living, and nursing care to see which type of care makes the most sense.
Alt text: Home health care services can arrange for errands and outings
Weighing the Pros and Cons of Hiring a Home Healthcare Agency or Independent Caregiver
There are many pros and cons to hiring an independent healthcare aide, and the same is true when considering hiring in home healthcare aides through a home health care agency. You’ll also want to learn more about the impact of taxes, risks, and the legal relationship between you and an independent senior caregiver.
Pros and Cons of Hiring a Private or Independent In Home Health Aide
Independent caregivers are sometimes a little more flexible than hiring through an agency, especially if you just need a few hours a week or have an unusual schedule. Many independent caregivers have several clients so that they can accommodate varying schedules.
Pros—Flexibility, Savings, Caregiver Choice
You’ll also have greater flexibility in the types of services that an independent caregiver may provide. Agencies standardize their procedures to ensure a high standard of quality, which might mean that their caregivers are not willing or required to provide some services that you might want.
The two biggest benefits to hiring a home health aide independently are the choice of caregiver and lower cost. When interviewing aides privately, you have the benefit of meeting them in person and allowing the senior to get acquainted with them to make sure that it’s a good fit.
There is a greater range of costs between independent home health aides than you will find with agency fees. Varied costs give you more room for negotiating fees, and you can offer a bit more if you find someone who is a really good fit.
Cons—Being an Employer
There are some big downsides to hiring an independent home health care aide. You will essentially need to perform all the administrative duties that a home health care agency does for you.
If your regular aide can’t come to work for any reason, it’s up to you to find a substitute or fill the role yourself. It’s wise to have a designated backup plan if your regular caregiver gets sick, plans a vacation or quits unexpectedly.
Home health care aides incur a daily risk of back injuries due to lifting patients. According to the Department of Labor’s Bureau of Labor Statistics, nursing assistants have about three times the rate of back and musculoskeletal injuries as construction workers. [viii] The Department of Labor also reports that nursing employees report over 35,000 back and other injuries each year that caused them enough pain that they missed work. Injuries also means that the family employer may be responsible for costs associated with on-the-job injuries, which could well exceed the savings of hiring someone independently.
Two very big cons to hiring an independent worker are training and protection. Seniors that need help become vulnerable when a senior health aide lacks proper training or has not had their background checked thoroughly. Family members often lack the resources to perform adequate screenings and verify credentials.
It’s essential to understand that you are an employer when you hire a home health care aide independently. This relationship carries a lot of more responsibility than doing a background check and maintaining a paper file. As an employer, you will need to withhold Social Security taxes, Medicare taxes, federal unemployment taxes, and purchase an insurance policy. Families that neglect this responsibility could end up paying big. They can be subject to paying interest on back taxes, civil fines, or criminal penalties.
Some home health aides work as an independent contractor where they pay their own taxes and insurance. Families who hire independent contractors need to verify that those who work for them are actually paying their taxes, so the family doesn’t become liable for them.
After weighing the pros and cons, if hiring someone independently still looks like your best option, you might consider hiring or consulting with a labor lawyer to make sure that you’ve done due diligence in your administrative duties.
Pros and Cons of Hiring a Home Health Care Agency
Home healthcare agencies make it their business to make sure that the home health aides they send out have been thoroughly background checked and vetted for safety and professionalism. Their staff has all the proper documents and resources to make quick work of all necessary administrative tasks.
Pros—Training, Supervision, Reliability, Legal Administration, and Liability
When you hire a home healthcare aide through a professional agency, you have the assurance in knowing that the aides they send out are trained to provide care according to your loved one’s specified needs. Agencies accept and prepare for this responsibility by carefully training their aides and double checking their training and other credentials. They also supervise their employees to make sure that you loved one’s care meets or exceeds your expectations.
There’s no need to worry about a health care aide calling in sick, quitting, or not showing up for work for some other reason. The agency will be happy to send in a substitute worker. As the senior’s needs increase, most agencies will discuss changing your agreement to a higher or different level of care.
An agency will take care of all of the administrative tasks. The agency staff will make sure that the worker has the proper legal status to work in this country and pay all of the necessary state and federal taxes. The agency will also cover any accidents or injuries that the home health aide incurs on the job.
Cons—Minimum Shifts, Lack of Choice of Caregiver, Cost
Some agencies have a minimum cost per shift, regardless of how many hours you need them. This is to make it worthwhile for the healthcare aide’s time because they have travel and preparation in between clients.
When hiring a home health care agency, seniors and family members may be disappointed that they don’t get to choose the exact home health care aide that want. Personal and medical caregiving requires a degree of trust and acceptance. The agency will make sure that the worker they assign has the right skills and qualifications to meet your needs. They will do their best to make sure that the client and caregiver are a good fit for each other, but it’s not as personal of a decision as when you hire someone independently.
Cost is a big consideration for all seniors and their families, and you can expect to pay a higher cost when you hire through a senior healthcare agency.[ix] As the senior’s needs increase, costs add up. Remember that when you compare costs of hiring an independent home healthcare aide and the services that an agency provides, you are not comparing apples to apples. The agency is providing insurance, which would be very expensive for you to obtain on your own. They also pay the overhead of other administrative costs like setting up payroll, taxes, background checks, credential checks, reference checks, and other legal protections. While the cost appears high, when you add up the costs of performing the same tasks on your own, they will likely be even higher.
In some cases, it makes sense to cut back some of the hours to make up for the higher cost of working with an agency. Just be sure not to cut back so much that it compromises the care or safety of the senior.
How Do I Find and Hire a Home Healthcare Agency?
When you’ve decided that the best choice for your family is to hire a home health care aide using a senior care agency, where do you look to find a reputable agency? Fortunately, there are many resources at the national, state, and local level that can lead you to the best agencies in your area.
Ask for Personal Referrals
One of the best resources for home healthcare agencies is to get a referral from another family member or friend. If they’ve had success using a particular agency, chances are good that you will too. Use your personal and occupational networks to spread the word about finding an agency. There’s a good possibility that someone you are close to may get a referral from someone they know.
Use Online Search Locators
Several senior care associations have online search directories of home health care agencies that you can locate by area, city, or zip code. Try the National Care Planning Council, Eldercare Locator, the Alzheimer’s Association, or Area Agency on Aging. [x] [xi] [xii] [xiii] The National Area Agency on Aging will help you find your State Area Agency on Aging, where you will find a host of information on every available type of senior care service in your state. You can also try performing an online search using the terms “home healthcare aide” and the name of the area where the senior needs care.
It will be worth your while to pay a visit to your local senior centers. The staff at the centers will most likely be your best resource for finding senior services of every kind including recreational, housing, food, and anything else the community offers to their seniors.
Checking Home Health Care Agencies for Quality
Once you’ve begun your search for a home health care agency, you might just find that it was easier than you anticipated. What do you do with your list of senior care agencies? It’s time to check them out and see what kind of reputation they have.
Make your first stop at the Better Business Bureau (BBB). [xix] Do a search to see how the BBB rates the agency. Find out as much as you can about the agency. Read the reviews by other clients and see if there are any complaints filed.
Search your local news media for any reports of negative or serious incidents that the involved the agency. Taking all of these steps should lead you to a short list of the best agencies in your area. Narrow your list down to two or three agencies that you are considering. Arrange for an appointment to go into the agency and start the process of getting acquainted with the staff. Prepare a list of questions for them and schedule enough time for you to get all of the information that you need.
What to Ask Home Healthcare Agencies During an Interview
If you’re new to interviewing with a home health care agency, you may be at a loss regarding for what types of questions to ask. [xx] Depending on the type of care that your loved one needs, you may have specific questions. Your discussion should include questions about the agency, the credentials and training of the healthcare aides they employ, general practices, application, and payment. Read on to learn about some additional questions that you may want to add to your list.
Questions to Ask About the Agency
Before you ask any questions about caregivers, you’ll want to learn some of the background and history of the agency. Find out how they got started in the home healthcare industry and how long they’ve been in business. Has the agency won any awards for quality services?
You’ll also want to learn if there’s been a recent change in management. Learning more about the agency’s mission, vision, and background will give you a good first impression about whether their services are likely to be a fit. Since most seniors will pay for the bulk of home healthcare costs with Medicare. Medicaid may cover some other services. Most states require home healthcare agencies to be licensed by the state to bill for Medicare and Medicaid so, you’ll want to check and make sure the agency is able to accept your form of payment. If the agency isn’t licensed for Medicare, you’ll want to ask the reason.
Most states regularly review licensed home healthcare agencies. You may want to ask when the last review was and where you can get a copy of it. If you can’t get a copy right away, check with your state health department and see if you can get a copy there.
Home health care agencies typically get referrals from doctors, hospital discharge planners, social workers, and other professionals. Ask where the agency gets most of their referrals from and use them as references to check for credibility.
Ask the agency representative if they have privacy practices and if you can get a copy of them. Your loved one’s confidentiality is an important consideration.
Find out the types of services the agency provides including personal care, medical care, companionship, and housekeeping. What steps will you need to take if you need to expand the level of care? You’ll also want to find out what their protocol is for responding to an emergency situation. Ask for verification that the healthcare workers are insured. What happens if a home healthcare aide gets injured or has an accident at your loved one’s home?
Ask the agency staff to tell you about a time that they needed to fire a caregiver. What are the circumstances surrounding letting someone go?
If you decide to contract with the agency, what is the process for applying? How are things handled when you decide to terminate services for any reason?
Questions About Home Healthcare Aides and Senior Fit
Learn more about how the agency manages their staffing needs. Can you reasonably expect to have the same caregiver on a regular basis? What is the protocol for you to use if the assigned worker doesn’t regularly show up on time or if they don’t show up at all?
It’s a good idea to keep in mind that the agency may be short-staffed on weekends, holidays, or when there are special events going on in the area. Ask about the workforce supply during times when home healthcare aides ask for days off for holidays and other annual celebrations.
The agency, the senior, and the family members all have the best intentions of setting up the best overall care program, but sometimes, it just doesn’t work out. The senior doesn’t click with the caregiver or vice versa. What is the agency willing to do in the event that the caregiver and senior clash?
In a perfect world, the caregiver will have similar interests as the senior that needs care. After all, they will be spending much time together. Find out if the agency matches caregivers to clients with the same hobbies or other interests. Seniors who love to read but have trouble seeing may enjoy having a home healthcare aide that can read and discuss their favorite genre of books together. Will the agency accept any special requests for caregivers with certain interests or passions?
Asking Questions to Assess the Quality of Home Healthcare Aides
By this point in the interview, you will have undoubtedly learned much about the agency. The next phase of the interview should focus on how the agency hires, trains, and supervises their crew of home healthcare workers. Use this part of the interview process to learn more detailed information about how the agency screens their home health care aides. Do they perform background and criminal checks? Find out if the agency makes any exceptions for background and criminal checks that aren’t perfectly clear. Will they perform additional screenings throughout the healthcare aide’s employment? If so, how often do they screen them?
Does the agency have a minimum standard for new home healthcare aides? How do they assess new caregiver applicants? What does their evaluation process look like and how often do they evaluate caregivers?
Find out if the caregivers get their training from the agency or from another source. Does the agency require the home healthcare aides to get continuing education or training? Find out more about how the agency monitors and supervises their aides. What is the family’s process for reporting any concerns or issues of non-compliance by agency workers?
Getting Specific Information About Caregivers
Ask if it’s possible to meet some of the agency’s home health care aides. Do they seem friendly, helpful, and knowledgeable? Do you feel comfortable and at ease? Do you see them being a good fit for your family?
If you decide to contract with the agency will you be able to learn about the health care aide’s credentials and degree of experience in senior caregiving? Will you be able to double check that the person has a health care license? Will the senior be able to meet the caregiver and get acquainted before a formal working relationship starts?
Having Final Discussions About Charges, Payments, and Extra Expenses
Make sure that you leave enough time during the interview to discuss how your family will pay for home health aide services. By this time, the agency should be able to give you some idea of what kinds of services they can provide and how much they will cost.
Most seniors have Medicare, Medicaid, long term care insurance or healthcare through the Veteran’s Administration. Be sure that the agency will accept the source of funding that your senior has. Find out if the agency is willing to bill the proper insurance agency on your behalf or whether someone in the family will need to do it.
Find out if the designated insurance program excludes any services. The agency will also let you know if you can get additional services paid for by the insurer. Learn about whether the aide will be eating meals at the senior’s home and if you will incur any out-of-the-ordinary expenses.
What Are Some Possible Sources of Funding for In Home Healthcare Services?
Most seniors have a primary source of insurance, which is typically Medicare or insurance through the Veteran’s Administration. These programs usually cover the bulk of the cost for in home health care services. It’s important to be aware that these programs don’t necessarily cover all services, so it’s best to find out what is and isn’t covered before you apply and arrange for services.
Double check your personal insurance and life insurance policy files. If you purchased a long-term care policy, you would be paying premiums on it. It’s also possible that you may have purchased a long-term care rider on one of your life insurance policies. A nice benefit of long-term care policies is that they include personal care. Look for limits on the number of years that you can use the policy, which may only be for a few years or the benefit can last for your lifetime. Note that some long-term insurance policies require caregivers to be licensed, which means that your family members can’t fill in as your caregiver if you use funds from your long-term care policy.
To make the most of your funding opportunities, look for other senior programs and resources that your community offers. [xxi] It’s often by blending programs and services together that families find ways to cover the high costs of senior healthcare. You will find senior services that offer funding through federal, state, and local programs. Many states and local communities also offer non-profit organizations that dedicated to serving seniors. Your local senior centers are the hub of expertise that can assist you in putting together the most comprehensive plan for senior healthcare at the most reasonable costs. Senior centers receive federal funding for congregate meals and senior transportation. Most senior centers provide meals at no cost, but they may request a small donation for each meal.
The Meals on Wheels program is also federally funded. Homebound seniors age 60 and over that cannot shop or cook on their own can get nutritious and delicious meals delivered to their homes several times a week.
By connecting with others at the local senior centers, you will expand your network and learn more about ways to reduce the cost of senior expenses. Networking gives you the opportunity to learn tips from other senior caregivers about negotiating lower rates, getting tax breaks, setting up respite care, getting low-cost medications, finding senior transportation, how to keep seniors active and engaged, and much more.
Differences in Home Healthcare Agencies
- Medicare-Certified Home Health Agency (CHHA)-provide skilled services for which they can bill Medicare or Medicaid. The states license CHHA’s. Some of these agencies also provide personal care through their agency or through an affiliate agency that specializes in personal care.
- Licensed Home Care Agency also licensed by the state. They provide nursing and personal care services. Medicaid pays for some services, but families incur most of the cost.
- Non-Medical Agency or Companion Care-not required to have a license. They are often small business which are locally run. Non-medical agencies typically don’t file claims with medical insurance companies.
- Employment Agency or Senior Registry Agency this is a referral type agency with a directory of local providers. Families select and interview their own candidates. The agency has no legal or financial responsibility for the workers they refer.
All home health care agencies are not equal, and licensing varies by state. Here’s a snapshot of some different types of agencies and the services they provide:
Final Thoughts on Hiring a Home Healthcare Agency
The information listed here will give you a good start, but don’t stop here. Keep doing research and expanding your network of senior care resources until you have everything you need in place. As part of your plan, be sure to look for services for the caregiver as well. Providing care for many hours of the day takes a toll on the health and well-being of the caregiver, especially when a loved one needs care for many years. Many caregivers need regular breaks and respite care.
No one looks forward to needing assistance during the senior years, but knowing how to hire a home health care agency can make all the difference in the world.