Westmont Eldercare Navigator offers advice on in-home care

The quality of life and health deterioration for seniors changes gradually over time (unless there is a major illness or injury), and they themselves or their family may miss the signs that a senior can no longer safely live independently. This change in healthcare status often requires a change in the living situation necessitating in-home non-medical assistance or a move to an assisted living or nursing home. By the time the situation is recognized, prompt action is often required.

Most seniors, and their families, prefer to remain at home. Staying in their home means they will need assistance with activities of daily living (ADLs) to remain safe. ADLs are defined as the things we normally do...such as feeding ourselves, bathing, dressing, cooking, grooming, homemaking, and leisure activities. Assistance with ADLs does not require a licensed nurse, so a home maker or non-medically trained individual can safely provide these needs.

The upside of staying at home is the familiarity of the setting. Moving from the family home to an institutional setting is very disruptive. The down side of staying at home is social isolation. Even though family come to visit and the attendant is in the home, there is little ability to socialize and stay connected.

Mardy Chizek, an RN and Eldercare Navigator and president of Westmont, Illinois' Charism Elder Care Services, offers these four considerations to take into account when home care is being considered as the preferred option.

1.) Identify the home care options in the area

ADL services are provided by non-medical agencies that are either small businesses privately owned or agencies that are part of a franchise. In the case of a franchise, they are usually confined to service area boundaries defined by zip codes. However, if one agency office cannot provide service in your area, another franchise owner likely can.

Regardless of ownership, Illinois now requires all of these agencies to comply with regulations including licensure, criminal background checks, training and screening of staff for communicable diseases.

There is also an option of the family hiring an attendant privately rather than through an agency. In this case, the attendant is the family's employee and the family is responsible for taxes, withholding and worker's compensation if the attendant is injured on the job. The downside of this option is there is no back up if the individual resigns or is too ill to come to work.

If skilled nursing care is required the doctor may prescribe Medicare home care for the senior. Medicare has strict criteria that must be met for them to reimburse for home-based nursing care. There is a time limit to the care which is defined by the acuity or level of illness of the patient and their recuperation. Medicare skilled home care can provide licensed nurses, home care aid, and physical, occupational and speech therapy. Generally, the senior must be home bound to continue to receive Medicare reimbursed skilled care. Once they are well enough to leave their home, they are not considered sick enough to require skilled home care.

2.) Understand what services can be delivered by the non medical agency staff

Non-medical attendants may be certified nursing assistants (CNAs) or have no formal healthcare training. Regardless of the level of training, the non medical attendant is not a licensed nurse and is not approved to provide nursing care. Many families assume traditional nursing responsibilities, but this does not mean that these can be transferred to a non-medical attendant. For example, non-medical attendants are not able to administer medications, provide feeding through a tube into the stomach, apply dressings, cut nails or any other skilled nursing service. If a CNA is practicing outside of their scope of practice, the agency can lose their license and the CNA their certificate.

If the attendant is expected to provide transportation for the senior, you will want to know if they have a valid driver's license, and if they carry up-to-date insurance. If they are driving their own vehicle, ensure that the vehicle is safe and in good repair. Make sure to inspect the vehicle and verify that the driver's license and insurance are valid. If your car is being used, make sure your insurance covers non-family drivers.

The skill sets of the attendants vary widely. Most are drawn to the non-medical field because of a desire to help others, but don't confuse this desire with the skills to manage illness or healthcare issues.

3.) Screen and evaluate home care candidates

Even when the family's choice is the non-medical agency, the family and senior will want to screen the attendant prior to bringing them into their home. Personality, culture, language, gender are a few of the criteria to take into account that will help determine whether an engagement is successful.

Ask competency questions to see if the attendant understands the disease process and how to manage in an emergency situation. Ask pointed questions about the attendant's experience and do not be shy about the depth of the questions. These individuals are going to be in the home without direct supervision and may be caring for a vulnerable or even dying senior. While personality and friendliness are important, the senior usually requires supervision and assistance as well.

You will want to determine whether they have cared for someone with the senior's health conditions, and how they have performed during past emergency situations. Make sure you reach an agreement under what circumstances a call to the family will be required.

Don't assume that all attendants meet your expectations for care, or possess the same degree of skills required to assist a senior, so determine if they have experience in incontinence care and whether they know how to cook for a diabetic patient or one on a low salt diet. The attendants are responsible for light housekeeping, so review their procedure for housecleaning, dish washing, cleaning the bathroom and doing laundry.

The first attendant that you retain may not be right for a number of reasons. This is a process of trial and error as with any employee selection process. If there is not a fit, the attendant or agency must be notified immediately for replacement for the well-being of the senior.

4.) Understand how home care aides are compensated

For licensed agencies where the attendant is an employee, the agency is responsible for payroll, hours and benefits (if provided). Long-term care insurance may pay for some or all of the fees for non-medical care. Check with the long-term care insurance policy because some policies only provide coverage if the agency is licensed or if the non-medical attendant has specific training and skills.

If the attendant is your private employee, you will negotiate their compensation with them. As your employee, you are responsible for all employment related taxes and paying for medical expenses related to on-the-job injuries. Make sure that you do your homework so you are not taken advantage of.

“No matter what the choice is for home care, the family ultimately will become caregivers, and this care will take more time than you may have envisioned. Be realistic about how much care a senior may need at home, and be prepared to make the best informed choices,” said Chizek.

For more information on making informed decisions about home care options or long-term nursing facilities, visit Mardy Chizek and Charism Elder Care Services on-line at www.charism.net.