There are two primary types of agencies that provide care for persons requiring assistance within the home. They are the home health agency and the home care agency.
A home health agency primarily provides services under Medicare. They offer skilled services which must be ordered by a physician, not custodial care. These are the kinds of skilled nursing services persons may need when discharged from the hospital or an acute rehabilitation center. Home health agency caregivers have training that qualifies them to do skilled nursing tasks such as dressing changes, catheter or feeding tube care, and respiratory care. They also provide in-home therapies, medical equipment and supplies. All home health agencies are Medicare certified and may also have an accreditation from other organizations. Individuals eligible for home health agency services must be homebound (must need assistance to leave their residence) and have a need for skilled care by nurses, physical therapist, speech therapist, and/or occupational therapist. The care provided is based on need so a nurse may visit daily or a little as once a month depending on the patient’s level of need.
A home care agency provides custodial care and other types of personal care in the home. This type of agency provides assistance with activities of daily living, transportation, and help with cognitive or behavioral management. It provides supportive services that persons need to live their lives in homes and communities over an extended period of time. Some home care agencies also offer skilled nursing, but most do not. Not all home care agencies are licensed; it all depends upon the requirements of each state. Families should confirm the status of an agency before contracting for services.
A good agency will partner with the family and client in providing and overseeing services. How the agency interacts with you during the initial contact gives the first indication of whether or not to explore that particular organization further. When you call, how do they answer the phone? If the agency is unable to hire front office employees who are polite and courteous, their ability to hire competent employees in more critical areas is doubtful. The first contact sends a strong message about the agency’s priorities and commitment.
If you move to the inquiry stage, be aware of your reactions. How do they make you feel? Are the individuals knowledgeable? Do you sense a level of trust and confidence?
Some questions that touch on the key information a family needs to know before hiring an agency include:
- How long has the agency been in business?
- Is the agency licensed by the state?
- Do they offer 24-hour/day, seven-day/week services with agency supervision?
- What are their employee hiring requirements?
- Does the agency do the following before placing and employee in a home:
- Criminal background checks
- Drug Screening
- Check driving history
- Check state records for caregiver reporting
- Verify previous employment
- What type of training is provided to the caregivers?
- What competencies are expected of the caregiver they send to the home, i.e., lifting and transfers, wheelchair safety, homemaking skills, personal care skills (bathing, dressing, toileting), training in behavioral management and cognitive support?
- What is their policy on providing a substitute caregiver in the event a regular caregiver cannot provide the contracted services?
- What if there is dissatisfaction with a particular caregiver? Can he/she be replaced without cause? Some agencies claim their only responsibility is to provide a person, not a match for the person or family seeking a caregiver.
- What are their billing practices? How much do they charge? How frequent do you pay? Are any prepayments required? Do they take credit cards?
- Does the agency have a mission statement? This should give you an idea of the philosophy of customer service and commitment to the clients they serve.
- What is the reputation of the agency? Ask for reference to previous customers.
When a person is being placed in your home or a family member’s home be sure to take precautions. It is a good idea to be prepared by either making a video or itemizing valuable jewelry or heirlooms. If you have a safe it is a good idea to lock up very expensive items. Even the best of agencies has been fooled by an employee.
After a caregiver is placed within the home, keep in touch with the agency management personnel. Let them know of any concerns you may have before they escalate.