Recently I had a nurse colleague reach out to me to find a Patient Advocate in the Chicago area. As part of the conversation, she mentioned that she was considering getting an in-home caregiver(s) for her mother. I thought about this and decided that many people are in this quandry about how to care for their parents. There are several choices when it comes to elder care– in or out of a nursing facility. Many seniors would prefer to receive care in the comfort of their own home. No matter what level of medical or personal assistance, home healthcare is readily available and can be customized to your needs. In-home caregivers can be a great solution for maintaining our parents’ independence. Here are just a few things to consider when looking for an in-home caregiver:
Agency or Private Caregivers
Do you want to hire privately or through an agency? Hiring through an agency gives you additional support (i.e. by providing a substitute when your main caregiver is out sick or on vacation.) Hiring privately may be a little cheaper. If you do hire privately, make sure that you do a background check on your future caregiver. I have had several clients who had issues and regrets because they didn’t check out the caregiver ahead of time. This is also essential if you don’t live locally because you cannot drop in from time to time to observe mom or dad’s caregiver.
Caregiver Education, Training and Title
What is the education of your caregiver? Is he/she a certified nurse’s aide (CNA), Home Health Aide or licensed vocational nurse (LVN)? This may seem incidental, but it really is important criteria to evaluate. Remember- this person will be spending several hours per week with your parent (maybe more than you!) Are they trained by the in-home care agency? IF trained by the Agency, what does the training consist of? This is perfectly within your rights to ask. If you hire your in-home caregiver through an Agency, is there an RN or LVN who oversees the development of your parent’s care plan? The roles of the RN and LVN in the development of care plans for your family member may vary from state to state. In California, it is within the Scope of Practice for an LVN to develop care plans for situations that involve ‘Activities of Daily Living’. This would most likely be the same case for in-home assistance. However, RN & LVNs can give medications. However, non licensed in home care givers can only provide medication assist and remind patients to take their medications. Some care facilities, such as some Assisted Living facilities have Medication Assistants with LVN or RN oversight. Medication Assistants are limited within their scope. Ask the facility what the training is for the Medication Assistants. Ask the agency what is permissible for their caregivers and who will be handling the skilled nursing responsibilities. You can see it can get confusing but it is important to know who the caregivers are and what their scope of practice is for you to be comfortable.
Non-medical vs. Skilled Care
It’s important to establish your parent’s level of independent living. Some people can handle daily activities very well, while others need assistance with mobility, medications and nutrition. Start by determining your needs:
- Do you need the caregiver to run errands?
- Do you need them to take your parent to their appointments?
- Do you need the caregiver to do food shopping and meal preparation?
- Bathing/getting in & out of bed?
- Will they be handling money?
- Are there pets in the home that will need care too?
Cost of In-home Care
Cost will very from state to state. How will this be paid for? A Patient Advocate can help you determine how much your loved one’s care will cost, what’s affordable and how much your long-term care insurance will cover. In-home caregivers are usually private pay or through long-term care insurance. There are special circumstances in which Medi-Cal/Medicaid will assist. However, generally this is paid for privately. In many cases, Medicare does not cover in-home assistance.
Make sure that the following are in place for your parent:
- Healthcare Power of Attorney
- List of Emergency Contacts
- Financial Power of Attorney
- Advance Directives
- POLST (Physician Orders for Life Sustaining Treatment)
These steps should help you begin deciding what is the best path for your loved one and whether an in-home caregiver will be beneficial. If you would like more detailed information, please contact a Patient Advocate at MVLNC.
Donna M. Post RN CLNC LNCP-C, CHA
“Navigating Your Way Through Our Healthcare System”