The Nuts and Bolts Behind Quality Home Care

It’s a story facing families every day: Mom has had mild dementia for a while, but she and Dad have been married 48 years, and it’s his “job” to take care of her. So he compensates, compromises his own care and ends up in the hospital himself. The family never knew how advanced Mom’s dementia had gotten, because Dad covered it so well. Now they both need help.

The details may vary, but at some point, everyone is faced with a situation that requires home health care or home care. Understanding your options so you’re prepared to make decisions for your family and loved ones is key.
Home care and home health care sound interchangeable, but they’re vastly different. Home health care requires a doctor’s prescription, is paid for by health insurance and involves the services of skilled labor, such as licensed nurses or therapists.

Home care is a much wider array of services, including everything from companionship (so someone is not home alone) to personal grooming and other activities of daily living. Home care does not require a prescription, is usually paid for privately or through long-term-care insurance, can range from a few hours a day/a few days a week to 24-hour care and is not provided by skilled labor. Unskilled labor does not mean untrained — it simply means someone who is not licensed, but the companies providing the care services are licensed and regulated by the state.

What can be arranged with home care? The simple answer is almost any service an individual needs. It could be simple things that an individual can no longer manage on their own, such as personal care, meal preparation, light housekeeping, transportation for medical appointments or general errands, and medication reminders. It also includes companionship — someone to be with them and engage them in activities.

Home care can provide moderate to total assistance with tasks such as safely taking a shower, getting dressed and other grooming activities. This can be temporary, as when someone is recovering after surgery or an illness, or long term, with the services provided adjusting as the needs of the individual change.

“We work with people on a short-term basis, post hospitalization, helping them manage their needs until they’ve fully recovered, as well as long-term patients who need regular assistance,” explains Andres Cruz, alternate administrator with Pride PHC Services in San Antonio.

If short-term personal care sounds simple, it’s not. Personal care — helping someone safely take a shower, get dressed and tackle other grooming activities — is essential. Meal preparation and grocery shopping are important because balanced meals are needed to help someone maintain their health. Medication reminders, and ensuring that medication is taken, is key. Organizing appointments, keeping a social calendar, ensuring that the home is tidy and safe — all of that helps someone maintain their independence. It also relieves overwhelmed family members who may be trying to juggle all of that around their jobs and other commitments.

“Home care allows someone to stand in for the family so they can maintain their schedule, continue to be breadwinners and manage their lives in addition to being responsible for a loved one’s care,” explains Dawn Hamilton with Caring Companions.

“Statistics show that the health of a caregiver declines 50 percent faster than the individual that’s ill. Caregivers ultimately wear themselves down and set themselves up for failure because they’re trying to do everything on their own,” explains Hamilton. She speaks from personal experience after navigating the needs and care of her husband, John, who lost his battle with Lewy Body Dementia earlier this year. She tried to handle his care on her own, but ultimately turned to home care for help. “Life has to go forward. You still have to have your livelihood. You still have to maintain your schedule, but your loved one needs care. It’s overwhelming.” says Hamilton.

Home care also allows family members to be family, versus caregivers. “Providing care for a family member is hard on your health; it’s stressful and changes the dynamics of your relationship. There’s nothing wrong with simply wanting to be the daughter versus the care provider,” explains Jackie Robb, director of operations for Home Instead Health Care. “If your loved one doesn’t live with you, or lives far away, home care providers are the extra hands/eyes/ears you need, giving the family and health providers information on the individual, while ensuring that they take their medication, are eating properly and are safe.”

Working with a home care provider begins with an in-home consultation to assess each individual’s needs and to customize a personal plan of care. The assessment recommends the number and length of visits that will address the needs of each individual — there’s no set standard. “We talk to families and individuals, review the status of the home and what the individual needs, then make a recommendation based on the services needed,” explains Robb. “We also do safety risk assessments, checking the home environment for scattered rugs, cords that are in the way — things that could cause falls. We even help clear clutter to help make an environment as safe as possible.”

One aspect of home care that is highly customizable is frequency of care. Clients can request services only as needed, or just a few days a week. Some may need help daily for two, four, eight or 12 hours, but are safe alone at night, while others may need help around the clock to help with all aspects of daily living. Some agencies may schedule as short as a two-hour visit, while others have a four-hour minimum, so that’s something to consider when reviewing home care providers.

In Texas, licensed home care providers are known as Home and Community Support Service Agencies that are licensed and regulated by the Texas Department of Aging and Disability Services, or DADS. DADS visits each provider regularly to ensure they are following all mandated regulations, often making unscheduled visits to review care logs and record keeping. They also follow up on complaints — any client has the right to report a provider to DADS.

When reviewing home care options, research the agencies you’re talking to and ask about their history, license status and training. Ask to see a copy of their license and proof of their liability insurance and bonding. Ask what their billing procedures and operating hours are. Do they have a back-up plan in place in the event that a scheduled caregiver is unavailable? How long have they been in business under the current owner? What is the background of the management staff?

“Mostly, how comfortable do you feel when you call the office or visit with the staff? Does it seem like they genuinely care about you and your family’s needs? I know this sounds odd, but do you get the ‘warm fuzzies’ when you talk with them? It’s important for you to feel that they care,” explains Cruz. “Call the agency at different times of the day. If it takes two days to get a call back, that’s probably the response you can expect when you have a need. And know that you can always change agencies if you decide that the service is not meeting your expectations.”

By Dawn Robinette