4 Things You Must Know When Picking a Home Care Agency

Everyone says that they want to stay at home as they age. And, actually most of the frail older adults living in this country today are, in fact, living in a home setting. Really very few live in nursing homes or assisted living facilities.

Now you might think that this is pretty great — our parents want to be at home and we want them at home. The problem, though, is that the vast majority of frail older adults living at home are 100% being cared for by their family and friends. And if you’re the one doing this work, you know that caring for a frail older adult without help is very, very hard.

One way to make it a little easier is to hire someone to help. But, many daughters can’t go this route because one, it’s expensive and two, it’s not covered by insurance. Medicare does not cover the expense of a home care aide — even for very sick people. The program does have a “home health” benefit but it’s extremely limited and pretty much only covers therapy…not ongoing help with basic needs.

The thing that’s surprised me, though, over the past few years.. Is how many daughters tell me that, even when they can afford home care, it’s no easy thing to hire or manage someone to take care of your parents at home.

Often a sudden downturn in our parent’s health catches us completely by surprise and there’s little or no time to think about what we’ll do or who we’ll hire. Those of you who’ve been through it know that the whole process is bizarre, crazy and at times overwhelming.

It’s hard to know even where to start. In any community, there can be dozens of home care agencies. These are organizations that take responsibility for finding, vetting and scheduling home care workers. But, how do you choose one…. There’s really no Yelp or Angie’s List for home care. It’s not like picking a plumber.

Also, when you do find a website to help you choose an agency, it often turns out to be a thinly disguised attempt to get your contact information into the hands of agency sales personnel. On top of that, very few physicians or hospitals have the time, energy or inclination to get and stay up-to-speed on the best options for home care in their community.

I gotta be honest with you right now. Being a paid caregiver is a really hard job. It doesn’t pay much and as families we’re kind of nutty to work with when it comes to our parents. So, it’s important to recognize that if you take the time to find the right agency, develop a relationship with the right care aide, and are patient about getting the right schedule in place, you can find some real relief in the work you’re doing caring for your parent.

In other words, hiring a home care aide is not an “easy fix” to a hard problem. You’ve gotta invest the time and energy into finding and developing a relationship — sorta like how you would if you were picking a school or babysitter for your child — only maybe even more so.

Given the importance of this decision and the fact that often there are dozens and dozens of home care providers in any community, where do you even start? And what’s the most important thing to look for? I wondered about this myself; what experts would say about choosing a home care provider. So for this week’s blog, I’ve asked a friend and colleague of mine, Antonia Bernhardt (yay Antonia!!), to help me do a little research and talk to some experts.

Here’s what they told us about the most important things to know when picking an agency!

Find Out How Long the Agency Has Been in Business

New agencies are everywhere you turn! It’s just not that hard to open one.

So, the eldercare and home care professionals she interviewed were unanimous: a key indicator of quality is how long an agency has been in business. Because agencies rely so heavily on word-of-mouth, a long history in a community means that a lot of families have thought highly of the care they received.

When you are asking an agency about how long it’s been in business, it’s also important to ask for references from other families so you can call to verify and get some inside scoop.

Ask About the Staff and Leadership

In many cases, professional caregivers are not actually employees of the agency you’ve called. That is, the agency doesn’t actually employ the caregivers, it contracts with them. This isn’t always a bad thing because it gives agencies the flexibility to staff according to a patient’s needs (ex: 24/7 care, or language preferences).

That said, however, our San Diego Daughterhood Circle Co-Leader, Christine Lee, CEO of Casa Companion Homecare Solutions, believes it’s really important to work with an agency that employs its caregivers rather than staffing through independent contractors. The supervision and training are stronger and there’s more accountability and consistency. I tend to agree with her so be sure to ask about this.

Another extremely important indicator of a well run agency is its “turnover” — meaning the degree to which agency staff stick around. Longevity in an agency reflects a number of good things, including the ability and willingness to pay for the best workers — and the strength of leadership of the agency. Someone who is a good boss is also likely to be a business owner who takes responsibility for your parent’s care.

If one agency seems to have higher rates than others, ask why. Ask what the caregivers get paid. I recognize that this care is expensive but it’s not okay to choose based on the lowest price and then complain about the quality of the care. You’re not negotiating for a used car here. This is the person who’s going to take care of your parent!

Scheduling, Scheduling.

Ask about scheduling flexibility and timing. How easy will it be for you to get the same person to come consistently when you need the help.

It drives me crazy that so many agencies refuse to send a worker to your house unless you can guarantee a minimum of four hours of work. But, at the same time, I get it. It’s difficult and expensive to send aides all over town for one hour’s worth of work here and there. Don’t forget that these are very low wage workers and they’re trying to make a living.

We’re starting to see some new home care entrants touting their ability to provide service in flexible time increments. These organizations, like Honor Senior Care and Hometeam, also make use of technology to help with scheduling in a manner that allows them to save money which they then can use to increase salaries for their workers. If you’ve got one of these organizations in your area, you should definitely check them out.

Know (and Communicate) Your Needs

Home care is a SUPER personalized experience that will grow and change as your parent ages. Understanding past and present needs, and predicting future challenges, can help you select the service that works best for you and what might lie ahead.

Talk to the doctor about medical needs and be ready to share those with the agency. Things like types of care/treatment, medication needs, frequency of dosages, or administration of medications.

You should also consider the social or cultural needs of your loved one. For example, your mother might have once balked when a male relative offered to help her get dressed, or lit up when an aide spoke to her in Mandarin. Services may be able to accommodate such preferences, leading to greater comfort throughout the home care experience, so it’s good to discuss options with your family.

Finally, it’s important to keep in mind how needs can change over time. Make sure to talk to your care team about what to expect as your parent ages. Larger home care agencies are more likely to offer a broader range of services; that flexibility comes at a cost premium, but can be helpful when looking to coordinate care.

The Hardest Part

As hard as all of this is, the hardest part is dealing with the guilt you feel leaving your parent’s care to someone outside the family. And it’s also tough to get your mom or dad to accept someone into their home. It can be crushing to your parents’ dignity to have someone there, in their space, doing things that they used to be able to do for themselves.

I remember hearing Maria Shriver talk about this and it really stuck with me. She was struggling to get one of her parents to accept the help of an aide and It wasn’t until she took the time to really empathize with what her mother was going through — rather than just trying to cross one more task off her long, long list of things to do — that her mother was finally able to accept the help. We all need to be seen in our difficulties and struggles before we can overcome them.

So, stay tuned for our blog in two weeks on how to ask for, get and accept help!