Dementia and Alzheimer’s Care / ADL Support for Home Health / Senior Care / Elder Care / Geriatric Care
Standards
CAHSAH is the California Association for Health Services at Home, which we used to look at as the standards-setting body for in-home care in California. The certification program focuses on six specific standards for Home Care Aide organizations, including:
Agency has adequate general/professional liability insurance
Workers' Compensation Insurance provided for all Caregivers
Pre-hire background checks required for all Home Care Aides
All employees must be covered by a Dishonesty Bond
Pre-employment Tuberculosis screening required
Client Service Agreements specifies all fees that will be charged
Support For Home exceeds the requirements of CAHSAH certification, but we are now more focused on the efforts of the National Private Duty Association (NPDA) and the NorCAL Chapter of NPDA.
Agency has adequate general/professional liability insurance
Workers' Compensation Insurance provided for all Caregivers
Pre-hire background checks required for all Home Care Aides
All employees must be covered by a Dishonesty Bond
Pre-employment Tuberculosis screening required
Client Service Agreements specifies all fees that will be charged
Support For Home exceeds the requirements of CAHSAH certification, but we are now more focused on the efforts of the National Private Duty Association (NPDA) and the NorCAL Chapter of NPDA.
Choosing a Caregiver
There are many factors which need to be considered when one makes the important decision about an in-home care provider. We believe that the more carefully families look at these factors, the better the decision they will make.
Our goal, with every client, is to be the highest quality, most trusted in-home care (private duty) agency. If your evaluation of agencies enables you to identify a short list of the best in-home care providers, we know we will be on the list. Whether that results in a family choosing Support For Home is honestly less important to us than that a very high quality agency is selected.
So, what are some of the questions you should ask? With the exception of the first question, below, there is no priority order implied in the list below. They are all important.
Why should I hire an agency, instead of an individual?
The answer to that question is another question -- "What happens if something goes wrong?" This is really important. In hiring individual caregivers, there is not much recourse if she or he does not show up or gets sick or does something they should not do. You can fire them, but then you are starting over, and, if they damaged property or, even worse, stole from you, you are on your own. With an agency as the actual employer of your Home Care Aide, it is their responsibility to "make things right." If your regular Home Care Aide is ill, the agency should provide backup coverage. Liability insurance, dishonesty bonds, Workers Comp insurance, background checks, payroll taxes, etc. -- these are all things you should expect from an agency, not items you should have to worry about.
Our goal, with every client, is to be the highest quality, most trusted in-home care (private duty) agency. If your evaluation of agencies enables you to identify a short list of the best in-home care providers, we know we will be on the list. Whether that results in a family choosing Support For Home is honestly less important to us than that a very high quality agency is selected.
So, what are some of the questions you should ask? With the exception of the first question, below, there is no priority order implied in the list below. They are all important.
Why should I hire an agency, instead of an individual?
The answer to that question is another question -- "What happens if something goes wrong?" This is really important. In hiring individual caregivers, there is not much recourse if she or he does not show up or gets sick or does something they should not do. You can fire them, but then you are starting over, and, if they damaged property or, even worse, stole from you, you are on your own. With an agency as the actual employer of your Home Care Aide, it is their responsibility to "make things right." If your regular Home Care Aide is ill, the agency should provide backup coverage. Liability insurance, dishonesty bonds, Workers Comp insurance, background checks, payroll taxes, etc. -- these are all things you should expect from an agency, not items you should have to worry about.
Caregivers are Agency Employees?
Frankly, if the answer is “no,” look elsewhere. If a private duty (non-medical in-home care) agency does not take the responsibility of hiring caregivers, but tries to send “independent contractors,” there are several problems you need to worry about.
The first is that the company is trying to back away from taking responsibility, legally and ethically, from the caregivers it sends. Secondly, there is the question of who is paying workers’ compensation, unemployment insurance and other personnel expenses. The chances are that you may end up, as the client, being responsible for more than you think. An agency that looks like it is cheaper, in terms of rates it quotes, may result in much higher real costs to you, as a result.
Support For Home’s caregivers are employees and part of our extended family. For a very good analysis of the issues with referral agencies and registries, please take a look at an article on Consumer and Worker Risks published by the National Private Duty Association.
The first is that the company is trying to back away from taking responsibility, legally and ethically, from the caregivers it sends. Secondly, there is the question of who is paying workers’ compensation, unemployment insurance and other personnel expenses. The chances are that you may end up, as the client, being responsible for more than you think. An agency that looks like it is cheaper, in terms of rates it quotes, may result in much higher real costs to you, as a result.
Support For Home’s caregivers are employees and part of our extended family. For a very good analysis of the issues with referral agencies and registries, please take a look at an article on Consumer and Worker Risks published by the National Private Duty Association.
Bonding and Insurance
Is the agency -- are the caregivers -- adequately bonded against dishonesty? If they cannot show you a certificate of insurance, including professional liability and workers’ compensation, again, look elsewhere. You need to be protected against claims, and the company needs to be able to meet any financial obligations that may occur through its actions.
Support For Home provides a certificate of insurance to all prospective clients. Our Dishonesty Bond is at $50,000, five times what most agencies provide.
Support For Home provides a certificate of insurance to all prospective clients. Our Dishonesty Bond is at $50,000, five times what most agencies provide.
Free, No Obligation Assessment
If the company charges for an in-home assessment (or makes it free only if you sign up with them), look elsewhere. There is no justification for such a charge. At Support For Home, assessments are free, with no obligation on your part. Some agencies will charge you an "Administrative Fee" if you sign up for them. We know of one franchise that actually charges $75 for you to sign up do business with them! We don't think that makes any sense.
Caregiver Experience and Certification
Some agencies require no experience for their caregivers. Others feel that serving as a family caregiver substitutes for professional experience and training. Support For Home only hires experienced professionals, for all levels of care, including Homemaker Care and Companion Care. For Personal Care, assisting with the most intimate activities of daily living (ADLs), Support For Home highly recommends state certification (Certified Nurse Assistant, Home Health Aide). More than 80% of Support For Home caregivers are California state certified CNAs and HHAs.
Are Caregivers Thoroughly Tested?
We use the Caregiver Quality Assurance system, which tests attitudes, behaviors and personality, covering the following areas:
Dependability - Measures the risk that an individual will be undependable, careless, lazy or disorganized
Honesty/Integrity - Measures the risk for dishonest behavior
Hostility/Aggression - Measures the risk of a person being aggressive, hostile, disruptive or having poor control of anger
Substance Abuse - Measures the risk of substantial use of alcohol or use of illegal drugs (of course, we also do drug screening - in our office, using mouth swabs)
Sexual Harrassment - Measures behaviors regarding sexuality that are likely to be considered harrassment
Computer Misuse - Measures the risk of using computers and Internet connections in ways unrelated to job tasks
Cognitive Reasoning - Evaluates problem-solving abilities and learning speed
Dependability - Measures the risk that an individual will be undependable, careless, lazy or disorganized
Honesty/Integrity - Measures the risk for dishonest behavior
Hostility/Aggression - Measures the risk of a person being aggressive, hostile, disruptive or having poor control of anger
Substance Abuse - Measures the risk of substantial use of alcohol or use of illegal drugs (of course, we also do drug screening - in our office, using mouth swabs)
Sexual Harrassment - Measures behaviors regarding sexuality that are likely to be considered harrassment
Computer Misuse - Measures the risk of using computers and Internet connections in ways unrelated to job tasks
Cognitive Reasoning - Evaluates problem-solving abilities and learning speed
Thorough Background Checks Done?
Some private duty agencies point with pride to their use of governmental background checks, which, in reality can be quite limited in scope. California's DOJ check only gives state and local data for the last five (5) years. At Support For Home, we include a nationwide felony/misdemeanor check, a Federal crimes check, DMV records in the state of California, and Sex Offender Registration verification. The nationwide check includes running the social security number through a national database to retrieve address history. A check is then run wherever additional residences are found.
Reference checks should be part of all background checks. They are at Support For Home. Additionally, Support For Home ensures there is a negative TB test within the last year.
Reference checks should be part of all background checks. They are at Support For Home. Additionally, Support For Home ensures there is a negative TB test within the last year.
Do You Choose the Caregiver?
This one may be a little counter-intuitive. If (as we discussed above), the caregiver is the employee of the agency, the company must protect against all forms of discrimination (age, sex, race, etc.). So, a good agency will work extremely hard to match a caregiver to a client in terms of skills and personality, but the agency is responsible for the employee’s assignment.
On the other hand, our philosophy is that every day is an interview. If a Home Care Aide is not a great match, we change them, immediately. If we, as a team, do not meet the client's expectations, every day, we (Support For Home) do not deserve to serve the client. Our service agreement can be cancelled in just 24 hours.
On the other hand, our philosophy is that every day is an interview. If a Home Care Aide is not a great match, we change them, immediately. If we, as a team, do not meet the client's expectations, every day, we (Support For Home) do not deserve to serve the client. Our service agreement can be cancelled in just 24 hours.
Passionate and Dedicated?
Is the agency committed to improving the industry, working with bodies focused on standards and certification, passionate about the welfare of both their clients and their employees? If not, they are in the wrong business and they are not going to provide you with the care and the caregivers you deserve.
Is There a Minimum Number of Hours or Days?
This is not as straight-forward as it appears. Caregivers work for a living, and it is much more difficult to schedule a 2-hour shift than a 4-hour shift. This is especially true with excellent caregivers, who are in demand. It is also easy to under-estimate the services, and therefore the time needed (we’ll talk about that next). At the same time, if the agency is unable to meet your real need (financially as well as in terms of services) they will tell you, not make false promises. A good agency will work with you, being as flexible as possible, but will be honest about what can be accomplished.
How is a Plan of Care Determined?
A plan of care should comprehend all of the services that you and your family need. To achieve that, the in-home care agency needs two capabilities. One is a thorough needs assessment tool, covering both the client and family and the client’s residence (from the standpoint of safety). The other is a network of plan of care partners who provide complementary services to non-medical, in-home care. Those partners may include private fiduciaries, social workers, home health (medical) providers and others. A private duty (in-home care) agency provides only a slice or two of the plan of care pie. At the same time, that agency should be charging for only its own services, not have a financial stake in others.
Are Caregivers Expected to Obtain Continuing Education?
In addition to the skills, experience and certification requirements at the time a caregiver joins Support For Home, we provide in-service training during the employee’s tenure with us. We use experts in a variety of areas, as well as the best available material from the leading training provider in the field of in-home care. Support For Home certified caregivers are expected to maintain their certification through continuing education.
Is There On-Going Quality Control?
Do the owners/managers of the company perform close supervision of caregivers? At Support For Home, we visit the new client and caregiver on days one and two of new client care assignments, and perform regular supervisory visits thereafter. Is client feedback actively sought and responded to quickly? If the agency is Support For Home, the answer is yes.
Are the Owners of the Agency Involved and Committed?
If the owners have not made the personal commitment to be available to their clients - and their employees - 24 hours per day, they the owners need to find a different business and the clients need to find a new agency.
When our phone rings at home (we forward from the office to our personal phones when the office is closed) at 2:00 am, it is because someone needs help. An answering service or voice mail is not going to provide that help. Our clients and Home Care Aides are part of our extended family. You do not turn your family over to an answering service or some "on call" who really cannot help.
If you have any other questions about how to make the right decision - even if it is not Support For Home, please call or email us.
This is not as straight-forward as it appears. Caregivers work for a living, and it is much more difficult to schedule a 2-hour shift than a 4-hour shift. This is especially true with excellent caregivers, who are in demand. It is also easy to under-estimate the services, and therefore the time needed (we’ll talk about that next). At the same time, if the agency is unable to meet your real need (financially as well as in terms of services) they will tell you, not make false promises. A good agency will work with you, being as flexible as possible, but will be honest about what can be accomplished.
How is a Plan of Care Determined?
A plan of care should comprehend all of the services that you and your family need. To achieve that, the in-home care agency needs two capabilities. One is a thorough needs assessment tool, covering both the client and family and the client’s residence (from the standpoint of safety). The other is a network of plan of care partners who provide complementary services to non-medical, in-home care. Those partners may include private fiduciaries, social workers, home health (medical) providers and others. A private duty (in-home care) agency provides only a slice or two of the plan of care pie. At the same time, that agency should be charging for only its own services, not have a financial stake in others.
Are Caregivers Expected to Obtain Continuing Education?
In addition to the skills, experience and certification requirements at the time a caregiver joins Support For Home, we provide in-service training during the employee’s tenure with us. We use experts in a variety of areas, as well as the best available material from the leading training provider in the field of in-home care. Support For Home certified caregivers are expected to maintain their certification through continuing education.
Is There On-Going Quality Control?
Do the owners/managers of the company perform close supervision of caregivers? At Support For Home, we visit the new client and caregiver on days one and two of new client care assignments, and perform regular supervisory visits thereafter. Is client feedback actively sought and responded to quickly? If the agency is Support For Home, the answer is yes.
Are the Owners of the Agency Involved and Committed?
If the owners have not made the personal commitment to be available to their clients - and their employees - 24 hours per day, they the owners need to find a different business and the clients need to find a new agency.
When our phone rings at home (we forward from the office to our personal phones when the office is closed) at 2:00 am, it is because someone needs help. An answering service or voice mail is not going to provide that help. Our clients and Home Care Aides are part of our extended family. You do not turn your family over to an answering service or some "on call" who really cannot help.
If you have any other questions about how to make the right decision - even if it is not Support For Home, please call or email us.
Call us at 916 482-8484 or 530 792-8484 for a free assessment -- or just so we can answer any questions you may have. You can also email us for information.
1333 Howe Ave, Suite 206, Sacramento, CA 95825, Tel: (916) 482-8484 & (530) 792-8484.
Support For Home In-Home Care, serving Sacramento, Yolo, El Dorado, Placer counties.
© 2007-2012 - Support For Home, Inc. All Rights Reserved.