Choosing Homecare for Seniors

Denise ran into the house... "Hi Mom, gonna quick throw a load in the washer and get the dishwasher started.  Have you eaten yet?  If not I brought over a plate with some chicken and potatoes on it.  I know I am late, I'm sorry.  Only have a couple minutes until I have to pick up the boys from school.  I'll try to stop by later to switch over the laundry otherwise tomorrow.  Did you take your pills? (pause) Mom... you're not dressed yet.  Are you okay?  Ya Sure?"

"OK... Anyway... Jerry says his meeting ran long and he won't be out early tonight so he can't do the lawn but I will try to get Randy or Justin over here to at least get the mowing part done.  Yeah, if I do it that way, I can run and get your meds refilled and pick up a few groceries for you while that is going on... looks like a pizza night tonight!  Gotta run, see ya in a bit!"

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Senior Caregivers

If you can relate to the above scene, you are not alone.  More than 1 in 5 people who live in the same town as their parents are current caregivers for at least one aging parent.  Another 1 in 5 has been a senior caregiver in the past 

In a recent survey, over 97% of people over the age of 50 said that they would prefer to always remain at home receiving homecare services, rather than move into an institutional setting.  This is still true even though there has been quite a transition in the look and feel of assisted living centers.  

However, self-care is not always possible and we must then turn to outside sources for assistance.  The first line of assistance is generally local family members as caregivers.  

Family caregivers often help senior parents with various home tasks, if and when they are around.  Unfortunately, it isn't always possible to be there or be there with enough consistency.  Trying to run two households can become virtually impossible and being a caregiver is a demanding task.

Most aging parents also have at least one adult child that doesn't live close enough to supply personal services.  Even 15 miles across a busy city can make it difficult to be an active caregiver.  Such a distance after work in many cities can take an hour or longer.  Add that to the trip home and do that every day and you have quite a time investment in the traveling much less the typical caregiver tasks.

The Case for Homecare

When self-care at home has become difficult or family caregivers are not immediately available to do the volume of work that is necessary, many people are now choosing Homecare over institutional care.  Doing so often relieves family members of basic caregiving functions and makes it possible to spend quality time, rather than the functional caregiving time.

Aside from being easier and faster to implement than moving to a institutional care setting, Homecare allows the senior to stay at home in familiar and comfortable surroundings. The time that adult children do have can the be spent on quality time... visiting, having fun with the parent, instead of just being a caregiver.

Homecare should not be confused with home health care.  While some home care workers may take and record vital signs or record other measurements and some companies provide both services,  most homecare companies are not licensed to go far beyond recording basic vital measurements.  If you need more than home and personal care, you should talk with a home healthcare company.  To reduce costs, consider mixing the two services.  Some homecare providers offer both home healthcare and personal non-health care at lower costs.  Others only provide one service.

If you need someone to administer and adjust medication levels, wounds that need to be monitored and dressed, or anything similar, you will have to talk about home healthcare, not homecare.  Home healthcare is provided by trained medical personnel and is therefore more expensive.  Be sure that you understand what it is that you need or utilize the services of a Geriatric Care Manager to determine the level of services that you need.

Homecare companies provide a wide variety of personal services that are non-medical such as:

• Bathing, dressing, and personal hygiene 
• Taking and recording vital signs
• Assistance in the bathroom
• Light housekeeping
• Meal preparation
• Companionship
• General observations of health
• Grocery shopping and pharmacy errands
• Home safety supervision
• Medication reminders
• Laundry
• Transportation

Transitioning to Homecare

Bringing an unknown person into your home is a very hard process the first time.  Adult children seldom realize that parents may initially feel a bit abandoned... like you don't care.  The elder parent may also feel like they are a tremendous burden to you and that you wish to shove them off on someone else.  

It is important to take things slow when transitioning to homecare, if possible.  Providing home care services can be a great relief to you but may be a bit disconcerting at first for the senior parent.  They are used to having you around, but are not used to having a stranger in the house.  Consider the use of a geriatric care manager to help facilitate the transition.  Geriatric Care Managers (GCM) are not only great organizers, they typically understand the emotional aspects of what you and your senior parent will be going through in the transition phase.  A good GCM can help both you and your senior parent work through this.

Over time, you will likely find that the senior parent will not only become very used to having home care staff around, but enjoy it.  Things that they didn't feel like they could ask you to do are easily asked of the home care worker and they find that they have time to spend with you when you do come over instead of having you rush in and out or feel like they are a burden to you. 

It is often said that in senior years, the parent becomes the child and vice versa.  This is probably largely due to the necessity to provide basic physical help.  Bringing in homecare can help put you back in that adult/adult relationship. 

Talk About Homecare

It's always best to sit and discuss hiring homecare with the parent before doing so.  Explain that while you enjoy being able to help, there aren't enough hours in the day to be able to do it right and still have the quality time visiting.

Everyone will react differently to the idea.  Some will be very accepting of the idea, others will argue, some will do the guilt trip thing, and others will probably just say no!

If the reaction that you get isn't positive, explain again why it is that you want to bring in a home care company, explain your problem again, and then ask your parent to come up with other alternatives... to help you!  It can be frustrating and it may take some time, but eventually most still come around.  Bottom line, it's best not to force the issue, but to be persistent.

Slow Transitioning

One alternative is to bargain for bringing Home Care come in for something that is non-personal.  Light housekeeping is a great place to start so that the elder parent will get used to the idea and even enjoy the company of the Home Care worker.  At the same time, this can take quite a burden off the family caregivers.

There is an understandable dislike for the idea of someone coming in to help in the bathing process or even doing laundry.  Such feelings are rarely expressed about someone who prepares dinner, does the dusting, and transports them to the doctor.  Those things are not as personal

Over time, you can begin to gradually add services, if and as you need them.

Interviewing the Homecare Company

Again, it is a very personal decision to bring a homecare caregiver your home.  You and your parent should determine that the company and the person that will be supplying services is the right one for you.

Take your time in an initial telephone interview.  Don't hesitate to ask any questions that come up, including hypothetical ones.  Homecare companies are there to serve you and you will be billed for services that you agree on.  You are not taking up their time and it only makes sense to want to know what it is that you get and don't get for your money.

There are no dumb questions.  Homecare companies seldom work with people that have been through this before and they know you don't fully understand their services.  People that are in homecare have to be very approachable.

You may have other questions, but be sure to ask:

1. How long the company has been in business?

2. Do they have any complaints against them with the BBB, or with any licensing commission?

3. Do they check their workers' police records?

4. Do they do drug checks?

5. Do they check their workers' driving records? (Where transportation is a consideration)

6. Have they every had any charges of elder abuse?

7. Do they pay their workers as employees or contract agents?  

8. What kinds of duties can they perform?

9. Can you add duties later?

10. Can they schedule according to your needs or must you fit around their schedule?

11. Can you meet the person who would be doing the work before signing an agreement?

12. Can you change workers later if there is a problem?

13. What if your worker is sick or quits?

14. What kind of feedback will you get from the Home Care worker?

15. What kind of evaluation services are available for determining the extent of need and changes to those needs?

16. What are the costs?

17. How are bills calculated (by job or hour)?

18. How are payments handled?

19. Are emergency call services available?

Be sure to check with your local BBB and any licensing agency that might be available or appropriate.  While the vast majority of homecare companies are careful about who they hire, you don't want to hire the one company that has had problems with hiring good or honest people.

The Personal Meeting

Set up a home interview time with your elder parent and the person from the homecare company to meet.  It won't be a long one but will help to break the ice a bit on the first day, especially if you are not there to get them started. 

Show the homecare aide around the house where cleaning and other supplies may be located.  Talk over any questions that the homecare aide has as well as those of the elder parent.  It is important that all feel comfortable in this setting.

Be sure to leave the homecare aide with your contact information during the day so that questions may be answered.  This is the time for everyone to come to a complete understanding of what is to be accomplished and get off on a great footing.

Mutual Courtesy, Respect, and Professionalism

There are occasionally some strange dynamics in homecare situations.  While most are easily remedied, every once in awhile, someone will contract for minimal services and then expect that the homecare aide will be only too happy to do more, without notice and without additional cost. 

This is not a big problem for most people, but it should be pointed out that while your homecare company aide is there to help you, mutual courtesy and respect are a must.  Doing so will help all parties understand where the boundaries are and a terrific relationship.

Setting Boundaries

You should have a list of what service can be performed and you will have agreed to the performance of certain duties.  Don't expect that you will be able to add to these duties without notice and when you do, be prepared to pay for them.  You would want to be compensated, even if you were working for a friend.

Be aware of why it is that you want a homecare worker to come in.  Homecare companies exist to take care of your family member, not to clean the house.  While most consider that some basic homecare is part of that process, it is not their primary duty.   Don't expect to leave the job of cleaning under the refrigerator to the homecare aide.