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Finding In-Home Help

Among your most valuable assets will be the people who help you take care of your loved one. Knowing that your loved one will be cared for by someone you trust, with the appropriate skills, provides a peace of mind which is impossible to measure. Managing the day-to-day activities can become overwhelming and can make dealing with the big picture even more difficult. You want to make your daily routine as pleasant and organized as possible. Finding the right person will provide you with needed breaks, enable you to focus on the more important issues, and, ultimately, improve the quality of the time you and your loved one spend together.

We were fortunate to find two wonderful women to take care of my father. I remember feeling better as soon as I'd hear one of their cars pull into the driveway. They had a positive "we're going to help you get through this" attitude and they literally kept us going. Ideally, that's the kind of person you're looking for.

So let's get started. A few tips: To save yourself time in case one agency and/or employee doesn't work out, keep a notebook to record your impressions about agencies and the services they provide. Keep notes about people you interview so you can refer back to them. Also, have your loved one's insurance information handy.

Here are some places to start looking:
  • Visiting Nurse Associations of America. VNAA is the official national association of not-for-profit, community based home health organizations known as Visiting Nurse agencies. You can find them in 40 states and search the VNAA to see if there is a Visiting Nurse Assoc. in your area.
  • Yellow Pages in your phone book; check under Nurses, Nursing Services, Social Service Organizations, Home Health Services, and Senior Services
  • Hospital discharge planner or hospital-based home health agencies
  • Hospice (See Hospice)
  • Church or synagogue bulletin boards or newsletters (*my mother found someone this way)
  • Nearby nursing home which might have employees seeking part-time work

Choosing a Home Health Care Agency
  • Interview several agencies to maximize your options and try to get references.
  • Make a list of the services you need performed.
  • Find out the range of services they provide.
  • Ask if you can interview the nurse and/or home health aid in advance and make sure you can request a different person if the first person is not compatible for whatever reason.
  • Ask if the same nurse or aide will visit each time.
  • Find out if you are guaranteed a substitute if someone doesn't show up and get the number for whom to call (ask for a pager number if that's available).
  • Find out what to do if there is an emergency on the weekend or at night.
  • If you have a non-hospice home care agency, ask if the staff will support end-of-life requests by the patient (such as not calling 911).
  • Learn the process for filing complaints against the agency with the state ombudsman or long-term care office at the state level.
  • You might also want to contact the local/state Division of Aging Services to check if there are any complaints filed against an agency.

Determining What You Need

Agencies vary. Some are for-profit, others are not-for-profit, and still others are governmental. The expertise of agency employees varies as well. Here are some basic definitions to help you distinguish between the different levels of expertise provided by different kinds of employees.

Registered Nurses (RN's) have at least two years of academic training and are licensed by the state Board of Nursing.

Licensed Practical Nurses (LPN's) complete a one-year course of study and are licensed by the state Board of Licensed Vocational Nurses.

Certified Nurse Assistants (CNS's) have completed 70 hours of classes and 50 hours of clinical practice in a nursing center setting; they must also pass a test and register with the State Board of Nursing.

Home Health Aides have training requirements that vary state to state and you can evaluate them on the basis of work experience.

Questions to Ask a Home Care Employee
  • The Basics. Check his/her licenses, training, experience, and references.
  • Insurance. Make sure he/she is insured for malpractice or liability and ask to see an insurance card.
  • Specialty. Find out if he/she has a specialty (such as dealing with terminally ill patients or people with paralysis).
  • Personality. Finding the right person is important, so make sure you ask some personal questions to try to get to know the person. (How long have they been doing this kind of work, what got them interested in it, are they experienced in dealing with your loved one's special problems, are they a smoker/non-smoker, etc.)
  • Compatibility. Consider things such as sex, age, and general demeanor.

Questions to Ask His/Her References
  • How long did he/she work for you?
  • Was he/she reliable, trustworthy, and polite?
  • Was he/she receptive to special requests and suggestions?
  • How well did he/she deal with conflicts and emergencies?

Paying for Care

See Insurance Issues.

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