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5 Questions to Help Make Sense of Homecare

-Laura Kiniry & Beth Popolizio, PT, DPT

Understanding the nuances of home care can seem overwhelming if you don't know where to start. Here are some questions to ask to assure you're getting the best possible care for your loved one, and peace-of-mind for your whole family.

1. What are the Different Types of Home care?

Knowing the different types of home care begins with being aware of the skills and scope of the professionals providing care. There are two main types of home care: Skilled and Custodial. Skilled care refers to Home Health Care. This is provided by licensed professionals educated in their field of clinical practice, including nurses, home health aides, physical therapists, occupational therapists and speech therapists. These services are often prescribed by a doctor following hospitalization or injury requiring a period of rehabilitation. These practitioners can engage in “skilled” activities, like administering medications and dressing wounds. These visits commonly take place at a patient’s residence. Custodial care, on the other hand, is assistance with the non-medical tasks a person may have difficulty doing independently. For example, custodial assistance helps with feeding, dressing, bathing, household chores, meal preparation, laundry and providing transportation. Custodial care professionals, or Home Caregivers, can work independently or through an agency. This type of care can be initiated directly by an individual or family member without a doctor’s referral. Here is a breakdown of the different types of home care:

2. What's the Difference Between Home Caregiving Agencies and Private Caregivers?

There are two primary differences between home caregiving agencies and private caregivers: regulation and liability. Regulation refers to who oversees agencies and what requirements must be met in order to provide care. Home caregiving agencies are regulated by the California Department of Public Health (CDPH). The CDPH requires that caregivers working for agencies must be licensed and complete annual training. Private caregivers and Direct Referral Agencies (DRAs) are not held to this same standard. When interviewing agencies it is important to ask if they are licensed and bonded. This is a good indicator as to whether you are speaking with a private individual, a DRA or a formal agency. Because DRAs and private individuals are unregulated, they may be able to perform duties outside of the standard caregiver scope of practice. However, there is no way to know that background checks are completed, verify the level of training or type of experience a caregiver has.

When it comes to liability, this comes down to who is considered the “employer of record.” If you are working with a licensed and bonded agency, it is the agency that takes responsibility as the employer. If you are working with an individual or a DRA, the employer is you. That means you, as the employer, are liable for providing worker’s compensation benefits and managing payroll taxes. These are things to be aware of and plan for if you decide to go with a private individual or hire through a DRA. A table included in the July 2019 research brief published by UCSF HealthForce simplifies the training requirements and employers for different types of caregivers:

Training can vary by state, so take a look at what your state mandates. California caregivers participate in 5 hours of training for their initial certification plus 5 hours annually to maintain their license.

3. What Should You Expect from a Home Caregiver?

Home caregivers can really help with anything—from reminding a patient to take their pills to driving them to a doctor's appointment, even seeing to it that the family dog has gone on his morning walk—that falls within the realm of caregiving and companionship. A main goal of home caregiving is to assure that individuals are cared for in a manner that’s both comfortable and convenient, providing them at-home assistance so that they can continue living at home safely in a way that’s both productive and meaningful. It is important to remember that home caregivers are not house cleaners. While they are able to help with housekeeping, it should only account for 20% of the time they are working with someone. The other 80% should be dedicated to “personal care” tasks. These include bathing, dressing, using the toilet and mobility (getting in/out of bed or a chair or going for walks). Medical or skilled activities, such as administering medication, caring for wounds, managing IVs or doing tube feedings, are outside the scope of caregivers and require a skilled professional to perform.

While most caregivers have experience working with people in their homes and-if they are employed by an agency-receive at least the state mandated training, there can be significant variation between homes and individuals. Expect to allocate some time to help get a caregiver acclimated, inform them of any particular preferences and communicate daily routines. It’s always helpful to have things in writing and can improve continuity of care if someone else needs to take over care.

4. How are home caregiving costs covered?

Medicare doesn't cover either private caregivers or home health care agencies, but does pay for skilled health care. One more consideration: According to the IRS, a private or individual caregiver is considered a household employee (not an independent contractor) if they're paid more than $2,100 per year—so this is something you’ll need to factor into your annual taxes. Health care agencies handle the payroll for you.

5. Are There Other Resources to Help Care for Someone?

Absolutely! We are living in a time of innovation and that has begun to take hold in the caregiving space. Everyday there are new technologies appearing that are designed to keep people safe, engaged and connected. TheraCare has partnered with some leaders in the field, including People Power, Alto Pharmacy, MedFolio, and others, helping us connect our clients to the best resources available and offer comprehensive, individualized care.

Additionally, TheraCare has introduced a new Concierge Line that provides short-shift care or on-demand service for sporadic needs, like transportation to doctor’s appointments or a trip to the grocery store. Visit our website or give us a call at 650-396-2207 to learn more.

Ultimately, choosing the type of care that is right for you is about listening to the needs of your loved one and determining your own requirements in terms of budget, overall security, and peace-of-mind.

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