Articles By A Servant’s Heart Senior Care

Introduction

The California Telephone Access Program (CTAP) is an equipment loan and network services program mandated by the state of California to provide special equipment to individuals that have difficulty using standard telephone equipment. This program is offered at no cost to the individual and is funded by a surcharge that is billed to all California telephone customers under the label of “CA Relay Service and Communications Devices Fund.” The CTAP falls under the governance of the California Public Utilities Commission (CPUC).

To be eligible for the equipment offered through this program, the individual must reside in California, currently have residential telephone service (although it does not need to be in their name) and must be certified as having one of the following disabilities, either temporarily or permanently:

•    Cognitive
•    Hard of Hearing
•    Deaf / Late-Deafened
•    Speech Impairment
•    Low Vision / Blind
•    Mobility / Manipulation

The condition must be verified and certification for the application process must be made by a California licensed medical doctor or clinical audiologist, a qualified state agency such as the California Department of Rehabilitation, or a hearing aid dispenser.

Types of Equipment and Services Offered

The program offers only one set of specialized equipment for a customer’s use. The types of equipment offered through the CTAP, includes:

•    Amplifiers
•    Braille TTYs
•    Fax Machines
•    Headsets
•    Ring Signal Devices
•    Speech Devices
•    Switches
•    Special Telephones
•    TTYs
•    Accessories

The network services that the CTAP offers at no charge for its customers include: Three-Way Calling, Speed Dial 8 and Speed Dial 30. Three-Way Calling is offered for customers who have speech or motion difficulties. The Speed Dial services are offered to those customers suffering from low vision, mobility and/or cognitive disabilities.

The Application Process

Once it has been determined that an eligible individual could benefit from this program, a short application needs to be filled out. The application is divided into two parts. Part A needs to be filled out providing some basic information about the individual requesting the special equipment or services. Part B must be filled out by a certifying agent verifying the condition that the individual suffers from.

You may download an application form directly from the CTAP website at: www.ddtp.org/CTAP or you can request that an application be mailed to you by calling the CTAP Call Center at (800) 806-1191. Once completed the application may be faxed, mailed or submitted in person.

After the application has been submitted and approved, a CTAP Call Me Letter will be sent out. The letter will request that a call be placed to the CTAP Call Center so that the needs of the individual can be reviewed and then matched to the equipment or services that will best assist the individual.

Sometimes, a combination of special equipment and services will be provided. Training on the specific equipment and/or services is also offered. Additionally, the CTAP may be able to provide a Field Visit when an individual is unable to go to one of the CTAP Service Centers or is in need of additional assistance.

Staying Connected

Today telephone service is deemed more as a necessity rather than a luxury. It is a means to reach out and connect with friends and family as well as a way to ask for assistance when needed. In an emergency, it can be a lifesaver.

Having the proper equipment and services is essential for your loved ones to stay connected to the outside world and can be provided for free by the CTAP program.

At A Servant’s Heart Senior Care, we work to provide you with the most up-to-date information on public programs and community services that are available to assist older adults. Most home care companies provide only caregiving services, but we offer both caregiving and professional geriatric care management so that you have expert care and advice in one resource! For additional information, call us toll free at 1-800-777-4750.

A Servant’s Heart Senior Care is One of the First Companies to Become a CAHSAH Certified Home Care Aide Organization

Introduction

The California Association for Health Services at Home (”CAHSAH”), is a statewide home care association and the primary advocate of home care services for the western United States. Founded in 1966, CAHSAH has a long tradition of service to the home care industry and to the public. CAHSAH’s mission is to promote quality home care services and enhance the overall effectiveness of its members.

Home Care Aide Organizations are companies that provide a variety of supportive services to those in need of assistance either with home management and/or non-medical personal care. Some of the services offered may include homemaking, meal preparation, live-in attendants, supervision and assistance with feeding, dressing, bathing and toileting, respite/companion, childcare or pet care, shopping and escort or transportation services.

Currently the State of California does not provide any type of licensing or regulation over the home care industry. Additionally there are no certification standards that a Home Care Aide must meet in order to work in home care settings. CAHSAH has stepped in to fill this void by implementing an industry wide certification program for the benefit of all older adults and their families. All home care organizations are encouraged to participate in this new certification program.

The CAHSAH Home Care Aide Organization Certification Program

The CAHSAH Certification Program is a voluntary program open to all CAHSAH members and non-members alike. Home Care Aide Organizations that wish to apply to become CAHSAH certified must submit proof of that the applicant company does all of the following:

• Have General and Professional Liability Insurance coverage
• Have Workers’ Compensation Insurance coverage
• Have Crime / Employee Dishonesty Bond coverage
• Perform Pre-employment Background Clearance on all Home Care Aides
• Perform Pre-employment Tuberculosis Screening of all Home Care Aides
• Provide signed Service Agreement including a specification of fees before service begins

Once these standards have been met and verified, the CAHSAH Home Care Aide Organization certificate is issued to the applicant company indicating that the company has met CAHSAH’s certification standards. The certification is valid for one year and must be renewed annually.

Benefits of the Certification Program

CAHSAH’s certification standards have been established as a means to protect the organizations themselves as well as the older individuals that they serve. The intent of the program is to help standardize the industry as a whole by providing consumer and worker protections for the benefit of all involved.

Whenever anyone is brought into your home, it is important that the individual be thoroughly and properly screened. Unfortunately, these days it is not enough to simply “trust” in the home care aide or manager. A higher standard must be met in order to provide security and peace of mind. That is why it is so important when screening any organizations to make sure that they meet CAHSAH’s certification standards before you entrust them with the care of your loved one.

By implementing and advocating certification, CAHSAH hopes to promote and ensure quality standards, guide ethical conduct and promote best practices for home care providers.

Among The First to Become CAHSAH Certified

A Servant’s Heart Senior Care is pleased to announce that it is one of the first Home Care Aide Organizations to be certified by CAHSAH. We strongly advocate that all providers meet the certification standards set forth in the CAHSAH certification process in an ongoing effort to support and strengthen the industry as a whole.

In addition to meeting CAHSAH’s certification standards, we also have implemented a rigorous caregiver screening and selection process of our own. We require that all our potential caregivers or home care aides complete extensive application, testing and interview processes in our office and we test their knowledge and ability to provide caregiver services. After they are interviewed by at least two members of our field supervision and staffing team, we check all their prior work references as well as conducting thorough background checks and TB tests before employment is offered to the candidates.

Once hired by A Servant’s Heart, our home care aides are provided with continuing education classes to ensure that they are knowledgeable about the latest procedures. We also provide frequent and close supervision (and support!) of our caregivers.

At A Servant’s Heart Senior Care, we truly want to provide professional and trustworthy care for seniors living at home. For more information call us toll-free at 800-777-4750 to find out more about how you benefit from working with a full-service, CAHSAH-certified home care aide organization.

Introduction

Dehydration in older individuals is a real problem and many times is the unrecognized cause of hospitalizations, morbidity and mortality. Dehydration is often linked to infections that can be fatal. It becomes an even bigger problem during the heat of the summer months or during a heat wave.

Early diagnosis of this condition is essential but is sometimes difficult because the classical physical signs of dehydration may be absent or misleading in an older patient.

Older adults are more prone to developing dehydration due to losses in muscular mass, total body water, and bone mass. If an older individual is sick, they usually become dehydrated more quickly without ever being aware of it. Additionally as we age, the thirst sensation decreases thus compounding the problem.

Some of the physical signs of dehydration to watch for in an older indivdual, include:

• Dry, cracking skin
• Frequent headaches
• Parched, chapped lips
• Low urine output and/or constipation
• Nasal passages that are particularly dry and/or bleeding

In cases of severe dehydration, changes in blood pressure may also occur. The individual may also act excessively irritable, disoriented or confused and may become dizzy or lightheaded. Prompt intervention is crucial.

How is Dehydration Treated?

The best treatment for dehydration is to prevent it from occurring in the first place. If that is not possible then fluid replacement is the next step.

Prevention

Prevention is best achieved by early detection and measures taken to prevent fluid loss. Caregivers and health care professionals should be constantly aware of the risk factors and signs of dehydration in elderly patients. Strategies should be implemented to ensure that the older individual maintains a normal level of hydration. This can be accomplished by encouraging the consumption of fluids frequently and by offering a variety of liquids. Steady levels of hydration can be best maintained in older adults by consuming smaller amounts of liquids more frequently throughout the day.

It is important to note that alcoholic beverages as well as tea and coffee (because of their high caffeine content) can contribute to dehydration and should be avoided. If they are consumed, then additional liquids are needed to offset any fluid loss.

Fluid Replacement

Fluid replacement involves slowly replenishing water loss, usually over 48 hours, by drinking liquids or by an intravenous solution (IV).

The best forms of replacement fluids for rehydration include:

• Water
• Clear broths
• Popsicles
• Jell-O
• Drinks that contain electrolytes (Pedialyte, Gatorade, Powerade, etc.)

Monitoring urine output is the best way to determine if the rehydration therapy is working. When the body is dehydrated, the kidneys try to hold on to as much fluid as possible thus urine output is decreased and the urine itself is concentrated. As treatment begins, the kidneys sense the increased fluid and urine output increases.

A healthcare professional should always be consulted when complications exist or in the cases of diabetes. When a diabetic becomes dehydrated, additional medications such as synthesized hormones or anti-inflammatory drugs may be needed to aid in fluid retention and decrease urination.

At A Servant’s Heart Senior Care, we realize that each client’s needs are unique and so we create a custom care plan for every client. After an initial assessment, a custom plan of care and services will be introduced and established. Most home care companies provide only caregiving services, but we offer both caregiving and professional geriatric care management so that you have expert care and advice in one resource!

For further information, call us toll free at 1-800-777-4750.

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Introduction

We all agree that it is a tough situation to go through – deciding if and when your loved ones need outside assistance. Sometimes that decision is almost made for you if an acute crisis triggers the need for help. Often times, though, the need is of a less acute or more subtle nature.

Your loved one may still be able to successfully navigate through their day on their own and may only require minor assistance at times. It is in situations like these that the introduction of outside help can become more difficult. Your loved one may simply not be ready to accept the fact that they need some assistance.

In these situations, the next steps that you take can be crucial for the happiness of your loved one and the success of the caregiver.

Step 1: Keeping Your Loved One Involved as Much as Possible

Step 2: Keeping Communication Open

Step 3: Allowing Your Loved One to Still Make Decisions

Keeping Your Loved One Involved as Much as Possible

Once the decision has been made that caregiver or companion services will be beneficial in your loved one’s life, it is important to allow your loved one to be involved (or to feel like they have been involved) in the planning process. If possible, have your loved one meet with the new caregiver(s) before the caregiving visits begin. After all, your loved one will be the person who works with the caregiver and ultimately comes to rely upon that person.

Both your loved one and the caregiver must feel comfortable with one another for a foundation of trust to be established. If your loved one is not comfortable with the new caregiver(s), work with the home care company to decide how to resolve the problem promptly and fairly.

At A Servant’s Heart Senior Care we personally introduce caregivers to clients with whom they have not previously worked, and normally we do this at least a day before the caregiver’s first visit with that client. By doing this we can ensure that both the client and the caregiver are satisfied that their working relationship will be satisfactory.

Once the caregiver has been introduced to your loved one, it is important that you and the home care company work together to portray the caregiver as having a position of support and not authority. Many older adults will feel their spirit and zest for life diminish once they feel they cannot take care of simple things for themselves. You must emphasize that the role of the caregiver is to simply assist your loved one in experiencing the best quality of life possible. The caregiver is there to empower your loved one and not to control them.

Keeping Communication Open

You and the caregiver and the home care company must all be watching for areas where your loved one needs help. Many times, older adults do not want to become a burden for their relatives so they do not always express their needs or concerns. It is important for you, the caregiver and the home care company to work as a team and to convey to your loved one that you want to have their input and that you are willing to listen to them. Giving your loved one a “voice” in their own care is a great way to foster their sense of independence and self-worth.

Allowing Your Loved One to Still Make Decisions

Often times when we try to help someone, it’s easy for us to in too far and take too much away from the person we are trying to help. It is important to remember that your loved one has been self-reliant up until this point and in control of his or her affairs. Try not to turn their life upside down.

If they were used to a regular schedule of daily activities, try to maintain that. If the introduction of a caregiver requires some changes to the daily routine then have your loved one help decide upon those changes. Many people, not just older adults, do not always welcome change so try to make changes in small steps.

Whenever possible, have your loved one make the final decision on a matter. Unless they are experiencing diminished mental capacity, older adults can still make competent decisions for themselves. Their sense of independence can be successfully balanced with their need for care, if they feel involved and still maintain a sense of control over their own life.

A Servant’s Heart Senior Care helps older adults and their families navigate through the next steps in aging. Whether it’s providing caregivers so that your loved ones can remain at home, resolving an immediate crisis, helping you find an appropriate retirement home or assisted living facility, or just looking in from time to time to make sure that they’re ok, we can help. Most home care companies provide only caregiving services, but we offer both caregiving and professional geriatric care management so that you have expert care and advice in one resource!

Call us toll-free at 1-800-777-4750 to get started on making sure that the next steps in your loved one’s life are safe, satisfying and rewarding.

Introduction

When you first have to face the fact that your loved ones are no longer safe living completely on their own in their homes, the decisions that you must make can seem overwhelming. One of the first decisions that you and your loved ones must make is whether your loved ones should remain in their home and “age in place” or move to an assisted living facility or retirement home.

Most people, including most seniors, prefer to remain in their own homes for as long as possible. For that reason, the second question that most families face is how to obtain home caregiving services for their loved ones.

When you and your parents face that question, you’ll first have to decide whether to obtain caregivers by:

1. Requesting caregiver services from an established home care company, or
2. Privately hiring caregivers yourself.

In this article we’ll look at just one of the things that can go wrong when families try to privately hire caregivers on their own. There are many other potential problems that can arise but we’ll just focus on one problem in this article: the risk of being sued or owing back wages and taxes when families don’t fulfill all their duties as employers under the labor laws of California.

Which labor and tax laws apply to “household employers” in California?

The answer is: almost all of them! That’s probably not the answer you were expecting. However, it’s true. If you employ someone in your home in California, you must comply with federal and state wage and hour laws (do you know how overtime rules apply to work in your home?) and tax and workers compensation laws.

Here’s a partial list of the reading that you’ll need to do:

• The IRS publishes a 19-page book called Household Employers’ Tax Guide - Publication 926.

• The California Employment Development Department publishes a 77-page Household Employer’s Guide - Publication DE8829 and a 4-page Household Employment Information Sheet - Publication DE231I

And that’s just for starters. Don’t forget that you’ll also need to study up on the Federal rules on overtime and wage and hour record keeping.

Does this sound far fetched? Not at all!

This article is the beginning of a series on the perils of privately hiring caregivers. In this and future articles we’ll examine real-life cases that illustrate just how much can go wrong when families try to save money by hiring caregivers on their own instead of through an established home care company.

Liability for Back Wages and Failure to Keep Records

This first story is about a real-life case that a privately-hired caregiver and housekeeper filed and won against her California employer. The caregiver’s name is Josepha Gonzalez, and she successfully sued her employer, the Beck family.

Ms. Gonzalez worked for the Beck family as a caregiver and housekeeper from April 1998 to September 2003.  During her employment there, she worked five to six days a week.

After her employment ended Ms. Gonzalez sued the Beck family for back wages, claiming that she was not properly paid for all her hours and for overtime wages.

Ms. Gonzalez also claimed that the Beck family did not keep complete and proper records of the hours that she worked (in California the employers bears the responsibility for detailed records of all hours worked). Ms. Gonzalez filed the suit by filing a claim with the state’s Labor Commissioner’s office.

The Beck family lost the case.  The Commissioner found in favor of Ms. Gonzales and ordered the Beck family to pay her $62,228 in unpaid wages, $4,172.14 in interest, and $3,398.40 in penalties, for a total award of $70,238.54.

Note: it could have been worse!

In this case, the defendants (the Beck family) had apparently been correctly withholding and paying payroll taxes and workers compensation insurance.  Because of that, the award was strictly based upon the family’s failure to follow the wage and hour laws.

If the family also had failed to properly withhold and pay the appropriate payroll taxes, the federal and state tax authorities would have been lined up at their door to add their own claims to the family’s financial woes.

For another excellent blog posting on the topic of paying caregivers privately, see this topic on the Nanny Tax blog: http://www.4nannytaxes.com/blog/2008/11/in-tough-economy-families-ignore-nanny.html

Summary

At the end of the day, most families don’t understand the wage and hour consequences of their private employment decisions.  The often risk catastrophic losses like the Beck family suffered if they try to do this on their own. It may seem to cost a bit more in the short run to obtain caregivers through a home care company, but in the long run it’s the safest and most responsible choice for most families.

A Servant’s Heart Senior Care is a full service employer-model based home care and geriatric care management company. We take responsibility for the wage and hour and tax issues and provide workers compensation coverage and bonding. We are here to help you and your family whenever you need us!

Introduction - Why not just rely upon the government to protect us through regulation?

Most people believe that the state of California licenses and oversees professional Geriatric Care Managers (”GCMs”). After all, California regulates everything , doesn’t it?

Well, not in the case of professional Geriatric Care Managers. California does not provide any type of licensing, regulation, oversight, minimum standards, or any other sort of controls over the GCM industry.

In effect, the state is leaving it up to older adults and their families to protect themselves and leaving it up to them to think about all the right questions to ask and the things to watch out for. Caveat emptor!

In this article we’ll provide information about what to look for and what to watch out for so that you can make well-grounded assessments regarding the GCMs that you select to work with you and your loved ones.

What to look for in a Geriatric Care Manager

Here are the selection criteria that we recommend. You should look for professional GCMs who are:

1. Competent - they know what to do, and how to do it.

2. Trustworthy - they are reliable and keep their promises.

These are the two absolutely essential criteria.

How to proceed

Referrals from people you know are the best starting point. If someone you know gives a strong endorsement to a GCM with whom they have worked regarding their own loved ones, that is a valuable starting point.

In any event, with or without a referral from a friend, you should conduct interviews before selecting a GCM.

1. You should interview more than one prospective professional GCM (I recommend interviewing at least three) before selecting one to work with your loved ones.

2. After initial phone screenings with prospective GCMs, if at all possible conduct a final interview with your first choice in the GCM’s office before committing to beginning service.

Criteria for selecting a Geriatric Care Manager

Competence

In order to assess competence, you can look for certifications and similar devices from authoritative third parties. Such sources of assurance include the following.

Degree

Does the GCM have a degree, preferably a graduate degree, in a relevant field of study?Most GCMs have a masters degree in Social Work, Gerontology or similar fields.

Note: Sometimes nurses practice as GCMs. When you are considering a nurse who offers services as a GCM you must ask yourself whether your loved one has

• primarily medical (disease or wound issues) needs, in which case a properly qualified nurse might be a good choice, or
  
• primarily psycho-social needs (loneliness, socialization, advocacy, care needs assessment, gero-psychological issues), in which a social worker might be a better choice.
  

When considering these choices, don’t forget to include consideration of the education that the prospective GCM has completed.  Many nurses don’t even have bachelor’s degrees, so be sure to ask about this.  Social workers may have a bachelor’s degree but we recommend working with GCMs with master’s degrees because they have more comprehensive educational preparation for GCM work.

Membership in NAPGCM

The primary professional association for GCMs is the National Association of Professional Geriatric Care Managers (”NAPGCM”). If you are considering a prospective GCM who is not a member of the NAPGCM ask yourself why they aren’t a member and what that says about their qualifications.

Trustworthiness

There are really two main ways to assess the GCM’s trustworthiness:

Experience

How many years has the GCM been working as a professional GCM? Before that, did the GCM have other experience that is truly relevant to GCM work, such as working in a hospice organization or a geriatric medical group?

Client References

Can the GCM provide at least three client references who will attest to the GCM’s performance and reliability? If so, ask the references questions like, “Tell me about a time when the GCM really came through even though circumstances were difficult” and, “How many times has the GCM failed to keep the promises that they made to you?”

Professional References

Can the GCM provide at least three references from professionals who have referred clients or patients of their own to the GCM and who are satisfied with the results?
Interview impressions

At the end of the interview, how do you “feel” about the GCM? Although this is not a precise measurement, you should ask yourself whether someone who makes you uncomfortable or about whom you have post-interview doubts is going to be the best person to trust with the care of your loved ones.

Beware of Pretenders

One last thing to watch out for: Some companies call some of their employees “care managers” who really aren’t professional Geriatric Care Managers. Often these so-called “care managers” are people who are staffing or scheduling coordinators for non-medical in-home care companies.

Scheduling and staffing coordinators are different from true professional Geriatric Care Managers, but there’s no law preventing them from using the GCM title. When a company tells you that they provide “care managers”, ask questions using the information in this article to make sure that you know what those “care managers” really will be doing.

Summary

As you can see, there are many factors to consider when selecting a professional Geriatric Care Manager, especially in a state like California where there are no consumer protection laws that apply to this type of professional service. By following the suggestions in this article, you will be able to select a great GCM to work with in protecting your loved ones and providing for their care in the best possible way.

If your loved one is in need of professional Geriatric Care Management and lives in San Diego County or South Orange County, our company is ready to help you! Please visit our website at A Servant’s Heart Senior Care for more information, or call us toll-free at 800-777-4750 to speak with a professional Geriatric Care Manager!

First of all, let’s deal with the name itself, “Geriatric Care Management”.

To tell the truth, we don’t really like the term “Geriatric Care Management”. After all, who wants to be thought of as:

• Geriatric?
• Needing care?
• Needing to be managed?

Nonetheless, the term is an industry standard and so for now we’ll stick with it. Someday I hope that we’ll find a better term for this profession. For now, we’ll forget about the name and talk about what it IS.

Geriatric Care Management (often referred to by its acronym, “GCM”) is a family of services in which:

1. The care needs of older adults and their families are assessed by trained professionals, usually social workers, who then
2. Develop care plans for the acquisition of services to take care of those needs,
3. Implement those care plans,
4. Advocate for the client when needed, which often occurs when other service providers are unresponsive,
5. Monitor the results and make changes as needed, and,
6. Report as required to family, referral sources, and other authorized persons.

This series of steps all sounds very tidy and orderly. Actually, it almost never happens that way in real life.

In fact, most GCM cases begin with some acute problem or crisis which requires immediate action. After the acute problem is solved, in most cases the family chooses to have us continue to be involved to monitor the client’s status and needs on an ongoing basis. Occasionally, the client’s family or friends take back control of the day to day care needs of the client.

Most of our GCM clients are older adults who live within our service area and whose family or friends are either:

• Not living nearby and therefore are not able to help as much as they would like to, or
• Working full time and therefore not able to help as much as they would like to.

The family or friends ask us to begin providing GCM services to solve the acute problem, if there is one, and then to monitor and provide “family assurance visits and reports” on a periodic basis if they so desire.

Note number 4 in the list above, “Advocate for the client when needed, which often occurs when other service providers are unresponsive”. Although this may not sound important, it can sometimes be critically important when considering the elderly.

Many seniors are too “polite” to be assertive and insist upon the service and attention to which they are entitled. This often occurs in medical settings where the staff is overwhelmed with large numbers of patients and demands for their time. It can happen in other contexts as well, such as when dealing with insurance companies or governmental agencies, where the staff attends to the needs of the “squeaky wheel”. This outcome may not be intentional, but it nonetheless does happen and results in the senior being marginalized and the senior’s needs being neglected.

An experienced professional GCM is able to recognize such situations. The GCM can take charge of the situation and make sure that the client’s needs and concerns are taken care of in an appropriate and timely manner. That is what “advocating for the client” means.

We welcome the opportunity to help you and your loved ones within our GCM service area, which is San Diego County and South Orange County. You can find out more about us by visiting our website at A Servant’s Heart Senior Care.

What a great question! After all, California is one of the most highly-regulated states in the country. For heaven’s sake, you have to have a license to have a carwash in California, so how can it be that there is no license required for Home Care companies?

The answer is, as usual, complicated. There are a number of factors that led to this situation. We were members of a task force that wrote and then introduced licensing legislation in 2007, which was promptly defeated by a coalition of powerful political forces. Here are some of the things that we observed contributing to the defeat of California consumer protection regarding regulation of home care companies.

First of all: not all company owners WANT to be regulated

There are a number of potential disadvantages for companies, even well-intentioned ones. Those disadvantages include:

• Cost of the license itself (last year the Department of Social Services estimated that it would have to charge each home care company $4,400.00 per year to regulate and license them!)
• Costs of compliance if the rules required companies to do things they weren’t already doing such as background checks or TB tests.
• Intrusion by government into an area where owners of companies previously had complete liberty to do business however they wanted to. (Last year when we tried to pass legislation to require licensing, there was substantial opposition from company owners themselves.)

Second: the costs might drive up the cost of care

Because there are many home care companies in California that cut corners and bend the rules that DO apply, such as labor laws, then companies that cut corners and save money by doing so might have to charge more money for their “services”. Probably the most serious example of this is the case of the “domestic referral agencies” or “DRAs”, the companies that claim that the caregivers that they supply are NOT their employees.

The DRAs don’t pay payroll taxes, workers comp insurance or bonding (even though some dishonestly claim that their caregivers are bonded). Because they dont’ incur those significant costs, some of them (but not all) compete by charging less. The other DRAs just charge the same as the legitimate employer-model companies but they get away with it because consumers don’t know what questions to ask.

Third: The Legislature doesn’t make consumer protection or caregiver protection in home care a priority

There is no impetus in the legislature for regulation of home care companies. Even though many older adults and their families are victimized by unscrupulous companies every year, the legislature hasn’t seen fit to make this issue a priority compared to many other issues. Even though caregivers are taken advantage of by dishonest employment practices, the legislature doesn’t see that as important compared to other issues.

So, what’s the answer?

For now, and probably for a long time to come, home care companies in California will continue to be unregulated and not subject to any governmentally required minimum standards.

Therefore the answer is, and will continue to be, that older adults and their families will have to be wise about asking good questions and making well-grounded assessments about which home care companies will provide excellent care for them. By utilizing tools such as “The Checklist” on our website, families can start the process with an already comprehensive set of criteria and standards for assessing their choices.

WHEN YOUR PARENTS BEGIN TO NEED HELP AT HOME, you’d better know the most important questions to ask in order to help them select the best home care company for them. Every home care company promises that they are the best and that you will be happy with them if you choose them. If you really know what makes the difference in home care services, you are better prepared to make the best choice.

Believe it or not, in California there are absolutely no laws governing how non-medical home care agencies select, hire, and supervise home caregivers, so it is up to you and your parents to be thoughtful and thorough in selecting the home care company that will be safest and best for them. Here’s a list of questions to ask each company.

When you need to find help for your loved ones, it’s always a good idea to ask people you trust for recommendations and referrals. Keep in mind, though, that knowing the right questions to ask, as outlined below, will be the most important part of the selection process.

FIRST, ask this: “Who is the employer of the caregivers that your company will send into my parents’ home?”

A home care business that answers, “The caregivers are employees of our company” will be the best choice in the long run.

Why? Because when the company is the employer, then the company pays for workers compensation insurance and payroll taxes. Also, when the company is the employer, the company is able to provide employee honesty “bond” coverage for the caregiver (and you should ask the company if it does so!)

If the company does not act as the caregiver’s employer, then the burden lies with you and your parents to determine whether the caregiver is an employee of you or your parents. If you or your parents are the employer, then you or your parents are responsible for making sure that payroll taxes and workers compensation insurance are paid for. Some agencies will claim that the caregivers are “Independent Contractors”, which leaves you at risk for second-guessing later by the authorities.

Also, caregivers from non-employer agencies are not covered by any sort of employee honesty “bond” that those agencies may otherwise claim to have, because only true employees may be covered by such bonds. In fact, some non-employer agencies will claim to be “bonded”, but when you ask for specifics you will find that only the staff that works in the company’s office is really covered by the bonding, not the caregivers.

SECOND, ask this: “What criteria do you use to select and hire your caregivers?”

In other words, will they hire just anyone off the street regardless of training, experience, and criminal history and then send them to your parents’ home? Or, does the company enforce important standards with respect to whom and how they hire their caregivers? Here are some specific questions to ask about the company’s minimum standards for hiring:

• Do they conduct thorough criminal background checks? If not, how can you be certain that your parents and their property will be safe from harm?
• Do they require that the caregivers have current TB test results on file? If not, how can you be certain that your parents will not be exposed to TB?
• Do they require that the caregivers have a car, proof of auto insurance, and a good driving record? If not, how can the caregivers safely take your parents to doctor appointments and the store, or how can they safely evacuate your parents to a safe place in event of an emergency?
• Do they train, monitor and supervise the caregivers? If not, how can you be certain that your parents will receive top-quality care? Who will come and fill-in for the caregiver when the caregiver is unable to come to work due to illness or babysitting problems?
• If the caregivers need additional training, coaching and mentoring in order to take care of specialized needs for a particular case, does the company have the tools and personnel in place to deliver that training?

THIRD ask this: “What kind of training, monitoring and supervision do you provide?”

A good home care company will want their staff trained to do a good job providing the requested services. The caregiver is not only on the job to meet the client’s needs, but is also an ambassador for the company, and for a good long term solution to care at home, must know not only how to do their job, but also how to know when there is an emergency and what to do then.

Also, a good home care company will perform supervision visits regularly so that you and the company can be assured that the caregivers are doing a proper job of caring for your loved one.

FOURTH ask this: “Do you have insurance for professional liability, workers compensation, automobile liability and employee bonding?”

Naturally, you always hope that there won’t be any problems and that therefore you won’t need to worry about whether the company has proper insurance coverage. However, it would be irresponsible for you to do business with a company without asking about their insurance coverage. Any reputable company will have the insurance coverage mentioned above and should be able to provide you with a certificate of insurance if you request one.

FIFTH ask this: “How do you determine what my mom needs?”

A reputable company that really cares about matching clients with the appropriate caregivers will conduct an in-home, in-facility or in-hospital interview and work with you and your parents as to the best plan of care for the appropriate price.

SIXTH ask this: “What will this cost?

In order to assess the cost, you need to know what causes one company to be higher priced than another. In order to understand this you must consider the answers to the preceding questions.

If the company does not employ the caregiver, then they can provide care at lower costs because they are not taking responsibility for meeting the expensive requirements of being an employer.

Non-employer companies are sometimes referred to as “registries” or “placement agencies”. They may appear to be cheaper because they sometimes (but not always) charge a lower hourly fee rate.

HOWEVER, there are costs that someone has to bear, and if the company isn’t accepting that responsibility, the client or the client’s family must assume them. Such costs include payroll taxes, unemployment taxes, workers compensation insurance and bonding. Also, the “registry” company is NOT accepting responsibility for supervising the caregivers, so the client or client’s family will have to do that.

The bottom line is this: someone has to employ the caregiver, and that someone has to bear all the employment related expenses and time costs. For peace of mind it makes sense to pay a bit more and have a legal, monitored, supervised, checked-out and guaranteed care provider with your parents.

Summary

If you follow the advice in this article and apply good judgment and common sense, you will be more likely to make a great selection in choosing a home care company for your loved ones. Remember to ask good questions, make sure that you get clear answers to them, check references and get recommendations from people you trust, and keep in mind that you get what you pay for.

As the old saying goes, the two things that you can’t avoid are death and taxes. Taxes may be minimized or postponed by creative tax planning, but as Hebrews 9:27 tells us, death is something that we will all face someday, so understanding the role of hospice may help you or someone you love be more prepared to better face that event..

What is hospice care?

Hospice care begins when a doctor makes the assessment that the patient’s illness cannot be cured and that the patient is likely to be within the last six months of his or her life. When that happens, the doctor may recommend hospice care for the patient. In order to begin hospice service, the patient (or the person holding the patient’s healthcare power of attorney) agrees to accept hospice care and to cease any further attempts at curative care.

Hospice service provides “palliative care”. Palliative care means management of the patient’s pain and other symptoms when it is no longer possible to cure the patient’s primary illness. In addition to palliative medical care, hospice care also provides psychological, social and spiritual support for the patient and for the patient’s family and friends, helping them prepare for the death of their loved one.

What services are provided in hospice care?

The goal of hospice care is the achievement of the best quality of life for patients and their families, and therefore hospice services are most often provided in the patient’s own home. However, depending upon the patient’s wishes, hospice care may also be provided at a specialized inpatient hospice unit or at another health facility..

When a patient goes on hospice service, the dying process is openly discussed with the patient and with others that the patient wishes to include, such as family members. The care offered by hospice service includes ongoing help and support for family members for up to one year after the patient passes away.

Who provides hospice care?

Originally, hospice care was mostly provided by non-profit organizations. However, as the size of the hospice care market has grown, it has attracted the for-profit sector as well. Now there are many different organizations that offer hospice service in San Diego County, both non-profit and for-profit, including many that have opened their doors within the past year.

The patient has an absolute right to choose which hospice agency to use, to change hospice agencies if not satisfied, and to revoke hospice service if so desired. In most cases the patient’s doctor recommends one or two hospice agencies for the patient. In order to make a wise choice it is also wise to ask for suggestions from friends and neighbors who have had experience with hospice agencies.

Who pays for hospice care?

In most cases, all the expenses for palliative treatment of the patient’s primary diagnosis are covered by Medicare when the patient is on hospice care. Those covered expenses include medications and home care supplies, as well as the services of nurses, social workers, home health aides and spiritual counseling services.

Hospice does not pay for routine round-the-clock home care. The patient or family has to create a support system that the hospice nurses and other hospice personnel work in as part of the support system. The support system also has to include attendants to help the patient with activities of daily living such as bathing, toileting, dressing and meal preparation. Hospice does not provide nor pay for those attendants, so the attendants can be family members, friends, or caregivers provided by home care agencies. The hospice often can provide a list of home care agencies that provide such caregivers.