The California Association for Health Services at Home (CAHSAH) is an important influence in California home care. A senior home care company working under the certification of CAHSAH in San Diego County commits to adhere to the organization’s code of ethics. The group, founded to provide home care companies with accountability, resources, and influence in the California legislature, posts its code of ethics on its website so that caregivers, patients, and the general public alike can view the standards that member companies hold. The code includes the following commitments:

Cooperation For the Good of Clients

 A priority among members of CAHSAH in San Diego County is cooperation for the common cause of excellent senior care. By uniting and communicating with one another, these companies can be more effective in lobbying lawmakers for senior protection laws, raising public awareness of senior abuse, and other activities representing elderly care issues.

Ethical Business Practices

 A member of CAHSAH in San Diego County promises to conduct business in a way that is ethical, moral, and fair. When serving elderly individuals who are vulnerable, it is critical that a home care service refrain from false advertising, coercive or harassing attitudes, and questionable financial activities. A company’s certification from CAHSAH assures concerned loved ones that their elderly family members are in good hands.

Personnel Training and Qualification

 CAHSAH member companies consider the capabilities, training, certification, and qualification of their employees to be very important. Only workers with sufficient training are sent into the homes of seniors to provide care. In addition, each company makes sure that its employees receive the ongoing education or updates required to maintain any licenses.

Employee-Client Relations

 The most important part of the code of ethics for any company certified by CAHSAH in San Diego County is the section detailing certain commitments to excellent client and patient care. A member company promises, first and foremost, to treat every client with respect and dignity. It recognizes that every senior under the company’s care should receive excellent service and must retain all the rights and privacy they deserve. In working closely with these clients, privacy and confidentiality receive high priority as well, ensuring that seniors’ health and resources remain safe.

A CAHSAH certification means a lot of things, and it gives comfort to family members of seniors who need home care. The code of ethics is just one of the ways that a member company dedicates itself to giving the elderly members of our communities the best care possible.

If your loved one has become increasingly dependent on the help and assistance of others, it may be time to look for an at-home health care provider. This daunting task can be stressful, and you want to make sure that you leave your relative in the hands of a capable caregiver that will give him the care and attention that he deserves. By finding an elderly care provider in San Marcos, you can have access to a wide variety of caregivers that offer in home visits.

When searching for an elderly care provider in San Marcos, there are two main types of caregivers that you can choose from. First, there are hourly caregivers. These caregivers are paid an hourly rate, and can stay as long as you need them to. This gives you the benefit of only having to pay for a few hours a day if your loved one is able to get by on his or her own throughout parts of the day. The disadvantage of this type of care is that it can be more costly if your loved one needs round-the-clock care. The other type of at home health care provider is a live-in caregiver. This type of caregiver can live in the same home as your loved one and help with daily tasks throughout the week. This gives you the ability to leave your loved one in the hands of a qualified professional, and it is much cheaper than paying an hourly worker to stay with your loved one 24 hours a day, but if your loved one is able to do some tasks on his own, it may be easier to pay an hourly worker to come in for a few hours a day rather than having an at home health care provider.

Working with an elderly care provider in San Marcos is a good way to find a knowledgeable caregiver. By researching companies and learning about company histories, you can find a reputable care provider that has dozens of qualified home health care providers that provide home visits to the elderly. A quality elderly care provider in San Marcos can assign a health care professional to your family who can help your loved one with everyday tasks like remembering to take pills, eating, bathing, and light housekeeping.

The population in the United States is growing older, and with the older population comes a wide variety of health problems, mobility issues, or other needs. Rather than spending time in an impersonal nursing or assisted living home, senior citizens that suffer from debilitating diseases or disorders that hinder their ability to function as they used to be able to, the elderly can have benefit from private home health care in Carlsbad. Private home health care has a wide variety of benefits, and can help keep patients comfortable and close by their family

The Best Care

Private home health care in Carlsbad can be provided by certified experts that have years of expertise in their field. These health care providers are able to provide the same care that nursing homes or assisted living homes could provide, but from the comfort of one’s own home. By having your loved one’s health care delivered directly to their home, you can keep them near you and your family, and you can continue to provide for your loved one while ensuring that he or she is still getting the necessary care from a qualified professional. When searching for private home health care in Carlsbad, finding a certified agency to provide a health care provider is the most important thing that you can do for your loved one when finding a home nurse or caregiver.

By finding a certified provider, you can ensure that the caregiver has the knowledge and skills necessary to take care of an elderly person while maintaining a level of comfort that is not possible in a hospital or living center. This can help ensure that your loved one is getting personalized care, rather than being just another number or patient, your loved one will get the sole attention and care of the health care provider, and the efficient planning and care will be tailored specifically to your loved one’s needs.

When you find excellent home health care in Carlsbad, you can also help your loved one maintain his independence and postpone the reliance on 24/7 care and attention. This type of environment and care is helpful for providing an easy environment for recovery, and it often helps slow down chronic or progressive diseases. Private home health care in Carlsbad is a unique option in which affordable health care is merged with an efficient and personal style of keeping elderly patients comfortable in a familiar environment.

Summary

In California, there are two main types of “certifications” for non-medical home care companies: CAHSAH and ABHC.  Both certifications serve as guides for families when choosing an in-home elderly care company for their older loved ones.  Both certifications use their own set of “minimum standards” for certification.

Those minimum standards are necessary but not sufficient when families are deciding which company to select to provide trustworthy care for their older loved ones living at home, and families should use additional criteria and standards besides those minimum standards when selecting in-home care companies for their parents.

Certifications vs Licensing

California does not provide licensing, regulation or any other sort of oversight regarding non-medical in-home care companies.  Because of that, it is easy to start an in-home care business.  There are already thousands of in-home care companies in California and there are more new companies entering the market every day.

In the absence of governmental oversight, those companies are free to follow any standards they choose to follow, and they often follow no standards at all.  There is no guarantee that the company that families select to provide in-home care will protect their frail and vulnerable elderly clients.

In response to this situation, independent, non-governmental standards for “certification” have been created by two completely different (and somewhat competing) organizations, CAHSAH and ABHC.  Each of those organizations has established its own set of “minimum standards” for certification, and while those two sets of standards are somewhat different from each other, they are in other ways similar.  We have written about the differences between the two standards in an article titled “Does It Matter How My Parents’ Home Care Company is Certified? on our website.

Minimum Standards – Necessary but not Enough

So what are these “minimum standards” that CAHSAH and ABHC utilize when certifying in-home care companies?  Well, the details for those programs’ minimum standards are described in detail in our article mentioned above so we won’t repeat them here.  They do indeed address some important concerns such as whether or not the caregivers are employees of the companies instead of the clients or the clients’ families.

The problem is, those “minimum standards” are not sufficient standards by themselves.

In other words, those minimum standards address some but not all of the concerns that families must consider in order to make a careful, thoughtful and thorough decision in selecting the best in-home care company for their older loved ones.  Therefore families should use a more comprehensive list of standards when selecting an in-home care company for their parents.

For example, families should ask whether the in-home care company that they are considering does the following things that are not included in the CAHSAH and ABHC minimum standards:

• Require that new caregiver applicants have experience or training before they are hired.
• Conduct bona-fide, in-person interviews and skills testing before hiring new caregivers.
• Prepare and maintain a current written plan of care for each client, containing specific types of information necessary for routine matters and for emergencies.
• Make supervisors available to both consumers and workers on a 24/7 basis for support and emergency assistance.
• Maintain an emergency evacuation plan for each client for whom the home care company is providing at least 8 hours per day of service.
• Provide an appropriate level of supervision, including unannounced supervision / quality control visits.
• Ensure that the caregivers who work with its clients have the necessary language skills to safely provide care for each client, taking into account each client’s own language skills.
• Offer continuing education or training to its caregivers.

For a more complete list of all the questions that families should ask when choosing an in-home care company for their elderly loved ones, see the Checklist For Choosing A Home Care Company on our website.

Summary

Paid caregivers should be allowed to perform the same medication tasks in a home care setting that family members are allowed to perform.  Currently they are not allowed to do so, but that should be changed.

Health care reform can take place in big, sweeping movements or in small, sensible ways.  This is one of those small but helpful steps.

Introduction

Under current law, in California only licensed nurses may perform “pass or administer” medications in a home care setting…

…EXCEPT:

Any non-nurse third party else can legally perform certain medication tasks IF that non-nurse is NOT being paid for performing them, under the correct circumstances.  Those circumstances include being properly instructed in how to do it.

Thus, any third party, including family members, friends, neighbors, even convicted felons may do it so long as they’re not being paid to do it.  If they ARE being paid, they cannot do it.  This means that paid in-home caregivers cannot legally perform those same tasks that family members can perform, even though the paid caregivers stand in for family so that the family members can go to work, school, and so forth.

Why Are Family Members Are Allowed To Administer?

It is difficult to know the “legislative intent” for this exception for non-paid third parties, for this provision has been in the law for almost forty years.  However, it is reasonable to speculate that the reason for the provision was to make it possible for families to care for their loved ones.

That was particularly appropriate back in the day of one-earner households when one spouse could work and earn a living to support the family while a non-working spouse or partner stayed home to care for a loved one who lived under the same roof.   Today, however, almost all households have both adult members of the family working in order to make ends meet.

In today’s world, one of the currently-working spouses or partners must quit their job or work only part time in order to care for the loved one who needs care if that loved one cannot take their own medications.  There is no legal option to hire in-home caregivers to care for that loved one so that both spouses or partners can continue to work if that loved one requires administration of medications.  This is just one of the many challenges facing members of the “sandwich generation”.

The Question Is, Why Is This Law Still On The Books?

If there’s pay involved, a nurse must be doing it.

But wait a minute.  Ask yourself this:  what is the justification for making this all depend upon whether or not pay is involved?  Is this all just a ploy to make sure that there is a protected income stream for nurses?

I think not.  I think that this is merely an example of part of the law that no longer works in our modern times, one that should be changed.

A Modest Proposal

The purpose of this message is to make the following modest proposal for California non-medical in-home caregiver services:

• Paid non-medical in-home caregivers should be allowed to pass or administer drugs in a home care setting under very specific circumstances while being paid to do so as part of their normal duties, whenever it would be legal for unpaid third parties to do so, such as family members, because such caregivers perform tasks normally performed by family members.

The required specific circumstances would include, but not necessarily be limited to, these:

1. The medication task involved must be one that would be legally allowable if it were being done by an unpaid family member
2. The caregiver must be trained by a nurse in the same way and to the same degree that a family member would be required to be trained.
3. The caregiver must be employed by a certified home care company, so that there is appropriate supervision and legal responsibility for the acts of the caregiver.
4. The caregiver’s employer home care company must prepare and maintain a written plan of care for every client for whom medication tasks will be performed.  Each plan of care must include specific descriptions of, instructions regarding, the medication tasks to be performed for that client.
5. The caregiver must keep records of the medication tasks performed.
6. The caregiver’s employer home care company must adopt and enforce appropriate policies and procedures regarding the medication tasks.
7. The client (or client’s authorized representative) must give informed consent for the medication tasks that will be performed by the paid caregiver.
8. The caregiver’s employer home care company must carry appropriate general and professional liability insurance with at least $1Million/$3Million limits that includes coverage for medication tasks.

Let’s Talk!

I expect that this proposal will provoke lively discussion, and I look forward to your comments to this posting.

In California, it’s important to make sure that your home care company has a meaningful certification because the state of California does not license or regulate non-medical in-home care companies. Thus, in the absence of state regulation for consumer protection, older adults and their families have to rely upon certification to help make sure that they’re choosing a home care company that employs at least a minimum set of “best practices” by meeting the minimum standards established by the certification program.

In California, there are at least two relevant certifications available for non-medical in-home care companies.

• ABHC, the American Board of Home Care
• CAHSAH, the California Association for Health Services At Home

There can be significant differences between companies that meet one or both of the certification standards. For more information about this, see our article titled Are Home Care “Minimum Standards” Good Enough For My Parents?

When this article was originally published in July 2009, there were significant differences between the two certifications. Since then, the difference between the two has diminished and today it is appropriate to say that both are valid and that it is better to have one or the other than to have none at all. We believe that both are relevant and A Servant’s Heart Care Solutions has both certifications.

With that said, we also believe that both consumers and care workers should look for much more than just the minimum standards specified by the certification criteria. There are standards that we believe are important, but which neither CAHSAH nor ABHC require for certification.  These missing standards include:

1. Requiring that the certified home care company always prepare and maintain a current written plan of care for each client, containing specific types of information necessary for routine matters and for emergencies.
2. Requiring that the certified home care company make supervisors available to both consumers and workers on a 24/7 basis for support and emergency assistance.
3. Requiring that the certified home care company maintain an emergency evacuation plan for each client for whom the home care company is providing at least 8 hours per day of service.
4. Requiring that the certified home care company provide an appropriate level of supervision, including unannounced supervision / quality control visits.
5. Requiring that the certified home care company ensure that the caregivers who work with its clients have the necessary language skills to safely provide care for each client, taking into account each client’s own language skills.
6. Requiring that the certified home care company offer continuing education or training to its caregivers.

These are all standards that A Servant’s Heart Care Solutions follows, but you cannot assume that any other certified company does so without asking them.

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 and others have tried to have California adopt lightweight but meaningful licensing laws on several occasions, but surprisingly there is strong political opposition to any such state-mandated protection for home care consumers and workers in California.  Oddly enough for such a highly regulated state, you have to have a license to have a car wash, but not a home care company.

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.

Are Minimum Standards Good Enough When Selecting Home Care Companies?

Those minimum standards are necessary but not sufficient when families are deciding which company to select to provide trustworthy care for their older loved ones living at home, and families should use additional criteria and standards besides those minimum standards when selecting in-home care companies for their parents.

Starting from the list of certified companies allows you to simplify your work because it saves you the time of checking on the concerns that are addressed by the certification criteria, but you should still ask about concerns not addressed by the certification criteria.  We have written about this topic and you can read more about it at Are Home Care “Minimum Standards” Good Enough for My Parents?

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.

Among The First to Become CAHSAH Certified

A Servant’s Heart Care Solutions was one of the first Home Care Aide Organizations to be certified by CAHSAH and we have continued to maintain our certification through the annual renewal process since then.  We participated in the creation of the certification standards themselves and we encourage all providers to meet the certification standards set forth in the CAHSAH certification process in an ongoing effort to support and strengthen the industry as a whole.

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