Questions to Ask Before Hiring In-Home Health Care Services – Patrick J. Kelleher, Esq. ELDERLAWCARE.COM

There is a wide range of home health care services available from daily household tasks to medical care. Before identifying a health care service for information, get a clear idea of what you are in the market for, be it recovery from surgery or long-term care for a chronic illness. The first step is to determine what you need help with and how often you need that help. Then assess your budget to provide home health care services. Get the specific information together about the types of insurance you will be relying on for payment. Determine what your loved one’s comfort level is with the process. A non-compliant recipient of care is going to make for misery all around. Have open and non-threatening discussions with your loved one and listen to their concerns. They may give you refined information about what type of individual to look for in a home health aide such as a non-smoker, early riser, card player, fastidiously neat person, an aide with experience with a specific chronic disease, or a multi-lingual aide.

Once you have identified your needs, though they may change or need to be scaled back, the search for a provider begins. The Mayo Clinic recommends finding a qualified home care service agency. Only deal with properly licensed agencies. Most states require agencies to be licensed and regularly reviewed, so check with your state health department. Be sure the agency is Medicare-certified for federal health and safety requirements. If it is not, inquire as to why. Ask about employee screening and if the agency is willing to provide references and follow up on them. Request a list of the doctors, hospital discharge planners, and other medical and administrative workers who have experience with the agency.

The individual home health aide should have proper credentials. Check to see that they are appropriately licensed by directly checking with the licensing body itself. Does the aide have a track record, and can they provide references from at least two employers? Follow up on any references given. Also, check with your loved one’s medical team to see if they have specific individuals who would be qualified and a good fit as your home health aide. Check for the quality characteristics of the agency. How do they monitor and train caregivers? Are caregivers licensed, accredited, and insured through the agency and proper licensing bodies? Is continuing education provided to health aides? Does the overall attitude of your potential home health aide have a positive attitude and display patience? Can scheduled hours be consistent with the patient’s needs? Will the same aide reliably and routinely show up?

Once you have a few qualified home health care options available, it is time to identify which agencies are affordable to your budget in the area of your loved one. It makes no sense to learn about specific services that you cannot afford, so pricing is one of the first considerations beyond qualifications. Ask the agency how it handles billing and expenses and get literature that explains services and fees. What levels of care do they provide? It is important to get detailed, written information as to all of the costs associated with home care services. If it is not in writing, be wary and walk away.  

Does the agency allow for fees to be covered by health insurance or Medicare? Talk with the agency’s billing personnel to ensure that your health insurance is accepted and be sure to understand the criteria that Medicare requires. Do not forget to ask about financial assistance or payment plans and again request that all the information is in writing. Once you understand the payment set-up, reconfirm what services are included in those fees. Often the sales pitch in the front office does not map out to the details of fee-for-service in the accounting department.

How much will the aide charge for providing home health services, and what services are included? Does this information mirror the data provided by the agency? Inquire about sick days and check for any scheduled vacations that might impact continuing service to your loved one. Who is responsible for payroll, social security, and other taxes associated with the aide? Does your aide receive standard holidays off as defined by federal guidelines; are they paid holidays, and who pays?

Before an aide enters into your loved one’s home, there should be a written care plan that includes details about medical equipment, specific care needs, and the responsibilities of the aide and the agency. This plan is usually in the form of a 3-ring binder where an aide denotes hours of care provided and can reference doctor input, which should be frequently updated. Also in the book should be a list of responsibilities and rights for everyone involved, which is often referred to as the patient’s bill of rights. This document varies widely, but Medicare.gov provides a detailed example of what they include. 

Inquire if the agency will continue to work directly with you and other family members after the aide is identified and hired for service. What is the process for elevating concerns and complaints? If there are problems, what is the protocol to resolve them? What are the emergency plans in the event of power failure or a natural disaster that can create safety hazards, particularly with medical equipment? What are the response times during a medical emergency? Is your aide instructed to dial 911 first? Check for a back-up plan in the event the home health aide has an emergency come up or has car trouble, or inclement weather precludes them from showing up.

According to Homecare.com, the average agency health care worker has between 1 to 2 years of experience, so implement the 3 R’s and get resumes, references, and reviews. Ensure the credentialing process through your identified agency includes home health aide social security number and trace verification. Be sure it checks federal and state criminal records, sex offender registry, and valid driver’s license check through the licensing department in your state. The aide’s license and credential verification need to be vetted. Finally, there should be contact with the Fraud and Abuse Control Information Systems (FACIS), which checks for wrong actions by individuals and agencies in the health care field.

To hire the best home health care services possible for your loved one do your research thoroughly before moving forward. Once you are engaging agencies and individual aides ask questions, get literature, take notes and then follow up on references, license verifications and credentialing. The research and care you put into the process upfront can stave off unwanted complaints or problems with your home health aide selection. You will create the best outcome for the patient by identifying the most qualified and affordable candidate for your situation.

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Patrick Kelleher is an author and Estate Planning & Elder Law attorney and founder of the elder law care learning center in Hanover, Massachusetts. Patrick has been teaching free educational workshops for over 10 years at his learning center and surrounding communities. Learn more at elderlawcare.com or follow Patrick Kelleher on Facebook because you will learn a lot!  Offices in Hanover and Quincy. You can find Patrick’s new book “How to Avoid the Four Headed Monster” of Estate Planning & Elder Law on Amazon at https://www.amazon.com/How-Avoid-Four-Headed-Monster-Financial-ebook/dp/B084MB96SK

Our Elder Law Care Team www.elderlawcare.com serves families in Boston, Milton, Canton, Randolph, Dedham, Norwood, Westwood, Quincy, Weymouth, Braintree, Weymouth, Hingham, Norwell, Hanover, Hanson, Marshfield, Duxbury, Pembroke, Scituate, Hull, Cohasset, Abington, Rockland, Holbrook, Kingston, Carver, Plympton, Bridgewater, East Bridgewater, West Bridgewater, Plymouth, Barnstable, Sandwich, Wareham, Pinehills, Sharon, Avon, Brockton, Easton, Mansfield, Franklin, Newton, Wellesley, Needham, Bedford, Concord, Lexington including Suffolk County, Norfolk County, Plymouth County, Barnstable County, Bristol County, Middlesex County, Essex County, south shore, north shore, western suburbs, cape cod and surrounding communities. 

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