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What’s In-Home Care All About?

What’s In-Home Care All About?

Bob Nations, CEO of Senior Helpers in the North Bay of Northern California discusses what to look for when hiring in inhome care organization or caregivers.


Frank:  I'd like to introduce Bob Nations with Senior Helpers. Bob, great to have you on.

Bob:  Hey, it's great to be on Frank and be part of your venture in broadcasting podcasts on the internet.  I think it's an excellent idea.

Frank:  So, please tell our listening audience a little bit about not only Senior Helpers but in-home care?  And certainly there's such a tremendous growth in home care.  Maybe explain the different types of in-home care and help our audience just understand things a little better.

Bob:  When I came across this concept of home care, I thought, oh that would be interesting for me because I could help people and not have people give up prematurely or give up before their time like my grandmother had done.  So, in honor of my grandmother, I started researching homecare and came across this company called Senior Helpers and other companies that I've investigated.

And what it is we do is non-medical homecare.  What that means is that we go to the person's living environment, whether that's an apartment or a residential home or in some cases even in Assisted Living, or we've even been hired to work in nursing homes.  We go into that environment and help them do whatever they need that is non-medical.

Non-medical is kind of a gray are because we do bathing, dressing, we do bed management; we can check blood pressures, those kinds of things.  But the medical side of it is doing injections or doing Physical Therapy or doing Speech Therapy or Occupational Therapy.  Those are all medical-oriented things we don't do.  Now, we could follow directions by a licensed pro that does those medical things, but we can't do that on our own.

Frank:  Yes, there are companies out there though like yours but they're concentration is on the medical side of things right?

Bob:  That's correct.  Those are known in the industry as Home Health Agency.  A Home Health Agency can go into the same environments and do the medical side of things.  And typically, what those people..., there are two types of home health agencies:  Medicare and Private Pay.

The Medicare rule within home health is they cannot do continuous care.  What they can do is go into a home environment and help somebody for a short term in that if, in the case of my grandmother, she's fallen and broken her hip.  Now, she's come home and the doctor ordered Physical Therapy, she could in fact move back to her home now and get physical therapy done through a Physical Therapist in the home and do that up in to the point where she no longer needs it.  And she also needs to show progression.

So, typically, Medicare would approve physical therapy in the home for about 60 days of time and that physical therapist comes a couple of times a week and works with in individual and gets them back up on their feet.  So, that's a Home Health Agency.

Now, Home Health Agency would sometimes also do the private care things which means Medicare will pay for parts of it, and then you have to pay privately for the other parts of it.

The other type of agency that goes into people's homes that we work a lot with is the hospice organization.  That's when it's been determined that their life is shorter and they may be in a position where they're going to start experiencing pain and discomfort.  And so a family would bring it up, a hospice agency to help manage the pain, and manage the last months or years of a person's life.

Frank:  So, what's your suggestion where people begin?  Where do they start?  Many people have never dealt with this before.  So, it could be the first time.  So, where do they turn, where do they start?

Bob:  A couple of things that are known facts in the United States that 80% of the U.S. population want to remain in their home for as long as possible.  The other thing is that, we know that people, as we age, are likely to get at least pre-chronic problems; arthritis being number one.  So, that leads to a spot where people aren't going to keep the same lifestyle or the same things that they've been doing in the past.

And I'm just going to use arthritis as an example because it's the number one chronic illness in our country.  Because I got arthritis, I may not be keeping my house up to the same level as I always have.  So, in that case it could very well be having someone in health come in and help do the housework, a service that a non-medical home care agency might do.  But also because of my arthritis, I'm not cooking, and I'm not eating as well as I used to.  Well, that starts the vicious cycle but you start spiraling down because when you stop eating as well as you always has, then in fact, your health starts deteriorating.

So, the best thing to do is for people to start at when they start noticing signs that "I'm not eating as well, I'm not eating as often, and I'm not keeping my house up."

When you start seeing signs like that, particularly family emergencies are going to visit mom and she kept an immaculate house, and all of a sudden she's not doing that, and when you look in the refrigerator there's no real food in there, those are sign that, "Oh you know, she may need some help."  Because what's happening today is most of the time people don't call for help until something tragic happened. And that's when they contact my company.

So, what we try to do is educate adult, children, and also the older population about what we do as a servant.  And when people start changing their pattern, then that's the time to call us and get us involved.  Don't wait until the tragedies happen and now you ended up in the hospital and now you need help, although we do respond to that as well.

Frank:  So how does somebody know what types of questions should they ask of a company like yours?  What types of things should they be looking at that kind of compare and make sure that they have the right fit?

Bob:  Well, the first question that I would, there's several questions, I'm glad you asked that because that's really important.  No matter who you're hiring or you're talking to, whether an agency and/or hiring somebody that's privately running an ad in the paper, and you got somebody coming in the home, the thing's that you need to find out about is, number one is, did they have experience?  I mean do they know how to do certain things because, if in fact they don't know how to do certain things, then they couldn’t affect and they're hurting someone.

Secondly is, what kind of background do they have?  In the case of hiring an individual, you can go down to your local government agency and ask to see if they would perform a background check.  If you're hiring an agency, ask them, "Do you do a background check?"  But don't stop there.  Ask "What type of background check?"

So, what you want to do is you want to find out what kind of background check they're doing.  What I look for is a company that's doing a background check that's going actually down to the county records seeing if this person has had any violation whether that's criminal activity, going to the Department of Motor Vehicles to determine what their driving record is.

So that you really get a really good sense of who this person is because as you all know in the interview process, you're going to put your best foot forward because you want the job and you're going to tell me what I want to hear. What I want is to see what I can find out about you.  We do three different kinds of background checks.  Number one is we do fingerprinting which allows us to find out from the Department of Justice here in California whether that person has had any criminal activity.

We also do a national search because if this person I'm talking today and hiring has lived in Alabama for the last 10 years and just recently moved to California, well, my California background check with the Department of Justice is not going to tell me that.  So what I've got to do is go and access a national database to find out what their activities were in Alabama.  So that's important.

And my third is what kind of driving record?  That's important because that gives you all kinds of different little signals.  Because if you've got somebody who's consistently getting ticketed, well, what kind of judgment are they using?  Because if they're consistently getting ticketed, then they're not using their judgment while they use good judgment when they're taking care of your mom. And last but not least if they've got a pattern of drinking while intoxicated which shows up of course on their DMV, that's not a person you really want somebody driving around your mom either.  So those are the kinds of things that I recommend.

The next thing is make sure that the agency that you're working with is an agency that employs the caregiver that they're talking to you about, because there are two different kinds of agencies that you could be talking to.  There’s one that's called the referral agency where you may be hiring a caregiver from them but in fact you as the homeowner become the employer.

So, in that case, then you're responsible for them for paying into their taxes, if they fall in your home and get hurt; you're responsible for their medical bills.  And I always believe, you know, before I got into this business, "Oh when someone comes in my home and falls or gets hurt, I just call my homeowners, and my homeowners covers it. Well that's not the case.  Homeowner's state that if you have a person coming into your home on a one-time basis, your homeowner's chance are would cover someone getting hurt.  But if you have someone consistently coming into your home and this case taking care of your mom, then in fact your homeowners will not take care of that expense.

So there comes a liability that you've brought into yourself or brought upon yourself by hiring somebody who hasn't been consistent coming to your mom's home and they fell on the kitchen floor and hurt themselves.  So you've got to be careful of that kind of thing.

Also, you don't want the government come looking for you for any back taxes that may be owed if you are the employer record.  In the case of my agency, all of my caregivers are my employee.  So, it's my responsibility to make sure that the taxes are paid, make sure they are covered under workman's comp.

Last but not least is you want to make sure the person's bonded and insured, and those are different, I always thought that maybe they're the same.  But those are different because if there's a problem in that the person covered in the home breaks something, then you want to make sure that they have insurance in order to cover the breakage or the loss of that.

So those are all things that need to be considered when you're hiring somebody to take care of your mom.

Frank:  These are great points and I think you know without even a family asking specifically if you hear probably I would think if one company charging so much per hour and another company charging quite a bit less per hour, that will kind of tell you that not all things are included in the lower price.

Bob:  Well, exactly.  That's simply a red flag.  If you find a big discrepancy in prices between agencies, chances are that person, that agency you're talking to at the lower end is a referral agency.  And all they're doing is referring a person to you.  And when that person becomes in the employment, that person is your employee, not their employee.

If you've got a company that's charging more money, then in fact the reason why they're probably charging more money is because they are paying the taxes, it's because they are paying workman's comp, and they are paying insurance to protect our mom in case something goes wrong.

Frank:  Great!  Thanks so much and thank you all for listening.  I'm your host, Frank Samson, on the Aging Boomers.  You can get more information on my company at seniorcareauthority.com.  You could also listen to all the Itunes podcasts at my previous radio show at www.theagingboomers.com.

What’s In-Home Care All About?