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Caregiving Chronicles

News and analysis on caregiving topics in MetroWest and beyond.

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Caregiving Chronicles will present news and analysis on caregiving topics in MetroWest and around the world, in-depth Q&As with experts in fields related to caregiving and updates and announcements about caregiving resources available in MetroWest from CaregivingMetroWest.org Program Director Douglas Flynn.


Caregiving Chronicles Q&A: Navigating the world of home health care
By Douglas Flynn / January 6, 2015

Home health care aides are a vital part of the health care system, but understanding the different kinds of home health care available and finding the best options for your unique situation is often one of the biggest challenges facing caregivers.

In the latest edition of our Caregiving Chronicles Q&A series, we spoke with Lisa Gurgone, the Executive Director of the Home Care Aide Council to discuss the work that the Council does, the different kinds of home health care aides and advice to help find the right home health care aide for you and your loved one.

Caregiving MetroWest: What is the Home Care Aide Council?
Lisa Gurgone:
The Home Care Aide Council is a non-profit trade association with over 150 members throughout Massachusetts committed to enhancing quality of care throughout the home care industry by focusing on the advancement of the home care aide workforce.

Home care aides are the heart of the Commonwealth's home care system, providing personalized and supportive services that enable our elders and disabled children and adults to remain at home. The Council works with state agencies, the legislature, the media, and the general public, providing timely information and education on home care services and advocating for the priority of home care issues and initiatives.

The purpose and primary functions of the Council are to:

•    Establish Standards of Best Practice for Home Care Aide Services in Massachusetts for certified, non-certified and private pay home care agencies
•    Develop publications and other resources home care agencies and training providers can use to ensure that their organizations comply with laws and regulations governing home care aide services and training
•    Partner with the workforce development community to provide access to career development opportunities and grants to the home care aide workforce
•    Educate our leaders on the needs of the home care industry (including home care aides, home care clients, and home care agencies) and the link between the workforce and quality of care

CGMW: What is your role with the Home Care Aide Council?
LG:
I have served as Executive Director of the Council since 2002.  Through this role, I am responsible for managing all operations of our association and for advancing our mission, vision, and strategic plan as crafted by our Board.  My responsibilities include: implementing policies and carrying out activities for the Council, working on regulations to establish and maintain statewide standards for paraprofessional home care services, acting as a liaison to state agencies and advocacy groups, developing membership, organizing all events and educational programs, participating in coalitions and partnerships to advocate for policy changes on both the state and national levels, working with members to create both short and long term strategic planning for the organization’s future, and producing communications including monthly newsletters and legislative alerts.   

Throughout my tenure as Executive Director of the Council, I have also served on numerous committees and advisory boards where I have worked to educate policymakers and the public on the needs of the home care aide workforce.  For instance, I served as a lead partner on the Massachusetts Personal and Home Care Aide State Training (PHCAST) Initiative funded through the Affordable Care Act to develop an enhanced training program for direct care workers caring for clients throughout the Commonwealth.  In 2014, I was appointed by Governor Deval Patrick to serve on the Massachusetts Elder Economic Security Commission.  I also serve as a legislative appointee to the Massachusetts LGBT Aging Commission.  

CGMW: What kinds of different home care aides are available and what are the differences?
LG:
Throughout our history, the Home Care Aide Council has worked with state purchasing agencies and regulators to develop the following Massachusetts career ladder for home care aide services:

Homemakers – provide assistance with: shopping; menu planning; meal preparation; laundry; light housekeeping including, but not limited to, vacuuming, dusting, dry mopping, dishwashing, cleaning the kitchen and bathroom, and changing beds; and training in home management. Homemakers are NOT allowed to provide hands-on care to clients.

•    Training: 40 hours of training is required within the first six months of employment, at least three of which must be given as orientation before placement. The subjects in the training and orientation follow the Council’s Training Course outline.
•    In-service training: Six hours for full-time employees, pro-rated for part-time employees is required.
•    Supervision: In-home supervision not less than once each quarter by a qualified supervisor in a representative sample of a homemaker’s clients.

(Source: Homemaker and Personal Care Homemaker Standards of the Executive Office of Elder Affairs.)

Personal Care Homemakers – provide assistance with: bathing; dressing; shampoo and hair combing; foot care (excluding nail cutting); denture care; shaving; bedpan routines; eating; and ambulation and transfers (assistance only).

•    Training: Before providing personal care, the aide must have completed the 40 hours of homemaker training plus an additional 20 hours in personal care conducted by a qualified Registered Nurse, three of which is a practicum.
•    In-service training: See Homemaker in-service training. One half of the hours may be one-to-one supervision of personal care.
•    Supervision: Introductory orientation visits in each client’s home by a qualified nurse on the first day of service and in-home supervision by a qualified nurse not less than once each quarter.

(Source: Homemaker and Personal Care Homemaker Standards of the Executive Office of Elder Affairs.)

Home Health Aides – provide hands-on personal care, simple procedures as an extension of nursing or therapy services as delegated by the nurse or therapist, assistance in ambulation or exercises, and assistance in administering medications that are ordinarily self-administered.

•    Training: 75 hours, including a practicum of 16 hours, covering subjects specified in the Health Care Financing Administration’s Conditions of Participation for Home Health Agencies, 42 CFR Part 484.
•    In-service training: 12 hours per calendar year.
•    Supervision: If the consumer is receiving skilled services, every two weeks by the appropriate clinician; if the consumer is receiving unskilled services, every 60 days.

(Source: Center for Medicare and Medicaid Services’ Conditions of Participation for Home Health Agencies, 42 CFR Part 484.)

Supportive Home Care Aides – provide assistance with: meal preparation; shopping; menu planning; laundry and housekeeping; personal care; escort services; and socialization and emotional support. These services are provided to clients with emotional or behavioral problems.

•    Training: 75-hour home health aide training plus an additional 12 related to the responsibilities of the Supportive Home Care Aide. There are two Supportive Home Care Aide Training tracks: Mental Health Supportive Home Care Aide and Alzheimer’s Supportive Home Care Aide.
•    In-service training: Minimum of 12 hours per year.
•    Supervision: Weekly support through training/in-services, team meetings, or supervision that includes in-home, by telephone, or in person. Team meetings shall be held quarterly.

(Source: Supportive Home Care Aide Standards of the Executive Office of Elder Affairs.)

Hospice Aides – provide hands-on personal care, simple procedures as an extension of nursing or therapy services as delegated by the nurse or therapist, assistance in ambulation or exercises, assistance in administering medications that are ordinarily self-administered, and services beyond those listed above related to Hospice care.

•    Training: 75 hours, including a practicum of 16 hours, covering subjects specified in the Health Care Financing Administration’s Conditions of Participation for Hospice Care, 42 CFR Part 418.
•    In-service training: 12 hours per calendar year.
•    Supervision: If the consumer is receiving skilled services, visits with consumers are required every 14 days by a nurse. In addition, an annual visit by the nurse while the consumer is receiving care.

(Source: Center for Medicare and Medicaid Services’ Conditions of Participation for Hospice Care, 42 CFR Part 418.)

Companions – provide non-personal, non-nursing care to clients. Companion-provided services are activities related to: socialization and recreation; assistance with the preparation of light snacks; help with shopping and errands; and escort to medical appointments, nutrition sites, and walks. Companions are NOT allowed to provide hands-on care to clients.
    
•    Training: None required – The Council recommends Companions receive a three-hour orientation.
•    In-service training: None required – The Council recommends home care agencies offer in-service training to Companions based on their agency policies.
•    Supervision: None required – The Council recommends in-home supervisions be conducted by a qualified supervisor at least once quarterly.

(Source: Attachment A of the Non-Homemaker Provider Agreement of the Executive Office of Elder Affairs.)


CGMW: What are home care private pay agencies?
LG:
Caring for a loved one at home can be an overwhelming experience.  Fortunately, there are many options today for those who need assistance to remain safely in their homes.  However, deciding which option is best for your family can be difficult if you don’t understand your options and know what to look for.  Most people are not aware that Medicare and most insurance policies cover only short-term clinical home care aide services for limited increments of time.  Fortunately, Massachusetts can offer assistance to some families through our state Home Care Program and other services offered through the Aging Services Access Points, Senior Care Options Program, PACE Program and other programs.  

However, the amount of care provided through insurance and other programs is sometimes not sufficient to keep a person safely at home once their medical needs have been met.  In those cases, their family might choose to purchase additional services for their loved one through a private pay home care agency.  If an individual purchased a long-term care insurance policy, they should check to see if their policy covers home care services.  Private Pay Home care agencies accept payment for services directly from individuals and can also bill long term care insurance when applicable.

CGMW: What are the differences between using a private pay agency and hiring a caregiver privately?
LG:
As a business in Massachusetts, a home care agency must follow laws and regulations designed to protect both the consumer of care (and his/her family) and the home care worker. These include conducting criminal background checks and employment authorization/immigration checks, maintaining worker’s compensation insurance and professional/general liability bonding, and complying with state and federal tax requirements, including Social Security.

In addition, home care agencies are responsible for managing and supervising all of the care provided in your home. They are responsible for hiring, interviewing, and employing the home care workers providing care in your home.  They conduct reference checks and are responsible for ensuring that all home care staff are properly trained and supervised.  The home care agency will work with the consumer and his/her family to develop a service plan and select the appropriate home care workforce to meet their needs. They will manage the schedule for your caregiver and have professional staff available 24 hours a day to answer any questions you may have.  The agency can also provide back-up support to the home care aide and your family as needed.

When a consumer or his/her family hires a caregiver on their own to provide care to their loved one, the family is responsible for all of the tasks listed above and takes on all of the liability required with employing a caregiver.

CGMW: What services can you get from a private pay agency?
LG:
The types of private pay home care services available vary greatly depending on the needs of the individual receiving service.  Home care services may include:
•    Home Health Aide
•    Homemakers/Personal Care Homemakers
•    Companions
•    Case management services
•    Specialized Alzheimer’s and dementia care
•    Skilled Nursing Services
•    Overnight care
•    24-hour care
•    Live-ins
•    Respite care
•    Laundry services
•    Medication reminders
•    Transportation

CGMW: How can you pay for those services?
LG:
Private Pay Home care agencies accept payment for services directly from individuals in the form of cash, check, or credit card.  Agencies will also bill long term care insurance when applicable.  Many private pay home care agencies require a deposit before providing services to a client and some have service minimums.  

CGMW: What should you ask or do to find the right home care aide for you or your loved one?
LG:
When selecting a home healthcare agency, it is important to know what questions to ask. Hiring in-home care requires due diligence. By educating yourself, you can determine your needs and find a qualified reputable agency that employs caregivers who will care for your loved one with compassion and skill.

Start by acquiring the names of several home healthcare agencies as you will want to learn more about their services and reputations. Ask for a list of references, such as doctors, discharge planner, patients or their family members, and community leaders who are familiar with the provider’s quality of service. Next, ask important questions that will help you determine the best home care provider for you or your loved one. Below is a list of 10 basic questions you will want to ask any prospective home care provider
1.    How long has the agency been providing private duty home care?
2.    Is a written, customized care plan developed in consultation with the client and family members, and is the plan updated as changes occur?
3.    Does the agency employ a nurse, social worker, or other qualified professional to make regular visits to the client’s home? How frequently?
4.    Do they closely supervise the quality of care, including maintenance of a daily journal in the client’s home and non-scheduled supervisory visits?
5.    Do they provide a written document that states the rights and responsibilities of the client, and explains the company’s privacy policy and code of ethics?
6.    How are emergencies handled after normal business hours?
7.    What are the hiring requirements for prospective employees?
8.    What screenings are performed on caregivers before they are hired?
9.    Does the agency train caregivers? What does that training entail?
10.    Are the caregivers insured and bonded through the agency?

CGMW: Is there anything else people should know about home care aides?
LG:
Home care aides are the heart of the state’s home care system. In FY14, these front-line caregivers provided over 43,000 elders with more than 8 million hours of the basic care they need to remain in community-based settings.  Home care is widely acknowledged as a high-quality and cost-effective solution in caring for elders and disabled individuals. With the advent of the Affordable Care Act, Accountable Care Organizations, Community-Based Care Transitions, and Patient-Centered Medical Homes, home care aides will play an essential role as they assist with the monitoring of conditions and provide direct daily care to consumers.  

Yet, all too often, these dedicated workers committed to caring for others, struggle to support themselves and their families. On average in Massachusetts, home care aides most part-time and earn on average $12.31 an hour or $16,003 per year.  Forty-percent of direct-care worker households in Massachusetts rely on some form of means-tested public assistance, including Medicaid and food and nutritional assistance.  

Massachusetts, like the rest of the nation, is already facing a shortage in the number of the home care aides needed to care for individuals in community-based settings.  Personal Care Aides are #2 and Home Health Aides are #3 on US Department of Labor list of the 30 Fastest Growing Occupations in our nation by 2022.  Nationally, the demand for home care aides is anticipated to expand at a rate 4 to 5 times higher than the general job growth rate.

In the coming years, the success of our Council to advocate for additional resources and solutions to support this critical workforce will depend upon our continued collaboration with partners throughout the elder care system.


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Caregiving MetroWest is a no-cost program of BayPath Elder Services, Inc. and was made possible in part by grants from the MetroWest Health Foundation.

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