A Q&A WITH THE CAHC TEAM - ANSWERS TO YOUR HOME CARE QUESTIONS
We asked the members of the CAHC team to discuss some of the top issues and concerns that families should address when choosing a home care agency. The following insights and advice are based on many decades of their collective experience in the home care field. You can scroll down as you read or CLICK on the questions.
• How do I start choosing a home care provider?
• Why does CAHC accreditation make a difference when choosing a home care provider?
• What is the difference between licensing and accreditation?
• If I don't have Medicaid which requires accreditation, why do I need an accredited agency?
• How do I find out my payment options?
• What is the difference between good home care and bad home care?
• What is the aide or nurse going to do for the home care patient?
• Struggling with obtaining home care services or feeling conflicted?
• What if you feel there is a problem with the provider's quality of the service or suspected abuse?
• If I have loved one in home care, what should I be monitoring? Precautions?
• How much supervision does the home care staff get from the home care agency?
How do I start choosing a home care provider?
There are typically two scenarios when home care services are needed. The first scenario is when someone has a stroke, accident, or other type of acute medical episode and needs home care for a defined period of time after a hospital stay.
The second scenario occurs when someone gradually becomes ill or frail, and it becomes obvious they need help in the home.
In the first scenario, typically the family can speak to a hospital discharge planner, nurse case manager, or social worker while the patient is still in the hospital. These professionals can assist you in setting up services for the short term through an appropriate source from a Medicare certified provider. You should also talk to the physician about coordinating care after the patient is discharged from the hospital.
Unfortunately, families sometimes get very short notice about the patient’s discharge and are overwhelmed about the type of care that may be needed at home. So, it is important to be proactive about getting the discharge planning help you need. The hospital may suggest a few home care providers, but they generally cannot suggest just one or "the best one" if asked.
In the second scenario, our listing of CAHC accredited agencies is a good place to start. But before you call, you need to determine what your care needs are and any other considerations, like language, that are important. That way you can select an agency whose services are a good fit for your situation. You can make the arrangements for care directly with the agency.
We strongly recommend that you use the CAHC website to get a list of the accredited agencies in your county. Click Here for our listing of accredited agencies. They are organized by county and will make your search easier. When obtaining services through a CAHC accredited agency, certain standards must be followed: A registered professional nurse will conduct an in-home assessment of the patients’ needs and develop an appropriate plan of care. Ongoing supervision is required to determine if the plan of care is being followed properly, and the patient’s status is evaluated to determine if changes are needed. Staff members are supervised in-home and must undergo competency testing to ensure they have the proper skills to safely provide patient care.
Accredited agencies are required to follow federal, state, and local regulations. Agencies or "freelance home aides" that are not accredited do not meet the same standards of professionalism, safety, or quality of care.
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Why does CAHC accreditation make a difference when I choose a home care provider?
Home care is a very specialized area of healthcare. The staff at CAHC are home care experts who try to ensure that agencies deliver on their promise of service, meet industry standards, and follow best practices for care. We pride ourselves on being New Jersey's eyes and ears for the home care industry.
In 2010, our agencies reported that they provided personal care services to 36,429 patients and provided skilled nursing services to 2,367 patients. In all, 38,796 patients were serviced by CAHC accredited providers in New Jersey in 2010.
If you are entrusting someone to perform home care services for a family member, you want to be sure the person entering your home is thoroughly screened. While accreditation is not a guarantee of employee performance, it provides an important safeguard for home care clients.
Homemaker-home health aides and nurses employed by accredited agencies have been interviewed, have provided references, and have a current license or certificate from the New Jersey Board of Nursing (for more details Click Here for A Consumer’s Guide to Homemaker-Home Health Aides). Screening also includes an initial physical examination and screenings for tuberculosis and other diseases..
In addition, accredited agencies are required to supervise their homemaker-home health aides and nurses. They need to ensure that aides, LPNs, and RNs delivering home care have the necessary skills to take care of their patients. Freelance agencies may not have this level of supervision. Homemaker-home health care aides from accredited agencies are supervised by an RN, who visits the home to establish a care plan. The patient and family participate in the development of the plan of care. The RN then supervises the aides to ensure the plan of care is followed as it should be. Again, this may not be the case with a "freelance" agency.
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What is the difference between licensing and accreditation?
In New Jersey, there are agencies that provide home care services without being licensed by the State to do so. “Licensing” is permission granted by a competent authority to engage in a business or occupation. In selecting home care services for a loved one, an important first step is to discover if the agency is licensed by the State of New Jersey.
There are two types of home care agencies in New Jersey: certified home health agencies and health care service firms. The home health agencies are Medicare certified, and licensed by the New Jersey Department of Health and Senior Services. Medicare certified agencies provide skilled services to homebound patients, such as nursing, physical therapy, and speech therapy on a short term, intermittent basis, usually after an acute illness or hospitalization. Medicare certified home care agencies are generally accredited by a national accrediting body.
The second type of agency, health care service firms, is authorized by the Department of Law and Public Safety, Division of Consumer Affairs to provide home care services.
“Accreditation” is a voluntary process in which the provider has allowed an independent, outside entity to evaluate its operation before earning the “seal of approval." When an agency is accredited, it is voluntarily submitting its operation for examination and must meet specific standards of care to qualify. The provider must undergo annual site surveys to ensure ongoing compliance with the Accreditation Standards before accreditation is renewed each year. CAHC providers may receive accreditation for Personal Care Services, In-Home Skilled Nursing services, or both. In selecting home care services for a loved one, ensure that the agency is both licensed and accredited.
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If I don't have Medicaid, which requires accreditation, why do I need an accredited home care agency?
Finding safe home health care services is no easy task. Even if you don't have Medicaid and must depend on private pay, a CAHC accredited provider is a better choice compared to finding an agency on the internet, in newspapers or magazines, or through word of mouth. Not all home health care is equal. While many consumers employ aides privately, this can be a dangerous practice when you consider these questions:
- What guarantee do you have of the aide’s training, skills or competence?
- Has a criminal background check been conducted? Have references been checked?
- Who pays the employment taxes, worker’s compensation, and disability for an aide privately employed in your home?
- Who is liable if the aide is injured while in your home?
- Who will oversee the care provided?
- Who will evaluate the aide’s performance?
- Who will cover for the aide if he/she is ill and unable to come to work?
New Jersey has over 900 health care service firms. CAHC accredits approximately 175 of them each year. Every New Jersey home care agency we accredit is monitored on at least an annual basis and must meet our performance standards, including the screening of their employees. That is why CAHC accredited home care agencies are the right choice - no matter whether you have Medicaid, insurance, or private pay.
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How do I find out my payment options?
Most CAHC accredited home care agencies are eligible for payment by Medicaid. To determine if the person needing home care is eligible for Medicaid or one of the special state assistance programs for home care, Click Here to order A Shopper's Guide to Long Term Care Insurance (it is the last booklet listed) for more details to help you find your options from the National Association of Insurance Commisioners. If the person is not eligible for state assistance, contact your insurance company to see what services they will or won't pay for. Sometimes, insurance companies will restrict you to selected providers. Other times, they will allow you to use any accredited provider in the state.
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What is the difference between good home care and bad home care?
Everyone wants good home care for the person they care about. They want to be able to trust the care-givers that come into the patient’s home. They want to be assured that the patient is getting quality, compassionate care.
Choosing an accredited agency is a very important first step to ensure that good home care is being provided, but it is not an absolute guarantee. It is essential that as a healthcare consumer or advocate for a home care patient, you remain attentive, and monitor the care that is being provided.
Good home care begins with knowing who's walking in your front door. It is knowing that the person that you or your insurance is paying for to take care of your loved one has had adequate training, is being supervised, and that the level of care has been determined by a registered professional nurse. Good home care means that the person has been properly screened.
Good care is knowing that your care is being evaluated and assessed by a registered professional nurse, and that there are changes to the care based upon that professional's evaluation as well as input from the patient and family.
A good agency is one that is responsive - that responds quickly to concerns and addresses them right away.
Bad home care is the opposite. You don't know who is coming into your home. You don't know what screening or training the aide or nurse has had. There are also liability issues that most consumers don't think about. What if the person falls or is injured in your home? What about disability, workers' compensation and employment taxes? Some people pay privately "under the table" for home care services, but there are pitfalls that come with that choice.
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What is the aide or nurse going to do for the home care patient? What kind of care can we expect?
It’s important to understand the different kinds of care that are provided by different professionals and workers to ensure that all of the needs of the patient are being met.
Generally speaking, health care services may be provided by registered professional nurses (RNs), licensed practical nurses (LPNs), and other health care providers - such as occupational therapists, physical therapists, respiratory therapists, dieticians, and social workers.
Personal care services are provided by certified homemaker-home health aides (C.H.H.A.). An RN develops a plan of care and supervises the homemaker-home health aide and the care provided. Homemaker-home health aides provide personal care services such as bathing, dressing, meal preparation and feeding. In New Jersey, certified homemaker-home health aides must work under the direct supervision of a registered professional nurse through an agency. Aides may not work “freelance.”
For the most part, housekeeping services such as shopping, cooking, and laundering for the family are provided by a housekeeper, companion, or a domestic service rather than a C.H.H.A.
In order to know what type of care you are going to get, ask specific questions. Will the bed be made? Is there help with a bath or shower? Do you only provide companion services, such as watching TV with the patient? If the patient requires nursing services, and the agency sends a companion who cannot perform medical tasks like emptying a catheter bag, then you are paying for a service that is not on the level of care needed.
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Struggling with obtaining home care services or feeling conflicted?
Some people struggle with obtaining home care services for their loved one - they may feel conflicted that they are not providing all the care themselves.
Elderly people generally prefer to live in their own home as opposed to a living in a nursing home or moving in with an adult child. Home care enables them to stay at home while addressing their need for support - whether it be medical, assistance with daily living tasks, or companionship.
Many adult children of elderly parents are in the "sandwich generation" - typically a two-income family with children at home and an older adult who needs care. These families have real world constraints from their jobs and family life. Family members who feel torn about home care should try to assess what they can realistically provide given their circumstances and obligations.
The foremost concern for your loved one should be, is the level of care that I can provide sufficient and safe? Click Here for some helpful tips on how to talk with your senior about home care.
It is important to remember that the home care caregiver does not supplant a family member. A home care caregiver does not have the same bond you have developed during the years of your relationship with your loved one. While you are providing an oversight function while your loved one is receiving care, you can also continue to maintain your relationship.
An important part of taking care of someone who needs help is taking care of yourself. If you are overly stressed or exhausted, you need help. Home care services give caregivers a break or respite. By having home care, you can usually sustain the care needed for a longer period of time. Providing better quality care by getting home care can help reduce the guilt you may have.
We also suggest considering a caregiver support group as an option - sharing your experience with others in the same circumstances as you can help you feel better. Click Here for a list of support groups in your area.
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If you feel there is a problem with the home care provider - whether it is the quality of the service or suspected abuse - what can you do?
If your nurse or homemaker-home health care aide is from an agency, you should start by reporting your concerns to the agency. One of the questions you should ask when choosing an agency is how they handle complaints or concerns. Many will provide a resource guide explaining their home care operation including how to address complaints. It should state clearly who to contact - whether it is the owner, director of nursing, or director of operations, etc - and how to do so. So, your first step should be contacting the agency.
CAHC accredited agencies are required to have an internal process of investigating grievances. If you make a complaint and you are not satisfied with the internal process, you have the following options:
File a complaint with the NJ Division of Consumer Affairs, Department of Law & Public Safety. All CAHC accredited agencies are health care service firms.
For patients receiving Medicaid funded care: Notify the NJ Department of Human Services and/or NJ Department of Health and Senior Services.
File a complaint against a particular nurse or homemaker- home health aide: notify the NJ Board of Nursing.
If you suspect theft or fraud, you should also contact the police. If the agency is a CAHC provider, please contact CAHC so we are aware of the problem. If you believe physical abuse has occurred, you should contact your local police department and your local Adult Protective Services unit which is usually located in the social services department of your county. In the event of child abuse, you can contact Division of Youth and Family Services (DYFS) which is part of the Department of Children and Families.
One caveat to keep in mind is that people with dementia or Alzheimer's Disease may imagine they are having items stolen or that someone is acting abusively. You need to assess the situation to determine how to respond. Does the person have bruises? Have you looked for "missing" items? When an agency has an internal process to investigate your concerns, it may prevent you from jeopardizing a good care-giving situation by making unfounded accusations. On the other hand, having a clear process to address your concerns allows you to act effectively if
an abusive or fraudulent situation actually exists.
If your aide is a "freelancer," you have fewer options. If someone is a freelancer, and you suspect criminal behavior, then contact the police. If you have a concern about the aide’s credentials or whether the aide is certified, contact the NJ Board of Nursing.
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If I have loved one in home care, what should I be monitoring? Precautions?
Whether you have a certified homemaker-home health aide or a freelancer, the family has to have a presence in the home. They have to be aware that there is a stranger in the house, and that they are leaving a loved one who is vulnerable and frail alone with an aide or a nurse. There is a responsibility on the part of the family to be involved in the home care process and to monitor it.
A simple precaution is to drop by unannounced periodically to check what goes on during a typical day. Another important safeguard is to talk to the older adult receiving home care without the caregiver present. Ask them for feedback.
Make it clear that they don't have to be afraid that you are going take the caregiver away, but you really want to know their perspective. Sometimes older adults feel like they have to accept whatever they get. It is important to allow the older adult to feel like they are empowered to give real feedback and, if the situation is not okay, that you will do something about it. As discussed previously, a person with dementia may accuse their caregiver of stealing. One way to prevent this situation is to be sure that valuables such as jewelry, cash, or important papers are safely secured.
It is also important to remember that the home care arrangement is a work arrangement and that the caregivers are not family members. Aides, nurses, and the elderly often develop close, personal relationships. There's a level of intimacy in the relationship that can develop when the aide or nurse is taking care of very private needs.
Your loved one is grateful for the support he or she receives and often comes to feel that their aide or nurse is a member of the family. You have to draw the line and ensure that your senior does not give them money or other valuable items or share confidential information with their aides or nurses.
Consumers can go on the NJ Board of Nursing website to check the licensure or certification of nurses and aides. They can go to the websites of the Department of Health and Senior Services (for Medicare certified agencies) or the Division of Consumer Affairs (for health care services firms) to check the licensure of the agency that they're using.
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How much supervision does the home staff get from the home care agency?
Supervision is the difference between working with an accredited agency and a freelancer, even if the freelancer was recommended to you by a friend or family member.
Home care is a very autonomous role for the professional and paraprofessional. Unlike a hospital or assisted living facility where many others work with them, nurses, and aides work alone in the home with your loved one who may be quite vulnerable. A key consideration is the amount of oversight or supervision that the caregiver receives. Is there an assurance that care is conducted the way it should concerning safety, infection control and similar issues? Is there someone who is monitoring the care? The advantage of using an accredited agency is that you know that the employees are screened, supervised and a registered professional nurse is monitoring the level of care.
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