Eventually, most families who have loved ones with dementia will have to make the difficult decision about living arrangements.  Nursing homes, assisted living facilities, in home care…there are many options and important decisions to be made.  When my brother and I made the decision to keep our parents living at home (his home) for as long as possible, we had no idea how to go about finding a professional caregiver, nor did we know what questions we should ask to be sure that we were selecting the right person. 

DMDEC thought it would be helpful to write a brief article on the subject of selecting a home care provider, and consulted with one of our favorite caregiver experts, Julie Kollada, a Certified Dementia Practitioner and owner of Open Arms Solutions, an in-home care provider based in Northbrook, Illinois.  I hope you find her advice helpful.

DMDEC:  Making the decision to bring a professional caregiver into the home can be a difficult and emotional one.  My parents insisted that they were fine on their own, but they were obviously not fine.  It wasn’t easy to “defy” them, but we knew what was best.

JK:  Unfortunately, there comes a time when people need more help with their day-to-day tasks.   Statistics report that 1 in 3 persons over 65 take a fall at home each year, 1.8 million are treated in ER for non-fatal injuries, and 433,000 are hospitalized.

DMDEC:  Are there warning signs that can help a family determine if home care is needed?

JK:   Yes there are.   They include:

• An accumulation of diagnoses (more than two)        
• Falls or repeated hospitalizations
• Short-term memory problems
• Periods of confusion or disorientation
• Calls from your parent’s friends/neighbors expressing concern
• More frequent requests for help or support
• Weight loss over the past year

If you live far away from your loved one, you may need to make frequent visits to assess their situation.  You may also want to reach out to their friends, neighbors and clergy to help you gather accurate information about their situation between your visits.

DMDEC:  Or you may want to consider retaining a local Geriatric Care Manager if no one else is available to help you, correct?  A GCM can assess the situation and provide you with options and resources to get your loved ones the help they need.

JK:  That’s correct.  No matter how you go about getting it, a functional assessment is critical when taking stock of an aging senior’s needs.  Normal aging, dementia, disease, and hospitalization can contribute to a decline in the ability to perform tasks necessary to safely live independently.  The information obtained from an assessment can assist in creating a plan for care services that might include meal preparation, nursing care, personal care, continuous supervision, fall prevention, companionship, transportation, and light housekeeping.  This plan can help the family decide on the home care services they need.

DMDEC:  So once it’s decided that a home care provider is a good option—and it’s not an option for everyone— how do you go about selecting a homecare agency?  What questions should we be asking to vet the agencies and select the right one for our particular situations?

JK:   Here is a list of questions you definitely want answers to:

• If you found the nearest home care agency online through Google or similar, it’s important to make sure that the agency is licensed to provide care in your loved one’s area within that county.  It’s not always the case.      
• Ask if their caregivers are insured.  This is important if they need to drive your loved one to a doctor’s meeting.  While you are at it, ask about their driving record so you know that your loved one will be safe if they are driven by them. 
• Many home care agencies have a minimum amount of hours of care.  Ask about that. (Wonderful caregivers are invaluable, so offering them a minimum hour shift helps agencies keep the best employed.)
• Is there a cancellation fee?  If so, know the terms so you can avoid unnecessary charges.
• How do they know their caregivers have arrived?  Ask about their clock-in system and what happens if a caregiver does not clock in on time.  What other supervision methods do they employ?
• Can they provide your loved one with consistent caregivers?  An ability to provide the same caregiver or caregiver team helps everyone to form a deeper connection.  This is not only good for your loved one, but it helps the caregiver to discover any changes in their behavior/health.
• If there are changes in their behavior/health, what is the communication plan for their doctors/family/care managers?
• Some home care agencies have specializations for different needs.  Ask if they have any and if they will benefit your loved one. 
• Many home care agencies will allow you to personally interview the caregiver they pick for your loved one.  Just ask.  It could help you become more at ease with the idea of leaving them with your loved one.

DMDEC:  Oh, I would insist on that.  Considering that they’d be taking care of a precious person in your life, inside a family home, I would insist on interviewing the person before hiring them.  Actually, I wouldn’t go with an organization that doesn’t let me meet the person or persons that will be in my parents’ care.

JK:  I understand. Welcoming someone into your home to care for a loved one is a hard decision.  It’s okay to call multiple home care agencies and “interview” them.  Most agencies understand the importance of this decision, the difficulty of it from an emotional standpoint, and are willing to answer your questions.  They know you’re asking because you care.  If an agency isn’t willing to do everything they can to make you feel at ease, then go somewhere else.

DMDEC:  I agree.  I understand that there are Home Care Registries that are different from Home Care Agencies.  Can you explain how they differ?

JK: The main difference between agencies and registries is agencies’ caregivers are their employees versus registries’ caregivers are their contractors.  Home care agencies employ, train and supervise their employees. They are responsible for making sure care is provided to the patient.  They conduct interviews, check references and perform a criminal background check on caregivers.  They manage and supervise the caregivers and are responsible for arranging for a substitute if the caregiver is absent.

DMDEC:  So if you go the Registry route, you are cutting out the middle man, so more of the responsibility falls on you.  I suppose that might be a less expensive option, but it’s probably not the best option for families that live far away from their loved one and can’t be more involved or be there at a moment’s notice to take care of problems should they arise.

Thank you so much for your time, Julie.  I know that a lot of people will find your advice helpful when the time comes for them. 

To contact Julie Kollada directly, or to learn more about the services of Open Arms Solutions, please click here:  www.openarmssolutions.com.   For a handy checklist to use when looking for a home caregiver, here’s a great one from OAS. 

To contact a Geriatric Care Manager in your loved one’s area, go to the website of the National Association of Professional Geriatric Care Managers at www.caremanager.org and they can steer you to a professional in your area.

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