How do we find a better home health agency?

6 answers | Last updated: Sep 23, 2016
A fellow caregiver asked...

Our elderly aunt has both medicare and VA. She was sent home from hospital and they set up home health care via medicare. However, the workers they sent out are terrible. They are lazy and dont want to do a good job. How do we change home health agencies and can we interview the workers before deciding who will come out.

Expert Answers

Maria Basso Lipani writes a popular website on geriatric care topics, where she puts her expertise as a Licensed Clinical Social Worker to good use answering care planning questions. Maria is a graduate of Columbia University School of Social Work and is licensed in California and New York.

If you're unhappy with the home health aides you can absolutely call the agency that sent them, explain the behaviors, and ask for different workers. Finding a better home health agency would be a much bigger feat in part because this episode of home care (i.e. an episode that follows a hospitalization) is paid for my Medicare and it is only temporary. In fact, it may only last a few weeks. Many people confuse the home care that Medicare pays for (short term) with home care covered by Medicaid which is long term. The other option is to pay for home care privately. If this is something your aunt can afford you would then be able to choose the agency freely and interview the workers to find the best fit.

Community Answers

A fellow caregiver answered...

The answer provided good basic clarification of how home health care works, especially immediately following hospital discharge. But having been a social worker with older adults for many years, I think it's important to understand one reality about home health care services. In most cases the workers (usually Certified Nursing Assistants, or CNA) are very poorly paid, earning the least amount of money possible. That means the majority of the pricey hourly rates charged by home health agencies become profits, while meager wages are paid to their employees. Of course that should not justify laziness or "not wanting to do a good job", but it does explain why that occurs -- not enough staff and too many assignments for already exhausted employees is another factor. Sometimes agencies hire individuals who simply should not be doing the type of work expected of them -- but they needed a job, and the agency needed a worker.

This entire matter of home health care services, provided by members of a sector of our society who simply are not valued in our for-profit home health agency world, is going to hit the fan very soon. Baby boomers will be joining the current elderly population, and in all likelihood there won't be enough workers to provide basic services, not to mention quality care. Sorry if this sounds grim, but that's the reality.

I hope the family of the elderly Aunt is able to work something out -- perhaps consider hiring a private aide via word of mouth, someone who can provide verifiable references. Consider forming a "share-the-care" type of arrangement, where friends and family pinch-hit the provision of services until the right agency staff comes along. Ultimately, we're all in this boat together -- Good Luck!

Homehealthdirectorrn answered...

It is important to become an informed consumer when you know someone who needs assistance in order to be able to stay in their own home. There are many types of assistance available, such as Personal Care (funding sources vary such as Medicaid, long term care insurance, and private pay to name a few), Skilled Care (often funded by Medicare and Medicare supplements), or just housekeeping duties (funded by private pay and some long term care insurance policies), to name a few.

Consumers have the right to change agencies at any time they feel dissatisfied with the services. However, depending on the type of care being received and the funding source, the consumer may be limited to choosing among agencies that have particular licenses. Check with the funding source (such as the patient's long term care insurance company, Medicare, or the VA) for any restrictions they may have.

Personal Care is, I believe, what you are looking for. Personal Care involves hands-on the person duties, such as assistance with bathing and grooming activities, and the government regulatory agencies require that certified aides be used. Additionally, Personal Care and Skilled Care agencies are held to much higher standards than those agencies providing only housekeeping duty assistance.

Here are some questions you should ask when selecting a provider:

Is the provider a non-profit organization or commercial business? In other words, what's the motivation for their business? How long have they been in business? Are they members of the Better Business Bureau and the local Chamber of Commerce?

Is the provider licensed to provide Personal Care? By whom? What government agencies provide oversight, regulation, and quality assurance? What services are they licensed to provide? Is the business bonded and insured?

Are the in-home aides licensed/certified? What kind of licenses or certifications do they hold? Reputable agencies use PCA's (Personal Care Assistants) or CNA's (Certified Nurse Aides). Are they required to have annual continuing education? Who provides it? Who checks to make sure it has been completed?

Are the in-home aides employees of the agency or contract labor? Does the employing agency provide Worker's Compensation and Liability Insurance for their employees?

Are the in-home aides screened with reference and criminal background checks?

Is the Plan of Care developed by a Registered Nurse? Do the Registered Nurses make housecalls on a regularly scheduled basis to monitor the quality and appropriateness of the care being received?

Is there a Registered Nurse on call after regular business hours? Are in-home care providers assigned on a permanent basis? Who do you call if there is a problem? If your aide is sick, will they send a substitute?

Is there a contracted period of time?

Are there set up or exit fees?

These are just a few ideas to help you select the right agency to provide yourself or your loved one with in-home care. If you need more assistance, contact your local Area Agency on Aging. To reach an Area Agency on Aging throughout the United States, call 1-800-677-1116 or look in your local white pages under Area Agency on Aging.

Missy Masterson, RN, RVT, PLNC Director of Health Services Area Agency on Aging of West Central Arkansas a Not-for-Profit 501(c)(3) organization)

Roaring mouse answered...

All of the above are great responses for understanding how the system works. Wish I had that info 5.5 years ago when first faced with it myself for my SCI husband. He has since acquired autonomic dysreflexia, syringomyelia, and stage II complex regional pain syndrome.

Here are some of the questions I have learned to ask for my husband:

Are they afraid of dogs? (If they are fearful, they lose focus on the job itself.)

What procedures are you skilled in? My husband requires digital stimulation for his bowel program. I actually had one nurse tell me it was a back rub.

What is your hands experience, how long, and challenges faced? In this case I asked with respects to my husband's condition. (With specialized medical conditions you may also want to ask if they have experience from working at major hospitals/institutions.)

Ask to have the employee come out and meet with you before they start work.

Do they observe sterile technique? That is do they wash their hands when coming into the home or use sanitizer. I usually expand this on their first day of work as well.

Why do they like doing this type of work?

When they come out, do they show up on time? (Especially for your loved one..) Are they also good at engaging them (not you!) in conversation?

We have been through 7 companies in 5.5 years (in Florida we knew of someone who had been through 60 of the 120 companies in the county.) The current 7th company is our favorite and here is why: We told them of our experiences (both my husband and myself!) and of our concerns. They sent out an employee on day one who has been with us 11 months and we have no intentions of letting him go. PS>>My husband never liked working with male nurses...and this one is a male nurse!!)

When you decide to change agencies, answer your question of whether you need back to back service. If you don' may be worth it to take on your loved ones medical needs until you can find the help that is appropriate. If you do need back to back service...keep your current service going while interviewing other companies. When you find a firm that you think will work, be honest with them and let them know that you have to let the other company go first. Many times the new company will work with you during the process to keep the gap between companies small...if at all.

Hope this helps.

Mamu answered...

You said your aunt is also covered by VA. Have you looked into the option of having Home Health Care provided by their staff or a company they contract with? They may have a different group of agencies they deal with that might provide care at the level of competence you are looking for. We have witnessed an exceptional group of care-providers contracted by VA (because he lived outside the geographic area where their own home health care staff worked) who cared for a homebound friend at the end of his life. It might provide an additional resource for her.

Rofsf answered...

These answers are all very good.