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How to Choose In-Home Care

Whether you are choosing in-home care as a way to provide periodic or routine respite from caregiving duties or as a way to delay facility placement, you need to ask many questions of the agencies you are considering. These workers will be coming into your home and you want to ensure that both your needs and the needs of your loved one with dementia will be met. It is vitally important to know the right questions to ask and what type of in-home care you may need. Here are some basic issues you need to think about before signing a contract with an in-home care agency. And, before signing any contract, be sure to get a copy of the contract, read it carefully and understand its terms.

A first step in deciding what type of agency to interview and hire is to determine what type of in-home services you need—companion services or more hands-on care. Then ask yourself and any prospective agency the following questions:

  • What is the cost? What types of payment does the agency accept—Medicaid or Medicare? Do they have a sliding-scale fee that is based on ability to pay?
  • If you are paying out of pocket, you might want to consider hiring your own in-home care staff, including writing the contracts and conducting background checks.
  • If you are paying privately, consider hiring a personal assistant. A companion normally does not touch the person. The “lowest” level worker who could help with Activities of Daily Living would be a nursing assistant.
  • When the level of care and amount of time changes, how will the cost change?
  • What kind of training do the caregivers have in dementia? From whom and where? How many years has the agency dealt with people with dementia?
  • Is the agency accredited and the workers bonded and insured? Is a criminal background check conducted on employees?
  • Does the agency provide the full range of care, from occasional companion care to full nursing care, or would you have to change agencies as care needs increase?
  • How does the agency select a care worker for your loved one? Will there be one assigned person or multiple caregivers?
  • What level of interaction will occur between the worker and your loved one?
  • Would the worker be able to care not only for the person but for the surroundings as well, such as cleaning the bathroom when necessary?
  • Does the agency have a minimum number of hours that must be worked?
  • What are the agency’s policies and procedures if the caregiver doesn’t show up at the assigned time?
  • Do supervisors do spot checks? How are the workers monitored by the agency?
  • Is assistance provided for the spouse, if necessary, without paying extra?
  • Where is the agency located in relation to your home and to where the caregivers live? Proximity will help with reliability.

Also, it is important to think of yourself as a supervisor when a worker comes into your home. If there are any issues, such as lack of trust or personality conflicts, then you need to step forward to make a change. Other aspects to consider include whether there are animals in the home or if smoking is an issue.

Other Resources

For additional resources in making this important decision, the Division of Facility Services, which licenses home care agencies in North Carolina, has developed an online guide to home care available at http://facility-services.state.nc.us/cnsmguid.pdf.

Information about in-home care agencies is available on DFS’s web site, http://facilityservices.state.nc.us/reports.htm or contact a Family Caregiver Resource Specialist at your local Area Agency on Aging. A listing of AAAs can be found on the our web site: www.alznc.org/aaa.php.

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