Choosing an Elder Care Agency

Are you in need of an elder care agency for a loved one, but don’t know what you should be looking for? I’m here to help you get started.

A few years ago, when my father began to experience cognitive decline and difficulty with organizational and household tasks, he was diagnosed with Alzheimer’s disease. He became anxious when left alone, even for a short amount of time, so my family decided to hire a home health aide.

The agency we chose didn’t charge too much for caregivers, and they could take him out to lunch or to do errands. But personalities between my father and the few caregivers on staff didn’t mesh, so we hired a different agency about a month later. These caregivers lasted six weeks before they burned-out. After a lot of research, we found a larger agency with several caregivers and years of experience caring for people with Alzheimer’s. Because of reasons too complicated to discuss here, it took more than a year before the agency found a few caregivers that my father felt he could trust. And, in the event of illness, there was a large pool of others to fill in. The agency assigned a nurse case manager to oversee the caregivers, to trouble-shoot glitches in schedules, and to coordinate medical appointments. More than two years later, due to policy changes and poor communication from management regarding updates about my father’s condition, we fired them and hired another agency. That was about a month ago and, so far, things are working out well (I’m keeping my fingers crossed).

If you’re in search of an elder care agency, I’ve gathered a list of questions to ask whoever is in charge. But, first, it’s worth noting that private home care agencies are for-profit businesses; they’ll work hard to convince you that they’re the best ones to oversee the care of your loved one. So, before signing your name to a contract of any kind, think of the following as an interview – you do the interviewing:

1)  “Does your agency accept Medicare?”

If the services being provided are for activities of daily living – bathing, dressing, feeding – Medicare will not pay. They will only pay if skilled services like dressing changes or physical therapy are needed. Most likely you, or whoever is receiving care, will either have to pay out of pocket or use long-term care insurance, if you are fortunate enough to have a policy (see #2).

2)  Is your agency registered with the state?

Long before he was diagnosed with Alzheimer’s, my father  bought long-term care insurance, in the event he would need care for an indeterminate amount of time. His policy doesn’t cover the cost of care with agencies not registered in the state in which he lives. I didn’t know this until after we hired the second agency, which was not registered. But Long-term care polices can be costly. I recently learned that most companies no longer offer insurance because they don’t have enough funds to pay benefits; however I heard that New York Life still does.

3)  Does your agency meet federal requirements for safety and health?

4)  How long has your agency been in business and do you have experience caring for people with Alzheimer’s, etc.? What are the primary services your agency provides?

5)  How experienced are your caregivers? Can I see references?

6)  How often do you conduct performance reviews? How are your home health trained, and how do you monitor their skills? Are they licensed? How do they handle emergencies like choking or a heart attack? Are they trained in CPR?

7)  Are caregivers able to drive clients to appointments, to lunch, etc.?

8)  Is there a lot of employee turnover? If so, why?

9)  Are you affiliated with local hospitals? If so, which ones?

10) Do you have case-managers? How often do they visit clients? Will they go to medical appointments? Are they available for emergencies? What are the fees for these services?

Depending on the agency, the fees can range between $125 and $165 per hour. Though it’s expensive, if your family can afford it, it’s worth it.  Case managers help coordinate all aspects of care, including assigning caregivers, and following-up with physicians. And they advocate for their clients.

11) What are the fees for caregiver hours?

12)  How often do you bill? Do you bill directly to long-term care insurance companies, or do clients have to pay upfront?

13)  How do you communicate with family? By email and/or phone. How often? Who are you allowed to speak with? All family members, or just a designated individual like a health care proxy or legal guardian?

If you’re the one designated to speak to the case manager and other staff, I urge you to remind them to send you updates on a regular basis, otherwise they will forget. Remember, you are your loved one’s voice.

Feel free to offer feedback.

Good-luck!