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!

Once a nurse, always a nurse. For those of you who are retired from nursing, or have left nursing because your back, or psyche, can no longer bear the weight of patients, does this phrase sound familiar? Maybe you’ve changed careers – maybe you’re now a lawyer, or a writer. But you’re still a nurse.

You’re a nurse when your mother calls and says, “My leg has a red spot on it and it’s been itching for three days, what do you think it is?” You wonder if she could possibly think that you have superhero vision and can see through the telephone wires into the red spot. You tell her to stop scratching it, to put some cream on it.

You’re a nurse when a good friend asks you if you would mind telling her alcoholic brother that drinking is bad for his liver and he is at risk for liver cancer. You want to tell her that he probably won’t listen to you any more than he’d listen to family, but you know she’s desperate. You want to tell her you don’t have experience with liver disease, that you’re background in nursing is with babies, and they don’t drink, as far as you know. She says she’ll get you her brother’s phone number, but the next time you get together with her, she forgets it. You’re relieved and careful not to ask how her brother is doing.

You’re a nurse when your sister-in-law asks you what to do about her bee sting. “It’s swollen,” she says. You tell her to put ice on it. And when your mother-in-law complains of a headache, you tell her to put ice on her head. “It decreases blood flow to the area, you say, “it should help the throbbing” You’re sister-in-law, who is in the room at the time, asks, “Is ice your answer to everything?” We laugh. But I think she’s on to something. Maybe ice is the answer. Maybe the next time my mother or father, or my husband or stepchildren ask what they should do for a stubbed toe, a twitching eyelid, or a paper cut, I’ll tell them to put ice on it.

Since “you’re the nurse in the family,” you’re assigned as your father’s health care proxy. He has Alzheimer’s and can no longer make decisions for himself. He requires caregivers to help him bathe, dress, and sometimes eat. His doctors call you for consent to admit him to the hospital when he suffers from pneumonia, or diverticulitis, or a blood clot. You are called upon to decide whether or not your father should have surgery to remove a lesion that might or might not be cancerous. You are asked to weigh the risks and benefits of every medical intervention your father faces. Sometimes you wish you never became a nurse.

But you are a nurse –no amount of ice can change that.