Welcome to “It’s My Turn To Care.” We know the challenges you face caring for someone with dementia. That's why each week we bring you tips, strategies, and most of all, support, as you navigate your role as caregiver. Let's get started. [00:15.6]
Dave: Hello. This is Dave Parks. I'm a certified senior advisor and owner of Home Care Assistance. Welcome to It’s My Turn To Care: Secrets for the Dementia Caregiver. It's always our goal to provide you tips, strategies and things to think about as you go through this journey, because we really want you to sur-thrive the journey.
I think I made up that word, but I really like it because I really think it's important to do more than just survive. A lot of people are trying to survive the journey, but we really want you to sur-thrive the journey. There are some things that you would need to do in order to sur-thrive the journey and we're going to talk more about that later, but today is kind of the second episode of a series of episodes on home care. [01:10.5]
That’s what I do. I do home care. I'm going to be kind of my own guest today and today I want to talk about the different types of home care, including home care provided by an agency, and I want to talk about top 10 must-do's to sur-thrive being a family caregiver. Let's jump into it. Let's talk about the different types of home care.
Last week, we talked about the difference between home health and home care. If you miss that episode, I do want to summarize what home health is really there to do a task for you. [01:57.2]
It could be physical therapy, occupational therapy, wound care. They're going to come in, they're going to do their tasks and then they're going to leave. They're not going to be there very long, whereas home care is there for an extended period of time, anywhere from, say, let's say, four hours a day to 24/7, depending on the level of care that your loved one needs. They're going to do things, what we call activities of daily living, preparing a meal, running errands, doing light housekeeping, bathing, grooming, dressing, helping get around the house, companionship, taking them, places, things of that nature, so home care is going to be in the home for a much longer than home health typically.
Let's talk about the different types of ways that you can have home care. One is you can hire someone privately. Now, I want to talk a little bit about the pros and cons of each type of way to get home care in the home. [03:02.9]
Privately, generally speaking, the pro is that private caregivers are generally going to charge less than an agency would. What are some things that you need to think about when you hire a private caregiver? One thing is that you need to make sure that you're satisfying all the burden of an employment situation, right, and that could possibly be unemployment insurance, worker's comp, things of that nature, so just make sure that you have that covered. I'm not suggesting that private caregiving can never work. We actually had someone I spoke with. They were actually an attorney.
We were going through and they wanted to actually hire one of our caregivers from us. They pay us a fee and they can hire one of our caregivers because they had been working for them and they had agreed that if they want to hire a caregiver, then they pay us a fee for that. He was an attorney and he made sure social security was being paid, unemployment. All of those things were in order. [04:16.3]
The other thing is just to make sure you understand liability, for example, what happens if the private caregiver is the one that gets hurt in your home? Okay, just make sure that you have that. Then, also, God forbid, but if something were to go wrong in the relationship between the private caregiver and the client, who's going to be held responsible for that? Is the private caregiver carrying insurance, for example? Most agencies are going to have protections for the client in the case of a liability situation. [04:56.2]
The other thing to think about is what if life happens, right? What if the caregiver gets sick? What if the caregiver’s child gets sick? Or whatever the case may be and they can't make a shift, how is that handled? Do you have a backup plan? Are you going to be made aware? Let's say, you're out of town and the caregiver can't make it, or there's some sort of an emergency and the caregiver can't make it, and you're under the impression that the caregiver is in the home with your loved one, but maybe something or an emergency happens and that's not the case.
Those are some of the things to think about. Like I said, I'm not suggesting that private caregiving can never work, but you just need to make sure that you have those safeguards in place.
Let's talk a little bit about using a home care agency and, full disclosure, that's what I do. I own a home care agency. Let's talk a little bit about what some of the advantages of using a home care agency are. [06:00.7]
Number one, when you choose a home care agency, you need to understand whether the caregiver works for the agency or the caregiver is contract labor. In our situation, the caregiver works for us, right? They're a W-2 employee is another way to say it. That means that we do things like we pay their social security taxes, right, where the employer pays half and the employee pays half. We pay for their unemployment insurance. We also pay for worker's comp. So, you need to find out, when you're hiring an agency, what the situation is and it's really about understanding who's liable for what. It's important to know that.
The other thing is, what about, let's say, we're not perfect and if we put a caregiver in your home who, let's say, for some reason, the personality just doesn't match well with your loved one? But we have a lot of caregivers and so we can make a change, but if you hire a caregiver privately, that doesn't work out. That could be a little bit of a messy situation. [07:14.1]
Also, when you hire an agency, you have a lot of oversight. We're licensed by the state of Texas and most home care agencies are going to be licensed by the state of Texas, and they're operating in Texas, of course, and there are certain license requirements we have. We also use and a lot of agencies have oversight from third parties that sort of audit what we do. They talk to our clients. They talk to our caregivers and they find out how we're doing, and we get a report actually every month on that and we can use that to improve our agency. [07:54.5]
What kind of training is being provided by the agency? We're going to make sure that the caregiver has the proper skill set to go into your particular home or your parents' home. That's our job, really, to make sure we make a good match between the caregiver and the client. We have a lot of clients with various degrees of needs and personalities, and we also have caregivers that have different sets of skills and personalities. It's really our job to match the two.
Also, the caregiver is part of what we do, but we also have access to resources that can help you in a lot of different areas. For example, we have contacts in home health and hospice with the Alzheimer's association, attorneys, financial people, a lot of people that have been on this podcast. We can get you in touch with the right people, depending on the situation with your loved one. [09:10.7]
There are a lot of advantages to using a home care agency and, of course, I'd be happy to talk to you more about that if you just call our office. Let's talk about one option that a lot of people use, which is being a family caregiver.
Now, the great thing about a family caregiver is that you're going to know your loved one the best and initially your loved one's going to feel very comfortable around you, so that certainly is an advantage. Now, we'll say that it is amazing to me to see some of the relationships that are formed between caregivers and clients. It really is kind of touching. It's really one of the great things in our industry, to see that relationship develop. [10:01.0]
You could probably tell me, what some of the things, too, are sort of on the negative side when it comes to family caregiving. It takes a lot of time. Last week we talked about the 20 hours a week the average family caregiver devotes to their loved one. If you're in the sandwich generation, so to speak, then you're taking care of your immediate family, kids, school, activities and ball games, and if you're married and you have a spouse or whatever the situation may be, you're trying to kind of manage your family, so that takes a lot of time. Then you have the additional responsibility of taking care of another family member.
The other thing we talked about last week was the rate of depression that's found in family caregivers. About 60 percent of family caregivers report some form of depression. That's six times the national average, so there are certainly a lot of issues there. [11:05.1]
The other thing is, a lot of times, frankly, the family member may not have the experience needed or the training necessary to be the most effective caregiver. A lot of people, and I always cringe when I hear this, they refer to the medical side of home health as the skilled side and then they refer to the nonmedical side, which is what we do, as non-skilled.
I always cringe when I hear that because if you've ever had to transfer a 200-pound person or 250-pound person from, let's say, the bed to the wheelchair or help them take a shower, there really is a lot of skill all involved in that, and a lot of the other things that we do require a lot of skill. Keep that in mind as well. There's probably some training you could get to help, but there really is some special skills that are needed to be the most effective. [12:08.4]
Those are the really the three types of home care. You can hire a private caregiver, a home care agency like mine, or you can have a family member do the caregiving. Sometimes it's a combination, frankly. It doesn't have to be all or doesn't have to be all of one and none of the others. We have situations where we are the only entity, so to speak, providing the home care. We're there 24/7 and there's no one else involved. I mean, occasional family visit or the family focuses on being the family member and doesn't provide any hands-on care.
But we're in the home many times with a private caregiver. The private caregiver is there for…a recent situation was the private caregiver was there during the day and we were there at night, so another combination. [13:08.8]
A third combination is a family caregiver where the family is there during the day while the daughter or son is working and we're there to help. Then they come at night and make sure they get a meal and put them to bed and things like that. A lot of times it's a combination, so it doesn't have to be all or nothing.
What I want to do is talk a little bit about, if you do choose an agency, there are some things that these are sort of questions that you can ask, and I’ll be happy to send you this list of questions if you call our office at (817) 349-7599. It's kind of a checklist really is what it is.
In home care, it's all about the caregiver, right? You want to know, How does the agency choose its caregivers? [14:03.9]
Okay, you want to hear things like we do criminal background checks. We check their work permit status. We check their references. We check their driving record. They have to have a driver's license. They have to have car insurance. You want to hear those things because you never know when they might have to transport your loved one somewhere.
What's the minimum years of experience? What are the training procedures when you newly hire a caregiver? Do you offer continuing education? You want to understand the hiring process to some extent because that's part of what you're paying the agency to do. It’s to hire good people for your loved one.
Then, you want to hear and want to talk about what the staffing and scheduling procedures are. What happens if a caregiver is sick? [15:02.9]
We have our clients where the family lives out of town, so if a caregiver calls in sick, then we have to provide care, and so what's the process? What's the procedure there? What do you do if a caregiver doesn't work out? Let's say, it's a personality issue. What are the procedures? How long does it take to get a new caregiver in there? You want to understand the safeguards when it comes to kind of the backup plan.
What's the agency's legal responsibility? I mentioned that some agencies do not hire caregivers on their own payroll, so they provide contract labor, and we talked about the pros and cons of that. Then, there are agencies that do provide. They are what we call the W-2 employees that we have insurance that covers their actions in the home. We do pay workers comp if they were to get hurt and we do pay unemployment insurance, all those kinds of things, so a lot of protections on that regard, so you want to understand that. [16:11.1]
Is the agency governed by HIPAA? That's another thing to think about.
I guess the last thing would be, and there are a lot of good home care agencies out there: what makes your agency different and better than the competition? For example, what's their approach to care? I think that's a great question. How do you approach care? Do you look at mind, body and soul? Do you provide activities to help stimulate the brain? Do you have a cognitive program? Things of that nature. Do you have a client care manager that's available 24/7? These are the kinds of things that you want to ask your agency before you hire them. [16:57.0]
Obviously, you want to know how much they charge and how do they charge. You want to take the cost and the services, and the quality. You want to find out how reputable they are, look at their Google reviews, talk to other people in the industry, see what other clients [say]. Maybe they'll allow you to talk to other family members that they have that they've served in the past or are currently serving. All these things you want to think about when you're choosing an agency.
What I want to do next week is we're going to do my top 10 must-do’s to sur-thrive being a family caregiver. My name is Dave Parks and I'm the owner of Home Care Assistance, and our website is www.HomeCareAssistanceFortWorth.com, and our office number is (817) 349-7599.
I really appreciate you listening, and we will talk to you again next week. Thanks so much.
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