Your mom can no longer live independently and needs help with many activities of daily living. You know she requires some home care, but are not sure if you should hire a agency or independent home health aide. The choice is personal but there are factors that should be carefully weighed. Below is a list of essential factors that should be considered.
Agency Home Care Aides
The advantages of an certified agency are in the details. Private home care agencies typically offer a broad range of services including skilled nursing care, home attendant service and companionship. A certified agency, i.e. an agency that has been licensed by the state, must conform to a strict set of regulations. All aides must go through formal training in dressing, bathing, nutrition, and helping with basic activities of daily living (ADLs). An agency will replace an aide if you are not happy with her performance or will find a substitute if your aide is ill or needs time off. The agency’s job is to insure you have an aide that fits your personal as well as health care needs. Even more importantly, an agency will cover any liabilities if there is an injury on the job.
Some “boutique” agencies offer services such as bill paying, correspondence writing, geriatric care management, transportation services, and other conveniences. These services come with a higher price tag but can be worth the expense.
Any aide hired through an agency goes through an extensive screening process. Her name is run through an FBI database to insure she is in the United States legally and has no criminal record. She must also come with personal references. Once an aide is hired, a certified agency is responsible for continuing her training through regular workshops on such topics as Alzheimer’s disease, mental illness, and new developments in care.
Independent Home Care Aides
Many certified home care aides prefer to work independently rather than through an agency. By doing so they can negotiate their own terms and rates.There are some appealing advantages to going this route. These aides are usually considerably less expensive to hire because they are cutting out the middleman. A portion of agency costs covers payroll expenses, insurance, overhead costs.
An independent aide is also not restricted to certification regulations. The biggest difference regards administering medicine and medical responsibilities. Agency aides are not permitted to give medication, change bandages, or treat wounds. This is often frustrating for the client. This is not an issue for an independent aide. An aide can perform any of these tasks. But be cautious if you decided to permit this route. Many medications look alike and you don’t want someone who might make a mistake.
An equally important issue regards accountability. If you hire someone independently you must forgo all the security checks that you get through an agency. In addition you will not be confirmed of training, screening or liability insurance. There are no set procedures if the aide or family member is injured at home or if something in the home is broken or stolen.
Finally there is the legal issue. Many people and aides prefer to work “off the books”. Both family and the aide may see this as a win/win situation. However this can cause complications, particularly if a family hopes to make their loved one Medicaid eligible. Medicaid is the federal government’s health program for people with limited income and assets. If a person wants to become income eligible they must “spend down” their savings to a set level. However all this money that is being spent must account for. An aide who is paid off the books cannot be declared which could cause complications and hold up the application process.
Whether you hire an aide independently or through an agency you must weigh the pros of making your own rules with the cons of no accountability. Every family must weigh these facts against their own personal situation and make a choice that best fits their needs.
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