Selecting the Best Care

Selecting the best care for you or your loved one can be a difficult and stressful task. You must ask yourself a variety of questions when determining which type of care you should select. It is critical that you understand the full extent of the patient’s situation before making any decisions. As you investigate your options you should consider two things:

 

  1. An assessment of the patient’s situation
  2. In-home care options: agency vs. private caregivers

 

 

1. An assessment of the patient’s situation:

 

The first factor to consider is whether medical care, in-home care, or both are needed.

           

Medical care: A patient’s condition can be considered either acute or chronic. When a patient is expected to make a full recovery from an injury or medical condition, they have an acute condition. This condition can include:

 

v heart attack

v broken bones

v knee or hip surgery

v heart surgery

v mild stroke

v chemotherapy

 

These patients will require a high level of medical care in a short period of time to help their bodies heal and restore their normal function and independence. Medical care includes taking vital sign measurements, caring for wounds, monitoring healing progress, physical therapy (if applicable) to restore the patient’s ability to walk and move normally, and occupational therapy (if applicable) to restore the patient’s speech or fine motor skills. This level of medical care is short-term and may be needed anywhere from two to six months.  

           

In-home care: When a patient is not expected to make a full recovery or if they are expected to be incapacitated in some way for the long-term, they have a chronic condition. This condition can include:

 

v Complications from a prior surgery or disease

v On-going conditions such as diabetes, COPD/emphysema, or glaucoma/blindness

v Progressive diseases such as Alzheimer’s, Parkinson’s, or ALS.

 

Their ability to ambulate (move by themselves) could be hindered. They may have difficulties remembering critical tasks for living. They may lose the physical capacity to keep house, prepare meals, bathe, clothe themselves, and pay bills. In these circumstances, the care focus shifts from medical care to in-home care. In-home care workers have less medical training and perform tasks that help compensate for the decreased independence brought on by chronic conditions. Because patients with chronic conditions are not expected to make a full recovery, in-home care will be needed for the long-term. When a patient has an acute condition that has developed complications and becomes chronic, in-home care will also be necessary.

            Some patients do not have a specific medical condition but still need in-home care. If a patient experiences strain from daily tasks of living, are mildly forgetful, have difficulty moving, or experiences incontinence, in-home care is usually a great fit for allowing them to maintain independence for as long as possible.

 

  • After determining which type of care you or your loved one requires, you must decide whether part-time (1-4 times per week and 2-4 hours per day), full-time (5-8 hours per day, 5-7 days a week), or round-the-clock (24 hour) care is needed.        

 

The daily amount of care needed depends on the patient’s level of independence and if there are family members, friends, or others in the community who are available to help with care. The level of independence can be measured by the patient’s physical and mental capabilities.

 

Part-time: A patient will need part-time care if he or she is still able to walk and use the restroom independently, needs light assistance with bathing and dressing, needs help with vigorous tasks such as housekeeping or cooking, and is only occasionally forgetful. This type of patient is considered independent.  If the patient has family members or close friends living with them, the level of independence is even stronger.

 

Full-time: A patient will need full-time care if he or she has some trouble walking and using the restroom independently, needs help with bathing and dressing, and forgets important things such as turning off appliances or electronics, location of house or car keys, and medication schedules. This type of patient is considered somewhat dependent. If the patient lives alone but has immediate family members and friends nearby, part-time to full-time care is suggested.

 

Round-the-clock: A patient will need round-the-clock care if he or she is physically incapacitated or bedridden, cannot use the restroom independently, cannot bathe or dress on his or her own, or is mentally incapacitated as in later stages of Alzheimer’s or Dementia. This type of patient is considered dependent. If a live-in family member can perform some of this care, the patient may only need full-time care. If there is no family member or close friend who can live with the person, round-the-clock care is required. It is recommended that 24 hours of care be broken into 2-3 shifts.

 

 

2. In-home care options: agency vs. private caregivers:

 

After assessing the patient’s situation, you must determine whether you want to hire a caregiver through an agency or hire a private caregiver. To make this decision, you must consider two things: management and payment.

 

 

 

  • Management:

           

When hiring an agency caregiver, the agency bears responsibility for recruiting, screening, background checks, reference checks, credential checks, hiring, firing, salary negotiation, and day-to-day management of the caregiver. Without an agency, these responsibilities fall on you.

When it comes to paying the caregiver, an agency will pay wages, withhold taxes, and file required reports with the state and federal government. Without an agency, the care recipient or the family is held responsible for accomplishing these duties.

If an agency caregiver does not show up for his or her shift, the agency will provide a back-up caregiver. If a private caregiver does not show up for his or her shift, it may be difficult to find another caregiver on such short notice. Agencies will often provide training for caregivers, such as CPR and first aid training. This is not the case when hiring a private caregiver. If a caregiver has an accident or is injured on the job, an agency carries a policy covering the caregiver. Without the agency, the care recipient or the family must carry a policy covering the caregiver.

Private caregivers are often less expensive than an agency caregiver and you will have more freedom choosing the perfect caregiver for you or your loved one. If you choose to hire a private caregiver, however, you must consider all of the responsibilities you are accountable for. If you are not willing to take on these responsibilities, an agency caregiver may be a better option for you.

 

  • Payment:

 

            The cost of an agency caregiver ranges from $11-$30 per hour, while the cost of a private caregiver ranges from $8-$20 per hour.

Most agencies accept many forms of insurance for payment. If you wish to make payments with private insurance or Medicare for an acute condition, you must use an agency that accepts these types of insurance. If you wish to make payments with Medicaid or Long Term Care Insurance (LTC), you must also use an agency that accepts these types of insurance.

Private caregivers are often less expensive than agency caregivers, but they seldom accept insurance as a form of payment. The patient or the patient’s family will have to use their own money and assets to pay for care. To pay a private caregiver, you must ensure that they sign a conditional waiver and an unconditional waiver. A conditional waiver will prevent the private caregiver from claiming rights to your property. An unconditional waiver should be signed at every pay period and will prevent any disputes about payment in the future.

When it comes to withholding taxes and filing reports with the state and federal government, you must first complete Form W-9, Request for Taxpayer Identification Number and Certification. You should keep this file in your records after completion. Then, you must complete Form 1099-MISC. This form will report your financial information, payment and due taxes, to the Internal Revenue Service (IRS). Form 1099-MISC must be distributed to your private caregiver by January 31 of the year succeeding payment and to the IRS by February 28. Form 1099-MISC is only required if you expect to be paying your private caregiver more than $600 per year.

 

 

 

 

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