10 Questions to Ask an In-Home Care Provider
In-home care is growing in popularity and for good reason. As Baby Boomers reach their golden years, more and more of them prefer to stay at home over moving to a new facility. Yet as the in-home care industry grows, the regulatory landscape appears to not be keeping pace. There is no federal regulation to govern in-home care providers nationwide; this power is left to the states who vary greatly in what they require. This has left the door open for bad actors to infiltrate an otherwise upstanding industry that started as a way to provide seniors with more choice in care. More than ever, it is extremely important for patients and their families to properly vet the in-home care providers they choose. The following are ten essential questions patients should ask an in-home care provider before signing up for their services.
1) What are the state requirements for in-home care providers, and what proof can the agency show that they are in compliance with those requirements?
This question serves two purposes. First, it allows patients and their families to learn more about their state’s regulatory requirements. Second, it will expose providers who are operating illegally or with too little experience. The rules governing the in-home care industry vary state by state, so it is important to ask a prospective provider what the rules are, as they understand it, for their agency, and what proof they have to demonstrate they are in compliance with those rules. More importantly, patients and families should ask this question of multiple agencies and compare their answers. If one agency is too light on their description of the state’s requirements, this could signal an underlying issue with the provider. Moreover, if an agency is unable to quickly and reliably demonstrate proof of their compliance with state law, this could also signal a problem.
2) Are all workers at the agency required to pass background checks?
In-home care regulations vary state to state, and not all states regulate the industry all that closely. The state of Connecticut, for example, does not regulate private duty in-home care at all, so patients who seek services such as light house work, care rides, personal grooming help, or anything that is non-certified work, may find that caregivers for these types of service might not be background checked at all. Hence, no matter where you live, it is essential that you ask a prospective agency if they require background checks of all their workers.
3) What credentials does the agency require of caregivers for each kind of service?
In-home care is an umbrella term for a large variety of medical and non-medical services. Some agencies exclusively focus on one specific subset, such as non-medical (or private-duty) services, while others offer both. When interviewing an in-home care agency, it is important to ask about what kinds of certifications they require of their employees. Non-medical caregivers typically do not require any form of certification, but if any of the services recommended for you involve medical expertise, it is important to ask about and understand the level of training required of the caregiver assigned to you.
4) For non-credentialed caregivers, what kind of training does the agency offer or require of their caregivers?
While non-medical services do not require any kind of certification on the part of the caregiver, most agencies still offer training to their employees and may even offer certificates of completion for those programs. It is a good idea to ask about how much training is required of caregivers, and what ongoing training programs (if any) involve.
5) Are the agency’s caregivers employees or private contractors?
This is another crucial piece of information that patients and their families need to know about the agency they hire. Employees who work directly for the agency will fall under the agency’s insurance program. The industry consensus is that this model is by far superior to hiring private contractors. Private contractors, on the other hand, will technically be self-employed and may need to purchase insurance either independently or from the agency. The private contractor model has recently come under heavy scrutiny and is quite rare in most states. But this question is still helpful to ask to ensure that a prospective agency actually employs its caregivers.
6) What are the agency’s quality assurance terms?
One of the telltale ways to identify a good agency is a thorough quality assurance policy. Quality assurance terms help reassure patients and their families that the agency they choose is committed to ensuring quality care. Agencies without a quality assurance policy are to be regarded with suspicion. For this reason, this is one of the most important questions to ask an in-home care provider. What should you look for in a quality assurance policy? Generally, these policies will explain the kinds of abuse that can occur, what the agency does to prevent abuse, policies for reporting abuse, and non-retaliation clauses. However, policies will vary, and some can be quite lengthy. Be sure to read through a policy in its entirety, and it’s always a good idea to compare policies between prospective agencies.
7) Will the caregiver assigned to me be the same every time?
One of the most common complaints about in-home care is a lack of consistency in the caregiver who shows up at a patient’s house. This occurs for a variety of reasons, the most prevalent of which is high turnover among caregivers. This question will unveil two major characteristics of an in-home care provider. First, it will expose whether the agency has high turnover rates among its caregivers. High turnover, while common in the industry, may indicate a difficult workplace environment, which in turn could signal something worse. Second, this question may expose staffing problems at the agency. The benefit of having individually assigned caregivers is intrinsic: it allows for a better patient-caregiver rapport, and it gives the patient consistency in their care. By extension, consistency provides better satisfaction in care. It is important to ensure that a prospective agency makes it a policy to personally assign caregivers to patients.
8) What other licenses, accreditation, and awards does the agency have?
The in-home care industry may not be heavily regulated, but there are several key industry players, such as the NAHC and Home Care Pulse, who offer further accreditation and quality assurance checks. While it is not necessary to have any of these extra accreditations and awards, patients and their families may find greater peace of mind knowing that the agency they choose is well regarded in the industry. From educational course certifications to helpful reviews about an agency’s operations, third party awards are a good sign that a prospective agency is serious about ensuring the highest quality care for you and your loved ones.
9) Ask for five client references.
For any situation where someone will enter the home and work in a privileged position, it is important to ask for references. The general rule is to ask for at least three, and preferably five quality references. References need to be previous or current clients, and they cannot be related in any way to the agency’s owner or its officers. At this point, you should have an agency’s licensing and quality assurance squared away, so the references serve as extra assurance for patients and their families. One of the greatest needs that must be met for patients and their families is peace of mind that nothing bad is going to happen.
10) Ask for one to three professional references.
In-home care providers generally rely on a referral network – consisting of doctors, nurses, and case workers – to refer patients in need of care to their agency. Referral networks generate up to 80% of an agency’s new patient load. These referral networks are a great place to further vet an agency because doctors and case workers will only refer patients to agencies they trust. Thus, it is a good idea to ask a prospective in-home care agency for professional references to help speak to the agency’s competencies. This is not a common request from patients, and some in-home care providers may protest, but the fact is that if they are as good as they say they are, there is likely a doctor or a case worker out there willing to speak in their favor.