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When older adults begin to need some assistance, we often encourage them to obtain help sooner rather later.

While people like to stay “independent” as long as possible, often the strain of trying to keep up with taking care of a house and/or a loved one who needs supervision or physical care can result in illness or an accident, which ends up taking away some or all of the independence that these individuals were trying so hard to hold on to. My boss likes to say that sometimes relinquishing a little independence can help preserve one’s dignity.

If you are finding that some tasks are proving to be a greater challenge than they used to be, or you have a loved one who is struggling to stay at home, consider investigating the option of non-medical home care.

Home care providers can assist with tasks such as transportation, errands, meal preparation, light housekeeping, medication reminders (they cannot fill medication boxes or administer medications) and personal care tasks such as bathing and dressing. Home care can be paid for privately or by long-term care insurance. Home care is different from home health care, which provides medical services by licensed professionals and can be billed to Medicare.

I checked with some local home care providers for their suggestions about how to have a positive home care experience. They recommended that families ask the following questions:

The agency:

  • Does it provide service in my area and perform the services I need?
  • Is the agency licensed and how long has it been in business?
  • Is it part of a franchise or a stand-alone operation?
  • Are the owners of the agency involved in the daily operation of the business?
  • Does the agency complete a comprehensive in-home evaluation prior to the start of services?
  • Are fees a flat rate per hour or are they based on how much assistance is needed?
  • Is there a minimum number of hours per visit or per week?
  • How is billing handled?
  • Is there one person who is the primary contact during regular business hours? Are agency staff available by phone 24/7 in case of an emergency?
  • How does the agency communicate changes in scheduling?
  • What is their employee retention rate?
  • Once services begin, what type of follow-up does the agency perform and how are caregivers evaluated?
  • What is the agency’s philosophy of care?

The caregivers:

  • Are they employees of the agency or independent contractors? (this is important for purposes of liability insurance and employment taxes)
  • Are background checks performed and if so, what type?
  • Are they required to have a certain amount of experience prior to being hired?
  • What type of training is provided and how often does additional training take place?
  • What is the process for matching a caregiver with a client?
  • What happens if I am not satisfied with a caregiver?
  • How many different caregivers will be providing care?
  • What happens if a caregiver cannot fill a scheduled shift or doesn’t show up?

In addition to taking the time to hire the “right” agency, families can also take some steps themselves to contribute toward positive home care outcomes. John Towne, general manager of Christian Companion Senior Care in Carlisle, believes that the most important step when considering home care is “whenever possible, choose your agency before the need for service arises.”

He often hears from families who avoid advance planning and only consider services when they reach the point of desperation. They have not thought about potential “what-if scenarios” and possible solutions, and the result is additional stress when a significant event occurs, fewer options, and a higher probability of an unsatisfactory experience.

Families should also discuss among themselves the specifics of their expectations for home care.

  • Who will be the point of contact for the agency? Effective communication is more likely to occur if one family member assumes this role as much as possible. As this family member and the primary contact person from the agency develop a relationship, problem-solving will also be easier to discuss.
  • What specific services are desired? If a family member believes that companionship is important for their loved one but the “client” expects the caregiver to be performing “useful” tasks throughout the entire visit, the client may complain when the caregiver makes attempts to socialize.
  • What are schedule preferences? A caregiver shouldn’t be arriving at 8 a.m. if your loved one likes to sleep until 9. Consistency in a schedule is also important, so that both families and the agency can plan appropriately and efficiently.
  • What are potential sources of stress between the “client” and a caregiver? For example, how would mom feel about having a male caregiver or a caregiver of a different race/nationality? Do hearing difficulties exist that might complicate communication with a caregiver who has an accent? Are potential caregivers willing to perform activities the way your loved one likes them to be accomplished?

Successful home care requires a team effort, flexibility and sometimes lots of creativity. It is not always as simple as it may appear. Remaining in the home is important to many older adults and the assistance of a home care agency can prove invaluable to family caregivers. Thank you to professionals from the following local home care agencies who contributed information for this article:

Christian Companion Senior Care (Phone: 717-249-1700)

Ella Home Care, Inc. (Phone: 717-963-7280)

Home Instead Senior Care (Phone: 717-731-9984)

Synergy Home Care (Phone: 717-243-5473)

Visiting Angels (Phone: 717-249-5900)

Learn more about the article’s author, and other community education opportunities, at Check out the book, “Long Term Care Guide: Essential Tools for Solving the Elder Care Puzzle,” at the Whistlestop Bookshop or Amazon, and see Keystone’s free directory of services for older adults at Keystone Elder Law has offices in Mechanicsburg and Carlisle. Call 717-697-3223 for a free telephone consultation.


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