02/19/2010 12:46 am ET Updated Nov 17, 2011

Aging Parents, Home Care: What You Need To Know When Hiring Health Aides

Finding a caregiver can be a stressful responsibility for family members. Because medical emergencies arise suddenly, decisions must be made quickly. Many baby boomers are faced with aging parents who demand home-care assistance. Marki Flannery, president of Partners in Care, a not-for-profit that provides certified home health aides and nurses throughout New York City, Westchester and Nassau counties, suggests a checklist when engaging such services.

Partners in Care provides mission-driven private-care services to people in their homes or communities, including personal care, private-duty nursing, patient review assessments and geriatric care management. Serivice can begin within 24 hours of a call. An affiliate of the Visiting Nurse Service of New York, it services Medicare, Medicaid and private-pay patients, more than 4,000 every year.

What do families need to know when hiring home care? Flannery says it's critical to factor in cost, job requirements, employee consistency, security issues and expertise. She has compiled a helpful, seven question list for potential clients:

Is it better to hire a home health aide from an agency or person recommended by a friend?
Placing ads in your local newspaper or through personal networks may not find a person that has received formal training. Make sure aides are insured and certified and properly trained. For example, Partners in Care requires aides to pass comprehensive background checks, as well as random drug testing. It also gets references and runs fingerprint checks through the FBI database. If you don't have time to check on the home-care aide, make sure the agency is reputable and has done so. Don't assume, ask!

Why is training so crucial?
There is a major difference between hiring a stranger recommended by a neighbor and a home health aide who is part of an organization. At Partners, we look at more than just medical needs. A client services rep will ask you a series of questions to understand a potential client's physical, emotional and mental needs. Our nurses create a customized plan of care, matching your loved one to the right home health aide. If, for example, your mother needs a regular walk in the park or afternoon tea, we do our best to accommodate.

What factors should we consider when choosing among different home health care companies?
Before you hire the agency, ask yourself, do they all offer the same services? Do they charge the same prices? Does one have a better reputation? Many for-profit companies often select the most lucrative cases and turn away others. A not-for-profit agency does not turn away cases. We take short-term cases and long-term complex cases matched to specific needs. Partners in Care's home health aides provide one-on-one service and undivided attention a minimum of four hours a day. Spending so much time in close contact makes it crucial that you get along with your caregiver.

What does it cost to hire 24/7 help and what is the most economical way to do it?
First, define exactly what level of care you need. Does your mom need a home health aide to monitor her 24/7, or only when she's awake? It's important to determine the patient's sleeping patterns. If they rarely disrupt the aide and you can provide an adequate place for them to sleep, a live-in aide is appropriate. In such cases, you will pay an overtime rate for an aide who works more than 40 hours per week. However, these costs can be minimized; Partners In Care can increase the number of aides assigned as live-in aides per week to split the hours. If you don't need live-in care, we can assign two aides who each work 12 hours per day or four permanent aides each week to control costs and avoid overtime.

Do I get to interview home health aides before I hire them?
At Partners, pre-interviewing is available for a fee; however, most people do not know what questions to ask. That's why we treat the first day or two of service as a trial period. During this time, our supervisor talks directly to you, the patient and the aide to ensure a good fit. Often, we can address issues before they cause serious problems. Our goal is consistency: the same home health aide each day service is needed. If the patient and the home health aide develop a trusting and caring relationship, it means better communication and overall better health care.

What is the best way to manage the aide relationship?
Establish and maintain a professional, employer/employee relationship with the home health aide. A professional aide will expect such boundaries, and you will feel much better about the relationship. If there are cultural behaviors and traditions a home aide needs to know, alert them. This is an intimate relationship, and it works best when there is respect for the needs and concerns of the person and families we care for.

How is the Visiting Nurse Service partnership helpful to clients?
It's a partnership that coordinates care. If your elderly mom's condition worsens and Medicare-type treatments are necessary, we make sure she gets the appropriate medical attention. She can keep her aide and Medicare will cover some or all of the cost. If her condition has improved and Medicare coverage has stopped, we can transition to private payment while keeping the same home health aide.

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