Personal Care and Home Care Services – What are the Differences?

Home Care services can be the solution to aging-in-place

When dad was released from the hospital, it was clear he was not going to be able to continue doing the grocery shopping, housekeeping and caring for my mother at the level he had previously. So now what? Home Care was the answer.
NOTE: This is the final of three installments on this topic.

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Lessons Learned
Home Care Agency (Non-Medical Home Care)
What to expect when you hire a non-medical home care agency
What to expect once the non-medical home care aide starts working

First we had to honestly assess what help was needed, given that dad could not keep up with tasks around the house. This led us to the solution of home care. Home care is defined as non-medical tasks that relate to housekeeping, meal preparation, shopping, laundry, cleaning or transportation services. It can also include companion care, which at the simplest level, is someone sitting with your loved one for companionship or, so they are not home alone. Later in this blog I go into more detail on non-medical home care agencies.

Home Care Services are different from “Personal Care Services” This definition of personal care services comes from New Jersey Public Safety website. “Personal care services” means those tasks for the purpose of assisting a patient with the activities of daily living, including assisting with feeding, toileting, bathing, dressing, grooming, transferring, ambulation, exercise or other aspects of personal hygiene. These services are a subset of health care services and workers are licensed. (emphasis mine). “Personal care services” do not include tasks relating to housekeeping, meal preparation, shopping, laundry, cleaning or transportation services which may be performed by unlicensed persons. Source: (NJ Public Safety publication on best practices for Home Health Care Service Firms)

I figured out we needed home care services, but now I had to get my parent’s OK to bring a stranger into their house. It was hard, especially for dad, who had been responsible for their home for so many years. It helped to point out that taking responsibility for the house off of him, meant he could concentrate on getting stronger. That still left me with the responsibility of grocery shopping and caring for mom. We kept dad involved by using a shop-at-home application for a local grocery store. It meant my parents could continue to figure out the grocery list together and he could input the list. All I had to do was go pick it up.

The second hurdle was getting my parent’s to agree that my brother and I would pay for the home care services. I think what finally swayed them was that we didn’t see needing this service forever. And paying for it actually helped my brother and I, because it was one less thing we had to worry about it.

I knew nothing about home care when I started looking. All I knew was that we needed help NOW. An internet search turned up so many local agencies it was mind boggling. I don’t remember exactly how we landed on the one we hired. I think someone picked up the phone and assured me they could help – I was in.

Since then I have learned a lot about this service business, but searching the internet I still find it hard to decipher exactly what each company does. There are industry standard terms, but it seems like few companies use them in marketing materials. I guess the terms and descriptions a company uses are designed to show how they are different from their competitors. Frankly, it just confuses me.

In addition, home care agencies employee certified nursing assistants (CNAs) that can perform personal care and home care services, so figuring which agency to use in addition to who is coming into your home can be interesting.

Home Care Agency (Non-Medical Home Care):

When dad got out of the hospital we needed help with instrumental activities of daily living (IADL). This term refers to six tasks that allow you to live independently in your home. The tasks are: light housework, preparing meals, taking medications, shopping for groceries or clothes, using the telephone and managing money. Since dad could no longer do the cleaning, laundry or grocery shopping, we hired a non-medical home care agency to provide these services. Source: (Inhomecare.com: Types of Home Care Agencies)

Today, mom requires help with some of the activities of daily living (ADL). This term refers to six specific activities: bathing, dressing, transferring (in and out of the shower or bed), using the toilet eating and walking. More about this in a later blog post.

ADL and IADL are not considered to be skilled care services, so they are not reimbursable under Medicare. Payment is private, so getting my parents to buy into my brother and I paying for services was important. In some cases, private long-term care (LTC) insurance pays. Note: Medicare will pay under certain conditions as part of an authorized episode of home health, but that is for another blog.

“These private pay agencies are usually still licensed under authority of each state but licensure requirements and regulations vary widely from state to state unlike federally regulated Medicare certified home health agencies. Most agencies employ their workers, do background checks and manage payroll and taxes. Most of these agencies professionally supervise and monitor their staff with regards to patient care. Non-Medical home care agencies play an undeniably big role filling gaps in home care services not covered under skilled care. Un-skilled home care services such as personal care assistance or other cooking and cleaning help is often what may be needed most and by many in order to remain in their homes (emphasis mine).” Source: (www.carepathways.com: Types of Home Care Agencies)

Because these services are considered non-skilled, a professionally authorized and RN monitored care plan is not necessary. However, a non-medical care plan is typically developed.

What to expect when you hire a non-medical home care agency:

• They will do a phone “intake” (interview), then schedule a time to come to your home to do an assessment and meet the client. The assessment includes finalizing the recommended home care services. And, a walk-through check of the house for safety issues such as area rugs that can cause a fall, or grab bars missing from a bathroom. Usually the business owner is the person coming to your home.
• This person will explain the services you are to receive and any limits. For example, don’t expect a home care aide responsible for light housekeeping to do windows. Nor are they responsible for any maintenance work inside or outside the house. They have work limitations like not being allowed to stand on ladders.
• The agency will want to know if there is an Advance Directive or Living Will and where it can be found.
• All agencies have a minimum number of hours they will place a person typically, 3 – 4 hours. This is to ensure the hiring of quality people. No one wants to work one hour at one client, another hour at another’s, spending most of the day on the road.
• Some require a deposit (up to 2 weeks) before starting the aide.
• Some agencies will bill you as “no show” or if you cancel with less than 24-hour notice.
• Some require 2 weeks’ notice for cancellation of service or you won’t get the deposit back.
• Many agencies prefer to make the choice of aide for you, without you interviewing them.
• You can ask for a change in aides if it is not working out, but they like you to wait a week or two to make sure before they find you a new aide.
• Holidays and weekends are charged at time and a half.
• If an aide runs errands for you, you pay the government standard mileage rate if they use their cars.
• Read the contract carefully – some agencies may still require you to pay even if the aide cancelled due to weather. Look under a “last minute cancellation” policy in the contract.

What to expect once the non-medical home care aide starts working:

• Since dad could no longer use stairs, I needed to be at the house to show them where the washer, dryer and cleaning supplies were in the basement. That was an interesting challenge if a new aide was coming.
• Since the aide could change, we worked out a schedule of what needed to be done on the days they were at my parents house.
• Gloves are used for many duties and we needed to supply them.
• Have a plan B. Cars break down, people get sick and scheduling is tight. If your aide can’t come on your scheduled day, the agency will most likely not have the resources to send someone in their place. Expect to be re-scheduled for another day.

Lessons Learned:

• Throughout this process, from the initial assessment through people onsite working, I had to repeatedly make sure the aide addressed questions to my mother or father, not me. For some reason if I was in the room, they looked to me. I found myself saying “mom, so and so has asked ….” And then let her answer the question.
• This is personal observation only, but it seems like the difference in dollars from one agency to another is largely based on the overhead of the organization. For example: 24-hour phone pick up by a live person, including weekends, we found to be at a higher cost. If this is important to you, expect to pay more.
• Front office staff of the agency can make or break your experience. Are they good at communications, keeping you informed? If you call or email a change in schedule or make a request how quickly do they acknowledge it was received?
• Although many agencies preferred to make the choice of aide, for us that was non-negotiable. If I was in Houston working, I wanted to know who was in my parents’ home. We interviewed all candidates.
• Terms are confusing: Non-medical home care aids are also referred to as personal care, attendant care, non-medical care and companion care. Again, these aides provide “custodial care”, helping people with their activities of daily living such as bathing, dressing, housekeeping and transportation.

Disclaimer: The material in this blog is for educational purposes only. It is not intended to replace, nor does it replace, consulting with a physician, lawyer, accountant, financial planner or other qualified professional.
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