In-Home Health Care: Your Guide To Hiring A Caregiver In St. Louis

The global home healthcare industry was worth approximately $306 billion in 2018. Hiring a caregiver is necessitated by factors like old age and chronic diseases. The global elderly population is expected to grow by 3% each year. Hiring a caregiver is a decision preceded by several considerations. First, it’s essential to understand the different types of home caregivers available. Recognizing the type of caregiver you require will help you with planning and having your needs met.

Types of In-Home Health Caregivers

When hiring a caregiver, remember they may not all perform the same tasks. Here's how to differentiate their services.

Home Health Aides (HHAs)
These are caregivers whose role is to monitor the condition of the patient. They check the vitals and assist with the basic activities of daily living. These include dressing, using the bathroom, and feeding.
These caregivers also provide company to the patient and do light house chores. They’re trained and certified, but certification criteria vary across jurisdictions.

Skilled Nursing Care
This category of caregivers meets federal standards for safety and health. They're licensed by the state to provide home-based care. Unlike home health aides, skilled nursing caregivers offer medical care to patients.
Their roles include managing, observing, and evaluating the patient’s health. They administer IV drugs, dress wounds, provide diabetes care, and give tube feedings. Their functions also extend to providing patients and caregiver education.
Some skilled nursing providers are trained in speech therapy, occupational, and physical therapy.

Licensed Nursing Assistants (LNAs)
This category also includes Certified Nursing Assistants whose work is to observe changes in the patient. They take vitals, change dressings, set up medical equipment, clean catheters, and monitor infections. They also offer walking assistance and range-of-motion exercises.
Other roles are providing personal patient care like dental care, feeding, bathing, and changing bed linens.
LNAs must be under the supervision of a Registered Nurse or Nurse Practitioner while providing medical-related tasks.

Personal Care Assistants (PCAs)
Take note that these caregivers are not licensed. Their level of experience and training varies from an individual to the other. Their work is to provide help and companionship to patients.
PCAs perform duties like bathing and dressing, light housekeeping, meal preparations, and transportation. They accompany patients for shopping, prescription pickup, and neighborhood walks.
Requirements for training vary from one state to the other, with some not having formal requirements. In terms of wages, PCAs are the least expensive but aren't covered by Medicare. Consider their services to be an out-of-pocket expense.

Registered Nurses
When hiring a caregiver from the Registered Nurses category, remember you may have to pay more. RNs are licensed by the state’s board of nursing, holding an associate degree or nursing diploma. The board requires them to pass the NCLEX-RN exam.
This is administered by the National Council of States Board of Nursing. Once you know the type of caregiver you want to hire, the next thing is to do some background check.

Selecting the Right Caregiver

Hiring a caregiver can be a daunting task. Despite the training and the requirements in place, individual characteristics of caregivers differ. Finding one who can blend with the needs of your loved one can take time.

While there are no set guidelines on what the path is to follow when hiring a caregiver, here are some recommendations.

List Down Your Needs
Together with your loved one, take an in-depth look at the needs at hand. What level of assistance would the patient need, their likes and dislikes, and expectations? For your Medicare insurance to cater for caregiver expenses, you'll need a doctor's letter confirming the need.
Remember that Medicare doesn’t meet the expenses for personal care only. Professionalism should be on top of the list. However, this shouldn’t be at the expense of friendliness and easy-to-relate-with personality. Once your list is ready, decide how to source the service.

Your Options
You can get a caregiver through friends, agencies, or the registry. Whatever option you have, be sure to assess them to ensure you have a person who has compassion and empathy.

  1. Hiring Through an Agency
    Medicare has a list of patient-rated agencies which you can use to find eligible caregivers. Whether your patient is Medicare-eligible or not, you can use the services and arrange for a consultation. Some of the advantages of finding a caregiver through an agency include:
    • Workers are pre-screened before hiring
    • Experienced caregivers
    • Backup for caregivers who are unavailable for work
    • Quick resolution of problems with the caregiver
    • Easy to upgrade to a more trained caregiver
    • No paperwork
    • Caregiver compensation in case of injuries at work

    However, there are also downsides like:
    • Caregivers from agency charge higher rates
    • Rigid working hours and duties
    • No overtime hours
    • The agency chooses your caregiver
    When choosing an agency to work with, put the needs of your loved one first. Don’t be afraid to ask any questions you might have. Remember to also seek clarification for anything that might not be clear.
    Most importantly, ensure that the agency is licensed by the state. Confirm with the state health department about the licensing of any agency you wish to engage.
  2. Recommendations from Friends
    You could ask for recommendations from your friends and neighbors for caregivers. Some crucial information to get in the referrals includes names, services, and hourly rates. The needs of your friends and neighbors may differ from yours.
    Also, consider consulting the community. Leave your contacts at the receptions of places like senior centers, places of worship, and community centers.
  3. Hiring from the Registry
    Both local and state-employment registries have a list of available caregivers. From the list, you can choose the caregiver that best suits your needs and call them directly.
    Advantages of hiring a caregiver through an agency include:
    • Easy to find a caregiver with flexible working hours
    • No agency fees required
    • Easy to negotiate terms with the caregiver
    • Easy to find a caregiver who is a better fit

    Some of the downsides of using the registry are:
    • The process is time-consuming
    • Lack of fall-back plan in case of caregiver’s unavailability
    • You have to do your own screening
    • Liability for on-job accidents is on you
    • You’ll have to meet the training costs
    • You sort out differences with the caregiver
    Once you’ve found the perfect fit, let your loved one be part of the interviewing process if possible. Be as clear as possible about the job requirements and your expectations.

How to Pay for Home Health Care

One of the primary factors to consider when hiring a caregiver is the associated costs. Paying for the services can be out of pocket or by third-party payers like Medicare. A third option is third-party payers like health insurance companies. Third-party payers have specific requirements for eligibility. Take note of these requirements before signing up for the services to avoid interruptions. If the third-party payment option is not available for your case, you can pay for services out of pocket.

Third-Party Payer Options
If you don’t qualify for privately-owned health insurance covers, consider some of these public third-party options.

  1. Medicare
    You’ll be glad to know that Medicare caters for most home-based health visits. The program caters for seniors of 65 years and over. It also covers individuals who've been living with a disability for more than two years.
    Medicare is usually the most widely available used option for home care services. However, it comes with very restrictive requirements for payment. The program has two parts; A and B. Both parts cater for all home health services, while other forms of health care fall under either section. Short-term home care and hospital health care are covered under part A.
    Under part B fall doctor’s visits, outpatient services, ambulance, and medical equipment. If your patient is a Medicare beneficiary under part A or B, they should meet the following conditions:
    1. The doctor must recommend skilled home health care and prescribe the same
    2. The patient must be in need of physical therapy, skilled nursing care, or speech therapy
    3. The services must be provided in a home environment
    4. Medicare must certify the agency providing the services
    If a patient meets these requirements, Medicare will cater for the following services as required:
    Skilled Nursing
    Only a registered or licensed practical nurse can deliver this service. The latter must be under supervision by a registered nurse. It involves health care services like complex wound care and injections.
    Home Health Aide
    These are personal care services that help make life easier for the patient. They include bathing, feeding, dressing and using the bathroom. Medicare pays for them only if you’re getting skilled care or in-home therapy.
    For Medicare to pay for therapy, a doctor must prescribe them. It includes occupational, speech, and physical therapy.
    Medical Social Services
    A patient requires counseling to help them cope with the emotional and social concerns of the illness. Group interactions are also great here.
    Some Medical Supplies
    These include ostomy supplies and wound dressings. Be sure to check your plan for all the essential details.
    Durable Medical Equipment
    Equipment that the patient requires for use at home is paid for by Medicare. It includes wheelchairs, walkers, hospital bed, and oxygen equipment. However, note that you’ll be responsible for 20% of the cost of the items.
    What costs does Medicare not meet?
    • Home-delivered meals
    • Some prescription drugs
    • 24-hour home care
    • Home-keeping services like laundry and cleaning
    Before hiring a caregiver from an agency, check to see that the agency is Medicare-approved. Those certified by Medicare have met the federal requirements for healthcare. The agencies are under the watch of Medicare due to legal requirements.
  2. Medicaid
    The Medicaid program is available in several states. It aims to provide healthcare to low-income citizens. One factor that determines eligibility is financial information, subject to periodic reviews. Reimbursement differs from one state to the other, since there are different requirements for participation. However, across all states, Medicaid covers essential home health care services like skilled nursing, medical supplies, and aide services. The program may also cater to personal care and home keeping services not covered by Medicare.
  3. Veterans Administration
    This program caters for veterans who were injured during service. They must be at least 50% disabled to qualify for the cover. To be enrolled, a physician must recommend home-based health care services for the patient.
    The patient must also be in need of occupational, speech, physical therapy or intermittent skilled nursing care. The health care services must be provided by providers from the VA’s hospital-based network.
  4. Older Americans Act (OAA)
    This program came into existence in 1965 through enactment by Congress. Its purpose is to provide funding for personal care and general home services. Only patients over 60 years old are eligible for the program.
    Another criterion for eligibility is that the applicant must be frail or disabled. They also must demonstrate a significant financial and social need. OAA usually provides the services through the local Area Agency on Aging.
  5. Social Services Block Grant Programs
    Every year, governments give block grants to states to meet state-identified service needs. A good portion of the donations is directed towards homemaker services and home care aides.
  6. Community Organizations
    In working together with state and local governments, some community organizations cater to personal care and home health care. There's an eligibility criterion to be met, which determines how much of the cost the organization can meet.

Hiring a Caregiver - Take Away

Getting quality home health care for your loved one can be tasking. However, if you’ve got the necessary information, the process of hiring a caregiver can be a lot easier. It all begins by knowing the needs of your patient and the services they require.

Once you list down your needs, decide whether you want to hire from an agency, registry, or through referrals. Each option has its fair share of advantages and disadvantages. Whichever option you settle for, ensure you get the best quality care possible.

Make use of the available home care payment options. Medicare, Medicaid, Community Organizations, OAA, and Veteran Administration are some viable choices. If your patient doesn’t qualify for any of the programs, go for services you can afford.

Most importantly, ensure the home care provider is trained and certified. You don’t want to expose your loved one to risk through unprofessional care. Do you have any question? Feel free to talk with us and let us help you.