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By: Jason Lom
In the home care health industry, there's a terrible pressure to give care quickly and inexpensively. Some in home care agencies have been tempted to cut costs, take shortcuts, and skip seemingly non-vital elements in order to reduce expenses. Unfortunately, the people who suffer most because of these middle-management level decisions are the patients, who have to deal with caregivers who weren't properly vetted among other problems.

"There are good caregivers and good agencies, but consumers need to understand that there are questions that you need to ask," said Dr. Lee Lindquist, an associate professor at Northwestern University's Feinberg School of Medicine. "You need to be discerning about whom you hire."

Dr. Lindquist recently published a study that examines the qualifications of home care health workers who assist the elderly with daily activities like meal preparation and getting dressed. "These are not nurses," Lindquist says. "These are caregivers, private duty attendants. They don't need any medical training..[yet] these agencies are a largely unregulated industry that is growing rapidly with high need as our population ages. This is big business with potentially large profit margins and lots of people are jumping into it."

The study revealed a number of startling statistics: -Only 55% of agencies did federal background checks on their employees. -58% relied on caregivers to accurately assess their own skill levels. -Only 33% of agencies even claimed that they performed randomized drug tests. -Only 33% of agencies tested their caregivers for competency in their core skills.

Most in home care agencies relied on 'patient feedback' to determine if a caregiver was doing an adequate job -- but how can you expect a senior with dementia to report correctly on the job their home care health worker is doing?

Earlier, we talked about the fact that many home care health workers aren't nearly as well-vetted or well-supervised as we might like. What are we as consumers supposed to do about it? Well, the obvious answer is that it's up to us to take responsibility for our loved one's well-being. They don't have anyone else that's going to stand up for them, so it's up to us to make it happen.

Dr. Lee Lindquist, an associate professor at Northwestern University's Feinberg School of Medicine, offers these dozen questions:

1.How do you choose your caregivers, and what are your hiring requirements?

2. How do you screen your caregivers before you hire them?

3. Do you perform criminal background checks at the federal or state level?

4. Do you perform drug screening?

5. Are your home care health workers certified in CPR -- or do they have any other health-related training?

6. Are the caregivers bonded and insured through your agency?

7. What competencies are expected of the caregiver before you send them to the patient's home?

8. How do you assess what the caregiver is capable of doing? (Self-assessment vs. some form of standardized test.)

9. If a regular caregiver cannot provide the contracted services, will a substitute be provided?

10. Will a substitute be provided if there is dissatisfaction with a particular caregiver?

11. How often does the agency send a supervisor along to evaluate the quality of home care?

12. If you suspect a supervisor's intervention is required, how does that happen? (Through phone contact, progress reports, in-person at the home of the older adult, or elsewise)?

Anyone expecting to get a high quality home care health worker to attend to the needs of their elderly loved ones should write down or print out a copy of that list, and make sure you get all of the questions answered to your satisfaction before you let your loved one anywhere near a particular agency.


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