What Amenities Am I Required to Provide to a Live-In Care-giver?
Illinois Law provides that a live-in care-giver is entitled to a mid-morning and mid-afternoon break, as well as eight hours of sleep a night, at least six hours of which is uninterrupted. While it is not required that they be provided a separate bedroom, there must be “acceptable” sleeping accommodations made. Also, three meals a day are the requirement.
Of course, you will find that most care-givers are very accommodating and will not require strict adherence to these requirements day in and day out, since individual circumstances do prevail……but do recognize that this is the law, and its intent is to ensure that care-givers are not taken advantage of.
Can Care-givers Assist With the Taking of Oral Medicines or Injections?
No, under Illinois Law, assisting with the taking of medicines, either in pill form or via injections, or even taking vital signs for that matter, is considered to be providing “medical assistance” and therefore is not something care-givers are allowed to perform. They can, however, remind their clients when it is time to take medicines, and if a family member or other responsible party have placed the appropriate pills in a “weekly reminder container”, they can point that out to their clients.
How are Duties Assigned to a Care-giver?
Typically, the Agency will meet beforehand with the Client or their representative and work out a “Client Care Plan”, which will specify which duties are to be performed and when. If the agency is the type that hires it’s caregivers directly, as employees, then they are responsible for bringing this to the attention of the care-giver as part of their supervisory oversight, and then monitoring the situation to ensure that the requested duties are performed as required. Does this mean that a specific additional request can’t be made directly to the care-giver from the client? No, of course not…..it is, however, the agreed upon plan, so the client should not make a habit of making a lot of additional requests on a daily basis, since this might detract from the care-giver’s ability to perform their expected duties.
Do Home Care Agencies Provide Supplies and Equipment?
No, medical supplies and equipment (walkers, crutches, latex gloves, etc.) are typically not provided by the Agency, rather, they are the prerogative of the individual client and it is their responsibility to provide these items in most instances. Frequently this medical equipment and supplies are paid for by health insurance however, particularly if it has been prescribed by a physician, so be sure to ask your doctor and insurance provider about this!
How Do I Plan For Hiring a Care-giver and Are Their Schedules Flexible?
Typically, it would be a good practice to plan at least a week in advance for hiring a care-giver…this will give you time to interview agencies and find a care-giver you like. But agencies are accustomed to handling the occasional “emergency”, so if you have a referral for a good agency and the need is immediate, go ahead and call them, they may be able to send someone on short notice.
Typically, care-givers either work hourly shifts for one or more days a week (between 4-12 hours a shift are fairly common) or 24-hour live in. They may work multiple days a week, or particularly with live-in assistance, a week or more at a time straight though. This is decided between you, the Agency and the individual care-giver. Be aware however, that for hourly shifts, if a single individual works more than 40 hours a week, over-time pay comes into play (this does not apply to live-in care-givers), so for this reason, shifts that run for multiple hours/days per week may involve more than one care-giver being assigned to avoid the additional costs; holidays are also typically paid at the time-and-a-half rate (the same rate as “overtime”.) These are potential scheduling issues that will also impact what the client is charged for services on those days, so attention should be paid as to how those services are scheduled and how these potential issues are resolved.
Once you’ve employed a care-giver, recognize that this is “their job”….it’s how they pay their bills. So asking a shift-working care-giver to go home early because you have no use for them for the rest of that particular shift is not fair to them and is not a good habit to get in to, and most agencies will charge for the full shift anyhow. Of course, if you know in advance that you will not need the care-giver during a certain day, or shift, then that’s fine…..just let the agency know enough in advance so they can alert the care-giver ahead of time, allowing them to develop an alternative plan or even find another temporary assignment so their overall income is not diminished. But in these instances, it’s always better to communicate directly with the agency, not solely with the caregiver, since it’s the agency’s job to coordinate their care-givers’ schedules and they may have an alternative assignment for them, allowing them to fill in for the missing period.
Are All Care-givers Insured and Bonded and Do They Undergo a Criminal Background Check?
No. Illinois State law requires that agencies directly hiring and providing care-givers to their clients carry liability insurance for those employees, and that the care-givers have had finger-print-based criminal background checks, but bonding is not mandated by the license law so some agencies bond their employee-caregivers and others do not. And of course, care-givers that are not hired through a State-licensed agency do not face any type of requirement with regard to insurance, bonding or background checks.
I’ve Found a Good Care-giver, Should I Tip Them?
No, Home Care Agencies are required by law to inform their clients that they should not provide any type of financial incentive directly to a care-giver. This would include the practice of “tipping”, but goes well beyond that to include allowing care-givers access to any financial documents, check books, credit cards or anything else that might lead to practices that might result in charges of embezzlement or fraud. This should be spelled out in detail in your contract with the Home Care Agency.
How Can I Find a Good Home Care Agency and Caregiver?
The first step in the process is to determine exactly what types of assistance you need. You can do this on your own, or with the assistance of the potential client’s Doctor…..or you can enlist the aid of a geriatric care manager or a social worker. Be sure to include the opinions of the client themselves in the determination process whenever possible, since you want them to be “on board” with the outcome. If it turns out they mostly need assistance with the tasks of daily living, as opposed to intensive medical assistance, then you can probably do well with a good Home Care Agency, and any needed less-intensive medical assistance can be provided by periodic visits to the Doctor or even a visiting doctor/nurse as needed.
Once you have determined the needs of the individual, the best place to start is with recommendations from friends, neighbors or family who have used the services of a particular Home Care Agency. Other sources would include the individual’s Doctors or Clergy, or, if they happen to live in a retirement community, then the administrative staff of that community would also be a good source of recommendations.
Next, you want to interview a few agencies, with your specific needs in mind….at this stage a telephone call is fine. Ask about their credentials and hiring practices. Many agencies actually employ their care-givers directly (but not all do – be sure to ask!), so they are responsible for their training, performance, and supervision, as well as their payroll, paying of taxes, etc. Once you have gotten comfortable with a couple of agencies, invite them for an in-home assessment. This is your chance to sit with them and ask specific questions and determine if there is a “fit” between what they have to offer and what you need.
Once you have decided on an agency, be aware that virtually all of them will ask you to sign a contract and to pay a deposit before they place a care-giver in your home. Typically these contracts are open-ended, without any specific ending date, but they are “cancellable” with a reasonable amount of advanced notice. And the deposits are usually either refundable or used to pay the last bill that is incurred with the agency.
Does Insurance Pay for Home Care Assistance?
If an individual has a special type of insurance, referred to as “Long Term Care” insurance, this will typically pay for the services of a care-giver for a certain period of time, as outlined in the individual policy; however the type of “regular health insurance” typically carried by individuals under the age of 65 does not usually cover this type of assistance. In very rare instances, and only under a Doctor’s prescription, Medicare will pay for this kind of assistance for a period of time. Likewise, Medicaid will sometimes pay for this type of assistance. With both Medicare and Medicaid, however, it is always wise to check first to see if paid-coverage is available, since that will usually not be the case. If it is, then the care-receiving individual would be required to hire an Agency which is specifically approved by Medicare/Medicaid.
For this reason, most in-home care-giving is paid for out of pocket…..so called “self-pay”.
What is the Difference Between a Home Healthcare Agency and a Home Care Agency?
A Home Healthcare Agency is one which employs visiting Doctors, Nurses and other professionals. These individuals will go to a patient/client’s home to monitor and/or treat medically-related issues. Typically these visits are short in nature, although they may continue over time for as long as is medically necessary, and are paid for on a “per visit”, or in some cases, a “per amount of time” basis.
A Home Care agency employs Care-givers, CNA’s (Certified Nursing Assistants), Companions and Home-Health-Aides. These individuals will go to a client’s home to assist with non-medical tasks of daily living, such as bathing, dressing, personal hygiene, walking, cooking/eating, providing companionship, and providing transportation to appointments, and other out-of-the-home places. (What constitutes “non-medical” assistance varies by State, but Illinois interprets this pretty strictly.) They may also perform light housekeeping tasks, and do some laundry, ironing and other household chores. Their purpose is to assist the client to remain in their own homes longer, living as independently as possible, however they should not be thought of as “all-purpose maids”…..their purpose is to focus on and assist their client with the tasks of daily living. They typically are available to assist in daily shifts for a number of hours at a time or as a full-time live-in situation, for as long as the assignment lasts.
In the State of Illinois, both of these types of Agencies require a different type of operating license, with different requirements, therefore most agencies do not provide both types of visiting assistance, but rather, focus on one kind or the other.
How Do We Determine Which is Better For Our Circumstances, In-Home Care or a Nursing Home?
This is a very personal decision that can only be made by the individual in question and their loved ones. But it may help to understand some of the general pros and cons of each approach, and then decide which of these are the most important to you and your loved one (please also see related topics in our blog, and visit some of the resources shown on our Outside Resources page for additional insights.)
Nursing homes come in a variety of shapes, sizes and costs, ranging from fairly sparse living quarters and surrounding “common areas” to opulent settings and amenities. They may also provide just one type of living arrangement, or run the gamut from “pre-nursing home independent living”, to “assisted living” to “memory care units” all available in a single complex, allowing the resident to “age in place”, or at least within the same complex, and therefore providing the ability to keep their same friends who live there. Typically, nursing homes provide on-staff medical assistance with nurses available around the clock, and sometimes Doctors are on staff as well. They may also provide care-givers, or allow their residents to hire their own from outside sources, to provide more one-on-one care. They also typically arrange for all meals and frequently provide “activity directors” and make arrangements for their residents to attend outside events, providing social opportunities for them. Of course, all of these amenities don’t come free……nursing homes can be financed in a number of different ways, but in general they are a much more expensive option than in-home care.
In-home care, on the other hand, allows the individual to stay in their own home with the assistance of a hired care-giver whose sole responsibility is to watch over them one-on-one and to assist them with all of their non-medical needs (medical needs would be handled either by doctor’s office visits or home visits by doctors or nurses.) The benefits of this arrangement include the fact that the individual remains in the familiar surroundings of their own home, not having to learn new routines and new home layouts or where things are kept… and importantly, they remain “masters of their own universe”, without the institutional intrusions that are common in a nursing home setting and with the full freedom to decide what they want to do, and when. And of course, living in their own home allows them to keep their own friends, neighbors and routines, which provides a further degree of familiarity and comfort. And not to be downplayed, typically in-home care is a much more affordable option for most people.
For these reasons, many people employ a blended approach, hiring in-home caregivers to allow their loved ones to live in their own residences as independently as possible for as long as possible, and then only if and when it becomes more medically necessary, move them to a nursing home where medical support is more intensive.
But as stated above, the decision is a very personal one, and not to be made lightly. We would suggest that options be researched…..contact a few nursing homes that you have heard of and learn what they are all about – what they offer at what cost and what the financing options are. And if you find some you think you like, go visit them and check them out thoroughly. And then contact a couple of home care agencies and learn the same things about them. And of course get references whenever possible. And finally, involve the person in question with any decision if possible…..you want to make sure that this is what they want and will be comfortable with, since you want to ensure their, and your, peace of mind with whatever decision you make.