Aware Senior Care Blog
Gina joined host Jennifer Fink on the Fading Memories podcast to discuss when and how to choose the best home care services when caring for a loved one. Below are excerpts from the interview. To listen to the full episode, click here: When and Home to Choose In-Home Care.
When and How to Choose the Best Home Care Services – Q&A
Jennifer Fink: With me today is Gina Murray. She is with Aware Senior Care and she is going to talk to us about how to select the best in-home care services for our loved ones and hopefully we can touch a little bit on when we should be doing that. So, thanks for joining me Gina.
Gina Murray: Thank you for, thank you for this, Jennifer.
J: You’re welcome. So when we had to do in-home care for my parents, we did not have the opportunity to do it, what I would consider, correctly. The hospital had said that they were done. They were releasing my dad. Basically come get him and I had to put the brakes on him being discharged because we didn’t have anybody, anything set up for them in their home.
My dad’s memory had gone south because of the toxins from his, his donated kidney was failing and he didn’t want to be back on dialysis. So when he left the hospital, he went on Hospice. But, we needed to also have in-home care for my mom who has advanced Alzheimer’s and for him because he just thought he was getting over the flu.
So I literally had 24 hours to figure out what in the heck we were gonna do. So, I had to pick an in-home care agency with gut instinct.
J: Thankfully, it wasn’t a disaster. About a third of the caregivers were just fantastic. Maybe a little more than a third were good, you know, average to better than average and there were a couple that we had to say no we’re not, you’re not coming back.
And yeah, so it’s like I guess gut instinct worked .
G: I’m glad.
J: Me too. Because it was really hard the first evening that we left my mom there with the caregivers or a caregiver and we had to drive away. And it was like worse than the first time I left our daughter with a babysitter, which was many years ago.
G: Right, right. It’s that same feeling of “Am I doing the right thing?”
J: Well yeah, because they’re so vulnerable. Like, my mom had no clue that what was going on and you know, all this upheaval and my dad had been in the hospital for 32 days. So, it was just, it was and it would have been traumatic even if she didn’t have Alzheimer’s.
G: Right. And you’re also dealing with the whole hospice, realizing what’s going to happen and-
J: Yeah, that was kind of a diff-, I don’t want to say difficult decision. It was a little bit difficult to admit okay, this is his advanced directive. I actually had to fight a little bit with his kidney doctor, nephrologist. She knew what his advanced directive was and she called me up and said well now you know, because your dad’s memory isn’t back all the way.
Not sure why she thought after 32 days it would come back 100 percent. It never did. Now, somebody’s gonna have to drive him to dialysis and sit with him. And I thought lady, do I look like I am independently wealthy? Do I look old enough to be retired? I just turned 50 and I paused and I said you know he doesn’t want to be on dialysis.
If somebody has to go and sit with him three days a week, then we need, then we need to call hospice. That’s what he wants and her response was to hang up on me.
G: Oh, I’m sorry, oh.
J: Oh yeah, she better not ever walk in front of my car because she knew. It was his doctor, it wasn’t the hospital’s doctor. It was his personal nephrologist. So yeah, that was my, my first experience that I, I thought, oh this is great.
He did end up in the hospital. He was home for three or four days and he fell and the care, the caregiving staff that was there. The ones that I had to hire and a big panic and using my gut instinct. You know they called the hospital and I said send him to the, the one that was in their hometown. Not the one that was closer to my sister and I. And when the nephrologist from that hospital system called and said his, basically his heart rate would drop really, really low when they did dialysis.
And they were trying to balance it. She talked to me for 20 minutes. The first 15 probably, was on everything they were trying to do for him to basically keep him alive. And I just finally said you know, we’re in a dark grey area of not honoring his advanced directive and she goes oh okay, left turn right into the hospice. I was like oh this is how it’s supposed to work and then the day that I’d already done all the paperwork for hospice and stuff and that was a little difficult.
I went into his hospital room and okay, typical health insurance, they’re doing dialysis on him. I’m like what the heck? You guys just trying to jack up the bill because that is the only reason I can imagine that you’re doing this? Whatever. And so there was a different nephrologist in there and she’s talking to me and I must have given her that look because she goes Oh, let’s go talk in the hallway. Then I told her yeah, we’re gonna do Hospice and she just goes that’s probably a good idea.
I’m like oh, thank god like I don’t have to fight with anybody ever again. So, that was the story of everything going on with my dad and when and how the circumstances of choosing an in-home care. So it was definitely not a scenario that I recommend.
G: Right, right.
When to Bring in Home Care for a Loved One
J: And so I’ve been trying to find somebody that would talk to me and the listeners about exactly how we should go about doing it. And what are the signs like if you’re the spouse’s caregiver, when should you bring in help? You know, these kind of you know, we want to make sure we’re doing the right thing for ourselves and our loved one and we don’t want to spend money sooner than we have to. But we don’t want to wait too long. That’s kind of what I wanted to talk to you guys about today.
G: Right, it’s because sometimes bringing you in a little bit of help early prevents the falls. Prevents some of the big you know, disasters that can happen. So, I think the best time to start is right now when there’s no crisis you know? Just to start getting information when it’s nice and calm and you can collect information and learn what’s out there.
J: That’s kind of what I thought. You know, obviously you don’t want to wait till someone’s in the hospital or you’re there at the point if they’ve got memory loss like my mom-
J: That you can’t leave them alone at all.
J: But I wasn’t you know, because I didn’t have the opportunity to do it quote right, I wasn’t sure how early in the process it would really be smart to start. So, earlier is
definitely better than-
G: It is. We, we wholeheartedly encourage, we, we do educational seminars in our community and we tell, you can call our office just to ask questions. Just to say you know, what services do you provide? Do you have minimums? So, you just store all the information away. Hopefully you never need it. That’s what we tell them.
We hope you never need our services. But, if you do, you can make an informed choice. So when you when people do have time, many times they turn to trusted friends, the clergy, your physician for recommendations. Which you know, people being individuals what I might need for my parents might be very different from what the next person needs for their spouse, so.
J: I think it would be easier to determine what you like, we had to just figure it out on the fly.
How to Find the Best Home Care Companies Near You (15:20)
J: So, we, like I said, we got very, very lucky. I guess my gut instinct is pretty good. But, you know looking back I think, like you’re saying, I don’t, I don’t remember other than the two, two gals who were just beyond above, you know, just fantastic. I don’t think any of them ever, ever talked to my dad like you were saying. Well, we’re really here for your wife and so you know, is there a way of I don’t know screening is the right word. But how would you go about, well, why don’t you tell us how we should go about selecting?
G: Sure, sure. So if you have plenty of time and you’re not in that scenario and you’re looking for information, a really good place to start is reviews on third-party websites. Places like Home Care Pulse, Caring.com, SeniorAdvisor.com.
So these are where you know, the clients or families can post reviews. You’re, you know not necessarily solicited. They’re honest and you get real feedback from real people. You can type in your zip code in these and find the best of home care in your area. They’ll give you the reviews. They give you insight into the quality, what the families are saying, any awards the companies have won. You know kind of validating their quality.
That helps you narrow the search. Like, okay, now I have five companies, three companies I’m gonna talk to. I think it’s important to decide what some of, what’s most important to you and what do you want to know from the company. Personally because I had a situation with my dad. I took care of my dad at the very end on Hospice and I didn’t even know there was such a thing as home care.
This is 13 years ago. So I was like how are we gonna do this? This is, this is crazy. So I would want to know why the home care agency owners are doing it?
J: That’s a good question.
G: You can teach skills, I’m a registered nurse, but I can’t teach someone to care and I believe-
J: That’s true.
G: It trickles down from the top. That if whoever’s running this agency is doing it because they care, because they’ve had experience, because they sat in your seat and walked that walk. That’s the way they treat their employees. For us, there’s nobody more important than our caregivers. Quite frankly it’s harder to find great caregivers than it is to find clients.
J: I’ve heard that.
G: So, you know, we know the most important thing is to take care of our caregivers pay them the best we can, the benefits, make them know that they are so appreciated and it’s trick-, that’s, that’s what trickles down. You take care of your caregivers and you teach, make sure they have the right skills, you know? How do they, an agency know the caregiver has the skills to take care of my dad? Do you know how to handle dementia and how to just roll with it when dad’s saying “Have you seen your mother” and “Well, mom’s been gone for ten years?”
G: You know? Well, you know I haven’t seen her right, you know, recently but are you gonna be in the living room? I’ll let her know you’re in the living room if I see her and you just enter their world. So, those aren’t really things you learn in a book. But we make sure our caregivers are equipped with those tools when they go to someone’s home where there’s you know, folks with memory issues.
What Questions Should You Ask a Home Care Provider? (23:47)
J: So, now you’ve narrowed it down to you know three to five companies you want to talk to. So, what kind of questions should people be asking? Because I don’t think I asked enough. Because like we got lucky.
J: Just in this short time we’ve been talking I’m like oh yeah there’s some questions I should have asked.
G: Um, what, what specific services do you offer? Some agencies only do companion care, where they’ll come in and do household tasks, transportation, make meals. Some do personal care as well as a companion care. We added nursing services onto our, we do personal care in home and companion care because like you said, the nurse, the caregivers can’t administer the medicines and we do a fair number of Hospice clients.
So, they’ll hire us and we’ll have a nurse overnight so the family can sleep and if the client needs medication administration, the nurse can can do that and the family can actually sleep. We, sometimes we have nurses around the clock because they’re giving injections. They’re doing IVs things like that. I would ask if there’s a minimum number of hours.
What’s the shortest visit you can do? Can you come for two hours or does it have to be four? Can I do two hours once a week or does it have to be a certain number of days of the week? So, different agencies kind of specialize. We decided we have longer cases. So we have caregivers that want to work like 8 hours, 8 to 12 hours so that’s what we do.
But there’s other agencies that’ll do you know, two, three hour visits because not everybody needs a lot of time. It’s important to know the costs and that way if you’re asking several agencies, you can compare their hourly rates. But then ask them, too, is it a different rate at night? Is it a different rate on the weekend? Some people do that, some don’t.
J: Yeah, the three I talked to were all the same price. It was one price for one person. It was a minimal amount extra when my dad was, we started with them before my dad was out of the hospital, I think for about close to a week. So it was just mom and then he was home for about a week and was in the hospital for a week. It was a little confusing with the billing because it was like, well you’re only billing for one right now. Now you’re billing for two. Now we’re back to one, now we’re back to two.
J: It was crazy. But yeah, they were all the same and I never asked about minimum hours because we needed 24. But I’ve got I know, there’s a gal in my support group that needs, she needs a couple hours a day. Not every day of the week and she’s just had nothing but trouble. So, I’m gonna suggest to her she’s at the group meeting tonight, to check these third-party review sites and I think she’s only been able to find companies that will do a minimum of four. Which I guess she thinks is too many.
J: And she’s had a lot of problems with agencies.
G: It’s, you know, the shorter the hours, the harder it is to get a consistent caregiver. That’s a pretty universal thing. We have a four hour minimum and then we start to tell the clients what, what else that caregivers can do. What el-, what other burdens can they take off, say the clients like, you know, we let them change the sheets and prepare get dinner started so when you come back home, the house is kind of straightened up. Dinner’s ready and you can have dinner you and you’ve had four hours to yourself, so.
J: Yeah. I know her husband goes to the local Adult Day Program at the Catholic Church that’s close by. So, that’s probably the biggest reason she doesn’t need as many hours.
J: And I’ve told her you know, go through the church. There’s probably a you know, retired gal maybe you know a younger gal with kids in school that could help you know a few hours a week. It doesn’t they don’t need full time, they don’t want full time. Because I know my grandmother’s friend did that before she passed away. She had a from her church that was her like in home companion at the end. I don’t think she I don’t think. It increased as the as the years went on.
G: Right. There’s a website Care.com that’s for private caregivers and they run, they run their own background checks.
J: She would like that. She’s pretty regular in our meeting and it’s tonight. So, I’m writing down notes and I could take it to her and say hey I talked to this person today and here’s what, here’s some things you might want to try.
G: Yeah that sounds like the perfect scenario for a private caregiver. It’s you know, you’re still then you’re, you’ve got to be careful because you got to check your homeowners policy that if that person gets hurt in your home and you’ve employed them. Does your homeowners policy covers their, their injury and what if something gets stolen? You know because with agencies, our caregivers are bonded. We carry the liability insurance. We are the back-up plan so that if a caregiver is sick, we are responsible for making sure somebody gets there. So that the person gets the care which can be challenging.
J: Yeah I mean it’s hard enough with just regular employment with people. And then when you’re dealing with somebody that’s got you know special circumstances like memory loss or lack of mobility you know they’re vulnerable people.
J: You know, it’s, it’s a really scary decision to have to make.
G: It is and you should ask the agency what if I don’t like that caregiver? You know how responsive are you to say okay, I want somebody else. This person is not, not a good fit you know? Whether it’s just a chemistry thing or I don’t like the way they treat my dad.
What to Look for When Contacting a Home Care Company (36:27)
G: Right, see that’s another thing that, talking to any agency whether it’s hospice or home care, how does that person make you feel when you’re talking to them? When you call into the office, are they welcoming and they’re listening and you know, maybe on you’re not ready for home care. But you know what? Have you considered this to give you other options? I mean, my husband and I own the company we started it five years ago. And we will never have a sales position. I said there’s no room for sales in this agency. It’s about information and this is what we can do and if we can help you, we’re going to be happy to. But we’re never gonna sell because I personally hate that. I hate pushy.
J: Yeah, they weren’t really I don’t if, this might have just been just a bad vibe combination. I don’t, it’s hard to think back about it because I also was trying to gather information without upsetting my sister and she came in and realized who I was talking to. It was like, blah. So it was kind of not a great situation at all and maybe that had something to do with it.
J: I’ve learned you know that you need a different kind of hospice care if somebody’s got memory loss and definitely want people that understand how to deal with somebody with memory loss as a caregiver. That way they don’t say something that triggers something unpleasant.
G: Right, right.
J: Which I don’t think ever happened with mom and well like my dad was easily triggered. So, that’s, that’s not a fair comparison. But I don’t think they ever said anything that upset my mom and I know he passed away late in the evening. It was like 10:30 at night and so my husband, my sister, and I ended up there really early the next morning.
J: And they were comforting my mom and talking to my mom. I mean, it was very obvious that they were handling the situation really well in our absence and I think that gal had only been there a couple hours. I’m trying to think. They were like 11 to 7 AM. So, she’d only been there like maybe an hour and a half. She walks into, ah! I’m assuming they told her before she showed up. But, still it’s like that’s gonna be a really tough part of the job.
J: Is dealing with somebody with memory loss and you know the spouse just died and the kids show up and the yeah, yeah, yeah. I was like yeah.
G: Yeah, you don’t need a sales position when you’re talking about people in vulnerable positions and at the end of their life. Yeah, no it’s not. You know, one question you ask is how do you know when you need care? How do you, and that’s, we designed an assessment. We have it on our website and you don’t have to put your name in. You don’t, we don’t ask you for your personal information so you can take it and we will never contact you.
But under our Resources page, it’s our take our home care self assessment (Editor’s Note: This link is now under Contact) and it helps you kind of paint a picture of some of the issues. And it’s interesting when we have adult children assess their parent and the parent takes it. It’s like no I don’t need help with that. No that doesn’t happen to me. It’s really quite fascinating. It goes through everything between the activities of daily living. You know, the bathing grooming, dressing, and then the independent activities of daily living. Managing finances and transportation and shopping. So I mean we found that Tim’s mom had memory loss when after his dad died, the bills weren’t getting paid. There was collection notices and it mostly not because she didn’t have the money. She just never did the bills and she didn’t know how to write the checks. It was like, uh-oh.
J: And that’s such a common scenario. That’s usually one of those, you know, red flag warning signs that you miss until it’s like a nightmare.
Using Home Care on Chores to Enjoy Free Time with a Loved One – 45:50
J: You know and that’s what’s happened with taking my mom to the doctor. They just think, oh we need to have this ultrasound done. Well it’s like a three-hour process to drive over there pick her up, take her to the get the process, take her back, get her settled. You know I don’t have three or four hours every week to just dedicate to taking her to the doctor and the doctors don’t seem to understand that. It’s, I get, I get the impression they think I’m not being very smart.
G: No, it is. It’s looking at what is taking up your time. So, we’ve had folks say now if you could-, I just, my mother wants to go out to lunch. If you could just take her out to lunch I just you know, when I go over there I do, I clean. I have to you know, do this, I have to do that. I said, well what if you had a caregiver that did the tasks and then you would have time to go out to lunch with your mom if the laundry was done when you got there. If meals were prepared when you came over, then when you got there, you can actually enjoy being with your mom and do some of the things that you know, relax together. Because she’s said oh, whenever I get over there, I’ve got ten thousand things I have to get done.
J: Yep. That’s pretty typical and I think there’s like volunteer type agencies in different areas that would do the take out to lunch. But obviously your mom would rather go to lunch with you than some church volunteer that she may or may not know.
G: Right, right. So it’s looking at that. It can just be overwhelming. I just say start before there’s a crisis. Ask, ask, ask and yeah.
J: Yeah there’s so many things I’ve learned in the last two years doing the podcast, about 18 months.
When to Look for the Best Home Care Services (49:04)
J: Well it’s smart to do plan ahead I’m and I’m a planner. I like to have everything lined up. I want to have contingencies built. Like what’s the worst-case scenario? Okay this, I will handle them. This is how we’re gonna hit-, I’m a planner so to have zero plans going into this, this time of life with Dad was, it was not fun. Gina is with Aware Senior Care. Is that Aware Senior Care.com?
G: It is.
J: Okay, so you guys can check out their web site and that assessment and have everybody fill it out so you can average the answer.
G: We actually even have a section under resources of the questions to ask a home care agency. There’s a lot of things under resources on our website.
J: That sounds very useful. I will make sure that you guys or all that is on the show notes. So, people can just click through and fill out those forms. Read those questions and if they have more, they can call you?
G: Sure, sure.
J: Is there anything we missed in what people should be thinking about when we’re getting to the end of our life with spouse or parents?
G: I think the hardest part is that everybody’s journey is different and what works for one family may not work for another and there’s no book. People keep saying well, how am I supposed to do this and I said it’s a day at a time. It’s constantly changing. I mean our care, our client’s needs, we have to keep changing and evolving as our clients needs change, so.
J: That’s the one thing I’ve noticed with my mom. She’s always been very physically healthy and we thought she had a bladder infection and that led us down to this other path where she’s got, she’s got issues that are not related to the Alzheimer’s.
And it’s, I’m glad we have our support group tonight. I’m gonna talk to our facilitator who’s a retired nurse and I think I’m mostly looking for her to validate what I’m thinking. But I’ll obviously listen to her opinion. But I never expected all these doctor visits and I just expected my mom to go from Alzheimer’s or maybe pneumonia.
J: Not either a cyst or a tumor. They don’t know what it is and they want to do a biopsy and I’m like I don’t think so.
J: So it’s been an interesting journey. It’s like and she declined quite a bit at the beginning of the summer and then she declined some more at the end of the Summer, which is unusual for her. She’s always declined and then plateaued for a long time. We’ve been doing this for about 20 years.
J: Yeah and I’ve told people I’m done. I’m ready and now we have this other health issue I’m like well maybe I’m not.
J: I mean I am but I’m not it’s like okay wait a minute now I have to it’s like reorient my thinking.
J: And it’s amazing. It’s just like you know you think you bring home the baby, you get them on a schedule and just when you think you got it all down, the baby changes.
J: That’s how it’s been with mom, so. It’s helpful to talk to people like you so we know what to plan for because trust me, you guys do not want to have to pick a home care agency in a panic. It is not fun and I, I’m glad that we got very, very lucky. And we didn’t have, we didn’t have issues like I’ve heard. You know the horror stories that I’m sure you’ve heard and we don’t want to repeat because we don’t, we don’t want to talk about those.
J: So, I really appreciate you taking the time out of your day to talk to us about this.
J: It’s definitely an important conversation and it’s probably easier to listen to us talk about it then to bring it up with family now that people have listened to it. They can bring it up with the family. Bring up that assessment and say, “I did this.” What do you think?
G: There you go.
J: That sounds awesome. Well, I appreciate your advice and you have a fantastic afternoon.
G: Thank you. Thank you for inviting me. I enjoyed it. Have a great rest of your day.
Full Transcript: When and How to Choose the Best Home Care Services