Family caregivers who need in-home care may not know the various types of care nor what levels of support to expect. Cost, frequency and level of skilled providers are among determining factors when choosing in-home help for a loved one. 

What are the differences between types of in-home care workers? 

Certified Nursing Assistants (CNAs) and Licensed Nursing Assistants (LNAs) observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments. All medical-related tasks are performed as directed by a Registered Nurse (RN) or Nurse Practitioner (NP). CNAs may also provide personal care such as feeding, dental help, bathing, bathroom assistance, and tasks such as changing bed linens and serving meals. 

Home Health Aides (HHAs) are trained CNAs who have an additional 40 hours of home economics training, although requirements differ from state to state. HHAs monitor a patient’s condition, check vital signs and assist with bathing, dressing and using the bathroom. They may also provide company, do light housekeeping and prepare meals. Local hourly rates for CNAs and HHAs may range $22 to $28. 

Skilled Nursing Providers must meet federal standards for health and safety and are licensed by the state. They manage, observe and evaluate the patient’s care and provide such medical care as administering IV drugs, tube feedings and shots, changing wound dressings, providing diabetes care, as well as caregiver and patient education. Some are trained in physical, occupational or speech therapy. 

Registered Nurses (RNs) hold a nursing diploma or associate degree in nursing (ADN), have passed the NCLEX-RN exam administered by the National Council of State Boards of Nursing (NCSBN) and have met all the other licensing requirements mandated by their state board of nursing. They provide direct care, can assist doctors in medical procedures, offer guidance to family members, operate medical monitoring equipment and administer medications. 

Medicare covers home health skilled nursing care that is part-time and intermittent, if arranged by a Medicare-Certified Home Health Agency (CHHA). However, occasionally families may require additional hours and can expect to pay out-of-pocket at an hourly rate of $100 and up. 

Here are some of the most important questions one should ask when considering in home care:

Does the agency have a Home Care Organization (HCO) number? 

An HCO number means they are registered by the State of California and operating within the parameters of the law. The agency must register their caregivers with the state and have them background-checked by the Department of Justice and FBI. The agency must be current with their fees and licensing and operating within guidelines created by the state.

Can an independent contract caregiver work for you directly without going through an agency?

Yes, but buyer beware. The caregiver must show proof of liability insurance and an insurance certificate with your name and address listed. Make sure they are bonded. 

Contact your homeowner’s insurance so, in the event of an accident, you and your caregiver are covered. Your insurance agent may require you to get worker’s compensation insurance for your new employee. If you hire a caregiver on your own, you are now an employer and, as such, should be withholding social security, unemployment insurance and all other state and federal standard payroll deductions. 

Is the caregiver getting a W-2 or a 1099 for their personal taxes? If they are an independent contractor, (1099) they must still be registered with the state and have their own HCO number so that you can report a theft or abuse situation to the Department of Social Services Home Care Aide Registry.

Arm yourself with information to make an educated decision. But, if you aren’t willing to do the research, hire a caregiver through an agency so you’re protected.

If your loved one has dementia, special consideration should also include hiring someone with training in dementia care. 

Alzheimers Coachella Valley provides state-approved continuing education units in dementia caregiver training for CNAs and HHAs. Classes are held the last Thursday of each month, except for holidays, 5:30 to 6:30 p.m. A different topic is presented each month. Training is free but pre-registration is required as space is limited. Call (760) 776.3100 to register.

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