Interviewing and Selecting Providers

When searching for a provider, we realize it can be difficult to know what to look for and what questions to ask. By reading through the following topics you will be better prepared to begin the process of finding a quality provider.

Hiring Cargiver Help	Questions to Ask Yourself
How to Choose an Assisted Living Community	Things to Observe During Visits
Questions to Ask Facility Staff	When to Consider Assisted Living

Once you have chosen the types of facilities or services that best suit your needs and lifestyle, narrow your search to those that meet your specific requirements. It is a good idea to visit several facilities before making a choice. Visit more than once and learn about the services offered. Talk with residents. Find out how much input they have in their daily lives and the care they receive. Meet with the staff and volunteers, and observe the way they interact with residents, visitors and each other.

Take the time to talk with an admissions representative. Review the admission policy and the resident's bill of rights. If the facility offers nursing or personal care, ask to see the results of its latest State Department survey. If you have questions about how you will pay for the care, the admissions representative can assist you or direct you to the appropriate agency for assistance.

It is important to stay organized and keep records of your Hospital and Doctor/Clinic visits. Before you leave take the time to sit down with a Nurse or Faculty Member and use the following forms to keep yourself organized and remember future appointments.

Hiring Caregiver Help Without an Agency

When using a home health caregiver, it is critical to know whether you are considered the employer of the caregiver, or an agency is. This is the only way to avoid tax and legal issues, commonly called the “nanny tax”.

The In-Home Care industry is booming with a wide range of services and just as many contractual agreements and employment policies. Consumers must ask questions up front about tax obligations and insurance coverage, or run the risk of tax penalties. If you privately hire a caregiver, and you pay the household caregiver more than $1700.00 in 2009, the tax code requires you to withhold and pay Social Security and Medicare taxes. The few exceptions typically do not apply to caregiving for aging parents.

However, even if you use an outside party, such as a home health agency, it doesn’t mean you are off the hook. Many of these agencies do not actually employ or supervise these caregivers - they simply find and place them. Under these circumstances, you are considered the employer and are responsible for paying taxes and other obligations.

Employing a relative or a friend can put you in the same situation. If you dictate when the caregiver is on duty and supply the equipment for proper care, you are building an employee-employer relationship, even if the care is part time.

If you pay the caregiver more than $1000.00 in any quarter, federal unemployment taxes must be paid. State and unemployment taxes must be withheld and paid as well. If unpaid, the tax payer will be responsible for what is owed and will face late filing charges between 5% and 25% of the underpayment plus interest.

Consumers can avoid tax snags if they pay an agency directly and that agency is the caregiver’s official employer. A geriatric case manager can also serve as a caregiver’s employer, if they screen, arrange, monitor and pay the caregiver on your behalf.

Employee injuries pose one of the biggest financial risks. If you serve as the employer and have no workers compensation and the caregiver is hurt on the job, you can be responsible for medical expenses and disability. Do not assume that your homeowner’s insurance will cover this; you may need to buy general liability insurance. Discrimination or harassment suits pose another risk.

Our Quality Providers can help you find a Home Care Agency that will work as an employer for the caregiver in your home.

How to Choose an Assisted Living Facility

Assisted Living Community allows older adults to enjoy an independent lifestyle with more support for their daily needs. These communities are not appropriate for older adults needing intensive medical or nursing care.

In an assisted living facility, the older adults will have their own apartment, and there are planned activities and entertainment if they wish to participate. Assisted living communities provide meals and support staff for housekeeping, laundry, medication management, social activities and transportation. In most cases, there will be transportation available for access to services such as banking, shopping, pharmacies and medical care.

Know that the assisted living facilities are paid for entirely by private funds i.e. YOU. That is why most of the time facilities do not meet federal and state regulations for Medicare or Medicaid. Thus, there are no uniform national licensing requirements for assisted living communities, so evaluating the right one for you or a loved one can become a very complicated task. One consideration might be the levels of care available, especially if you want to avoid making another move if health declines.

There are many emotional, medical and financial considerations required when looking for the right assisted living community.

Our Quality First Providers in your community can help you with resources for evaluating the right community for you or your loved one. These community Centers for Positive Aging will evaluate your needs and discuss the available options in your area. They understand all the dynamics of finding just the right fit for elder care, and can make the process easier for everyone involved.

Choosing an Assisted Living Community

Memory Loss

Will the older adult need to relocate if they experience memory loss? Some communities do not have locked access floors to prevent wandering, along with specialized staff to provide for those with Alzheimer’s disease and other types of advanced memory loss and mental health conditions.

Nursing Care

Will the older adult need to relocate if they need advanced nursing care? Some Assisted Living Communities offer nursing care in their communities, others do not.

Additional Costs

Which services are included in the monthly rental fee and which services will incur an additional cost? Think ahead about services, which the older adult may not need now but may need later, such as special dietary needs, medication management and assistance with mobility if a wheelchair becomes necessary.

Social Environment

Will the older adult feel comfortable and find other “like-minds” to easily build new friendships?
Are there activities that will be of interest to them and easy access to off-site activities they previously were involved in?
Does the physical layout of the facility promote social interaction among the residents?

Financial Planning

If the assisted living community offers a nursing center, will they allow the older adult to continue as a Medicaid client if they should run out of money? While no one plans on running out of money, even those with a million dollars or more in assets can run out of money when paying for full-time nursing care, which can easily be $100,000.00 per year. Find out if Medicaid is accepted – some communities will not take new Medicaid residents, but will allow a resident to stay on if they deplete their savings and must switch onto Medicaid.

Questions to Ask the Staff

Healthcare:

What is the payment policy?
What is included in the daily or monthly rate?
What services are included at an extra charge?
What happens if additional assistance is needed?
Will you have to move or can the facility provide the necessary care at your home?
Do residents use their own physician, or is there an on-staff medical director?

Government Approval:

Does the facility have a current state license? Ask to see the most recent licensure report.
Is the facility Medicare and/or Medicaid certified?
What are the credentials of the staff providing services? And are bonded?

Family Visits:

Will the location make it easy for family and friends to visit?
What are the visiting provisions? Is there a private area for visits? Whare are the visiting hours?
Can family members have occasional meals with their relatives at the facility? Is there a provate area for such meals?
Are there activity rooms and lounge areas for residents to use?
What are the choices of accommodations?
Are residents who need personal assistance well groomed and appropriately dressed for the time of day and season?
Does the facility have plans for expansion or renovation? What are the plans?
What personal belongings may be brought into the facility?

Medical Considerations:

What other medical services are readily available?
If a resident is hospitalized, will the bed at the facility be held until he or she returns?
what are the facility policies on "do not resuscitate" orders, physical restraints, and chemical sedation?

Another Factor to Consider:

What grievance/appeal procedure exists if there is a complaint?

Questions to Ask Yourself

Healthcare:

Does the facility offer the services you need and want?

Family Visits:

Does the staff seem friendly, caring and accommodating to residents and visitors?
Is the overall facility well maintained, pleasing and cheerful?
Are exits clearly marked and not locked on the inside?
Do bedrooms have adequate privacy and plenty of room to move?

Things to Observe During Visits

Resident Activity:

Is the resident's bill of rights posted and a copy available for you to review?
Is there an active resident's council?
Are special events held at the facility?
Are special excursions planned for those able to take advantage of them?
Do all residents have access to the outdoors?
What religious activities are offered?
Do volunteers from the community assist with residents' recreational activities?

When to Consider Assisted Living

The most difficult decision to make when moving a loved one from their home into a senior facility is when to make the move. Many times, the decision is not made until there is a crisis, when making the decision earlier may have helped to avoid a crisis situation.

What are some signs that it is time to seriously consider assisted living?

Difficulty performing daily activities
Wearing same clothes multiple days
Bathing less frequently - personal hygiene suffering
Not bothering to cook for one person, skipping meals
Laundry and housekeeping becoming a burden
Spends time in only a few rooms in the house

Memory loss:

Repeating questions or statements, multiple phone calls with the same questions
Wandering away from home
Trusting strangers, falling for scams, becoming the victim of elder abuse
Forgetting to do things they once did like paying bills and balancing the check book
Leaving the stove on, frequently misplacing items

Medication concerns:

Forgetting to take medications - resulting in missed dosages - or taking more than required
Running out of medications - or not properly ordering medications from the pharmacy
A lot of expired medications around

Lack of Socialization:

Losing touch with friends and isolating themselves
Loss of interest in activities once enjoyed such as going to church