Home care -Walking through the maze
By Betty Gibb

The scene is all too familiar:

Mom, who lives alone ordinarily, is coming home from the hospital after serious surgery—perhaps a hip replacement. Obviously she is going to need help. One son and his wife live in the area—both work at jobs already somewhat at risk. The family tries to decide what to do.

According to Sheila McMackin, President of the recently organized National Association for Private Duty Home Care, several myths will have to be dispelled immediately:

• Medicare will pay for Mom's home care while she recovers. Medicare will not pay for custodial care once a person goes home from the hospital, nor will most medical insurance policies.
• The doctor or the discharge planner will get private care service set up for Mom before she goes home. “It is simply not true,” says McMackin. “Physicians, along with other professionals such as attorneys, trust officers and social workers may not necessarily understand how to use in-home care services to the benefit of their clients.”

Once the family, and Mom, realize that her meals, baths, housekeeping and personal care are their responsibility, and once they realize that this is a service they are going to have to pay for, where do they turn to find help.

If they should choose to hire someone privately, answering a newspaper ad or on the recommendation of a friend, again there are pitfalls and responsibilities.

• They are responsible for payroll taxes.
• The person comes with no liability insurance in case he or she breaks something, steals Mom's jewelry or does other damage.
• There is no worker's comp coverage if the home care aide claims back injury or trips and breaks a leg.
• There is no back up or supervision. If he or she wakes up sick before shift time, there is no coverage or substitute.
• If the person just doesn't work out, Mom or the family has to do the firing.

Private duty home care agencies take most of the worry out of arranging for home care. Their services, however, are not inexpensive, and standards of care and operation vary by agency.

McMackin's new organization is on a crusade: to set high standards for the industry and to educate the public and health professionals about the complex area of home care. A first national conference is being held in Kansas City April 24, 25 and 26. McMackin was in town from her home base in Chicago earlier preparing for the conference and visited with The Best Times about home care.

“We need to get the word out about the difference between responsible private duty agencies and care provided by someone through an ad in the classifieds or through a registry,” she says.

“Private duty agencies are companies that provide home care aides, companion care, homemaker services and some skilled nursing services in the patient's home. Caregivers are employed by the agency and are bonded, insured and, if need be, licensed,” McMackin says. The agency takes on the responsibilities and the pitfalls listed above. They do the bookwork, provide the supervision and discipline, carry the insurance and ensure that shifts are covered no matter what. There is a great deal of relief in letting someone else carry those worries.

All agencies, however, do not offer the same level of service. The accompanying article lists questions you should ask a home care service before contracting with them.