[Critique Group 1] cleora's submission for 7/28/21

[sitting.duck at springmail.com]

2088 words
Help Wanted
by C. S. Boyd

Twenty plus years ago, I started using care givers. With my failing eyesight and some mobility restrictions, I needed help with house work and reading my mail. I asked my visually impaired friends what they did. Some had family members they could depend on. A couple of my male friends were hiring students from a local college. This was a good source since these students needed flexible hours, and were capable of doing the more exacting work they required. However, as a female, I didn't feel this would be a safe way for me to find helpers. I decided, instead, to use a home health care agency knowing that they were required by law to do background checks on the people they sent into other people’s homes.

At first, I used someone once a month, then a couple of times a month, and now three times a week. Around nine years ago I noticed a dramatic decline in the quality of care givers I was receiving. 

To date, I have used five different agencies. Nine if you count the number of times the agency I was using either sold out to or was taken over by another agency.

The Owners of the good agencies I've used started their business because of frustration they experienced when they went looking for a care giver for a family member. When they started their business, they hired people they would be willing to have taking care of their own loved one. Over time, as the business grew, they turned more of the responsibility over to others. These people were chosen with the same care they used to select care givers, but these people, while good people, didn't share the commitment and passion the owner did and didn't have the instinct for selecting quality care givers. As the owner became less involved with the business, While they still wanted to provide quality care for their clients, the service degraded into the same kind of business they had sought to replace. In other cases, the agency was bought out by another agency and office personnel were replaced, or given different operating instructions for conducting business. Again, The end result was that the business became the same as the ones they had sought to replace.

Let's face it. People who need help are often cranky, frustrated by their own inability to take care of their own needs, sometimes in physical discomfort, and may be inclined to take all this out on their care giver whether they mean to or not. People are needed that have the confidence, compassion, maturity, and self-esteem to be willing to do the task the way the care receiver wants it done, and accept that the person they are helping knows best how something will work for them. People are needed who can provide care with the understanding and compassion that instills confidence and trust in the care giver.

For this reason, a care giver has to be a very special person. They need to be someone who understands and provides good care without taking advantage of the person or abusing the person they are caring for. They need a high enough self-esteem that they don't become offended when the person they are caring for wants them to do the task in a particular way.

Government regulation is not enough to insure quality care. It is as important to check out the agency as it is for the agency to check out their care givers. There are a few things that can be done to try to weed out the agencies that may not have quality people in their pool.

1. What is the agencies mission statement?

Some I've seen:

Your Home, Your Way.
To Us, It's Personal

The mission statement conveys what the company owner wants you to believe they will provide. In most cases this is the true feeling of the owner. However, it doesn't necessarily indicate that the people working for him have been successful in hiring people that will fulfill the promise.

They all claim to match compassionate, reliable care givers with each person’s personality and needs. 

2. How does their help wanted ad read?

The ad for people may say something like "you’re compassion and heart can truly make a difference in the lives of aging adults." They will say they need people who are inspired to help others.

The first question to ask, is how well the agency fulfils these high sounding words.

Does the ad also say: "No experience necessary, we will train."

Training likely consists of anything from a 30 minute lecture on how to sign in and out of the shift, general information about what to do if the client doesn't answer the door, and things they are not allowed to do. Some agencies take up to a week to provide more detailed training in the types of duties the job may entail.

If this is a person on their first job as a care giver, they likely have no idea what to expect. If you don't mind taking raw material and you have the time and energy to provide someone on the job training while you pay them by the hour, this could be your opportunity to train someone exactly the way you want. Some flaws in this plan are the same as for the employer giving a young person their first job opportunity. Finding a person willing to learn, and that has the right disposition for the job. You may find that this new hire is going to realize this isn't what they want to do at all, and you will never see them again. They may also think that little trinket on your mantle is cute and you will never miss it. Some will resent you telling them how you want them to do something, and refuse to do it your way.

Check the agencies help wanted ad. If they are looking for people with three to five or above years experience, this gives a better chance of finding a good fit.

3. Do they charge for filing a long Term Care insurance claim?

If you have a Long Term Care policy that has been activated, most likely you cannot file the claim. It has to come from the agency. Don't let the agency tell you that they have a fee for filing the claim, and that you can avoid the charge by filing it yourself. This works for your medical insurance where the doctor's office provides you with a SUPER that has all the medical codes and all you have to do is fill out the claim form, attach the SUPER and send it in for reimbursement. To file the LTC claim yourself, you are going to need to be able to document the care givers clock in and out time, prove that the ADLs were done, and that the care giver was a qualified person. This information is available only through the agency. If you have a sharp family member or friend willing to do the work, or you are able to spend the time and hassle you can try it. Check with your insurance to find out what they require. My insurance wants a list of tasks done on the shift including the time the ADLs were done. The time must be within the shift time. This must be done for each day service is provided and signed by both me and the care giver. You may be able to get the agency to provide you a report, but in my case, each day has to be signed by both me and the care giver. The invoice the agency sends you showing the dates of service and amount of time for each day is not enough. The insurance company needs proof that the service was actually provided by a qualified person within the shift time. You can understand this. They have to be sure you and your neighbor or family member didn't make up some stuff, sign it, and send it in for reimbursement. For this reason, I don't think it is reasonable for an agency to charge for filing the claim. 

I have only dealt with one agency that wanted to charge for filing the claim. This agency did not have quality care givers and it was a hassle every month to have to find out what was wrong and get them to resubmit the claim sometimes as often as five times before they got it right so I could get my reimbursement.

4. How do they expect to be paid 

Most companies will tell you that you are responsible for the bill regardless of if you have long term insurance or are paying out of pocket. I have found a couple that will try to have the insurance company send the payment directly to them, and the client is only responsible for paying what is not covered by the policy like mileage charges, charges for filing the LTC claim, and any other fees the agency may charge. I personally, prefer to have the insurance reimburse me. 

5. What is their afterhours policy?

The government requires that an agency cover the phones 24/7. Different agencies handle this in one of three ways that I know of. There may be other ways, but the ones I've encountered are.

The main number may be either answered 24/7 or forwarded to an answering service. They may have an afterhours number to a cell phone that is taken with whoever is on call.

Try calling the agency of interest after regular business hours.
If an answering service answers, the agency may be alright, but put them at the bottom of your list and keep looking.
Some answering services are very good, so this shouldn't scratch the person off completely, but it isn't a good sign.

If you get voice mail. Again, the person on call may be talking to another client and couldn't pick up the line. Or, most likely in my experience, they are busy with some personal activity and just don't answer. One way to ferret this out, if you are very interested in the agency every other way, leave a message. If the call is returned promptly, keep them on the list. If more than 30 minutes passes without a call back, scratch them off.

The main number is actually answered 24/7 by a person that is actually at work and can answer your questions even though it is not regular business hours. This is the best and I have only talked to one that does this. Similar to this is when the owner or other office staff answers, and can address client needs, but wants you to call back during regular hours to discuss services.

5. How thorough is their check?

Do they just do the minimum required by the state? 

I tried to get specifics on what checks are required by my state, but was unable to get that information. In talking to various agencies I've used, I'm pretty sure a criminal background check and a check with DPS are required, I think there is a third check but I don't know what that is. Some agencies will also check the national record, but I don't think this is required on the state level. Some agencies also do a drug test on a regular basis, and I'm told there are as many as five possible checks. The more checks the agency does, the better. I've had a little experience with abusive people. In my experience, these people do not change. They only walk the straight and narrow as long as they know someone is watching.

I am still learning, and add new things to my list as my needs change and I discover more things I need to be aware of. These agencies are audited periodically. Supposedly they don't know ahead of time when this is going to happen. The auditors will look over the agencies records and pick up to 10 clients at random to visit and interview to check on the services being provided. I'm not sure how good this audit is. I was aware of a couple of issues with some of the agencies I have used, and was surprised when I learned they had been audited and got a satisfactory report. Hopefully, this will provide the reader some guidance in doing the best possible job to acquire help for yourself or your loved one.