[Critique Group 1] cleora's april submission 1000 words

[sitting.duck at springmail.com]

attached in case the paste is unreadable
group1 at bluegrasspals.com
4/19/23 submitted follow up version to critique group 1 for 4/26/23 critique
7/21/21 submitted to small critique group for 7/28/21 critique
7/31/21 bonding doesn't seem to be required. in talking with SynergyHomeCare, on call person said their owner uses something else that is supposed to be better
7/29/21 at 5:16pm
Sue Wallace - 817 371 9640
what background checks are agencies required to make
special dps bye dps
have to go on their secure site and get their criminal record
there is a list of unacceptable things that if they appear on the record they can't be hired
call their work and personal references
used to you had to run the dps criminal check. she doesn't know if that is still the case or not.
doesn't remember what the things are that if they appeared on the record they couldn't hire them. felony is one
we are in the baby boomer generation
baby boomers her age were similar to veteran
2nd half of the baby boomers were a different kind of people
she has noticed the same trend as me over the last 10 or 15 years. the same quality of people are just not applying for the job.
she broke both arms and that is what led to her starting the business
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 shopping, 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. One might think This a good source since these students needed flexible hours, and were capable of doing the more exacting work they required. Another advantage was they could pay their helper more since half of the fee wasn't going to an agency. However, I wouldn't be able to do my own background and screening checks, and I was concerned about allowing access to my home and personal information to someone I didn't know anything about. . I decided, instead, to use a home care agency knowing that they do background checks on the people they send into other people’s homes. Another consideration is should the care giver be unable to come for some reason, the agency would provide a substitute.
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, and a little while ago, I wrote a piece about questions to ask an agency to see if they would be likely to provide good caregivers. Well, things have changed. There is an abundence of agencies out there, and picking a good one has become more difficult. A trend I noticed in 2021 was agencies requiring the client to pay for services before they received the reimbursement. As I'm sure you realize, if the agency is paid out of pocket, there is no insentive for them to file the claim correctly. This often means that you will not get your reimbursement because the agency will not correct the error when the claim is refiled.
This can be a problem even if you do not have insurance. These companies also may not spend a lot of time trying to hire quality people or to place the best match with the client.
Over time, I found that the companies that have started requiring payment up front is that they were not getting paid, so they decided to require payment before the client gets their reiumbursement to be sure they got paid. My experience with these agencies reviels that the most likely reason they were not getting paid is that they were not filing the claims correctly so the client got their reimbursement. Another thing these agencies may do is add $1 per hour to the charge to pay for filing the claim. That would mean that if the client is using a caregiver 40 hours a week, they would be charged an additional $40 over the already significant hourly charge for the caregiver. If the client's insurance has a limit, this will significantly reduce the benefit for the client.
One thing I have experienced for in 2022 that I have never experienced before is caregivers that not only don't want to do anything, they will play pranks on the client if they know the client can't see or has cognitive issues where others may not believe them. These, so far, haven't been life threatening. That would get the caregiver barred from taking that kind of job, but it can add expense for things they take or destroy.
Just like it's not a good idea to give a worker money up front before they do any work, a good agency shouldn't need you to pay for services before you get your insurance reimbursement. Also, they shouldn't charge for filing the claim. One agency I talked to actually wanted payment as soon as each shift was over.

To date, I have used 8 different agencies. 12 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 employees were chosen with the same care they used to select people for their clients, 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. In many cases, the next step was that the business closed its doors.
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 intend 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. It's a typically low pay and difficult job not for whimps or the selfish.
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. Now, that said, there is a new twist to the story. Up until shortly before the pandemic, I was happy with the care givers I had from the agency I had been fortunate to find. Then my life tilted a little, and ultimately turned upside down. First, I noticed I hadn't received a bill in for the last two months services. I consulted with my current care giver, and after doing some searching, we concluded that, indeed, there was no invoice for the last two months services. Next morning, I called the agency. The receptionist assured me she would check it out and one would be sent. A couple of weeks passed. Nothing. I called again with the same result. My caregiver dropped by the office and talked to them in person. He was assured it would be taken care of. Christmas came, and I asked my caregiver to take me to the agencies Christmas party with the idea that I would corner the owner and make sure she knew what was going on. Office staff went to extraordinary means to make sure I was never able to talk with the owner.
Finally, I remembered that somewhere, I had the owners cell number. After several tries I was able to reach out to her and let her know what had been happening. Following was a nightmare of events filled with frustration that eventually resulted in the owner merging her business with another agency. Then came the pandemic. One of my caregivers decided to retire. The caregivers available at the new agency were not up to the task of providing the quality of care I needed.
Ultimately, I launched a search for a new agency. One that would have quality caregivers, and most important, people that had the kind of skills needed to help me do the kinds of things I needed help with.
I came up with a list of questions to ask in order to find an agency I felt would have the kind of caregiver I needed.
What I learned over the next 19 months was both disturbing and discouraging. We often hear the term "unprecedented times" to refer to the current situation created by the pandemic. Employers say "it's crazy out there" to describe their efforts to hire quality people. After almost two years of searching for another agency, I feel no closer to having someone I can depend on to help me with those things I can no longer do than I was when I started.
After selecting five potential agencies out of a list of over 20, I have begun the next step of signing up for their services. So far, four of them told me they didn't have anyone, and didn't even ask me to sign papers to add me as a client. One agency wanted a $100 setup fee, and the other $250. Both admitted they didn't have anyone they felt would be able to fill the position. I finally did sign up with the last one, and was told someone at the office would let me know if they could fill the shift. I had planned to start the service on the following Friday. She said a better target would be the Friday of the next week.
I was shocked by this result after spending so long weeding out the undesirable agencies. I didn't expect that the agencies wouldn't want me. So, what is going on?
We are indeed in uncharted waters. What I have learned goes further than home care agencies, I am hearing the same frustration from every type of business I talk to. Not only do they have trouble finding people who meet their standards, they have trouble keeping the people they find. The one I ultimately signed up with allows a minimum of four hours per shift and is okay with only one shift for the week, but is charging 36% more than what I'm currently paying with my current provider. Two months ago, my current provider raised their prices by 22% over what I have been paying over the last year. The new agency tells me that they don't know if they will be able to fill the shift because a new ruling from the CMS (Centers for Medicare and Medicate Services now requires that any agency that received Federal or state funds must require all their employees to be vaccinated. As a result, they had several staff members quit because they don't want to be vaccinated. OSHA (Occupational Hazard and Safety Organization) only requires employers with 100 or more employees to be vaccinated. As a result of this new ruling from CMS, many of their caregivers have quit. I agree with the mandate for caregivers to be vaccinated. It is curious that people whose profession is caring for those who are most vonerable, ubject to taking this precaution. Another factor is CNAs can double their salary by going to work at a hospital. At the same time, hospitals are having trouble keeping people, and other employers cannot find people even when they offer higher pay and better benefits. It would seem that the long period of time where employers have passed higher profits on to executives and cut benefits to employees has come to an end. But, it's not as simple as throwing money at the problem. It is indeed crazy out there. Not only are prospective employees looking for superior pay and benefits, they don't want to work for them.
<>end revised for current trends
<>revised version
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 shopping, 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. One might think This a good source since these students needed flexible hours, and were capable of doing the more exacting work they required. Another advantage was they could pay their helper more since half of the fee wasn't going to an agency. However, I wouldn't be able to do my own background and screening checks, and I was concerned about allowing access to my home and personal information to someone I didn't know anything about. . I decided, instead, to use a home care agency knowing that they do background checks on the people they send into other people’s homes. Another concideration is should the care giver be unable to come for some reason, the agency would provide a substitute.
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 employees were chosen with the same care they used to select people for their clients, 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. In many cases, the next step was that the business closed its doors.
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 intend 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
It's about caring, not just health care.
These are high sounding words. 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. What you will be investigating is how successful the staff is in fulfilling this 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 check the state's criminal data base, or do they check the national and federal databases. Do they do drug testing on a regular basis? A check with the Department of Public Services often reveals important information that doesn't show up in a criminal background check.
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.
Make sure the agency is licensed and bonded.
6. Do you have to sign a contract? If the agency requires you to commit to a contract for care, move on to the next one.
Typically, the agency will send out a consultant to come out and do a complementory assessment and plan of care. There should be no obligation. They will use this Plan of Care to match you with someone to best meet your needs. You are in the driver seat. Sometimes it takes a couple of tries to find the right match.
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.
<>end revised version
<>original version
7/10/21 at 10:00am
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.
<>end original version
this is a revised version of the essay a few months ago about choosing a home care agency.

1000 words
Help Still Needed
by C. S. Boyd
A while back I wrote a guideline intended to help readers select a good Home Care agency. Things are changing rapidly, and it is more difficult than ever to find a good agency with qualified caring people.
1. It still holds true to check the required experience. Since you will be a new client, you will most likely be sent a new hire. You may even be their first assignment. Past experience is important. If this is the person's first time to work as a caregiver, may likely have no idea what the job is really like. Many never stay past the first two weeks. You want someone who will provide the help you need, and will stay so you can develope a relationship.
It is also still important to let the agency know specifically the kind of help you need. If your care includes tasks that are not part of the run of the mill home care--you need help with reading mail, completing and submitting form, etc.--the agency may not have anyone on staff that can do this. Or, they may not be willing for their caregivers to have this kind of responsibility.
2. Does the agency file Long Term Care claims. If you are hoping to pay for services with LTC, ask if the agency charges for filing the claim, and if they are willing to wait until you receive your reimbursement.
If they charge for filing the claim:
If the charge is a flat fee, this charge will be out of pocket. As far as I know, no LTC insurance pays fees. If they add $1 to the hourly rate, and you have a limit on your benefits, this will reduce your care by that amount.
Example: if you have a caregiver 40 hours a week, this will reduce your benefits by $20,800 per year.
One hundred percent of the agencies I talked to said not getting paid was the reason they started charging to file and requiring payment immediately. My experience with the ones I tried indicates that you will have a hard time getting your reimbursement. These agencies chronically do not file the claim with all the necessary information required for it to be paid. This means you will spend your time finding out what was done wrong and trying to get the agency to refile the claim correctly. It took me two and one-half months to get my reimbursement for one service day. The problem was that the caregiver didn't mark that she did the ADLs, and the agency claimed they couldn't fix it. They continued to file the claim with the same error over and over. They put a note on the claim saying the ADLs were done and for the adjuster to call them, the insurance said they didn't have time to call and wanted the agency to call them instead. The agency said they didn't have time to call the insurance and most insurance would accept the note on the claim as proof. Mine does not. So I have this back and forth. My insurance said that if the agency calls and says the ADLs were done and they do not have access to correct the claim, they would pay it. I spent countless hours on the phone with the insurance company and with the agency trying to get this taken care of. Can you imagine paying extra for this headache?
I did finally get my reimbursement. I realized that I had access to the visit notes that the caregiver completed. I went into their system, copied the visit notes for the day in question, created a copy in Word, edited out the error, created a PDF and submitted it with a copy of the original invoice. The insurance accepted it and paid the claim. I moved on to another agency before I had to test this option again. I will also mention that this is the only agency I have used where I had this kind of access.
Keep in mind that if the agency requires you to pay up front for the service, there is no incentive on their part to help you get your money. One agency I talked to wanted payment as soon as the shift ended. They wanted to be able to make an ACH withdrawal or charge my credit/debit card immediately after the caregiver clocked out. I probably don’t need to tell you I didn’t sign with this agency.
3. How long has the agency been in business. I recommend looking for agencies that have been in business at least 10 years. This gives them the time to become experienced in selecting good caregivers and matching them with the right client. It is also important if you have LTC insurance. You want someone experienced in how to file the claims correctly. If they are willing to wait for you to be reimbursed to get their payment, it is a good indication that you will not have trouble getting your money.
4. What is their afterhours contact? If it is an answering service, mark them off your list and try the next one. Ideally you should be able to call the regular daytime number and reach someone from the office that is on call. If you get voice mail, leave a message. If it takes them more than 30 minutes to call you back, mark them off your list and move on to the next prospect.
There have been a couple of times over the last 20 plus years that it was vital for me to reach someone after hours. When shopping for a new agency, I deliberately call after 5:00pm or on the weekend to see how hard it is to reach someone in an emergency. If the owner answers, they will usually go ahead and talk to me about their service, but it's not a problem to call back when they are in the office.

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1000 words
Help Still Needed
by C. S. Boyd

A while back I wrote a guideline intended to help readers select a good Home Care agency. Things are changing rapidly, and it is more difficult than ever to find a good agency with qualified caring people.

1. It still holds true to check the required experience. Since you will be a new client, you will most likely be sent a new hire. You may even be their first assignment. Past experience is important. If this is the person's first time to work as a caregiver, may likely have no idea what the job is really like. Many never stay past the first two weeks. You want someone who will provide the help you need, and will stay so you can develope a relationship.

It is also still important to let the agency know specifically the kind of help you need. If your care includes tasks that are not part of the run of the mill home care--you need help with reading mail, completing and submitting form, etc.--the agency may not have anyone on staff that can do this. Or, they may not be willing for their caregivers to have this kind of responsibility.

2. Does the agency file Long Term Care claims. If you are hoping to pay for services with LTC, ask if the agency charges for filing the claim, and if they are willing to wait until you receive your reimbursement.

If they charge for filing the claim:

If the charge is a flat fee, this charge will be out of pocket. As far as I know, no LTC insurance pays fees. If they add $1 to the hourly rate, and you have a limit on your benefits, this will reduce your care by that amount. 

Example: if you have a caregiver 40 hours a week, this will reduce your benefits by $20,800 per year.

One hundred percent of the agencies I talked to said not getting paid was the reason they started charging to file and requiring payment immediately. My experience with the ones I tried indicates that you will have a hard time getting your reimbursement. These agencies chronically do not file the claim with all the necessary information required for it to be paid. This means you will spend your time finding out what was done wrong and trying to get the agency to refile the claim correctly. It took me two and one-half months to get my reimbursement for one service day. The problem was that the caregiver didn't mark that she did the ADLs, and the agency claimed they couldn't fix it. They continued to file the claim with the same error over and over. They put a note on the claim saying the ADLs were done and for the adjuster to call them, the insurance said they didn't have time to call and wanted the agency to call them instead. The agency said they didn't have time to call the insurance and most insurance would accept the note on the claim as proof. Mine does not. So I have this back and forth. My insurance said that if the agency calls and says the ADLs were done and they do not have access to correct the claim, they would pay it. I spent countless hours on the phone with the insurance company and with the agency trying to get this taken care of. Can you imagine paying extra for this headache?

I did finally get my reimbursement. I realized that I had access to the visit notes that the caregiver completed. I went into their system, copied the visit notes for the day in question, created a copy in Word, edited out the error, created a PDF and submitted it with a copy of the original invoice. The insurance accepted it and paid the claim. I moved on to another agency before I had to test this option again. I will also mention that this is the only agency I have used where I had this kind of access.

Keep in mind that if the agency requires you to pay up front for the service, there is no incentive on their part to help you get your money. One agency I talked to wanted payment as soon as the shift ended. They wanted to be able to make an ACH withdrawal or charge my credit/debit card immediately after the caregiver clocked out. I probably don’t need to tell you I didn’t sign with this agency.

3. How long has the agency been in business. I recommend looking for agencies that have been in business at least 10 years. This gives them the time to become experienced in selecting good caregivers and matching them with the right client. It is also important if you have LTC insurance. You want someone experienced in how to file the claims correctly. If they are willing to wait for you to be reimbursed to get their payment, it is a good indication that you will not have trouble getting your money.

4. What is their afterhours contact? If it is an answering service, mark them off your list and try the next one. Ideally you should be able to call the regular daytime number and reach someone from the office that is on call. If you get voice mail, leave a message. If it takes them more than 30 minutes to call you back, mark them off your list and move on to the next prospect. 

There have been a couple of times over the last 20 plus years that it was vital for me to reach someone after hours. When shopping for a new agency, I deliberately call after 5:00pm or on the weekend to see how hard it is to reach someone in an emergency. If the owner answers, they will usually go ahead and talk to me about their service, but it's not a problem to call back when they are in the office.