Home Care and Home Services

Selecting an agency that will provide you with home care services is an important and often difficult decision. Generally speaking, the agency must have the necessary experience in providing the kind of care that is needed and be able to provide it effectively. The agency must be able to demonstrate that it has properly trained and supervised staff to care for the patient. Talking to trusted relatives, friends, and professionals (such as one's doctor) about the agency can help with decision-making. The National Association for Home Care (1996) offers the following checklist of questions to ask when determining which home care provider to use.

• • How long has this provider been serving the community?
• • Does this provider supply literature explaining its services, eligibility requirements, fees, and funding sources? Many providers furnish patients with a detailed "Patient Bill of Rights" that outlines the rights and responsibilities of the providers, patients, and caregivers alike. An annual report and other educational materials also can furnish helpful information about the provider.
• • How does this provider select and train its employees? Does it protect its workers with written personnel policies, benefits packages, and malpractice insurance?
• • Are nurses or therapists required to evaluate the patient's home care needs? If so, what does this entail? Do they consult the patient's physicians and family members?
• • Does this provider include the patient and his or her family members in developing the plan of care? Are they involved in making care plan changes?
• • Is the patient's treatment course documented, detailing the specific tasks to be carried out by each professional caregiver? Does the patient and his or her family receive a copy of this plan, and do the caregivers update it as changes occur? Does this provider take time to educate family members on the care being administered to the patient?
• • Does this provider assign supervisors to oversee the quality of care patients are receiving in their homes? If so, how often do these individuals make visits? Who can the patient and his or her family members call with questions or complaints? How does the agency follow up on and resolve problems?
• • What are the financial procedures of this provider? Does the provider furnish written statements explaining all of the costs and payment plan options associated with home care?
• • What procedures does this provider have in place to handle emergencies? Are its caregivers available twenty-four hours a day, seven days a week?
• • How does this provider ensure patient confidentiality?

The following checklist of questions recommended by the National Association for Home Care are to be asked of those individuals and organizations whose names were given as references by the home care provider.

• • Do you frequently refer clients to this provider?
• • Do you have a contractual relationship with this provider? If so, do you require the provider to meet special standards for quality care?
• • What sort of feedback have you gotten from patients receiving care from this provider, either on an informal basis or through a formal satisfaction survey?
• • Do you know of any clients this provider has treated whose cases are similar to mine or my loved one's? If so, can you put me in touch with these individuals?

Particularly in the case of high-tech home care that necessitates the importation of various technical devices and services into the home, it may be difficult to determine whether this type of arrangement is appropriate for a particular patient or home setting. The decision will be based on factors including: the adequacy of space, electrical capacity, and power backup for the required medical equipment; the ability of the patient or his or her designee to operate and maintain the devices in the absence of trained personnel; the availability of third-party coverage or adequate private funds to cover associated expenses; and an assessment of all viable alternatives. Individuals respond differently to the prospect of turning a home into a high-tech hospital room, making the choice of doing so largely a personal one (Kaye and Davitt).