Finding Aides for Seniors

Discovering that a family member, friend or client needs assistance is hard enough, but convincing your senior that he/she needs help at home, and then finding the right help is a whole other challenge.

In our ongoing effort to educate ourselves about the choices available to our clients, we have researched local Home Health Aide agencies and learned about the different structures.  The process has reinforced our belief that a call to a Geriatric Care Manager (GCM) should be the first step.  Geriatric Care Managers will assess a client's health and the living situation, make recommendations about a client's need for aides, and the number of hours of assistance required.  GCMs will supervise the process of hiring aides using their own resources, a registry, or an agency, and then monitor the care provided by the aides.  Even with the hired know-how of a GCM, it is helpful to have some information regarding a senior's options for finding and paying for aides.  Medicare and supplemental insurance cover a limited number of Home Health Aide hours, acute care nursing visits, and limited physical, speech and occupational therapy.  Once that turns into long-term care, Medicare and supplemental insurance do not cover any of the personnel costs.  One should not rely on Medicare for long-term personal care (Home Health Aide) needs.

What are the Senior's Financial Resources?
One of the first questions to ask in considering a senior's home health aide choices is what financial resources are available.  Some of the payment options include:

  • Private Pay - the client has the funds to pay for care for an indefinite amount of time.
  • Long Term Care (LTC) Insurance - the client bought LTC insurance prior to an illness and is now able to use the insurance to pay for care. The policy needs to be reviewed carefully to ascertain how much money is available on a daily basis and for how long, how many days the client has to wait before drawing on the insurance, and what services it covers.
  • NYS Partnership Long Term Care Insurance - the client bought this form of LTC insurance (or a similar one in another state). It is a mix of private insurance and Medicaid support that allows the senior to keep more of his/her assets once he/she has used up his/her allocated amount of long-term care insurance and becomes Medicaid eligible. The same review of the policy as outlined above is needed.
  • Medicaid - depending on the state in which a senior lives and even the county within the state, a senior may be able to qualify for Medicaid.  New York State (and especially New York City) provides a very generous home care benefit under its Medicaid program.  Middle class seniors who do not have LTC insurance, or the resources to pay for long term health care themselves, should see an elder law attorney to discuss how to best plan ahead for assistance.  In New York, there are legal ways of transferring assets and becoming eligible for this benefit.  The work done with an elder law attorney would make a person Medicaid eligible, should the day arrive when they need the services.  The seemingly large payment to an elder law attorney is a wise investment for the future.

What are the Senior's Choices For Hiring Aides?
There are various ways to hire aides:

  • Privately Hired Aides - These can come through a variety of channels
    • Registry:  The client pays the registry a fee and the agency provides aides to be interviewed by the senior or his/her representatives.  Once aides have been hired, it is the client's responsibility to pay the aides and handle payroll taxes and statutory benefits (this can be done by a payroll firm or a payroll accountant).
    • Referrals from Geriatric Care Manager - The aides are ones that the GCM has worked with personally and feels good referring.  The same payroll issues exist.
    • Referrals from Friends, Family and Acquaintances - The aide may not be certified as a home health aide but may be very capable.  Again, the same payroll issues exist.  There could be a considerable cost benefit to hiring privately; however, if things don't work out, there is not an Agency to fall back on or hold accountable.
  • Home Health Aide Agencies - The agency recruits aides, provides training and supervision, selects the appropriate aides for the client, pays the aides, and generally bills the client on a weekly basis. Agencies vary in terms of licensing and skill levels of aides. Long Term Care insurance and Medicaid have specific requirements for the aides and the agencies providing aides, so it is important to know the difference.
    • Certified Home Health Agencies - Certified home health agencies (CHHAs) are certified by the New York State Department of Health and are qualified to participate in Medicare and Medicaid.  CHHAs must provide, at a minimum, the following services which are of a preventative, therapeutic, rehabilitative, health guidance and/or support nature to persons at home: nursing services, home health aide services, medical supplies, and equipment/appliances suitable for home use.  In addition, at least one of the following services must be provided by a CHHA: physical therapy, occupational therapy, nutritional services, speech/language pathology, or social work services.
    • Licensed Home Care Services/Agencies - Licensed home care services/agencies (LHCSAs) are voluntary, non-profit or proprietary organizations granted a license from the New York State Department of Health to provide, either directly or through a contract, at least one of the following services: nursing (e.g. blood pressure monitoring, medication coordination), home health care, or personal care (e.g. bathing, dressing, housekeeping).  LHCSAs are regulated by the New York State Department of Health.  Reimbursement is usually through private pay, Long Term Care Insurance, or contractual Medicaid/Medicare arrangements through a County, CHHA or Long Term Health Care Program.
    • Companion Services - Companion Services provide a quality alternative to nursing homes and costly private duty nurses with affordable live-in or hourly companion or homemaker care.  They handle the daily tasks of meal preparation, light housekeeping, transportation to appointments, companionship, medication reminders, and much more.

How Many Hours of Help Can a Senior Receive?
The amount of hours aides will assist a senior depends on what resources the senior has.  For private pay, the senior and his/her family decide what is needed and ask what the agency can provide; for those with LTC insurance, the number of hours will depend on the allotted amount of daily money to be distributed by the company; if a senior is Medicaid eligible the hours will be determined by Medicaid.  Some of the options for coverage are:

  • 4 to 5 hours minimum per day for as many days a week as is decided to assist with personal care, cooking, light cleaning, shopping, laundry, companionship, a walk
  • Two aides each doing 12-hour shifts
  • 24-hour live-in aides, which is usually cheaper than two 12-hour shifts because the aide is not paid for 8 to 12 hours of assumed free time/sleep.  It requires that the client sleep most of the night and calls for the aide infrequently.

It is rare that the agency can provide an aide to help for 2 hours in the morning and 2 hours in the evening, which is often all that is needed.  The loss of other clients due to wasted time traveling makes this prohibitive in most cases, but it is worth asking.

Team Building
We have given you a very brief overview of what is involved in hiring home health aides.  It is intended to provide a basic vocabulary and understanding so you will be able to speak comfortably with the team of professionals we recommend you use in helping the seniors in your life.  To learn more about potential team members, refer to our Newsletter Issue No. 3, from June 12, 2008 entitled Aging in Place takes a Team.

August 2009 - FEATURE
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