As we age, there often becomes a need for some amount of assistance in the later years. At times help may be needed for home management tasks like meal preparation, laundry assistance or yard work. If health deteriorates there may be a need for assistance with personal cares including dressing, grooming, bathing or toileting. As energy, mobility and strength change, some people benefit from assistance with running errands, completing shopping and attending appointments. At other times, a person’s cognitive status may decline necessitating someone to watch over or supervise the elder for safety and to provide assistance in all areas of functioning.
According to recent US statistics more than 65 million people provide care for an aged, ill or disabled family member, friend or neighbor during a given year and spend an average of 20 hours a week doing so. Most frequently the caregiver is a middle-aged woman caring for a family member with nearly a third of these also providing care for their own children or grandchildren as well.1
Caregivers provide care at varying levels and frequency and sometimes to more than one person at a time. Approximately half of all care recipients reside in their own homes and the caregiver assists them in their home. Approximately 30% live with family caregivers and are assisted in that setting. Others still live in assisted livings or nursing homes where family caregivers help them.1
All caregivers, whether providing around the clock care or periodic care and visits, are at risk for caregiver burnout and negative health impacts for themselves. Caregiver burnout is the greatest factor determining the need to move a client from their home into skilled nursing care.
Symptoms of caregiver burnout may include:
- Lack of time and attention to care for self
- Lack of energy, feeling exhausted, getting sick easily
- Changes in appetite, weight or sleep patterns
- Short temper, easily frustrated and overwhelmed
- Feeling helpless or hopeless, symptoms of depression
- Disengaged from others, activities, life in general
- Everything one does revolves around caregiving
When to Initiate Caregiving
Many people put off seeking assistance with professional caregiving until a crisis occurs or until family members are too exhausted to continue any further. Waiting until it gets to this point however is sometimes too late and attempts to implement in-home care can be unsuccessful. As soon as needs are identified it is beneficial to initiate caregiving assistance and in most cases, the earlier the better. At times, caregiving is delayed so long that elders are moved unnecessarily into care facilities as it seems to be the only option at a time when nothing seems to be working well. Early and proactive initiation of care assistance benefits the client by:
- maximizing the client’s ability to continue performing the tasks they are capable of completing
- minimizing a rapid progressive decline in abilities
- minimizing safety risks including falls and accidents
- enhancing the ability to age in place and remain home as desired
- providing observation to quickly identify other concerns or needs
- minimizing caregiver burnout in their family members and friends
- enhancing communication to decision makers and family members
Determining Level of Care
When it is determined that care assistance would be beneficial, a need for determining an appropriate level of care and qualified caregivers becomes the priority. The Nurse Practice Act of Minnesota specifies the types of care that can be provided by different levels of caregivers and these are further identified under particular license categories. When hiring caregivers, a comprehensive assessment to determine the level and amount of care needed should be completed by a registered nurse, who then delegates particular tasks to those caregivers with the appropriate level of education, training and licensure. The following designation of tasks is found in the Department of Health licensing rules and statues:
- Home Management tasks – housekeeping, meal preparation and shopping.
- Home Care Aide tasks – meal preparation, medication reminders, household chores, assistance with dressing, grooming, bathing for ambulatory individuals without additional health concerns.
- Home Health Aide tasks – personal care assistance, medication administration, feeding, skin care, hygiene assistance, toileting assistance, mobility assistance, performing delegated tasks and therapies, homemaking assistance and monitoring vital signs.
Homemakers, companions and home health aides can be hired privately or through an agency. Homemakers and companions are not required to be licensed, but when hired through an agency must adhere to its personnel policies.
Home health aides provided by an agency must meet certain criteria and function under the direction of the agency’s nursing supervisor(s). Privately hired caregivers are required to be licensed in Minnesota and meet specified requirements related to training, documentation and RN supervision and these details can be found on the MN Department of Health website.
What to Expect: Hiring Caregivers Through an Agency
When you hire a caregiver through an agency, there are basic minimum requirements as deemed necessary by the Department of Health, and in addition to those there are basic good practice standards that enhance the likelihood that safe, quality care will be provided. You should expect the following when hiring caregivers through a licensed agency:
- Background checks are conducted per state regulations
- The agency is licensed and bonded
- The agency maintains client confidentiality and follows HIPAA regulations
- The agency provides worker’s compensation insurance
- The agency manages tax withholding and payroll services
- The agency only accepts clients for which it has the capacity to care for
- The agency provides RN supervision of caregivers according to state regulations
- The agency is willing to work to find the best fit and most appropriate caregiver(s) for each individual client
- The agency individualizes each specific plan of care to meet identified client needs
When home health care is decided upon, a number of steps should occur. First and most important is the evaluation by a registered nurse prior to the initiation of actual care in the home. This evaluation is to determine the client’s needs and identify the level of care and type of care provider appropriate to meet those needs. This evaluation also identifies whether the care required is routine and well established in basic caregiver training or whether the care needed will require additional training and coaching for caregivers. This may include special training to individualized treatments, special procedures or equipment an individual may have like oxygen therapy, mobility equipment, blood glucose monitoring or other delegated tasks. The next step would involve determining the frequency of care and developing a schedule. This schedule should be devised to meet the needs of the client and their support system, it will aid the client by providing services and care needed and aid the family caregiver by providing respite and the opportunity to tend to other needed business, appointments and responsibilities. Ideally, once established the caregiving team should be consistent caregivers, familiar to the client and well oriented to the client’s needs and preferences. Every caregiver entering the client home to provide care must have an orientation provided by a registered nurse which specifically details each individual client’s needs and plan of care. The caregiver must then be supervised by a registered nurse on a regular basis set forth by the licensing regulations pertinent to the level of care being provided.
The responsible party in the home health caregiver arrangement, whether the client, family or professional decision maker should expect regular and ongoing contact with the home health care provider to know how the care situation is progressing. Status updates, care conferences, phone contact and written reports are all means of communicating how the care arrangement is working and whether or not adjustments to the plan need to be made. Communication should flow freely in both directions and prompt responses should be expected to assure that care needs are clear and well addressed.
Challenges and Concerns
As in any ‘new’ situation, there are bound to be bumps and wrinkles in the first few days but these should be smoothed out in short-order when initiating home health care. Clients and family members can expect to develop therapeutic working relationships with the caregivers, supervising nurses and home care administrative staff. Clients and family members should feel empowered to address concerns, have the opportunity to be heard and have any potential concerns addressed immediately. The ‘fit’ between caregiver and client should be comfortable and assure adequate communication, trust and confidence in abilities and skills needed to meet client needs. Clients should be informed of and aware of their rights as detailed in the MN Home Care Bill of Rights and be aware of the options they have to address concerns as specified in the bill of rights
How Matrix Can Help
- Matrix RN Care Managers are knowledgeable about home health care options and MN licensing regulations regarding in home health care. Matrix RN Care Managers serve as RN Supervisors for Matrix Home Care Specialists caregivers and are skilled at developing client focused plans of care and coordinating needed services.
- Matrix RN Care Managers and home caregivers understand the special needs of elders, those with complex medical needs, those with dementia of all levels, adults with disabilities and those who are dying and receive ongoing education, coaching and support to meet the individual needs of every Matrix Home Care client.
- All home caregivers are Matrix employees and are carefully screened and fully trained to meet each homecare client’s needs. As a licensed Class A home healthcare provider, Matrix assures that a licensed RN develops a Plan of Care in conjunction with the client and family, and supervises the home caregivers closely to ensure that homecare services are provided skillfully, respectfully, and safely.
For more information about Matrix Home Health Care Specialists or for a complimentary consultation, call 952.525.0505 or 800.560.0961