Responses provided by: Mary Krause Brady RN, Supervising nurse at SafeHarbor HealthCare Services, a family operated, 45 year old Staten Island-based Joint Commission Accredited agency.

What are indicators that you should look for to determine whether your loved one can maintain an independent lifestyle?

When determining if your loved one can safely live independently, there are a few indicators to look for aside from the obvious ones like frequent falls or not recognizing people who are regularly in their lives. Check to see if medications are being taken regularly by discreetly counting them when you are visiting; see if the food in the refrigerator is fresh and being consumed. Is the person having difficulty bathing, keeping clothes clean and not keeping up with personal hygiene? Are they having difficulty with paying bills on time?

After making the assessment do you have a conversation with loved one first or an agency?

Only the one making the assessment will know how their loved one will react to having another person in their home taking care of them. Many may feel their independence is threatened and will not be receptive to the idea at all. Of course the optimum solution, if at all possible, is to have a loving family member or members alternate care. If financial resources are available, suggesting that a non-relative be hired to do some cleaning or shopping once or twice a week may alleviate their anxiety about the situation. This may help to make the loved one more comfortable to having someone in the home; if appropriate the aide could then assist with activities of daily living, i.e. personal hygiene, preparing meals, etc.

Does an agency offer intervention to assist with THE conversation?

If an agency must be utilized, most will aid the family in helping the loved one understand the need for some assistance. The usual procedure is that a supervisory Registered Nurse from the home care agency makes the initial visit to access the situation and put the consumer and family’s minds at ease. Once an agency is selected, typically they will assign a Home Health Aide to the case, if that is the level of care required. The family will meet the Aide when they start working. Of course, we usually try to fill the position with someone who will be compatible to the loved one’s personality and likes. If the loved one is not comfortable with the person we send, someone else is assigned until their needs are met.

Once the decision to use a Home Health Aide service is made what are next steps for family?

The agency should help the patient and family feel secure.  It is often requested that a family member not stay the first day but return unexpectedly to see how well the consumer and aide relationship is going. I always suggest that, if possible, the family visit often and unannounced.

No matter who you have working in the home, and even though they are bonded and screened, it is always a good idea to put valuables away and not leave opportunities for any misunderstanding. Install a listening or video device that gives the family some level of comfort. You can decide whether or not to tell the home health agency that it is installed.

Once the type and level of services are needed and determined how do you “shop” for one? How do you compare? What resources are available to fully investigate the options?

Start by researching agencies in your area. Question how long they have been in business and most importantly, how are their employees screened?  Are criminal and background checks done on a regular basis? Other sources for references would be your physician and friends who have had similar services. The family should feel free to interview each agency, and ask for references from others who have used their services.

Once you’ve settled on a service how do you stay involved in the loved ones care? How do you monitor?

Does the agency keep in touch with the family and reassess the client? How often? The family should be assured that the service agency is available 24/7 and that calls will be returned within a reasonable time. Be vigilant by stopping by frequently unannounced, especially if your loved one is incapable of letting you know if there is a problem.

What should an agency provide to loved ones in terms of reporting?

Someone from the service agency should call once a week and a Registered Nurse should visit on bi-monthly basis at a minimum. There should be a receptive voice from the agency for any concerns or questions and you should be confident that messages will be relayed to the Nursing Supervisor.