Home care is the most widespread alternative to nursing-home care, a spectrum of services involving everything from round-the-clock skilled nursing to a few hours’ help each week with housekeeping, laundry, and meals. Because of advances in technology, today even people who genuinely need twenty-four-hour skilled nursing can get this type of intensive care in their homes, if they are able to participate in one of the few free demonstration projects for Medicaid recipients or are willing to foot the enormous bill privately. Generally speaking, however, home care, like any community service to forestall institutionalization, is most appropriate for people who do not require the intense services of a nursing home but do need minor to moderate help in negotiating life.

If your relative is being discharged from a hospital, the hospital social worker can help you find appropriate home care. Otherwise, either consult your office of the aging or go it on your own. Look in the Yellow Pages under “nursing care” or “home health care” for an agency. Be guided by these clues to quality – the words “certified” and “accredited.”

Certified home health-care agencies are government licensed and are the only ones able to accept Medicare or Medicaid. They provide a variety of home-care workers. Getting an employee from a certified agency is preferable because government regulations specify that anyone the agency sends to your home must have a certain number of hours of training.

Accredited agencies have met even more rigorous standards, requirements set up by nonprofit organizations dedicated to promoting high-quality home care. Accreditation is voluntary and takes place only after a careful review. While an agency may be excellent and still not be accredited, choosing this type of service ensures that you are dealing with the best.

The label licensed simply signifies that the agency has met basic legal and operating requirements. Services gotten through licensed, noncertified agencies must be paid for privately. If you decide to use this type of agency, find out how extensively it trains its employees.

In addition to independent agencies, hospitals are increasingly likely to offer home-care services. Or home-care programs may be operated by nursing homes and geriatric centers.

Once you call, the agency should offer you guidance in choosing the right type of care – services fitting your relative’s financial and physical requirements. When it sends you workers, a good agency will also monitor what is happening and resolve any problems. However, you also have to do your share in demanding quality care.

The front-line home-care workers – homemakers, home health attendants – are not highly paid. There is no prospect of advancement. Their job is often mentally and physically taxing. If possible, make sure the person caring for your relative is experienced, trustworthy, and competent and genuinely likes older people. While you are apt to have to make compromises, ideally you should be searching out someone like this:

What a relief it was to find Mary when my mother’s physical condition was going downhill! She approached her job with a combination of professionalism and genuine love. I felt confident Mom was being treated kindly. And she gently pushed her to get up and dressed and sit outside. When something was wrong, she knew it and could be trusted to give the doctor a call. He said he was amazed at hex ability to understand when Mom was really sick.

*145/159/5*

GENERAL HEALTH