Continuation of interview with home healthcare expert, Steve Olian, MBA (SO) by Larry Berkelhammer (LB):
LB: If you’re paying out of pocket, is there a standard price that agencies charge, or a standard price that individuals charge, and if not, how do you arrive at the price?
SO: You can check with the hospital discharge person if you need that kind of information. They have a general idea of what’s going on, but every community has a different wage level, and you really have to check that out. You’ll find that there’s going to be a range that is quite significant, and it may depend upon their credentials, whether they are an RN, LVN, CNA, or whoever it is that you require, you’re going to be paying scale.
LB: I imagine if medications need to be administered either IM (intramuscular) or IV, you’d want to have an RN. Are RNs available who do this? It seems to me that the ideal person to have would be someone who had worked on the floor of a hospital but is now retired from that, doesn’t want to work so hard, doesn’t want such a stressful job anymore, but might be interested in doing this. What do you have to say about that?
SO: Each state has its own restrictions and requirements as to who can actually administer the particular kind of medication that is required. Having a visiting nurse come to the house for the specific reason of giving a certain kind of medication to an individual who cannot leave the house is an easier problem to solve than ongoing, convalescent care in the home. There are RNs that are retired from full time care and want to work on a part time basis in a home. You could probably obtain information about that in your local nurses’ registry in your town or state, but this is a very high level of care, and the cost of that is going to be substantial.
LB: If you have good individuals coming in for each shift, or an agency managing the shifts for you, do you still need a family member or friend to mediate between the caregivers and your loved one who is being cared for?
SO: Issues come up constantly between the patient and the caregivers. I think the primary caregiver, whom I’d call the caregiver manager, is going to find him or herself in what you might call the conversation or the mediation between the two to resolve issues. The patient may want to express as much independence as possible and that may go contrary to how the caregiver wants to provide their assistance. Frictions commonly arise, and they can be quite difficult to handle from time to time.
LB: I imagine one source of friction would be from having different caregivers coming in at different times for different shifts on different days, I imagine you might have half a dozen caregivers taking care of that one person, and what happens if the different people coming in are in disagreement and doing different things to care for that person?
SO: Well, there are going to be different personalities and different chemistries for sure; that is going to happen. There’s always feedback. Obviously the primary caregiver manager is going to have to keep an ear tuned to the patient’s needs.
The primary caregiver manager has the primary responsibility, and that person is the one who is be responsible for seeing that the patient is receiving the most beneficial treatment possible. And there will be times when one will have to call an agency and ask for a replacement if there is someone who doesn’t work out, even if it just isn’t a good chemistry. This is not uncommon, and the agencies are used to this as well.
LB: Steve, how do you really know if caregivers are being sensitive to the patient’s needs?
SO: I think this is one of the hardest things to know, really. You can’t be present all the time, and if you’re not present, all you can really hear is the testimony of the caregiver versus what you hear from your loved one, and their opinions may be at some contrast to one another. You could certainly tell by the organization of the room, the cleanliness, the diligence and the emotional feeling that exists between the two if you are there to watch. In hiring someone, the primary caregiver manager (usually a family member) is going to have to be present, and keep an ear tuned to this as the process starts. At least in the beginning you’re not going to be able to hand over the key and walk off. The job doesn’t end just because someone else walked through the door. Sometimes, in the beginning, the job is even more difficult. More time is involved to make sure that these things are happening correctly.