How do you choose a Home Care Provider?

Consumers may arrange home care services through an agency or by hiring an individual directly (not through an agency). These home care providers (agencies and self-employed individuals) must be registered or licensed by the Minnesota Department of Health. Some agencies also are Medicare-certified. Both state licensure and federal certification for Medicare payment require certain standards for operation. To inquire about the licensure/registration or certification of an agency, ask the agency or call the Minnesota Department of Health or call (651) 215-8701.

How do you choose an Agency?

Most agencies will mail information or give information about their services over the telephone. Generally is it best to compare the services, prices and policies that agencies offer. Once you have chosen an agency, an appointment will be made with a nurse or social worker for an assessment. The assessment is an interview with the consumer to determine the services needed and to write a service plan or agreement.

If you are hospitalized or in a nursing home, have the assessment there, if possible, in order in order to arrange for services to begin the day you return home, if this is what you choose. Clarify if there is a charge for this initial assessment.

Other factors to consider:

  • Written information about the agency's services including their charges, types of services and qualifications of employees who work in the home. If you need primarily housekeeping and shopping, the services of a homemaker or housekeeper (or someone who performs home management tasks) will do. If you need major assistance with a bath, the services of a home health aide are needed. Be sure to purchase only the amount and type of service needed.
  • Billing procedure. Does the agency bill weekly, bimonthly or monthly? Before services begin, clarify whether Medicare or another source will be paying for the service. Put the payment agreement in writing (regardless of the payment source) and retain a copy. This is a home care licensure regulation.
  • Are services offered evenings, overnight, weekends and holidays. Are the charges higher at these times than during weekdays?
  • Employee reference checks. Agencies are required to do a criminal background check on current and potential employees.
  • What are the training requirements of employees?
  • What type of orientation to assigned tasks do workers receive? Does the supervisor make a home visit to give instructions or is the employee given verbal or written instructions?
  • Number of employees assigned to help you. Agencies usually schedule more than one employee.
  • Frequency of supervision. How often will the supervisor visit or call you?
  • Standards of performance. How does the agency measure employees' performances in terms of respectful and courteous behavior?
  • Daily assistance: if you need daily help (which will likely involve two or more employees) what arrangements are made to ensure communication and continuity of services? Some agencies require employees to communicate significant information in a notebook kept in the client's home.
  • Your needs and preferences regarding: days and hours of service and smoking (many agencies prohibit employees smoking in clients' homes). Inform them about your pets.
  • Meals. Generally, employees are expected to provide their own meals, however some clients prefer to offer meals.
  • Billing or employee problems. Who do you call?
  • Service schedule conflict. When an employee does not arrive, whom should you call? How much notice does the agency give if they are unable to staff your hours? How much notice does the agency want from you if you have to cancel service? Can your service be rescheduled? Agencies are required to have something called a backup plan for they are not able to provide services. Frequently, the family is named the backup persons. Be sure to clarify the backup plan.
  • Termination of services. How much notice does the agency give when they decide to discontinue services to you? If you continue to need services, the agency is required to give you a list of home care providers who service your area.
  • Other agency rules. Are there other policies that may impact you such as their policy regarding clients hiring their employees directly.
  • Insurance and bonding. How are they insured and bonded? If an employee breaks a valuable, how would you be compensated?

If, after having the initial assessment, you decide you do not want the agency's services, you are free to cancel all arrangements. You may also discontinue services at any time after they have begun. However, agencies appreciate at least a week's notice, if possible.

Service Agreement:

You must receive a copy of this agreement form containing the following:

  • a description of the services to be provided and their frequency
  • identification of the persons or categories of persons who are to provide services
  • the schedule or frequency of sessions (visits or phone contact) of supervision or monitoring required, if any
  • fees for services
  • a plan for contingency action that includes:
    1. the action to be taken by the agency, client and responsible persons, if scheduled services cannot be provided;
    2. the method for a client or responsible person to contact an agency representative whenever staff are providing services;
    3. who to contact in case of an emergency or a significant adverse change in the client's condition;
    4. the method the agency will use to contact a responsible person of the client, if any; and
    5. the circumstances in which emergency medical services are not to be summoned, consistent with any health care advanced directives.

You may be asked to sign vouchers that documents the employee's visit or hours work and the tasks completed. Before signing you should review them for accuracy. Keep a copy for your records; you may want to verify your bill.

Advantages of arranging services through an agency may include backup workers when your scheduled worker is unavailable, social security, workers' compensation and insurance paid by the agency for their employees, supervision of the employees and additional services when needed. Agencies also offer continuing education which is required of most employees. Also, agencies are the primary means through which consumers can obtain third party payment of services.

How do you hire an individual for direct services?

A consumer may hire an individual directly for services. There are specific licensure requirements for self-employed home care workers. Generally, when hiring an individual home care worker (registered nurse, therapist or paraprofessional) the consumer hires the worker as an employee or as an independent contractor.

When hiring someone as your own employee, you are responsible for paying all applicable taxes and when hiring someone as an independent contractor, the independent contractor is responsible for paying applicable taxes however, the consumer may still have some Internal Revenue Service responsibilities. Contact the IRS or an accountant knowledgeable in tax law for current information.

Other factors to consider

  • Credentials. For example, if hiring a nurse, as to see her/his nursing license or call the Minnesota Board of Nursing (651-617-2270) for verification; if hiring a paraprofessional ask to see her/his license or registration (if applicable) or call the Minnesota Department of Health (651-215-8701) for verification.
  • Criminal background check. Call your local law enforcement office or the Minnesota Bureau of Criminal Apprehension (651-642-0610) for more information. There is a nominal charge for this service.
  • Nursing Assistance Registry. The Minnesota Department of Health maintains a registry of nursing assistants found to have maltreated a nursing home resident. Under law, these persons can no longer be employed by Minnesota nursing homes. For more information, call the Registry at (651) 215-8705 or 1-800-397-6124.
  • Check references and relevant experience. Is s/he bonded or have liability insurance.
  • Expectations for time off or vacation leave. Will the consumer pay for vacation time. How much notice should the home care worker give the consumer.
  • Cancellation of services. How much notice each party should give when canceling service due to illness or other reason.
  • Termination of services. How much notice each party should give when one decides to discontinue services.
  • Service Agreement. Licensed paraprofessionals must write a service agreement with their clients. Both parties must sign the agreement and retain a copy.
  • Driver's license. If the worker will be driving your vehicle, verify her/his driver's license and check with your automobile insurance agent about coverage in case of an accident.
  • Pets and smoking. Clarify who is responsible for the care of your pets and your preference regarding smoking in your home.

Advantages of hiring a home care worker directly are the cost may be less that agency costs and the consistency of one person helping you. A disadvantage may be when s/he is unable to assist you, there is no one to provide backup assistance (unless prior arrangements are made).

Individual paraprofessionals who perform home health aide tasks are required to obtain a Class C home care license and be supervised by a registered nurse. Individual paraprofessionals who perform only home care aide tasks or home management tasks have no supervisory requirement. The consumer is the supervisor. See the handout Home Care Paraprofessionals for definition of these tasks.

The lack of formal supervisory oversight is an important consideration for consumers who have cognitive impairment and no active involvement of responsible persons living nearby.

How do you make sure the services are satisfying?

  • Realistic expectations. The home care worker may not perform tasks exactly as you would perform them so your flexibility is important. Inform each employee how you prefer tasks done but allow for some differences. Allow flexibility in their arrival time. When they must travel to your home, exact arrival times are not always possible.
  • Rescheduling services. When your personal schedule conflicts with your home care schedule, inform the provider as soon as possible to either arrange an alternative date or cancel service on that date. Providers appreciate your courtesy of informing them of scheduling conflicts. If your services are through an agency, call the agency directly instead of telling your direct care worker. If you become hospitalized, arrange for someone to call your provider, if possible.
  • Service changes and concerns. Most agencies arrange for one person, usually called a case manager, to be responsible for the implementation and monitoring of the service agreement and troubleshooting when conflicts occur between the consumer and agency. Contact your case manager directly regarding any changes you wish to make in your services agreement or any concerns you have about the services. Communicating concerns to staff other than the case manager may cause misinterpretation of a concern or may delay its resolution.
  • Discontinuing services. If possible, give advance notice if you decide you no longer want the service. If the agency discontinues services to you and you continue to need service, they must give you a list of home care agencies that work in your area. (An appeal process is available to consumers when the public funding of their home care service is terminated).
  • Emergencies. Agency employees are instructed to call their office or 911 if they observe you having a medical emergency. If hospice is involved, the employees are given specific instructions on how to handle medical emergencies. If you employ your own home care worker, be sure to decide how you want specific types of emergencies handled.
  • Broken items. Agencies usually have insurance that covers the repair or replacement of items broken by their employees. Should an incident occur, inform the agency as soon as possible. If your individual worker breaks an item, you will need to work out the issue together or make an agreement about this issue in your contract or service agreement. You or your worker may have insurance that will cover the damage.

Dissatisfaction with services

Agencies must inform you about their procedure for addressing your complaints. They are required to investigate and attempt to resolve grievance or complaints lodged by their clients. Directly informing the agency about your concerns or complaints gives them the opportunity to address or resolve them.

Here are resources if problems arise and you have tried resolving a problem without success or if you are uncomfortable voicing your complaint directly with your provider:

  • Office of Ombudsman for Long-Term Care
  • Telephone: (651) 431-2555 or 1-800-657-3591
    FAX: (651) 431-7452

    This office assists home care consumers of all ages with questions or complaints about home care services. Ombudsman services are an informal way of resolving complaints. Ombudsmen are located statewide so your phone call, FAX or letter will be referred to the ombudsman working in your area.

  • For placing a complaint with the state agency that regulates the provider, call or write to:
    Office of Health Facility Complaints (OHFC)
    Minnesota Department of Health, P. O. Box 64970, St. Paul, MN 55164-0970
    Telephone: (651) 215-8713 or 1-800-369-7994
    FAX: (651) 215-8712

    OHFC investigates alleged violations of the Minnesota Home Care Bill of Rights and home care regulations. This agency also functions as the hotline for Medicare home health care complaints.

  • If you have a complaint about the quality of Medicare home care, you may also contact:

    KEPRO, 5201 W. Kennedy Blvd. Suite 900, Tampa, FL 33609, phone number 1-855-408-8557. This agency is a Peer Review Organization in which a group of physicians and nurses, paid by the federal government, review the quality of home health care provided by Medicare-certified home health agencies

If you suspect theft by your home care worker...

Sometimes consumers may think money or items are missing. This may be a result of rearranging or forgetting where they were placed. It is important to look thoroughly for your belongings before taking further action.

However, if you think the person assisting you has taken anything such as money, credit cards, automatic teller cards, household or personal items, etc., call the police as soon as you discover the items missing. Just as you would call the police if someone broke into your home to steal, you should do the same if you suspect theft from your home care worker.

If the worker is an agency employee call the agency to report your allegations. Agencies are required to investigate and attempt to resolve complaints from their clients. If the home care worker is your employee, you must decide how to handle the situation. You may want to talk directly with her/him before taking further action.

Some consumers may choose to call the agency only and not involve the police. However, many agencies require a police report in order to consider restitution. If the police are unable to charge and prosecute someone for the alleged theft, agencies are unlikely to compensate you.

Keep your money and other valuables such as credit cards, telephone calling cards, cash machine cards, check blanks, income checks and valuable jewelry in a locked area or other secure location.

Unscrupulous workers may hide your belongings in their tote bags. Be aware of the activities of your home care workers. Most would agree that the majority of workers do not steal. But it is the very few who can present the most problems.

The Crime Victims Ombudsman is a resource for assistance. Call (651) 642-0550 or 1-800-247-0390. This office operates a 24 hour toll free number providing citizens access to information about crime victims rights, available services and county specific referrals throughout Minnesota.