Top 5 Policies for Live-In Home Care Services

While there are a number of policies and procedures to consider in creating a successful live-in home care experience, the following are some key ones that should be addressed right at the start! The list has been comprised using the 80/20 rule (roughly 80% of the effects come from 20% of the causes).  Here are the Top 5:

1. Job Description: While licensed home care providers will institute a Plan of Care for their caregiver to follow based on a nurse assessment, families who hire a caregiver privately are encouraged to clearly identify every task the caregiver will be responsible for performing. In addition to describing which personal care (ADLs) and homemaker (IADLs) activities are required, it is equally important to determine the daily routine. Details around the care recipient’s routine should cover time of day and/or frequency of when specified activities should be performed. Additionally, the routine should include instructions on how to perform these activities to the liking of the care recipient or their family.    

2. Defining the Workday: Based on Department of Labor regulations, licensed home care providers will define the number of hours a caregiver is expected to work in a 24 hr. period. This is typically between 8-13 hrs. per day (a standard set of hours has not been adopted across the industry yet because new federal regulation was recently passed and licensed home care providers around the country are still trying to figure out its application to live-in home care). The two most important aspects both licensed home care providers and families hiring private caregivers will be to establish the critical times of day for the care recipient and the uninterrupted sleep time/meal times/ break periods for the caregiver. In defining the workday, it is very important to allocate appropriate times in the day (e.g. break periods) for when the caregivers can use the time for their own purposes such as making calls on their cell phone, using the internet, watching television, exercising or reading.  

3. Food Appropriations: We have covered food appropriations extensively in the past. This is because it can be a pretty big hurdle if left unaddressed. The three key aspects to food appropriations include: food expense, food purchasing and food preparation. The food expense should cover whether or not the family provides the food for the caregiver or if they would prefer giving the caregiver a daily food stipend. The food purchasing should go over who is responsible for buying groceries and what the process is for doing so. In addition, methods should be put into place to limit identify theft (using debit cards, credit cards or checks) and to track petty grocery cash and receipts. The food preparation piece should go over cooking safety, meal preferences as well as any type of diet, allergy or nutrition requirements of the care recipient.

4. Theft Prevention: The mission should be clear – implement methods to prevent the loss or theft of care recipient valuables. Some of this risk can be reduced prior to hiring a caregiver by conducting criminal background checks and purchasing insurance coverage such as a commercial crime bond. Additionally, families are encouraged to safeguard a care recipient’s valuables and keep them out of reach from people in and out of their home. For care recipients suffering from a neurological impairment, such as Dementia, it may also be a good idea to keep a detailed inventory of personal items in case they become confused or paranoid. From a policy perspective, families should be very clear on their position when it comes to giving gifts to caregivers and under what circumstances – if any – it would be permitted.

5. Emergency Preparedness: Orientating caregivers on emergency planning is certainly a topic that needs to be addressed. It should begin by providing a list of contacts and their phone numbers (family members, neighbors, doctors, fire department, etc.). The list should identify and prioritize who should be called in the case of any specific events. Clearly the primary care physician would not be the first one called if the household has run out of milk! In all seriousness, it is too often that incidents are not reported by caregivers so families need to be firm on the protocol and make sure the caregiver understands the importance of notifying them on a regular and/or emergency basis.