Hiring an In-Home Caregiver to Act as the Family Lookout


When caring for a senior, various health conditions can arise that are difficult to detect but often have some key indicators. Mood swings, changes in eating habits, weight fluctuations, hallucinations and physical injuries are all signs that could point to a new or worsening underlying issue, like a urinary tract infection (UTI), advancing cognitive impairment, depression or increasing fall risk.

Professional caregivers hired through a reputable home care company, such as personal care aides (PCAs), home health aides (HHAs), certified nursing assistants (CNAs) and licensed practical nurses (LPNs), can serve as the eyes and ears for families who cannot personally provide full-time care for aging loved ones. This is especially helpful for long-distance caregivers, working caregivers and members of the sandwich generation who are busy juggling care for children and aging parents simultaneously. A professional caregiver’s training and supervision are essential for identifying problems in vulnerable elders before they become larger, potentially life-threatening issues.

In-Home Care Aides Are Attentive to Changing Care Needs

Both medically skilled and unskilled in-home caregivers receive elder care training and are educated on signs to look for in their clients. Detecting a new behavior or condition, while certainly challenging, isn’t a professional caregiver’s only responsibility. They must also determine when it is appropriate to alert their supervisor and inform a senior’s family members of the changes and how they will be addressed.

Home care companies typically have a registered nurse (RN) or care coordinator on staff who oversees the care that seniors receive. Even if an elder has not experienced any changes in their condition, their care coordinator should routinely review their record and assess their health and functional status to see if any modifications should be made to their care plan. For example, all Medicare-certified home health care agencies are required to review each client’s care plan at least once every 60 days to ensure it continues to meet their needs.

Outside of regulations set by the Centers for Medicare and Medicaid Services (CMS), each state’s Department of Health governs the requirements for home care companies regarding client monitoring and reassessment, reporting health issues, and making care plan revisions. For example, Partners in Care, a licensed home care services agency (LHCSA) and affiliate of the not-for-profit Visiting Nurse Service of New York, follows strict protocols set by the New York State Department of Health. At a minimum, LHCSAs in the state of New York are legally required to review and revise a patient’s plan of care “as frequently as necessary to reflect the changing care needs of the patient, but no less frequently than every six months.” Each care plan review and revision must be documented in the patient’s record, and all authorized care team members, such as their primary care physician and power of attorney for health care (if applicable) must be promptly notified of any changes.

Keep in mind that regulations may vary by location, so check with your local agency for specifics. Furthermore, reputable home care companies may set their own standards for care assessments and care plan reviews that are more stringent than CMS and/or state guidelines.

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4 Steps In-Home Caregivers Take to Address Changes in a Senior’s Health

1. Identify the Problem

A professional caregiver’s chief tasks are to know their senior’s routines, understand their common behaviors and monitor for subtle changes in their health and functioning. Whether it’s a development in the elder’s mental or physical state, in-home caregivers are trained to be on the lookout for the smallest indicators of change.

2. Report Cognitive or Physical Changes to a Supervisor

Upon identifying a change or problem, aides should immediately report to their clinical manager, care coordinator or supervising RN.

3. Evaluate the Senior and Make Care Decisions

The manager should then document the change in a senior’s record and assess the situation to determine next steps (if any). Depending on the severity of the issue, the care coordinator may advise a simple care plan adjustment, a doctor’s appointment or a visit to the emergency room.

4. Notify Family Members and Discuss Future Care Options

After the supervisor’s assessment and a determination that the change necessitates an updated care plan or emergency care, the home care company will immediately contact the senior’s authorized family member(s). If applicable, once a formal diagnosis and any necessary treatment recommendations have been made by a physician, the company, client and their family can discuss specific adjustments that must be made to the plan of care to meet the senior’s evolving needs.

Ensuring Quality Care in a Senior’s Own Home

The key to this whole process is one firm commitment to quality care and transparency. If the issue is a legitimate concern, family members should be contacted within 24 hours of the initial report by the in-home caregiver. Even if what they report does not result in a verified change in the senior’s condition or care plan, the concern should still be detailed in a report and added to their file. Gradual changes and seemingly small incidents can be valuable for a diagnosis later on.

No matter which home care company you choose for your loved one, understanding its policies for reporting concerns, handling emergencies, communicating with family members and updating care plans is crucial. Even subtle changes in a senior’s behavior could indicate a new condition that might require immediate attention from a doctor. The sooner these are detected and you are notified, the sooner you can weigh options for new medical and/or therapeutic treatments to combat the problem.

Sources: What’s a home health care plan? (https://www.medicare.gov/whats-a-home-health-care-plan); N.Y. Comp. Codes R. & Regs. tit. 10, § 766.3 Plan of care (https://regs.health.ny.gov/content/section-7663-plan-care)

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