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Is a home-health aide the answer?

That depends ...

By Anita Weinberg
This article originally appeared in Elder Caregiving: An Exploration, a special edition of New Jersey Jewish News.

When is it appropriate to hire a certified home health aide, and what is the difference between a CHHA and nonmedical assistance to the infirmed?

If personal-care assistance is not needed, but help with daily chores -- cleaning, laundry, changing linens and food shopping -- is required, then alternative home-based services may be an appropriate response. Home-based services may include home-delivered meals, a homemaker service or a nonmedical companion program.

But if the elderly or disabled person has difficulty performing the daily functions of independent living, such as bathing, grooming, dressing or walking about, then a CHHA may be the answer.

Aides can provide personal care assistance. They also can work with clients whose problems are not physical -- patients with Alzheimer's disease or those with some other form of dementia. Sometimes the assistance of a CHHA, even a few hours per day or a few days a week, is enough to help families postpone institutionalization or nursing-home placement of a loved one.

Under New Jersey regulations, all certified home health aides must work under the supervision of a registered nurse. That means that certified home health aides must work for an agency licensed by the State of New Jersey. The RN supervisor meets with the senior adult and family to define a plan of care which specifies all the activities to be accomplished by the aide. On an ongoing basis, the nurse supervises the aide in the home, making sure that the arrangement is working well for the client. The nurse also updates the plan of care if circumstances change for the client.

An aide should be well trained and skilled. In New Jersey, certified home health aides are required to complete successfully a 76-hour training program and demonstrate clinical competency. Ongoing in-service education is also required to maintain certification. Reliability is a major factor in selecting an aide since the elderly person is often dependent on the aide for care, and consistency is very important. The aide should arrive as scheduled and backup coverage should be available during the aide's vacation, for example. Agencies should be able to provide backup assistance if an aide becomes ill, goes on vacation or terminates employment.

Reputable home health agencies assume the costs of employment such as Workers Compensation, Social Security and other kinds of insurance (including bonding of employees).

Medicare includes home health-aide service within its roster of covered services; however, the coverage is very limited and is available only if the CHHA service is provided in conjunction with a skilled-care need provided by an RN or physical therapist. New Jersey Medicaid also covers these services. For long-term-care needs, the Personal Care Assistance program provides home health-aide service for incomeeligible individuals with medical needs.

Other programs such as the Community Care Program for the Elderly or Disabled or the New Jersey Assistance for Community Caregiving programs cover home health-aide services for an income-eligible population.

Long-term-care insurance policies may include coverage for certified home health aides.

Confronted with the cost of certified home health-aide service, one of the more expensive kinds of care, some people look for a lower cost alternative and attempt to hire an individual on their own or through the "underground market." The reasons may be understandable; not everyone can afford the CHAA alternative, but people looking at these alternatives should keep in mind the many protections provided by licensed agencies. Agencies assume the hiring burdens, medical screenings, immigration checks, criminal record background checks, insurance coverage, training, supervision, and backup provisions for the certified home health aides. A certified home health aide working without RN supervision is in violation of New Jersey State Board of Nursing regulations.

It's important to remember that there are activities outside the scope of responsibility of the certified home health aide. Regulations prohibit certified home health aides from administering medications. They can, however, assist with patient-administered medications and remind clients when medications should be taken. Aides should not be asked to help with personal finances or banking. Heavy cleaning or general family shopping is also outside the range of routine responsibilities for the CHHA. Most agency policies also prohibit CHHAs from driving their clients or family members, although they are permitted to accompany the client for medical appointments.

When calling an agency to inquire about its services, feel free to ask questions which will help you feel more comfortable with the quality of the services provided.

Some of the questions you might want to ask include the following:

How long has the agency been in operation?

Is the agency licensed? By whom?

Is the agency accredited?

Is the agency a nonprofit or a for-profit corporation?

Are all the aides certified by the New Jersey Board of Nursing?

What is the average length of employment for an aide in your agency?

Is the agency insured and are employees bonded?

Does the agency have written policies to protect clients and employees?

How are aides supervised?

What kinds of ongoing training experiences do the aides participate in?

What is the process for developing and revising the plan of care?

What are the fees and payment procedures?

Are there subsidies/sliding scales available for low or modest income clients?

Anita Weinberg is executive director of Visiting Health Services of Union County Inc. and president of Home Care Council of New Jersey. She also serves on the Union County Aging Advisory Council.

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