In-Home Care “Info Nuggets” – Part 1

Katie Koerper is the Operations Manager for Northwest Senior Management Services in Portland, Oregon.  One of her responsibilities includes interviewing and hiring prospective caregivers for clients.  Recently, she presented the following information at a Senior Care Workshop and with that presentation she detailed what it takes to be successful as you arrange care for yourself or for someone else.  With sincere appreciation to Katie, the following is for you to consider:

Use an agency or a private caregiver?

“This is a big important question.  The simplest answer I can give is the word ACCOUNTABILITY.  Most of the caregiver scandals you see in the news have to do with private caregivers.  That’s not to say that private caregivers are not to be trusted—far from it!  There are thousands of good and honest private caregivers at work.  But it only takes one bad one to make the news.   In Oregon, all agency caregivers are actual employees.  They’ve been interviewed, had previous employment verified, had their references checked, and they’ve been background-checked.  If they’ve lived out of state in the last five years they get their fingerprints checked as well; but that’s only if the agency has a Medicaid contract, which we do.  They have to prove they’ve had training, or we have to train them; and they have to provide evidence of ongoing training.

Top Three ideas for utilizing in-home care:

#1 The idea of independence and safety covers a pretty broad spectrum.  For some, having three hours of help once or twice a week is all it takes to prolong independent living.  For others, nothing short of ‘round the clock care’ will keep them safe.  The big idea is that a person should not have to use all of their energy to simply live.  They should have enough strength left over to be who they really are, and to enjoy a quality of life.

#2 Respite care, at least by that name is a newer idea.  In this case we’re talking about an elder who lives with an adult child or other relative because they need care; or someone who is completely dependent upon their spouse for all their daily needs.  These family caregivers need time off for themselves, and sometimes they need time off so they can go to work.  It is not unusual for us to have a regular schedule in a family home where there are pets and little children and/or young adults and other family members.  In other situations a single adult child might take a few days off every month, so we send a caregiver in to keep the schedule running for the elder.

#3 Bridge care has become more important for us in the last 5 years.  This is our term for people who are gearing up for a big move but aren’t ready to go yet.  Maybe they’ve agreed to go to Assisted Living, but they’re on a waiting list.  Maybe they can’t make a move to a facility or a family member’s home until a house sells, or until renovations are complete.  The idea is to provide short term care until the family can take the next step.

How do elders describe what their needs are?

When I go for initial home visits, or when the nurse and I go for intake assessments we usually hear the same lists or complaints over and over again, depending on who’s talking.  The adult children have their specific concerns, and the elders have theirs.    What do elders willingly identify as an important need?  Here are some top examples:

Fall Risk?
Meal Preparation and Shopping?
Changing the sheets?
Housekeeping and Laundry?

Being allowed to talk about an identified need opens the doors for other opportunities.  What “need” do you think is the one elders identify more often?  No, it’s not the ‘risk of falling,’ nor ‘bathing’… it’s actually ‘changing the sheets on a bed’ – at least that is what we’ve discovered during our initial home visits or intake assessments.  Some elders have told us it can take up to 2 days to get this done.  Surprising, isn’t it!

‘Key” examples of in-home care services


  • Reminding:  “Don’t forget your pills!”
  • Assistance:  Opening the bottles for people who know what they are taking and why
  • Administration:  Handing medications to people who don’t know what they are taking or why

Nurse Care Management:

  • The client gets their very own advice nurse who knows them well
  • Care coordination
  • Medication management and delegation
  • Liaison with all providers
  • Nurse acts as an active advocate on behalf of the client

Everyone needs an advocate

There WILL come a time when EVERYONE will need an advocate.  It happens when a person of any age is temporarily ill or injured, or hospitalized.  It happens when the situation becomes long term, and advocacy needs to become a way of life.  Some people seem to fall naturally into this goal, as if they’re gifted for it.

If there’s been too much family trauma and drama and the family unit doesn’t function well, a friend can often be a more effective advocate.  You need someone who isn’t carrying a lot of emotional baggage that would hinder open communication.  I personally have served as an advocate for several of my elderly friends.  In each case they didn’t have family close by, and because they didn’t get along very well, the adult children were relieved to have someone to act in their stead.

An advocate can’t be afraid to ask personal questions when necessary.  An advocate needs to be willing to learn to speak up on behalf of the elder—to healthcare professionals, to legal professionals, to anyone who is involved in the elder’s life.  Learn to respectfully push back.  An advocate needs to be ready to act at all times”.

Part II will follow in three weeks.  Thank you for following the Blog.

“If you don’t stand for something, you’ll fall for anything”  Anonymous