What EAPs Should Know About Non-Medical Home Care Services

By Peter Tourian and Rich Paul, MSW, CEAP

Many EA professionals rely on geriatric care managers and individuals in the work/life field when making referrals for home care services. However it is helpful for them to understand the basic characteristics of quality home care agencies and the impact these services can have on an employee’s emotional well-being. In addition, as the population continues to age, so will the number of caregivers in the workplace require resource and referral support from EA professionals.

Impact of Caregiving on the Workplace
More than 40 percent of the workforce are caregivers struggling with work and family demands. The financial and human toll are significant: Sixty-nine percent of employees who care for a family member or friend report having to rearrange their work schedule, decrease their hours, or take unpaid leave to meet their caregiving responsibilities (Feinberg, Reinhard, Houser, & Choula, 2011).

Research studies have demonstrated the negative impact caregiving has on career advancement, earnings, job retention, and physical and emotional well-being.  (National Alliance for Caregiving and AARP, 2009).

Due to increased recognition of the financial and emotional strain of caregiving, employers are acknowledging that home care assistance should be part of their benefit strategies to attract and retain talent. The aging U.S. population will only compound these challenges.

Reviewing Care Options
When an employee contacts the EAP or Work/Life program for assistance with caregiving, the EA professional needs to consider the range of caregiving options:

* Home care – non-medical support in the home for activities of daily living
* Home health care – medical care services, like skilled nursing care, physical therapy, occupational therapy, and speech therapy, provided in the home 
* Assisted living – residential facility and limited care for those who need some assistance with daily activities but do not require care in a nursing home
* Nursing home – residential facility and a high level of long-term personal or nursing care for persons (such as the aged or the chronically ill) who are unable to care for themselves properly.

If the employee’s relative does not need medical care and prefers to remain at home, then home care is the best solution because it addresses not only physical and emotional needs but also helps manage social isolation.

The emotional aspect of care is crucial on numerous fronts. Elderly individuals who report feelings of loneliness tend to attribute their mental state to illness, loss of spouse, and lack of friends. Poor health and functional status are also associated with greater feelings of  loneliness. Home care offers companionship for isolated individuals. 

Due to the stress involved in juggling their own work and home schedules to care for aging parents, employee caregivers also need emotional support – assistance the EAP can help provide.
Understanding home care is key, as EA professionals are ideally positioned to serve as a  conduit to these often-needed but frequently misunderstood services. Many health plans are increasingly using non-medical home care as part of the post-acute care continuum to alleviate cost pressures and prevent relapse or re-hospitalization.

A Premier study found that about 30% of emergency room visits by patients with chronic illnesses probably could have been prevented and handled in a less costly outpatient setting, and those unneeded ER visits amounted to $8.3 billion in additional spending. (Modern Healthcare, 2019).

While home care has been reimbursable by Medicaid for some time, it only recently became a covered benefit under many Medicare B plans. 

What is Home Care?
EA professionals and laypersons sometimes confuse home care, home health care, assisted living, and other similar support services, but the differences are significant. Home care is considered non-medical support that allows individuals to maintain independence and remain in their home. Home care provides assistance with daily living tasks without the need to move the person to a senior care facility. Home care can:

* Support Activities of Daily Living (ADL) such as eating, bathing, getting dressed and transferring.
* Support Instrumental Activities of Daily Living (IADL) such as cleaning and maintaining the house, traveling within the community, preparing meals, and medication reminders.
* Provide post-hospitalization care including scheduling and attending follow-up visits, medication monitoring, and ADL/IADL support.
* Offer emotional support through companionship that addresses issues of loneliness and isolation. 

Home Care for More than the Elderly
While 70 percent of individuals 65 and older will likely benefit from home care assistance at some point, these services benefit more than the aging population. Increasingly, home care services are being provided to wounded warriors and Veterans requiring assistance at home, individuals on disability leave and mothers requiring pre- and post-natal support due to a complex pregnancy.

In addition, the increase in same day surgeries and other advances in medical care have resulted in much shorter hospital stays. Individuals are sent home the same day or after a very short hospital stay. They too are candidates for home care.

For the working caregiver it can be overwhelming to determine the right level of care and provider for their loved one. If the preference of the older adult is to age at home then the first question is determining whether or not medical assistance is required. AARP offers a caregiver helpline at 1-877-333-5885, where they provide guidance and advice on a caller’s caregiver needs.

The EAP is often the first point of contact for an employee seeking emotional support as well as care referrals for a loved one. In a case like this, once an assessment indicates that no medical support is needed and the client prefers to remain at home, home care services are probably indicated.

The employee should be given a list of factors to consider when reviewing the home care services of a specific vendor. This point is crucial, because an EA clinician should be required to give a list of home care providers, never a single provider.

1. Are the caregivers employees of the home care provider or are they contractors? When possible we recommend that EAPs refer to an agency that employs its caregivers.   

When caregivers are employees of an agency, each home care office location must be guided by state and local licensure and certification requirements. In addition, the home care provider assumes the burdens and responsibilities of being the human resource, quality assurance, scheduling (including back-up planning) and education department for every caregiver.

In contrast, families who use private caregivers or organizations that offer contracted caregivers must be aware of the hidden costs of being the employer of record. They become responsible for hiring, managing and paying caregivers. They also will take on the complicated aspects of payroll taxes, Workers’ Compensation, and other liability requirements.
A critical function of the home care provider is to ensure that an optimal match is made between a caregiver and care recipient. This process ensures the selected caregiver has the professional skill level to meet the client’s physical and emotional needs. All of these aspects of quality home care become more challenging when the caregiver is a contractor versus an employee of the home care organization.

2. What background checks and screenings are conducted on caregivers? EA professionals and the employee need for home care providers to attest that their caregivers:

* Undergo a national and state background check;
* Meet driver eligibility guidelines before being assigned to a client who requires transportation services; and
* Have acceptable references and work authorizations.

3. What ongoing supervision, training and support are provided to caregivers?
Quality home care providers should require new-hire training for all caregivers, regardless of experience. This should include experiential learning to ensure they are familiar with any medical equipment needed in a client’s home. In addition, ongoing supervision and performance evaluations should be a prominent part of a home care organization’s policies and guidelines.  

4. How does the home care provider encourage and support communication and updates between caregivers, the client and their family members? 

Technology plays a critical role in all our lives and the same is true in the home care industry. Through a technology platform, family members or responsible parties can learn more about each caregiver providing care in the home, read care notes and see all scheduling activities. They can use these applications as their communication hub.

In addition, caregivers can record all changes they observe so that family and other health care professionals are kept up to date. Some home care providers also leverage technology that allows their office to know exactly when a caregiver arrives and leaves a client’s home. This regular communication provides peace of mind to families. 

5. The employee should expect the home care agency will conduct a comprehensive home assessment with the client and develop a customized care plan. 

Most often, individuals considering home care say: 1) “I want to live independently” and 2) “I don’t want a stranger in my home.” Few things are as personal and vital to each of us as our independence and the security we feel in our home.  
This underscores the value of high-quality home care services. Everyone deserves a caregiver they can trust and feel a connection to who will provide the best level of care.  

Summary
Because caregiving itself can lead to greater feelings of loneliness and isolation, employees also need emotional support. Caregivers consistently describe the isolation of the caregiver’s role as one of the most stressful aspects of caregiving. They consistently report higher levels of stress than non-caregivers and chronic stress is associated with poorer health outcomes and higher rates of mortality (Springer, 2018).

As such, any working caregiver contacting the EAP should be told of the full scope of EAP services that may not only assist their loved one but themselves as well. All too often working caregivers minimize the impact that caregiving has on them emotionally and physically.

Peter Tourian is the founder and CEO of SYNERGY HomeCare. Tourian has been a pioneer in the home care industry for the past 20 years, introducing transformational practices that continue to grow SYNERGY HomeCare’s business, already one of America’s largest home care companies.

Rich Paul, MSW, CEAP, is Chief Partnership Officer for SYNERGY HomeCare, responsible for business development and strategic partnerships. Prior to joining SYNERGY he worked for 25 years in the employee assistance field, consulting with employers on solutions to improve employee well-being, resiliency, work/life balance and engagement. Rich may be contacted at richpaul@synergyhomecare.com


References

Castellucci, M. (2019). Unnecessary ED Visits from Chronically Ill Patients Cost $8.3 Billion. Modern Healthcare.

Feinberg, L., Reinhard, S., Houser, A., Choula, R. (2011) Valuing the invaluable: 2011 update–The growing contributions and costs of family caregiving in 2009. AARP Public Policy Institute.

Springer, C. (Spring 2018) Health effects of social isolation and loneliness. Journal of Aging Life Care.