Republished with permission: Clare Absher RN, BSN CarePathways.com
The non-certified aide or assistant provides custodial, supportive, long-term personal care services which may also include housekeeping, meal preparation, and companionship. However, this can be very confusing depending on which state you live in as there are many variations in job titles, duties and costs. As a general rule these types of non-certified aides usually work as either private-duty hires for families OR as employees of non-medical home care agencies.
Services are privately paid for and not reimbursable under Medicare and private health insurance regardless of whether they are employed with a non-medical home care agency or hired privately. Some long-term care insurance plans may cover these services but need to check with insurance carrier first. Non-certified aides can provide general routine personal care services that often is what is needed most to help care for a loved one at home.
Homemakers and chore-workers fall under this non-certified category also and usually perform light household duties, meal preparation, laundry and other similar tasks. Chore workers sometimes do heavier types of cleaning such as washing windows. Both of these workers are supervised and they do not provide direct personal care as a rule. Companions also without formal training do not perform direct personal care but instead are more limited to providing comfort and companionship to those people who cannot be left alone and unsupervised.
Certified Nurse’s Aides (or Assistants) and Home Health Aides work as an essential part of the home health care team under the supervision of other health care professionals such as nurses and rehab therapists. Both CNAs and HHAs are certified with similar required training that varies from state to state. CNAs and HHAs have successfully completed a training course, passed both a written and practical exam and placed on a state registry. In some states the HHA has additional training in the homecare field while in other states the CNA has broader healthcare training including but not limited to homecare.
Certified nurse’s aides and home health aides are employed at both medical home health agencies and non-medical home care agencies. CNA’s and HHA’s services when employed with Medicare / Medicaid home health agencies may be reimbursed when certain requirements are met. These requirements include working under supervision of licensed professionals and a physician approved plan of care authorizing supplemental aide services to skilled care. In contrast aide services are usually not covered by Medicare and private insurance when provided through a non-medical home care agency or private hiring. However privately paying for CNAs and HHAs for needed personal care assistance might be the best or only option when skilled care is not necessary.
CNAs and HHAs both assist patients with activities of daily living (ADLs) including personal care, ambulation, nutritional, medications, toileting, health monitoring (i.e. blood pressure) and sometimes light housekeeping. The certified assistant must be skilled in actual procedures and also make competent observations of a patient’s condition for reporting to professionals.
CNAs and HHAs are CPR certified and based on level of training again varying from state to state, may provide additional bedside care. Such care might include wound / bedsore treatments and dressing changes, tube feedings, catheter care, ostomy changes, and diabetic monitoring under the supervision of a Registered Nurse (RN) or Licensed Practical Nurse (LPN).
LPNs sometimes known LVNs or practical nurses must pass rigorous specific state curriculum requirements and a standardized national exam after completion of their college program to obtain their nursing license. They are qualified to perform certain skilled nursing procedures and must work under the supervision of a Registered Nurse (RN) or a physician.
Registered Nurses (RNs) have more extensive education and must pass rigorous state curriculum requirements and a standardized national exam after completion of their college program to obtain their nursing license. They are competent to perform all aspects of skilled nursing care in addition to supervising other members of the health team including LPNs/ LVNs, CNAs, and / or HHAs.
Therapists including physical therapists, speech therapists and occupational therapists assist in the rehab of those with physical injuries or disease. Restoration of mobility, strength, dexterity, balance, communication skills is often the purpose for therapy. Helping individuals who are disabled by physical injuries or disease to regain maximum function with activities of daily living is always a main priority.
Social Workers assist in the evaluation of social, emotional and environmental factors affecting the ill and disabled. They may provide family or individual counseling for those in need or a crisis situation. Medical social workers offer support and often help identify and locate appropriate community resources.
Originally Published by: Clare Absher RN, BSN CarePathways.com – Home Care Checklist
General Safety precautions
- Make sure that there are working smoke detectors on every floor.
- Find a phone with large number pads and large speed-dial keys that can be programmed with important numbers.
- Post emergency phone numbers in large print on or near the telephone.
- Supply telephone with direct dialing system for emergency/important numbers.
- Hide house key outside or give to neighbor for emergencies.
- Put automatic door closing devices on doors to outside and alarms when needed.
- Notify local police department that if your family member is memory impaired.
- Be certain that there is adequate lighting throughout the house and install nightlights.
- Check that all electrical cords are free of frays. Put childproof plugs in outlets.
- Be certain that no outlets or switches are unusually warm or hot to touch.
- Reduce clutter; Remove furniture that is hazardous and may move when leaned on.
- Put reflector tape on furniture corners, hallways, bedrooms to create a path to follow at night.
- Avoid polished floors that may be slippery and remove all non skid resistant rugs and runners.
- Put opaque tape on glass door and picture windows
- Remove or lock up sharp objects/breakable ones and remove all firearms from home.
- Keep electric fans out of reach. Cover radiators with radiator guards.
- Supervise or restrict smoking, use safety ashtrays and keep matches/lighters out of reach.
- Use flame-retardant mattresses, pillows, and sheets and plan procedure for fire evacuation.
- Store all prescription and over the counter medications safely away and clearly labeled.
- Lock up cleaning supplies, chemicals and poisons and install a carbon monoxide detector.
- Lock up valuables, important papers and documents and have system for safe mail retrieval.
- Be certain plumbing and utilities are working.
- Remove poisonous houseplants and have first aid kit easily accessible.
- Take away car keys when necessary and disarm/hide controls for automatic garage doors.
- Inform neighbors of any safety features in home that may restrict entry.
- Ensure walkway is uncluttered and doorway accessible.
- Provide safe entry into the house or apartment with secure railing present.
- Provide viewing of visitors prior to entry when possible.
- Secure doors to outside with double key locks, or high or low locks.
- Furnish with chairs/sofas that can safely get up/down.
- Adapt seating with additional firm cushions to raise seat.
- Provide auto raising lift chair to assist getting up when necessary.
- Be certain safe opening/closing of windows or key locked windows installed.
- Ascertain ability to operate the television and light switches.
- Keep cords out from under carpeting and furniture and clear of walkways.
- Maintain appliances in working order.
- Ascertain ability to manipulate sink faucets with hot water temperature settings reduced.
- Make sure electrical cords aren’t dangling near water.
- Ascertain ability to open/close refrigerator/freezer/stove door/ and cabinets.
- Ascertain ability to reach dishes, pots, utensils, and outlets.
- Store sharp objects are safely away.
- Keep flammables away from the stove area.
- Remove small non-food items that could be swallowed.
- Cover stove burners, remove knobs/shut-off valves/ and install auto-pilots when needed.
- Unplug or put away kitchen appliances not in use.
- Disconnect or camouflage garbage disposals.
- Locate bedroom near bathroom or furnish bedside commode.
- Use night-lights to provide nighttime orientation.
- Ensure safe transfer in/out bed and remove bed frame if bed is too high.
- Rent or purchase a hospital bed if needed.
- Supply bumpers or padding to surround bed if needed.
- Install reverse locks on doors when needed.
- Use monitor to listen to activity especially at night.
- Remove carpeting if incontinence becomes a problem
- Install room darkening blinds or shades when needed.
- Be certain that phone and light is accessible from bed.
- Be certain that clothes in the closet/dresser are reachable.
- Install grab rails in tub or shower.
- Provide a tub bench or tub chair for sitting in tub.
- Install hand held shower nozzle.
- Remove any scatter rugs and furnish bath mat and non-skid strips in tub.
- Replace glass shower doors with unbreakable plastic.
- Install grab bars, safety frame, and/or raised seat on or near toilet
- Lock up razor blades, sharp objects, and store away electrical devices.
- Be certain that light switches, outlets and toilet paper are accessible.
- Widen treads or shorten risers.
- Replace outdoor stairs with ramps.
- Install sturdy handrail or grab rails along both sides of stairs.
- Put reflector tape on edge of treads.
- Install barriers or gates at stairs if needed.
- Provide adequate lighting and ensure steps are free of clutter.
Source: Carepathways & homecarefiles
Home Care is basically divided into two primary types of agencies. Those that provide skilled care such as Nurses (RN/LPN/LVN), Certified Nursing Assistants or Home Health Aides (CNA/HHA), Physical, Speach, Occupational, Respiratory, and Recreational Therapists, Dietitians and Social Workers. This type of agency is commonly referred to as a “Home Health Care Agency”. We have categorized them as “Medical” agencies. These agencies are licensed by the state and accept Medicare, Medicaid, insurance and private payment methods.
The second primary type of agency is limited to non-skilled care such as Home Helpers and Companions which provide a variety of assistance including House Cleaning, Cooking, Errands, Medication Reminders and Companionship. Licensing is limited, if at all, and they normally only accept private payment methods. We have categorized this type of agency as “Non-Medical” agencies.
Learn more about the Types of Home Care Agencies
Learn more about the Types of Caregivers
To assist in understanding which type of Home Care and caregivers may be best suited to your needs, our nurses have designed a useful tool which may help you.
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