Moving home health aides into companion roles
Can they make the adjustment well?
CHR-Ill Home Health Care Services in Montclair, NJ, is considering starting a companion business.The new division will include a job description that differs from that of certified home health aides. Through the company job posting program, those home health aides who chose not to be recertified will be eligible to continue their employment in the new division, says Vicki Pironti, RN, clinical operations manager.
But another provider advises that the lower pay rate and different skill requirements might make the transition a bit rough for some employees.
There are several questions to consider when thinking about moving home health aides into a new companion business, Pironti says:
• What services will you offer?
"I am drawing up a job description and making sure it’s absolutely not personal care," says Pironti. "There should only be a minimal amount of housework.
"Someone may need a person to take them to the hairdresser or grocery store. Maybe they want someone to read them a book or play checkers," she adds. "People will say they don’t need someone to bathe their parents. They just need the parents to have company in the afternoon while the [caregivers] are gone on their errands." (For information about "sleeper" services, see related story, p. 105.)
For example, VIP Companion-Care in Syracuse, NY, a provider of care and companionship to the elderly in their own homes, offers these services:
live-in and sitter companions;
companionship and friendship;
convalescent and respite care;
escorts for outings;
personalized plans;
daily activities;
meal preparations;
light housekeeping.
LifeStyle Options in Schaumburg, IL, has three levels of aides: companions or homemakers, certified nursing assistant (CNA) services, and a level called the "home care professional" that is in the middle of the other two, says Karen Gunter, RN, MSA, Illinois regional director.
Companions or homemakers services are strictly hands-off care. CNA services are more hands-on. The most requested aide, though, is the home care professional.
"We found in the population now a lot of frail elderly but not sick people — people who need a little bit of help," Gunter says. A home care professional might hold a client’s hand when she gets into the bathtub. Another may need to remind a client to take his medication.
"The home care professional needs to be able to touch that other person, but they don’t need to take vital signs or do a lot of extensive care. By far, that’s the level of care that people need."
What is the liability?
Pironti says one reason she wants to define the services is to reduce the agency’s liability.
"Because of all the negative publicity health care has received, it really scares people as to what their liability should be and what could happen," she explains. "Most agencies like CHR-Ill are cautious about doing reference checks and background checks."
CHR-Ill will continue to provide physicals, TB tests — whatever is required of any employee — and background checks for the employees, as well.
Companion sitters don’t have as much liability as home health aides, says Elizabeth E. Hogue, JD, a health care attorney specializing in home care in Burtonsville, MD. "If someone is truly a companion and truly a sitter and not providing any health care, then the liability is minimal. I would say you have to worry more about theft.
What type of clients will you serve?
VIP’s services are adjuncts for the elderly person who is beginning to have trouble coping with independent living because of a chronic disability or increasing frailty, the company says.
The question of client independence is important, Pironti says, because if you are limiting personal care and someone spills a cup of tea in his or her lap or has jelly on his or her face, you really can’t do anything about that. "We’re planning to do an initial assessment to make sure it is just companion services they need and then monitor them by phone after that."
What are the hours of operation?
Pironti would like to establish a minimum of four hours of care but no more than eight. "If you need someone for more than eight hours, you probably need more than just companionship," she says.
VIP Companion-Care’s minimum stay is four hours per day, 16 hours per week for companion sitters.
What is the pay rate?
"I’m shooting for a lower bill rate," says Pironti. You could have a reasonable profit margin and still provide work in the community and fill the need.
"My feeling is that [employees’] pay rate should be based on their task," she adds. "[But] we haven’t decided if we are going to make the lateral move with the employees’ current salary."
A lower pay scale for former home health aides could be problematic, says Gunter. "Would the home health aides’ salary demands fit into the scale for that level of service? They’ve reached a pay scale that is higher than a companion level. They don’t want to go down on the pay scale. And yet when you’re dealing with hourly care, you have to keep the cost affordable."
Another problem using previously certified home health aides as companions is that the two jobs require different skill levels, Gunter adds.
"On the surface it sounds like it would be easy, but it isn’t," she says. "Companion care tends to be cooking and cleaning and activities with the elderly. It’s long-hour service. People go in for three to four hours at a time.
"With home health aides, it’s the opposite. They go in, do a task, and leave. My experience has been that people who have been doing home health aide work do not enjoy the companion work and don’t stick with it."
Pironti can ease the transition by retraining the aides, Gunter says. LifeStyle Options has a training program that includes orientation and a 10-step modular program. Employees learn about the aging process, communication with the elderly, universal precautions, and hand-washing techniques, among others.
The ideal companion enjoys working with the elderly, Gunter explains. "Do they cook, do they clean, do they like to do those things? They need patience. Sometimes the best caregivers in that category are people who’ve had a parent or grandparent that they’ve been a companion for."
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