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The Urgency Under The Hood

Google may be great at finding a local mechanic, but it’s lousy at helping consumers sort out the vast landscape of navigating care in the home. This is particularly true when leaving the hospital or a short term nursing and rehabilitation community to head home – leaving the comfort of acute care where all aspects of care are managed and controlled.

In The Patients’ Playbook, Dr. Leslie Michelson outlines “The 10 Questions You Must Ask Before You Leave The Hospital”. Questions like “What should I expect during my recovery?”, and “What sort of equipment will I need?” fundamentally stand between success and failure for recovery at home, yet are riddled with areas of grey.

Getting answers to these questions sounds simple yet often end up posing issues which send consumers into a tailspin. Who’s going to make sure I follow these orders? How do I get the equipment I need?, Who will help me figure out what food to buy? Who will be there for my morning care?  My medication? My evening care?

Here is when families turn to experts in the same way drivers turn to mechanics when engine warning lights go on. They expect mechanics to tell them what’s happening under the hood, because they can’t. And they won’t know if they are getting superior service or just an adequate job until they drive off, or potentially weeks later.

You May Not Know

What You Think You Know

The last decade has seen a proliferation of companies offering home care, in large part because the fastest growing demographic is seniors 85+, and home care companies catering to their needs have become as ubiquitous as coffee shops. The other important reason is because there are no standards or certifications required in Massachusetts, home care can be an easy business to launch.  Let me say that again:


In the Greater Boston area alone, there are more than 125 organizations serving seniors with various definitions of “home care”.  This makes for a lot of noise in the marketplace. A lot of confusion. A lot of unknowns.  So while it is easy to compare companies based on price alone, there are more urgent issues to consider.

I am fighting hard for standards of practices because they are essential for protecting consumers, and for protecting the reputation of our industry.  I serve on the Private Duty Advisory Committee for the Home Care Alliance of Massachusetts (HCA).  The HCA has had an accreditation process in place and while a start – so much more is needed.

With a group of other concerned agency owners, we  established a Chapter of the Home Care Association of America in Massachusetts.  Our first issue is licensing standards. We need a high bar for consumer protection consisting of:

  • Professional Case Management by a nurse or social worker specifically trained in the issues of care in the home
  • Training Standards for Aides – both minimum requirements to work in the industry, and ongoing training to maintain currency
  • An Employment-Only Business Model - both to protect consumers regarding employment liability and employees so they are treated fairly
  • A meaningful "Client Bill of Rights".

As Owner of Senior Helpers Boston and South Shore, I have skin in this game when it comes to recruiting, training, and managing the most skilled caregivers in the region. I need their expertise to care for the clients I am privileged to serve, and for those I have yet to meet.  My reputation depends on it. And if you are a professional referring to an agency, so does yours.

Before putting your all important reputation on the line I urge you to ask questions in 4 key areas.

Checking under the hood now, can save families and loved ones precious days and weeks when it comes to securing the right caregivers, and care.

How Will The Case Be Managed?

  • Who supervises the cases and manages the care? There are significant implications to nurse case-managed home care. Right out of the box, nurse oversight distinguishes a high level of care.
  • How frequently do they make supervisory visits?
  • What is the case manager’s background and training?

How are The Caregivers Trained and Certified?

  • What are ongoing hiring criteria for caregivers, including training and experience?
  • How are the skills of new aides tested?
  • What is the annual training requirement for caregivers?

What are the Specialized Training, Programs and Expertise?  

  • Is there specialized training for Dementia, Parkinson’s, Diabetes? With the growing complexities of these diagnoses, there must be specific, specialized and dedicated learnings going on, far beyond the obligatory 8 hours in a classroom. So what are they, exactly?
  • Does the company have a formal approach to serve specific needs for Traditional Care? Live-In Care, 24-Hr. and End-of-Life Care?
  • How does the company manage Recovery Care and readmission risk for discharges? Recovery care is no longer a one-size-fits all program, so what exactly is the company’s approach?    

What is the Company’s Liability Management and Service Guarantee? 

  • Are the caregivers fully employed by the agency, with appropriate insurance?  How are families and caregivers protected? We live in litigious times, how are we all made good if something bad happens? What is the agency’s liability coverage? Workers Compensation coverage?
  • How are your operational policies and insurance coverages designed to protect the family from being a joint employer?
  • What is the company’s Satisfaction Guarantee?

Answers to All These Questions Matter

The home care companies around us represent a range of business models including private hire agencies, referral agencies, registries and employment based agencies.

  • The lack of defined standards allow any of them to hire anyone as long as they pass a background check.
  • There is no assurance to the consumer of training or certification.
  • There is no assurance of a skilled pair of eyes for supervision by a Nurse or Social Worker. 

Many agencies require caregivers have as little as 10 hours of training plus past experience.  What if that past experience was making meals and running errands?  How is that instructive for personal care, like bathing, grooming, or continence care. Or appropriate for more complex care for Dementia or Parkinson's?

Supervision could be from a well-intentioned owner with no specific skills in care. You should know all of this in advance.


 Just Because You Hire An "Agency"

Does Not Mean It

Meets A Standard That is Relevant Or Credible


With lack of defined standards, in many cases families have ended up hiring caregivers directly. Suddenly, they become employers, and completely unprepared to follow Fair Labor Standards. They have put themselves in harm’s way for employee law suits regarding minimum wages and overtime claims. This has hurt all of us who want to do well by our clients and caregivers.

Home care has come a long way in the last decade, thanks to competition, smarter consumers, pressure for licensing and standardized practices, and a much more sophisticated approach to caregiving. But, we all have to know the right questions to ask.

As professionals focused on helping seniors and families navigate the increasingly complex continuum of care, we all have skin in the game when it comes to looking closely under the hood.

At Senior Helpers Boston and South Shore I continue to forge relationships with industry leaders who understand that by partnering, we can do more than if we try to go it alone. To learn more how we might work together in Recovery Care or any one of our Senior Helpers Programs, please call me directly at 617.500.6999


Because Aging in Place Can Be The

Best Care and Comfort of All


About Mark Friedman: Mark Friedman is the Owner of Senior Helpers Boston and South Shore. Passionate about seniors and healthcare, the goal of his agency is to set a new standard in home care in Massachusetts. First by delivering an exceptional home care experience in a combination of highly trained and high-touch caregivers. And secondly by becoming a significant connection for elders to resources and services in the 100 communities his company serves.