When to Consider Hiring a Personal Care Aide
Consider hiring a personal care aide if your loved one needs human assistance to safely perform Activities of Daily Living like bathing, dressing, transferring, toileting and eating.
How a Personal Care Aide can Help Your Loved One
For people who are frail, ill, or recovering from injury or surgery, the assistance of a personal care aide can prevent problems such as skin breakdown, injuries from falls, malnutrition, social isolation, and loss of dignity. Personal care aides provide needed respite to caregivers and have expertise in how to safely assist their clients.
How Care is There can help:
If your loved one could benefit from a personal care aide, the care managers at Care is There can:
- Determine how hiring a personal care aide fits into the overall plan for your life
- Recommend whether to use an agency or a private aide
- Recommend agencies that provide the services your loved one needs and accept the payment sources available to you
- Work with your assisted living community to be sure your aide meets their requirements
- Communicate with your tax advisors and insurance professionals about the implications of hiring a private personal care aide
- Find and interview potential personal care aides
- Perform background checks and reference checks on potential personal care aides
- Determine whether your personal care aides qualify under your long term care insurance policy
- Suggest a process for backup care in case of emergencies
- Monitor the service of the aide
- Communicate progress, concerns, and suggestions to you, which is especially important if you live at a distance
What do I need to know about Personal Care Services?
The Basics of Personal Care Services
- Personal care is considered “non-medical” or “unskilled care”, and in Virginia personal care aides are not licensed to provide medical care (like changing the dressing on a wound.or to clip fingernails or toenails.)
- Personal care is distinct from “companion care” or “home helper” services. Companions who are not also personal care aides are not licensed to provide “hands-on” care for personal activities of daily living. However, personal care aides can provide companion services such as light housekeeping and medication reminders.
- Personal care is distinct from skilled “home health care.” Home health care professionals such as Certified Nursing Assistants have additional training and licensure requirements which qualify them to perform medical tasks which personal care aides cannot.
- Some agencies provide only one type of care (companion, personal care, or home health) and others provide two or more types.
- Personal care aides working privately for residents of assisted living communities must comply with regulatory requirements set by the Virginia Department of Social Services. (Check with your assisted living community for the specific ways they apply these requirements.)
Paying for Personal Care
- Personal care is usually not paid for by Medicare or Medicare supplement policies, but may be paid under Medicaid Waivers
- Short term personal care services may be rolled into the services provided by skilled home care agencies in certain circumstances like recovery from surgery or an injury. Making arrangements for this type of service often requires a special conversation with the home care agency
- Personal care is usually not paid for by private health insurance
- Personal care is almost always covered by long term care insurance, as long as the provider is qualified under the terms of the long term care insurance policy
- Some agencies accept Medicare, Medicaid, private insurance and private payment. Others accept only certain types of payment
- Personal care agencies usually charge a minimum of 2 - 4 hours per visit
Questions to Ask When Choosing a Personal Care Provider:
- Is the care receiver likely to need related services in the near future: companion/home helper services, skilled home health services, or hospice services?
If so, consider an agency that provides a broad spectrum of services that the client may need. This prevents the client from having to switch agencies when their care needs change
- What type of payment are you able to provide, and which agencies or private aides accept that form of payment?
- Do you have long term care insurance?
If so, find out the policy’s requirements for the type of aide that will be covered.
- Are the personal care services needed as a result of surgery or another short-term illness?
If so, it’s possible that personal care services can be bundled with home health services, which are covered by Medicare. (Alone, personal care services are not covered by Medicare.)
- Do you want the personal care aide to provide transportation?
If so, find out the agency’s policy on driving, and be sure you know the insurance implications.
- Do you want the personal care aide to help with medications?
Virginia law allows both personal care agencies and private personal care aides to administer medications that are normally self-administered by the client. However, each agency and private aide will have their own policies about medication reminders and administration - including filling pill boxes - so inquire in advance. Agencies offering home health services will be more likely to offer medication management services. Agencies certified by Medicare have additional requirements for training and supervision of employees helping with medications.
- Is a loved one willing or able to manage a staff of caregivers or employ a care manager to do so?
If not, a personal care agency is often a better solution than a team of private aides.
Choosing Between Hiring an Agency and Hiring a Private Aide
- Private PCAs are often less expensive per hour than the cost of hiring through an agency, but the employer - or a private care manager - is responsible for the tasks that an agency would handle, including:
- Sourcing candidates
- Running background checks
- Checking references
- Checking credentials
- Hiring and related paperwork
- Training aides for the client situation
- Finding backup care
- Compliance with overtime and minimum wage laws
- Payroll taxes
- Insurance for theft, liability and workers's compensation
- Agencies are governed by licensing standards; private personal care aides are not. See “What to know about Personal Care Agencies in Virginia” below for details on licensing requirements.
- Private personal care aides usually only accept private payment for their services.
- Agencies usually have many different aides employed, making it easier to find a good personal fit for the client and for finding backup aides, but sometimes making it more difficult to ensure the the client has the same aide consistently.
- In some cases, it works well to combine the use of agency employees and private PCAs.
What to know about Personal Care Agencies in Virginia
- Agencies accepting Medicare payments are subject to federal requirements as well as state requirements
- Some companion agencies and home health care agencies provide personal care, and some do not
- Virginia licensing requires personal care agencies to conform to certain standards including: Criminal records checks of potential employees, and not hiring people who have been convicted of certain crimes.
- Written policies, procedures, and plan of care
- Supervision by a licensed nurse
- Insurance and bonding
What to Know about Private Personal Care Aides
- Be sure you understand the minimum wage, overtime, tax, and insurance implications of hiring private caregivers
- See this guide from the Department of Labor about "Paying Minimum Wage and Overtime to Home Care Workers."
- Contact your tax professional to understand payroll tax, overtime, and minimum wage requirements. Do not assume the aide is an independent contractor; the vast majority are classified by the IRS as domestic employees.
- Contact your insurance professional to understand liability insurance and surety bonding implications. Ask about coverage if you experience a loss of personal property, but also be sure to understand your liability if the aide is injured while providing services to you.
- Consider using a payroll service for domestic workers to handle payroll taxes or insurance. One such company, HomePay, offers this advice about payroll taxes and insurance, and information about myths and mistakes for employing in home caregivers.
- If you already hire private caregivers, consider enrolling them in a registry like CareFamily.com to take advantage of payroll and payroll tax services and insurance benefits.
- Individual personal care aides can be hired through placement services or caregiver registries or through personal recommendations
- Obtain a criminal background check before hiring
- Ask for documentation that the PCA has attended a training program so they know how to provide personal care safely. PCA classes are typically 40 hours. An example of the curriculum is at this link. Licensed nurses or nurse’s aides providing personal care services will have their licensed listed under the License Lookup service from the Virginia Board of Nursing.
- Have a backup plan in case one of the PCAs cannot fulfill a shift and in case weather emergencies impair travel
- Have a plan for finding, interviewing, and hiring additional PCAs if a staffing change is required
- Speak to references and do personal interviews with potential private PCAs
- Administrative Code of Virginia
- Department of Labor
- CMS (Centers for Medicare and Medicaid Services)
- DARS (Department of Aging and Rehabilitative Services)
- DMAS (Department of Medical Assistance Services)
- Eldercare Locator - Department of Health and Human Services
Do you need to hire a personal care aide for your loved one, but don't live nearby, don't have time, or would appreciate assistance?