Frequently Asked Questions About Elder Care

Why Absolute Companion Care?

Absolute Companion Care is an established business that is privately owned and locally operated.   We have an A+ rating with the Better Business Bureau.  Our Directors have graduate degrees in education and training and actively mentor employees.  We are not part of a franchise.  We employ and train only the best caregivers throughout the Baltimore County area.  Our hands-on administrative approach is supportive to both client AND caregiver and individualized to each client.   We value our staff of 70+ employees who are reliable and prompt.  Our team approach to care is unique and provides consistency in an atmosphere we hope will improve the lives of our clients.   For more detail, please see Who We Are.

Elder Care Terminology: What’s the Difference?

Multiple terms can be confusing: home health, private duty, health aide, nurse assistant….. what’s the difference? 

Home Health Services:  In the State of Maryland, Home Health Services are temporary services prescribed by a physician following a hospital stay.  The agency providing these services is called a Home Health Agency and must adhere to federal guidelines.  Some of the care cost is covered by Medicare.  A nurse will make several home visits and may or may not be accompanied by a home health aide (HHA) that provides a bath or personal care.  It can also be physical or occupational therapy.  

Elder Care FAQsPrivate Duty Care:  As its name implies, it includes one-on-one services.   The services may include observation, assistance, and/or skilled care.  There are different types of private duty companies providing a range of services with varying levels of oversight:  

Registry:  A business that maintains a list of available caregivers.  They do not employ the caregivers.  The client pays the caregiver on the day of care and pays the agency an ongoing percentage for the referral.  They need only a business license to operate.

Companion/Homemaker Services:  these include many familiar franchises (and some privately owned businesses) providing “non- medical care”.  This means that their caregivers are not permitted to provide any services that require hands-on assistance.  Most do not offer the oversight of an RN since their caregivers cannot provide the type of service that is considered “certified” (help walking, bathing, eating, grooming, etc.).  Depending on the business model the Agency will consider their caregivers independent contractors (thus passing on liability and taxation to the caregivers).  Some hire their caregivers as employees. 

Residential Services Agency (RSA):  offers services that include private duty companion care, personal care, and skilled care under the off- or on-site supervision of an RN.   “Activities of Daily Living” or “ADLs” (bathing, bathroom care, oral care, grooming, walking with assistance, transferring from place to place, and/or assistance with eating) are provided by an RSA.   RSAs must apply for and be granted licensure by the Maryland Dept. of Health Care Quality.  The application process is rigorous and includes demonstration of policies and procedures for both employees and clients that adhere to state regulations.  Companies providing home physical and occupational therapy and/or durable medical equipment must also be licensed as an RSA.  Absolute Companion Care is an RSA. 

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Different types of Caregivers

Different types of caregiversAren’t an aide and a caregiver the same thing?

Although many terms are used interchangeably, each term can mean something slightly different.  An aide is usually a “home health aide (HHA) that works with a Home Health Agency (Medicare certified).  The HHA undergoes specific certification and training requirements before providing personal care for a Home Health Agency.

Can I just have a companion? I really don’t need a caregiver.

At Absolute Companion Care, the terms Companion and Caregiver are synonymous.  Some clients prefer the term companion because it implies more independence.  No certification or formal training is required but life experience and the desire to work with others is expected.

What is a nursing assistant? 

In Maryland, a certified nursing assistant (CNA) undergoes a Board of Nursing approved curriculum including clinical training under the instruction of a registered nurse (RN).  A CNA candidate must demonstrate competence in all types of personal care associated with activities of daily living (ADLs): bathing, bathroom care, oral care, grooming, walking with assistance, transferring from place to place, and/or assistance with eating.  Candidates sit for a written and skills exam.  Successful completion results in Board Certification (but not licensure). 

A geriatric nursing assistant (GNA) completes additional training after earning the CNA certification. Successful completion of an additional exam results in the designation CNA/GNA. 

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Absolute Companion Caregivers

Absolute Companion CaregiversHow does Absolute Companion Care feel about their caregivers?

Honestly?  We admire them.   We have a lot of reciprocal loyalty.  We appreciate them as much as we do our clients.   We love to tell people that our caregivers are our BEST ambassadors.  

How do you recruit caregivers?

We rarely advertise for caregivers because word of mouth seems to send us such wonderful applicants.   Most solid applicants come from employee referrals.    Many of our employees come from a facility setting (nursing home, hospital) and yearn for a one-on-one relationship with a client.   To read about what we expect of our employees click here.

Do you employ the caregivers or are they considered “independent contractors”?

Our caregivers are valued employees.   We withhold employee local, state and federal taxes and contribute to their FICA as per IRS rules.  We cover them with professional liability insurance, bond them, and pay both unemployment and workman’s compensation insurance.   

What do you require in a caregiver? 

We insist upon desire, maturity, pragmatism, and commitment.   A realist is better than an idealist.   Being a dedicated caregiver is a challenging career choice and we screen carefully in this regard.   A caregiver cannot just “want to help people”.  A caregiver has to be a decision-maker and a problem-solver.   If a candidate has those attributes then they make a wonderful caregiver and a valued employee.

How do you interview and hire caregivers? 

We have an extensive interview process that begins by phone and concludes with one and sometimes two in-person sessions.   Interviews include role-playing and situational questions and answers.   Language and communication skills are considered.   If we invite the applicant to join our team they must pass County, State, and Federal background checks, provide proof of residency and driving record, and health and drug screening.  We verify previous employment and speak to references.   The new caregiver then reports for extensive training in company policy and client procedure.  

What kind of education, experience and training do your caregivers have?

Different clients require different types of caregivers.   All caregivers must have a high school diploma or its equivalent and must complete our training to ensure that attention is devoted to the client’s mind, body, spirit, and environment.   We provide training in professionalism and responsibility.   If caregivers are hired as companions then we require life and/or work experience.   Caregivers hired to provide more hands-on assistance with daily personal care are usually licensed as certified nursing assistants.   If they are not certified, our RNs demonstrate and teach any needed skill.  The caregiver is observed performing the skill until the RN deems them competent to perform the skill on their own.  Our caregivers always have an RN available to answer any questions while with their client.

Do you have a high rate of caregiver turnover?

While losing a caregiver is never ideal we would be remiss to say it never happens. All companies experience employee turnover. Sometimes it is voluntary and other times it is a decision best made for the health of a company.  ACC had a voluntary employee annual turnover rate of 15% in 2013 which is lower than both the regional and national rates.  On average our caregivers are in our employ for three to five years, many for much longer.  We are proud to say we still employ the first six caregivers we hired when we started in 2006.  We currently have 70 caregivers working. 

What’s the difference between turnover and retention?

Retention measures how satisfied our employees are by measuring how many employees hired remain in our employ throughout the year.  ACC had a retention rate of 86% for 2013.  Employee satisfaction is a key factor in retaining qualified, dedicated people who meet our client’s needs. Of this 86% the number of employees who have remained continuously employed for more than 5 years is 21%. Employees working for ACC do so for an average of 32 months. This is all very good news for our clients who are searching for dependable, reliable and recognizable people to come into their homes.

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Paying for Private Duty Care

Private duty careDoes insurance cover the cost of Private Duty Care?

Private Duty Services are not covered by Medicare or health insurance.  Some agencies will accept Medicaid.   The Veterans Health Administration covers some costs for veterans but it varies. 

What about Long Term Care insurance?

Long term care insurance DOES cover the cost of private duty services but policies vary widely.  Most include an elimination period between 30 and 100 days (you need to receive care for that many days before you begin receiving reimbursements).  Read your policy: make sure that any private duty services are covered whether you receive the care at home or in a facility (hospital, rehabilitation center, assisted living or nursing home).  

Most policies require the client to need assistance with two or more Activities of Daily Living (ADLs).  ADLs include bathing, grooming, dressing, oral care, assistance getting from one position to another, assistance in the bathroom, and eating. 

Will you help me provide documentation to my Long Term Care insurance company?

Yes.  We supply the company with all evidence of our licensure and any additional information/paperwork they request.   We take the extra step to ensure compliance with their requirements, and with your permission, send all care notes to the company electronically. 

Does my insurance plan send payments directly to Absolute Companion Care?

No, but we will process all the paperwork needed for you to be reimbursed by your insurance company after you have paid Absolute Companion Care.  We will also advocate by phone on your behalf.

How do you determine fees? 

Fees for Private Duty Care are determined by the type of caregiver assigned, the type of care requested or required, and number of hours caregivers spend with each client.   

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We’re Ready! How do we Begin?

Elder care and companionshipWe are ready to begin care.  What happens next?

We’re delighted!    By now, you’ve spoken with us and we have an idea of your needs.   We will ask about  the  routines, and preferences of you or your loved one.   We will meet with you in person or by phone and explain costs and paperwork (Agreement for Services, Client Rights & Responsibilities, Emergency Contacts, Privacy Practices,  etc.).   Finally, we assist in choosing the right caregiver(s) and plan a schedule.  

How much advance notice does Absolute Companion Care need to begin care?

We can often plan for errands and transportation in a few days.    If an RN assessment is needed we will meet to discuss a plan of care and choose the best caregiver(s).  Two weeks is ideal, however, we’ve accomplished it in less time! 

Is an assessment by a registered nurse necessary?

It depends.   If the client needs only companionship, errands and transportation -- an RN assessment is unnecessary.    If the client needs supervisory or hands-on care -- the State of Maryland guidelines for our licensure are very clear: an RN assessment must be performed.

What does an assessment include?  Is there a charge?

One of our RNs will schedule a convenient time with you.   The RN uses a detailed assessment questionnaire to determine the client’s needs and level of care.  A tour of the home is made and safety concerns are discussed.    The RN and the Directors discuss possible compatible caregivers for each client.  We charge for the initial assessment but routine reassessments and oversight visits thereafter are free of charge for our clients. 

How do you help me choose a caregiver?

This is the most challenging part of our work.   Client preference comes FIRST.  Many factors affect caregiver choice – caregiver skill and availability, caregiver and client personality & compatibility, and distance between the caregiver’s and client’s residence, to name a few.

Do I meet the caregiver(s) before they come to my home?

We ask you to trust us to send an appropriate caregiver.  We will be happy to provide information about our caregivers before they come to your home.   We know and stand behind each and every caregiver.  Since we’ve worked with them, we have a good idea of whether or not they would provide an appropriate match. 

If the client is resistant to the idea of needing help, it can be counterproductive for the client to “interview” a potential caregiver since the client will often use the process to eliminate most candidates.

What if the caregiver is not a personality match for me?

Your peace of mind, contentment and comfort are priorities in this relationship.   We will do everything we can to make sure you are happy about the caregiver you have in your home.   The only thing that can delay a compatible match is the availability of our caregivers.  

Will the same caregiver arrive each time?

We prefer to have at least two routine caregivers for each client so there is always a familiar face in case of caregiver illness or emergency.    Clients who hire us for a few hours each week might have 1 or 2 caregivers.   For clients receiving 24/7 care we often have a minimum of 6 caregivers per team with a team leader so care remains consistent.   Some clients insist on only one caregiver, in which case they agree in advance that they will forego care on the days the caregiver has an emergency or requests vacation.   One caregiver for every visit is often not realistic.

What if my loved one wants to dismiss the caregiver early?

If your loved one is alone and you have asked us to reserve a time slot, the caregiver will remain until the time slot has ended.  Our caregivers are trained to be positive and reassuring while politely refusing to leave before the end of their assignment.   If a member of the family arrives home early and wants to relieve the caregiver, a verification call to the office is appreciated. 

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