Non Medical In Home Care Expert Witness Insights

​As a non medical in home care expert witness, Pamela D Wilson offers background about non medical in home care agencies, standards of care, and service gaps that can lead to lawsuits in this article for family caregivers and care agency management.

Family caregivers can miss important details when they are time-pressed or highly stressed. As a result, contracting with a non medical in home care agency may pose unexpected problems.

Lawsuits against non medical in home care agencies are becoming more common for a variety of reasons.

While agencies can take many steps to ensure adherence to standards of care and explain the service they offer, contracting individuals or family members may still lack a clear understanding of the meaning of non medical care.

These gaps in understanding can lead to standards, duty of care, policies, and communication issues that can cause significant harm to elderly spouses or parents.

Non Medical In Home Care Agency Contracts

Most caregivers and older adults are not skilled in interpreting contract language. Agency agreements are signed without reading or understanding them.

How often does one go to a doctor’s office and sign multiple forms without reading them? This is no different, except the consequences can be significant and result in unintentional harm.

Reading and Understanding Contract Details

Older adults and their caregivers who do not understand or ask questions about non medical in home care agency contracts and services can find themselves in a variety of risky situations. These include:

• Expecting agency caregivers to provide medical services they are not permitted to do by state statute. For example, administering medications, treating a skin wound, or assisting with insulin dosing.
• Not recognizing the potential liability of a caregiver transporting a family member in the caregiver’s vehicle to appointments or outings.
• Not acknowledging the client’s duty to provide a safe home setting so that agency caregivers are not injured performing their duties. Just as clutter in a home can be risky for an older adult, it can pose a risk for caregivers visiting the home.
• Failing to understand the consequences and effort to participate in a self-directed Medicaid non medical in home care program. This means rather than working through an agency, the client directly hires and manages the caregiver.  This can be highly risky when an older adult diagnosed with dementia can be financially exploited, isolated, ormanipulated by a rarely supervised non-medical in home caregiver.
• Establishing a personal relationship with a caregiver (or vice versa) and seeing each other during non-working hours. Off-the-clock relationships that can be seen as friendships can result in unintentional harm and are prohibited by most care agencies.
• Treating an agency caregiver like a family member. This can extend a sense of expectation and entitlement to the caregiver around access to belongings, money, and other relational aspects.

Challenged Faces by Non Medical Care Agencies

Individuals and families who hire non-medical in-home care agencies may expect highly trained and experienced caregivers. This may be an unrealistic expectation.

Turnover at some care agencies can reach 50%. Finding qualified and caring individuals can be a struggle. In some areas, there may be a shortage of available and interested caregivers.

The pay scale for caregivers is challenging, even though hourly rates charged by caregiving agencies may seem high. Most companies cannot offer healthcare benefits, leading to a highly transient workforce. Some caregivers rely on public transportation because they cannot afford a vehicle.

Finding the Right Caregiver

This is not to say that good caregivers cannot be found. Families may have to work through several caregivers or hire more than one care agency to meet their needs.

If a caregiver isn’t a good fit, the hiring individual should contact the agency to request a replacement caregiver.

In most cases, the hiring individual is responsible for communicating expectations around service requests. While non-medical care agencies have a list of services they know to provide, at the client’s request, it is up to the individual receiving services to tell the caregiver what is needed.

If this is not possible due to a diagnosis of memory loss, a family member may need to provide ongoing communication regarding required services and tasks.

And if a caregiver isn’t a good fit, it’s up to the hiring individual to contact the agency to request a replacement caregiver.

Hiring and managing a non medical in home care agency can be a process. 

Non Medical Home Care Agencies Serve Clients, Not Patients

One or all of these situations can lead to disagreements about standards of care and services provided  that result in a hired caregiver taking or not taking an action that seriously harms a spouse or elderly parent.

Note the use of the word “client” and not “patient.” Non medical in home care agencies serve clients.

Home healthcare and other medical providers serve patients. The word patient is used in the context of providing medical care.

Additionally, confusion about medical and non medical care can arise when family caregivers take on an unlimited number of tasks. These extensive and sometimes medically intensive tasks keep sick spouses, elderly parents, and other family members at home and out of nursing homes.

Because family caregivers do all of these tasks, they may expect in home caregivers to do the same.

The Friday Afternoon Rush to Hire a Non Medical In Home Care Agency

As an expert witness non medical home care, Pamela D Wilson has years of personal experience with Friday afternoon hospital and nursing home discharges. These unexpected events result in spouses or family caregivers rushing to hire a non medical in home agency.

So what does this look like?

• A family caregiver takes an elderly spouse or parent to the emergency room. The loved one is treated and discharged home in a matter of hours with a recommendation to follow up with a primary care physician.
• An older adult receiving rehabilitation services in a nursing home, may be discharged before they can fully care for themself at home.

These hospital or nursing home stays, where a spouse or aging parent is unable to care for themselves, often result in hiring a non medical in home care agency.

Last Minute Discharges and Panicky Caregivers

In her previous role as a care manager, Wilson recalls receiving panicky phone calls from family caregivers on Friday afternoons. These caregivers were told to come pick up a spouse or parent because it was time for their discharge.

These last-minute discharge situations lead family caregivers to react in crisis. Because many family caregivers work or have other obligations, they find themselves scrambling to figure out what to do next.

Many lack an understanding of the importance of having a plan to care for aging parents to help avoid unexpected situations and recurring crises. 

Risks When Families Hire Any Available Care Agency

The hospital or nursing home discharge planner may hand the caregiver a local resource book. This well-intended action may result in a caregiver feeling frustrated and exasperated because it is Friday afternoon, and the caregiver returns to work on Monday

Family members with a resource book begin dialing number after number to find an available care agency. What they may not realize is that this care agency may take a shortcut by sending a newly hired caregiver who has not yet been trained or background-checked.

In these situations, the unimaginable can happen.

As a non medical in home care agency expert witness, Wilson has been involved in cases where agencies took shortcuts to accept cases, ignored standards of care, including hiring and training procedures, and the result was serious harm or neglect by an agency caregiver.

The Blurry Line Between Medical and Non Medical Care

The work of family caregivers is never done. It can be difficult for non-involved family members or friends to imagine the life of a caregiver who is on call 24 hours a day and 7 days a week.

So why then does the healthcare system add to the work of family caregivers, knowing that they are already emotionally and physically exhausted?

The answer is cost shifting from the healthcare system to families who may already be overburdened

How the Healthcare System Shifts More Work to Family Caregivers

For example, the Medicare family caregiver training program billed through Medicare Part B offers education for spouses and adult children who are caregivers.

The training includes how to administer medications, understand and manage medical conditions, provide personal care assistance such as bathing and continence care, take blood pressure, monitor blood sugar, assist with insulin, prevent bedsores and infections, and care for wounds.

Doctors, nurse practitioners, clinical nurse specialists, physician assistants, clinical psychologists, and physical, occupational, and speech therapists train family caregivers to perform these tasks.

The Medicare family caregiver training program has two qualifiers:

• To help the patient, note the word patient, meet health and treatment goals that they set with their doctor or health care provider, and
• The patient (husband, wife, mother, father) needs a caregiver’s help for their treatment to succeed.

In theory, teaching skills to family caregivers is a good idea.

Who Can Substitute for Working Family Caregivers?

Family caregivers who can do more are the unpaid workforce who keep spouses, aging parents, and other family members out of hospitals and nursing homes.

The downside is that if a family caregiver is not available to perform these tasks, who can?

In some, but not all cases, the answer may be a non medical in home caregiver paid privately or through a state Medicaid program. In other situations, the answer may be a medically trained home healthcare worker or moving a loved one to a care community.

How Does Non Medical In Home Care Work? Expert Witness Insights

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Watch More Videos About Caregiving, Aging, and Health on Pamela’s YouTube Channel

Standards of Care and Service Gaps

A difference between needed care tasks or services and what a non medical care agency can provide is a key factor that results in Wilson being retained as a non medical in home care agency witness.

A service gap for a non medical in home are agency can mean a failure to deliver on standards of care. Family caregivers who want to keep a loved one at home as long as possible may not realize the importance of hiring a care agency with the necessary background and skills.

Documenting An Inability to Serve

When a care agency recognizes that it lacks the skills to care for a client’s advancing care needs, it is wise to advise the client and the client’s responsible party.

Being transparent about not being able serve a client’s medical care needs can protect the non medical in home care agency if the agency continues to provide services and a client suffers harm.

However, doing so is not a guarantee that the agency, by virtue of its continued presence, will not have to defend its decision to remain involved if a lawsuit occurs.

For example, the client requests a service that the care agency confirms it cannot provide. The non medical care agency offers information about an alternative service provider that might meet the client’s increasing needs.

Additionally, the care agency documents service gaps that cannot be provided. This list is provided to the individual and their responsible party.

This may be the time for a family member to consider that a care community is necessary to meet a loved one’s care needs.

State Licensure and Franchise Operations

Because non medical in home care agencies are licensed in most states, state statutes for these agencies outline the operational and daily requirements to provide personal care worker and homemaker services.

Agencies providing non medical in home care services reimbursed by state Medicaid programs are often locally owned. National franchises typically do not accept Medicaid as a payment source.

Alternatively, many private pay non medical agencies are part of national or worldwide franchises. In these situations, it is possible that the franchisor’s marketing or advertising promises more than the services delivered by independent local offices.

• An example would be a franchisor advertising specialized dementia caregiver services. A client may expect a dementia trained caregiver only to discover that the caregiver has no experience or training caring for a person diagnosed with dementia. This may be discovered by a caregiver taking a client out of the home only to have the client wander off and become lost

Tips for Families Hiring Non Medical In Home Care Agencies

When hiring a non medical in home care agency, be clear about the services requested and confirm that the agency can provide them.

A positive experience can happen when employees meet standards of care because they are properly background-checked, hired, trained, and supervised.

Also, realize that you may need to become more involved in training and communicating with the caregiver and the care agency than initially planned.

Having a good relationship with a care agency can relieve stress and pressure experienced by family caregivers and deliver appropriate care for aging loved ones.

Even still, this doesn’t always happen.

These are the situations where law firms contact Pamela D Wilson, a non medical in home care agency expert witness to assist. With over 25 years of experience in the caregiving industry, as an owner of a non-medical in home care agency, and experience as a care manager and professional fiduciary, Wilson has the expertise to offer litigation support.

Contact Pamela D Wilson, non medical in home care expert witness, to learn more about her expert witness services.

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