Let’s start with the most asked question first, because it’s on the top of everyone’s mind when they start exploring senior care options. How much is this going to cost me?
Unfortunately, home care isn’t cheap. Having a dedicated personal caregiver is expensive and in the Massachusetts area, the rates are between $33-$38 per hour. I believe once minimum wages have been raised to $15 per hour (which caregivers command more than that, but incoming tides raise all boats) home care services will plateau around $40 – $42 per hour.
If you are interested in comparing costs, you should take a look at the Genworth Cost of Care tool on their website. This allows you to look up the average cost of care, not only for home care services but assisted living communities as well as skilled nursing facilities. You will see that in many cases home care is far less expensive than the cost of assisted living and nursing homes.
Of course, this depends on the number of hours per week of home care you are purchasing. 24/7 care is going to be more expensive than an assisted living community because you are getting around-the-clock 1:1 care. Additionally, you should be hesitant to compare assisted living and home care services because they offer two different services. Assisted living communities to offer a social model of care including room and board with only a few hours of 1:1 time. If your loved one declines and needs more assistance, the assisted living community will either increase the care they are providing which means a higher monthly cost, or recommend you hire a private home care agency to provide the care.
Most home care companies charge by the hour, but in some cases, they charge a flat rate, especially with live-in services. The caregivers are paid a flat rate and customers are charged a flat rate. This is because there are fewer shift changes if any at all. The caregiver isn’t clocking in and out as they normally would with an hourly case, because as the name suggests, live-in life in the home.
You can expect to pay anywhere from $400 – $600 per day depending on the agency and if you want one caregiver or two caregivers to handle a week of care. If you want just one caregiver, that will cost more money as the caregiver is still paid hourly and overtime laws are applicable to this type of service.
As home care rates continue to rise it is understandable that prospective clients might consider hiring a caregiver privately and even under the table. The benefit of this is you save money, you cut out the costs of insurance and the agency staff who handle the day-to-day operations of management of the caregiving staff.
While there are success stories when it comes to hiring a “private private” as we call it in the industry, there are many downsides. Good caregivers with no supervision or accountability can easily turn into bad caregivers. There are horror stories of caregivers taking advantage of the seniors they care for, moving their own family members in, and stealing money as well as items from the home. It happens far more often than you can imagine, and there is little recourse if your parents have memory issues and there is no other proof that police can go on to make arrests, and even if there were, it is unlikely there will be any restitution.
Another downside is what happens when the privately hired caregiver gets sick or needs time off, who covers for them? Or what if they have a schedule change and can no longer work the hours you need? That likely means you are back to the drawing board of recruiting, interviewing, and hiring another caregiver.
Before going down that road to save money, consider the downside of those choices and the risks associated with it.
Yes, it does. Long-term care insurance is optional insurance you can purchase that will pay for senior care services once they are needed. Most insurance professionals suggest you start purchasing long-term care insurance once you are in your early 60’s, but you can purchase policies into your 70’s and possibly later. Long-term care policies pay for home care, assisted living, and nursing homes services.
Long-term care insurance has changed over the years. In the early ’90s, there were many issues where policyholders complained about their insurance holders. The insurance companies underestimated how long people would live and how expensive senior care services would become. This led to a perfect storm where insurance companies were losing millions on these policies. Many made their policyholders jump through many hoops to get their benefits, hoping they would pass away before paying out. Some companies just refused to pay outright because they were losing so much money.
Now things have changed. The premiums on the insurance policies have become much more expensive to reflect the cost of care and how long people live, but hybrid models have become popular where if you do not use your benefit you get a chunk of the premium returned to you. Most benefits have a 90-day elimination period, meaning you must pay out of pocket for services for that period of time, then you can start getting reimbursed.
The policyholder needs to require assistance with multiple activities of daily living needs. You must speak with your home care company about ensuring the proper paperwork is handled so that your claims are paid. Without the proper paperwork, you might not get your insurance money, so remember to mention it to your agency the moment you start services. The standard procedure is that the home care company gets paid by the family, then the family is reimbursed by the insurance company.
An option some families love, while others are not fond of, is the assignment of benefits. This is where the family provides paperwork to their insurance company that allows their home care company to directly bill their insurance. With the assignment of benefits, you do not need to pay anything out of pocket or wait to be reimbursed. The insurance company will pay the home care agency directly. Please note, that if you require more services than the insurance company will reimburse for, you will be left paying the difference. Also, the home care agency is not responsible for what happens with your insurance agency and policy. If for some reason the insurance agency stops paying the assignment of benefits, the home care agency will still need to be paid.
Since you are reading this, you are likely an adult-child considering care for your parent(s). The question you should ask yourself is, is now the right time for you to plan for your future, how you plan to age, and how you will pay for it? If so, I would recommend you speak with Mike Harrington, who is a local broker for long-term care insurance out of Woburn, MA. Minute Women has no financial relationship with Mike, just our recommendation of someone good that you can count on.
The short answer is, no it does not.
The longer answer is it isn’t likely, but there are a lot of different medical insurances out there and maybe yours does, so it is worth checking.
The reason why most insurances do not cover home care is that the services we provide are not considered medical services. In the senior care industry, we are often called “non-medical home care services.” We are providing assistance with activities of daily living and instrumental activities of daily living.
As you can see, none of the listed tasks relate to medical care which is a primary reason why medical insurance usually does not pay for home care and other similar senior care services.
As mentioned earlier, activities of daily living are important to know for not just long-term care reimbursement, but for conversations with senior care professionals, doctors, and nurses that will come and visit your parents.
Knowing what your parents are struggling with and what they are able to handle on their own is an important indicator of where they are in the aging process. Over time you can cross off the tasks that they are unable to accomplish on their own and use that as a guide on where your parents are going to need more support.
This will allow you to have some objective information to make the best decision possible for your parents. Does it make sense to have them move in with you? An assisted living? Age-in-place with home care? Or move into a nursing home setting. Without knowing what their baseline is, it will be difficult to make a confident decision.
Though most medical insurances do not cover senior care services, they are usually tax-deductible (talk with your accountant). If you are like the other 90% of families who pay for services out-of-pocket, you can usually deduct the cost of home care from your parents’ income. While not ideal, it is better than nothing.
Regardless of the industry, staffing costs are directly influenced by insurance and staff. It does not matter if this is a nursing home, assisted living, home care, or a white-collar staffing company; what you pay the workers will directly influence the cost of care.
The senior care industry’s costs are rising. Nurses (LPNs and RNs) and home health aides (HHAs) , and certified nursing assistants (CNAs) are always at the top of the list of shortages in the healthcare industry. There are just not enough nurses and aides to accommodate the demand. Because of this, wages have been increasing dramatically to keep current caregivers paid well, in addition to attracting new caregivers to the industry.
What is also causing the cost to increase is that more families are reluctant to let their parents move into a nursing home. This leads to seniors living at home with more complex and challenging care needs that are now in the hands of home care companies. Clients that are more appropriate for a nursing facility will need far more care in their home, leading to increased burnout of caregivers, leading to more caregiver turnover. To get caregivers to accept these shifts, means they need to be compensated more.
For example, we recently had two different cases where the clients we were caring for both had a form of dementia that caused them to be combative, angry, and violent.
We knew their actions were caused by their dementia, but it was still difficult for our caregivers to care for them day in and day out. In some cases, it may make more sense for seniors with dementia that results in these types of behaviors to be placed in a memory care unit, but often their families are resistant to placement.
On top of this, we are seeing more seniors with colostomy bags, g-tubes, and catheter bags attempting to age in place. These needs were usually met at a nursing home, but now we are being asked how much assistance we can provide with these types of tasks.
Because of the shortage, caregivers have the option to decline a case or resign from a case, knowing that soon enough a different case will become available. Again, this leads to the wages of caregivers increasing to entice them to take more complex cases, rather than wait for less strenuous assignments.
Insurance is a big cost for home care agencies, more specifically workers’ compensation insurance. Caregivers are considered at high risk to injure themselves just by the nature of the work they do. Transferring a client from bed to wheelchair, changing or positioning them in a bed that is too low/too high/does not have rails (ie not a hospital bed) are all opportunities for injury to the caregiver’s back.
Imagine entering a stranger’s home and being asked to provide care for someone. There might be clutter, animals, slippery surfaces, and stairwells you are not accustomed to; this all leads to increased risks of injury, which is why insurance is so costly.
Have you ever heard the saying “it takes a village”? Well, that describes the culture at Minute Women Home Care. There is so much that goes on behind the scene to ensure that we provide the best care possible to our clients.
I have promoted multiple caregivers to become schedulers or care coordinators and their primary job is filling all the shifts of our clients. There are a lot of moving parts and it is far more complicated than they ever imagined. Things change quickly in our world. Seniors decline, they get better, immediate services are needed then not needed. Long cases, short-term cases, and everything in between.
Every single scheduler who was once a caregiver has been shocked at the amount of work, organization, and skill it takes to handle the ever-changing schedules of our clients and also our caregivers.
In order to provide the best possible care to our clients and families, there needs to be ongoing supervision, customer support, and caregiver support which is provided by our client care staff. Once the client care needs are identified through our assessment process, our care coordinator schedules the shift with caregivers whose skills and personalities match the case.
It is essential to have an active recruiter working to find, interview, hire, and onboard caregivers that meet our standard to be part of the Minute Women team. The expectation from our clients is that when there is a call out or an emergency, we will handle it. That means having enough staff in the bullpen to provide care when a last-minute shift or emergency occurs.
We will often talk with new clients who are frustrated with a previous home care agency. They will explain how they asked multiple times for a new caregiver as they were not happy with their current caregiver, but the same caregiver kept showing up over and over. This is because the agency has not invested the time in recruitment and they have no one else who is able to show up and replace the current caregiver.
Finally, we need to provide 24/7 care as well as 24/7 customer and caregiver support. This means a Minute Women employee is on-call at all times for emergencies that occur when the office is closed. If you have a problem you can reach someone every day of the year including major holidays.
The cost of providing care will continue to rise over the next few years. These are the reasons why customers who use senior care services are seeing their bills increase.
As we have discussed in some previous questions, there is nothing about healthcare that is inexpensive. We hear from countless families that they had no idea their loved one was falling or declining…until that last fall which resulted in a fractured hip. After many months of brainstorming ideas and researching options, we are pleased to introduce Minute Women’s fall and emergency detection system powered by WellAware Care.
One of the biggest issues facing our industry is the cost of care. Simply put, not everyone can afford 1:1, assisted living, or a well-kept nursing home. While our fall detection system is not for prevention, this smart system alerts unlimited family members, friends, and neighbors if a fall has occurred. The fall doesn’t need to be from tripping, this can occur from a heart attack, stroke, epilepsy, or any other reason someone could end up on the ground.
The beauty of this system is that the senior does not need to wear anything, press anything or interact in any way with the system. Once installed, it just works. When a fall is detected, an SMS text message is sent to family members alerting them of the emergency. This is just the tip of the iceberg on what this system can do. Our smart sleep pad allows you to monitor your parent’s heart rate, sleep patterns and automatically turns on lights when they get up in the middle of the night. This enables you to have useful and objective data on what is happening in your parent’s home without the need for invasive cameras (which are available if you want them) that many seniors refuse to have.
All of this for a fraction of the cost of what home care, assisted living or a nursing home would cost.
Minute Women has partnered with WellAware Care in hopes of putting our fall and emergency detection devices in the homes of all seniors, regardless if they can pay for the services. Not everyone has a family who can help or can afford expensive staffing care. While we can’t prevent falls, we can prevent seniors from being on the ground unable to call for help for hours until someone checks on them. With our system, a senior’s family and friends (as many people as you add to the system) can be notified within one minute of a fall occurring.
Before we go into the most popular questions we are regularly asked, we should address how the private home care industry works. This will benefit you immensely so that you will understand some of the reasons why this industry operates the way that it does.
The private home care industry is essentially a staffing industry. Most agencies hire all their caregivers, they have W-2, insurance, and are bonded. What many customers don’t know is that all of our caregivers are considered “per diem” employees. They are not guaranteed work, whether it is full-time or part-time.
The reason for this is because both caregivers’ personal and professional schedules change frequently, as do our customers. We often get last-minute calls for hospice patients who need 24/7 care, for the five days before they pass away. In our industry, it is not uncommon to receive a number of these types of cases within the same day. When it rains it can pour, but there are also times where it is slow; because of this, caregivers are classified as per diem rather than salaried or guaranteed a certain amount of hours.
When these events occur it is our job to have ample caregivers hired with Minute Women to call, matching their availability and caregiving abilities to the case. Because clients call us requesting all types of different schedules, we need to have hundreds of caregivers available to meet the needs of our customers.
So back to how home care agencies operate. . .
If you imagine a circular lake and houses all around the waterfront. Now instead of there being water in the lake, it is filled with caregivers; and the houses represent home care agencies. The different home care agencies advertise for caregivers and hire the ones that meet their standards and decline caregivers who do not. This likely means the top caregivers are hired as per diem employees at multiple agencies.
This means they are being offered multiple jobs and shifts per day from multiple agencies. So the caregivers are in a position of accepting or declining shifts or resigning from one case to get more hours at a new case. Most customers I explain this to have no idea how our industry works (I didn’t when I went through home care for my mom so don’t feel bad) but it is important to know so you can make an informed decision on what you think is best for your family.
This leads to why having minimum hours is important and how the more hours you schedule the more consistency you will have. More on that later!
Minute Women offers three different services for prospective customers to consider.
The first, and most popular, is hourly caregiving services. This can be from a few hours of transportation to 24/7. Hourly cases allow families to pick times that work best for their needs and we find caregivers who are available for those shifts and who also have the abilities and skills needed to be successful.
As mentioned before, the more hours a family is willing to schedule will provide more consistency in having the same caregiver(s). Anything over 35-40 hours per week, and you are likely to have a consistent caregiver once you find someone who works well with your situation.
Live-in care is the next most popular service. This is when a caregiver moves into the home and lives with your parent(s). This can be for a few days, for the whole week, or ongoing. Most families looking for live-in services are expecting the services to last an indefinite period of time which is why this is the most cost-effective service we offer. It provides the most care for the least amount of money.
The caregiver is expected to be available to work for up to sixteen hours per day, and then has eight hours of sleep. While that sounds like a lot of work, most seniors have downtime while they are reading, watching tv, or taking naps throughout the day. This allows the caregiver to take a break if all the tasks around the house are completed.
You can choose to have one caregiver for seven days a week, or you can choose to have it split throughout the week. There are pros and cons to each situation. With a split-shift week, you have two caregivers who know the case. In theory, if one has an emergency or vacation, the other can fill in; though this is not guaranteed. With a seven-day-per-week caregiver, your eggs are all in one basket, but the benefit is no shift changes or major moving parts. The caregivers who are looking for full week live-in jobs have chosen that profession for their own reasons and they are willing to make that commitment.
While not a totally different service, one specific type of care we provide is hospice care. This is noteworthy because, unlike many other agencies, we have caregivers who can administer hospice medications from a pre-drawn syringe, on a scheduled basis with the hospice agency’s oversight. Our caregivers are trained to observe for signs of pain and/or discomfort, reach out to the hospice nurse to report their observations, and provide medications for breakthrough symptoms as directed by hospice. This allows the family the peace of mind that as their loved one’s condition changes, they will not need to be in pain. We are the eyes and ears for the hospice team when they are not present.
When my mother was on hospice, it was a time filled with stressful days, and at night you sometimes just crashed. It was a blessing to have overnight caregiving staff not only be there for my mother but to have the ability to provide comfort medications to her so that we could get some sleep. Otherwise, we would have to get up every 2-4 hours to administer the medications. Those who have been in that situation, know how important even a little sleep can be, so you can get ready for the next day to provide care, try to be upbeat and spend time with your loved one.
Minimum hours are the fewest hours you can request from a home care agency to staff. This can vary quite a bit from agency to agency. Many agencies have a minimum of a total of fifteen-hour per week, meaning you need to schedule at least fifteen hours per week for them to consider accepting you as a client.
Once you fall below the minimum hours one of two events will trigger:
The first is easy. Some home care agencies will terminate services or decline to work with you if you are requesting less than their minimum hours. Other agencies may accept the offered schedule but charge you more for the services because they fall below the minimum hours.
In the latter case, the “minimum hours” refers to the minimum amount of hours to receive their standard price, going below those hours triggers a cost increase.
The reason for minimum hours is not to be greedy or to make more money. It is because staffing low hour cases are difficult, the fewer hours in the shift the more likely there will not be continuity of caregivers and/or difficulty filling the shift.
As mentioned in previous questions, caregivers know they are in demand, and will often decline short-hour cases and wait for longer shifts. For those caregivers that do accept short-hour cases, they likely are accepting the shifts until they are offered long shifts by another agency.
What is unique about home care staffing is the understandable method of starting small and growing over time makes sense in theory but is inverse.
By starting small you are going to have caregivers who resign regularly to accept bigger cases that pay more money. This leaves families feeling like the agency can’t keep their staff and understandably leaves a sour taste in their mouths. “Why should we get more hours when these folks can’t handle what we already give them?” Then they leave for another agency.
The problem is this agency and the one after that is going to have the same issues. Caregivers will resign or decline to accept the shifts because they are all looking for 8-16 hour shifts. This leaves families who only need a few hours of care accepting new people into their homes regularly, and this is especially difficult when personal care is provided or the senior has memory care issues. Even outside those circumstances, families want consistency.
This all depends on the company. Some agencies do not bother with transportation unless you are an existing customer who is currently receiving home care services, and there are other companies who are happy to provide transportation as their only service. There are also agencies that provide both home care and transportation as separate services, meaning you do not need to be an existing client – you can call up, schedule a ride and that is all.
One big question is, who’s car is being driven. Families commonly use the caregiver’s car to drive their parents as the caregiver is most comfortable in their own vehicle, but you do have the option of letting the caregiver drive your car too. Many caregivers may have their licenses but do not have their own car. It is becoming commonplace that caregivers use Uber or Lyft for their transportation needs. This means it is harder to find caregivers who are able to provide transportation because they either don’t have their own care or don’t have a driver’s license.
Not every home care agency does a driving history check, it isn’t something that is commonly done in the “background check” for employment. The background check is more for criminal history rather than unsafe driving. Because of this, many agencies limit the driving jobs to the local area only. Grocery stores, pharmacies, and doctor’s appointments are the most common reasons for transportation needs. The changing landscape with the delivery of goods and telemedicine may soon reduce the need for transportation services except for medical procedures and mandatory in-person doctor visits and appointments.
At Minute Women we are happy to provide you transportation services. We schedule them regularly. The way we work is we charge per hour from the time we leave the office to the time we return to the office. If we need to wait, we charge for that time as well. Please note, this isn’t a taxi service, we are providing assistance getting to the car, out of the car, and to their appointment and back safely. We will walk with your parents or wheel them (if in a wheelchair) to their appointment, ensuring they arrive on time and safely.
You should expect to be charged more for transportation-only services. The higher hourly rate is because usually people only need 2-3 hours worth of time for transportation, and as we talked about in previous questions, the short hour cases require paying the caregiver a higher rate than the longer hour cases. This rate is usually all-inclusive, meaning there is not a per-mile charge as well. . The pickup, the drive, and drop off, then the ride back home takes a few hours of time. If you are an ongoing client, then your hourly fee would cover the transportation time. But if the caregiver is driving their own vehicle, you will likely be charged a nominal per-mile fee (ours is $.55/mile) to reimburse the caregiver for gas, wear and tear, and depreciation on the vehicle.
In all honesty, Uber and Lyft are cheaper alternatives to what we charge for transport-only services, but they only pick up and drop off. While you may have a driver willing to go above and beyond, escorting a senior to their appointment is not expected from ride-sharing services. Also, seniors are not as comfortable with using the app, setting up the payment (some seniors don’t have debit or credit cards) and then a “stranger” picks them up. With Minute Women, there is the chance the same person will be their driver each time, and seniors like that consistency.
Minute Women’s service area is broad. As an independently owned agency, we can service anyone in any town. Compared to franchises, who can only provide care in a certain geographical area (usually 6-7 towns), they are limited to where they can go.
One benefit is when someone calls for services, it is far more likely we can assist them with care, while a franchise may turn away clients or referral sources (hospital, rehabs, etc) because they legally can’t service that town.
Minute Women’s service area is roughly 15 miles around Lexington, MA but that’s a general guide. We have provided services in Gloucester, in Dracut, in Quincy, and in Stoughton. In the end, it all depends on the hours a client is looking for and if a caregiver is willing to drive to accept the shift. The more hours, the more likely someone is willing to drive there. If we get a call for someone in Quincy for four hours per day, it is highly unlikely we can fill it; but a live-in, I bet we could!
In general, the more hours you are looking to have scheduled (there are 168 hours in a week) the more caregivers are going to be interested in the shift. Like anyone else, caregivers are doing this to put food on the table, and longer, consistent hours are something they are all interested in.
One area of concern is that as it gets more expensive to live (rent and homeownership), towns outside of I-95 are going to have more difficulty finding caregivers, especially for lower-hour needs. Towns like Acton, Carlisle, Lincoln, and Sudbury are so expensive caregivers do not live anywhere remotely near them. This leaves the residents there who require just a few hours of care per day in a difficult position. Caregivers are unwilling to drive from where they live in Watertown or Waltham to Acton for a four-hour case, especially when they know if they wait a bit longer an eight or twelve hours shift will become available elsewhere.
This isn’t unique for Massachusetts. It’s happening in suburbs across America. Caregivers often live in the lower-cost cities and towns and feel that driving or taking an Uber 30-45 minutes with traffic to get to a client’s home is not worth the cost. If your parents need just a few hours a day of care for showering and they live in the suburbs or outside of I-495, you can expect to be asked to increase your hours to have the consistency of caregivers; otherwise, you will likely be disappointed in the services you are getting.
So we don’t end on a negative note, this does not mean you can’t find someone, it’s just more difficult. There is likely someone reading this who has had great success finding a caregiver that has provided a small number of care hours for a reasonable cost and consistency, and if that is you, congratulations – you’ve hit a home run! This is not the rule, it’s the exception to the rule.
There are three main ways that home care agencies find their caregivers. The first, and the most effective, is the word of mouth and internal recruitment. Offering bonuses to current caregivers to refer caregivers they know to join the Minute Women team has been a game-changer for us. These referrals, by far, have yielded the best and most competent caregivers. When you stop and think about it, it makes complete sense: a current caregiver is not going to recommend another caregiver who is not professional, dependable, and good at their job because it would be a poor reflection on them. The second way is through general advertising online. Online job boards make it easy for caregivers to search and apply for jobs in the comfort of their own home and when it works for them. The third way is by posting flyers. Flyers posted in apartment complexes that are known to have many renters in the healthcare field, churches, and home health aide schools enable caregivers that might not be actively looking for hours to know we are hiring. Having a QR code on the flyer makes it quick and easy for them to fill out a short application and get the process started. Good caregivers are not out of work for long. If their schedule opens up, it will quickly be filled by another agency if we don’t keep them employed. So once we find a fantastic caregiver it is imperative to keep them employed. As customers in the private home care industry, keep in mind that reducing the hours you currently have or going on long vacations may mean that the caregiver you currently have will not be available as they will likely take hours elsewhere to make up for that loss of income.
As an accredited member of the Home Care Alliance of Massachusetts, we follow their standards for vetting applicants. We highly prefer someone to have their home health aide certificate or certified nursing assistant license, with that being said, if someone has extensive experience and we trust their judgment, we would consider hiring them. We run a background check on every caregiver, usually a CORI, but in some cases it is a national background check. The reason we do not run a national background check on everyone is because national checks are completed through 3rd party private companies. Their checks are not endorsed or run by any national government agency, but by private companies who claim to have the ability to run these checks. With a CORI, we know the background check is run by the state of Massachusetts. Because most of our caregivers are immigrants who have only lived in Massachusetts since they moved to the United States, we feel a CORI check is sufficient to check if there is previous criminal history. We personally interview and onboard our caregivers. We provide them scenarios that commonly occur within our industry and get an understanding of their experience, develop a level with them. While almost all our caregivers have classroom training, which is great, real-world experience is ideal. Understanding their previous experience and what types of clients and situations they are comfortable handling is important for their success and the happiness of our clients and seniors we care for.
As mentioned previously, the vast majority of our caregivers are certified home health aides or are certified, nursing assistants. This means they have spent 45 hours in the classroom and 35 hours in a clinical skills lab. This training allows them to work in hospice, VNA, assisted living, long-term care, or home care settings. It is expected that the training they receive in these schools provides them with a solid foundation of the types of situations and the skills that will be needed in a non-medical environment with seniors. With that being said, there are situations where caregivers are uncomfortable or have not used their training in years and need to be refreshed. A common situation is when caring for someone who has an ostomy or catheter bag. While it is becoming a more common occurrence, most seniors do not have these devices. So a caregiver who was once trained on a catheter bag a number of years ago may need to be retrained on how to do this again. Also, technology changes, and there are many different types of devices on the market, so a caregiver may not yet have used a certain style of the device. In these situations, Minute Women staff would take the time to train and teach a caregiver how to handle these devices to make sure they are comfortable with the care they are going to be expected to provide.
Caregivers are supervised both remotely and in person. Technology has allowed for many tasks to be accomplished on the phone using our app. For example, clocking in and out of a shift is now done using GPS and our application. This allows us to supervise when a caregiver arrives and leaves a client’s home. Are they showing up on time and are they staying the whole shift, or staying longer? We receive the caregiver’s notes and tasks accomplished each day and week through the app. This provides timely information about a client, compared to collecting and reading through notes on a weekly basis. As for in-person supervision, we provide unannounced visits to clients on a regular basis. We pre-schedule these with clients but do not make the caregivers aware of the visit. This allows us to see the attire, condition of the home, and what is going on at the home when we are not there. These visits are done by multiple staff members, including our director of client care, our account managers, and the owner. It only takes a few visits for the word to get around that we are checking on our employees. While we like to think we hire great caregivers, that does not mean we shouldn’t ensure that our employees are living up to yours and our expectations. Supervision does not mean things won’t go wrong, but lack of supervision almost ensures problems will come up, and small problems can become big problems, but when addressed early can be handled without issue rather than something that is building over time and becoming a major service failure.
In our service agreement, we do have a rate for when we care for two people rather than one person. This situation commonly occurs with a live-in but can happen under other circumstances. How does one differentiate the care for one individual instead of two? When a caregiver is providing the assistance they are changing the linens, doing the laundry, making meals, cleaning up the kitchen, taking out the trash, and in some situations cleaning the home. This benefits both seniors, so where is the line in the sand when you charge for care for two people? This is a common question we are asked when couples are still living together. The short answer is safety. It is expected that the caregiver is going to clean all the laundry, the dishes and cook meals for both people when needed. The house would look silly if only one person’s laundry was being done, or only one side of the bed was made and the other was unmade! The big differentiator is when the safety of the other senior becomes the responsibility of the senior. For example, if the caregiver is being asked to escort someone to the car or up and down the stairs because they aren’t steady on their feet – that’s care for two people, as the caregiver is now responsible for the safety of both seniors. This also includes showering or personal care services. The other individual may benefit from some of the services the caregiver is providing, like laundry, meal prep, or taking out the trash, but they are able to handle that themselves if the caregiver was not there. If the second senior can no longer make their own meals because they leave the burners on, that’s when it becomes to care for two people because the second senior’s safety and wellbeing now depend on us. These situations are not always ideal. Being responsible for the care of two seniors is a lot of work, and it usually signals that a change is coming. Someone is likely to decline to a point where a nursing home, hospice, or a second caregiver is needed to ensure everyone is safe, as there is only so much one person can do. Having a caregiver provide care for two people also leads to burnout faster, so from a business point of view, it’s not a great scenario to be in, but it happens often enough that it should be mentioned. Granted paying the additional cost for caring for two seniors is still less expensive than an assisted living or nursing home, but it is still an added cost to what is already a lot of money being spent to keep mom and dad at home so they can age in place with dignity. Of course, we talk with families ahead of time when we see this change starting to occur, so they can have all the information they need to make the right decision for their parents.
As previously mentioned, our caregiver can provide pre-drawn liquid comfort medications for hospice on a scheduled basis. What commonly occurs is the hospice agency will set up a schedule and have pre-drawn syringes with the correct amount of comfort meds so that the caregiver knows that every certain amount of hours, to administer one syringe of liquid meds. If there is continued discomfort, we would contact the on-call hospice nurse so they could set a new schedule for our caregiver to follow. As for non-liquid medication, like pills that seniors take daily, we only remind your parents to take the pills. They should be separated out into a weekly or monthly pill dispenser and our caregivers will remind your parents to take their pill. We do not handle pill bottles or manage the medications over the course of the week or month. Our caregivers are not trained for that and mistakes could occur. What is becoming popular are companies like Medminder which use technology that locks the medications and dispenses them at the appropriate time of the day. They become the pharmacy and mail out the medications in packages that are placed into the machine and you are done! Also, many pharmacies will send seniors their pills in bubble packs for the day. This way the pills are already separated and the caregiver opens the plastic pack and pours the pills into your parents’ hands for them to take.
Our job is not only to provide care but you must be happy with the person delivering the care. With that being said, we can send out Mary Poppins and it might not be the best match. We’ve had caregivers who connect with a client in one case, but for whatever reason, they don’t gel the same way with others. If you are unhappy with a caregiver, whether, for a big or small reason, we want to know. If the issue can be corrected or handled by some communication with a caregiver, that is ideal – nipping small problems in the bud before they become big problems. If the situation warrants a change in a caregiver we can do that as well. The reason you are paying for our services is not only for care but the support of the office staff as well. We have a recruiter on staff because you always need to have caregivers in the bullpen ready to go at any time. Far too often a problem with smaller or newly opened agencies will be a lack of investment in their recruitment. This can lead to the same caregiver returning to a client multiple times even though a change request has been made. This is because the agency has no one else to send. You can be the best home care agency in the world, but if you don’t have the caregivers when families call in a crisis, it doesn’t matter. There are many great agencies to choose from, but the differentiator for many hospitals, rehab centers, and families in crisis, is:
The answer to both of those questions is yes. Let us know if there needs to be a change to the scheduled caregivers, that is why you have support from Minute Women’s office staff. We will wait until the caregiver has ended their final shift and we will notify them they are being removed from the case. We don’t let caregivers know beforehand they are being removed, we wait until after their final shift has finished. This doesn’t mean they are fired or can’t work for us again, it means that it wasn’t the right match and we will work with our staff and talk about the issues and what happened. We always provide feedback to caregivers and allow them the opportunity to tell their side of the story and provide us their perspective.
This is a question we often receive and it’s understandable for families to consider. If you have a visiting nursing association caregiver or a hospice caregiver, why would you pay out of pocket for an aide, when your parent’s Medicare benefit is supplying an aide for free? The big difference is in the type of care being provided. For VNA and hospice services, the aides are provided for short durations of time and are focused on a few specific tasks that once accomplished, leave to help another senior. Usually, these visits last an hour or so and occur 3-5 times per week. If you have a hospice patient, they are going to require more assistance than half a dozen hours per week. They will need medications, changing after soiling or using a bedpan, they will need adjustments and help to get and down. With private home care, you are paying for someone to be there at all times and ready to assist at a moment’s notice. Another example is a senior who fractures their ankle. How are they going to eat? Use the bathroom? Or move from the bed to the couch so they can enjoy the day while recovering? One common misconception is that the hospice or VNA aides will arrive at the same time every single day. While this is ideal, what happens if the previous client needs more care than expected, which will throw off the schedule for the day? If your parent was in need of extra care, you wouldn’t want the VNA aide to leave citing they have to keep a strict schedule. No, you would want them to stay and assist because your parents need that extra half-hour of help. The aides from VNA and hospice are valuable, but they have their limitations. Private home care aides will also work with VNA aides on tasks that might require two people. For example, it is far easier to change a bed’s linens while the senior is in the bed with two sides rather than one. Also, bathing becomes far easier when you have one person to assist in cleaning while the other is maneuvering the patient. We like to use the analogy of a lifeguard. A lifeguard isn’t always saving people drowning in the ocean, but they are there ready to spring into action the second someone needs help. So the question is, do you need additional assistance? Do you want the lifeguard as the insurance policy for other agencies having scheduling issues or even family members who overextend themselves thinking they can provide more help than really possible?
You can read more about our history if you like, but Minute Women was started by Carol Cucci in 1969 and was named as a response to the plethora of businesses named ‘Minuteman’…plumbing or electrical. Since we were located in Lexington, the name Minute Man-made sense, but Carol decided that it would be a women-owned company and would predominantly employ women, it should be named Minute Women. When Ryan purchased the company from his Aunt Carol, this big burly guy certainly received some looks when he introduced himself as the owner of the ironically named company. It ends up being a funny icebreaker, people laugh and then enjoy the back story! Minute Women is family-owned and operated. For over 50 years we have provided home care support and dignity to seniors in Boston and the suburbs of Boston. Located in Lexington, but conveniently just off I-95, we are able to provide services from Boston to Needham, up to Andover, and all the towns in between. One misconception is that Minute Women only hires women or we only care for women, which is inaccurate. We are happy to hire anyone who we feel meets the standards of a Minute Women caregiver, and we are happy to care for anyone, at any age, that thinks home care is right for them or their family. While we predominantly care for seniors, we have assisted adults in every age category.
The onboarding process is simple and easy. We can move at a pace that is comfortable for you. When you are looking to hire Minute Women, you are in the driver’s seat with how quickly we start services. First, we would love to conduct an assessment of your parents. This includes meeting them, seeing their home, and speaking with family members who are involved in the decision to move forward with home care. We prefer to do this in person, but because of COVID, much of this has taken place over the phone. The next step after the initial call and assessment is to sign the service agreement. This does need to be signed before we find caregivers for your parents. The service agreement can be canceled at any time you like. There are no fees associated with canceling services and you do not have to give us notice before you cancel. Once signed, we then find caregivers who meet the ability to care for your parents and have the availability to come often. Our goal is to minimize the number of caregivers your parents have as everyone appreciates consistency and continuity. This step is where the circumstances decide what comes next. If we have the time, we welcome the opportunity for our families to meet and interview prospective caregivers. If immediate care is needed, then this step is skipped, but if requested we would have caregivers meet families in person before the start of services so everyone is familiar with each other. Once we have a schedule set and caregivers ready to start services, the last step is payment. We accept debit, credit, or ACH (automated clearing house) as a payment. We bill on a weekly basis and email a receipt of payment with the schedule, hours worked and names of the caregivers who worked this way if there are any questions we have the information to reconcile any differences there might be. Once care is started, you would then be in contact with our Director of Client Care as well as our Care Coordinator to ensure proper care is delivered and the schedule is accurate and updated regularly.
The Minute Women service agreement is two pages and is divided into three straight-forward parts. The first section is the legal stuff we have to go through. Basically, you will pay us for services rendered. It goes through all the awkward things that will likely never occur because 99% of people are outstanding customers who pay on time, but unfortunately, there is the 1% that require this type of legal verbiage. The second section is that you won’t hire caregivers from us. Meaning that once the service agreement is signed, you can’t cut us out and hire the caregivers privately. If that were to happen, legal action could be taken like in the first section. Again, unlikely to happen. The third section is, you guessed it, the money. We take a security deposit depending on the type of payment and length of service and then we bill you on a weekly basis, sending you a PDF receipt. In this section, it states you can cancel at any time you like for any reason. We are in the business of helping aging seniors, we understand circumstances can change quickly and flexibility is needed in these situations. The only times we charge are if services end mid-sift (usually hospice situations where someone passes away). In these cases, we would charge until the end of the shift, then cancel services. The other instance is if a caregiver is turned away at the door. This doesn’t happen often, but on occasion, families will set up services, the adult-children are excited about help, and the caregiver arrives and is denied entry by the senior. We charge for the shift because the caregiver accepted this job based on the hours they were going to be working and it is not right for them to travel and accept a shift only to be turned away without cause and not be paid. In that scenario, we would talk with you and let you know the situation. You would then have the opportunity to schedule services again and see if things will change or we can end services until a later date.
We can start service as quickly as you like. We once received a call on Christmas Eve at 3 PM from a family in crisis calling to see if we could provide a live-in caregiver so their father could spend his last Christmas at home, otherwise, the hospital would not allow the discharge. We had a caregiver out to the house within a few hours so the family could be together on their last holiday. The busiest days for prospective clients calling are Thursday and Friday afternoons. This is when discharge planners from hospitals and rehab centers are informing families that their parents are being discharged home that day or the following day (Friday). Adult children experience drinking from the fire house, receiving a lot of information all at once, and trying to remember as much as possible. This is why our onboarding process is simple and streamlined. Many families call in complete distress and are extremely concerned about how they are going to keep their parents safe at home and prevent them from injuring themselves further and ending up in the hospital again. We have received countless calls from families on Friday afternoon between 2 PM – 6 PM frantic to find care and we always come through for them. Often they are from hospitals or rehab centers where seniors want to be at home or back in their assisted living apartment so they do not need to spend the weekend in the hospital. The hospital is trying to discharge them as well, as many case management departments (they perform the discharging) are only open during normal office hours 8-5 PM – Monday through Friday. So they are against the clock too when trying to get someone discharged home. We recently received a call on Sunday afternoon from a social worker in the emergency department of a local hospital. A senior had arrived by ambulance, but they were not appropriate to admit. He was weak, on hospice, and really needed his hospice agency to provide support but the family panicked and called 911 instead of the hospice agency. The adult children decided that having 24/7 care for their father was imperative and we spent Sunday afternoon scheduling the care. This is not to say that every single case is an emergency. We do get calls from families who are weighing their options, investigating, and taking their time to come to a consensus of what is best for their situation. Ideally, this would occur in all situations, where the family (and the agency!) have plenty of time to find the right caregivers and onboard without the stress of last-minute decisions. Unfortunately, most families do not have time to plan for this type of crisis, so when it occurs, it is chaotic. This is why we have a hummingbird as part of our logo. We are fast, nimble and can help you quickly in any situation you find your parents in. We are here to support seniors, their adult children and provide as much dignity as possible to their parents.
Minute Women offers 24/7 support and services for our clients. Our offices are open from 8:30 AM to 5 PM Monday – Friday excluding major holidays. Administrative questions about bills and future scheduling shifts should be handled during business hours. Because we are providing care 24/7, we are available 24/7. A Minute Women employee is always on-call, not an answering service, so you will be speaking with someone who can assist you immediately. On our service agreement in big red lettering is the on-call phone number. You can also reach this number directly by calling our office number and pressing “9” when prompted. What is an emergency? It’s whatever you think an emergency is. We don’t have a set of rules, and when you are working with the elderly, sometimes they are going to call when they feel like calling haha! As mentioned, administrative tasks and concerns should be addressed during normal office hours, but if you feel that a topic is urgent and you need to speak with someone immediately about the problem, we want you to feel comfortable giving us a call. That is what we are here for. Most of the calls we get are about a late caregiver or a change in condition with a client. For example, we have had situations where someone is being transported to the hospital and the family needs to suspend services. We can get calls from caregivers who have been asked to stay longer than their normal shift because the client is requesting more help. Also, caregivers can arrive late from time to time so we ask that they are proactive in letting us know, so we can inform the families we are working with. While being late is never okay, as long as we can let your parents know ahead of time, this usually smooths things over. Often the senior is just concerned no one is going to show up and they will be alone, which is not the case, so letting them know their favorite caregiver is running ten minutes behind is all that is needed to calm the situation. When issues come up, we believe in being proactive about them and addressing them immediately. Usually, small issues grow into bigger ones. Three or four small issues individually on their own aren’t a big deal but combined it builds to a big issue. We understand that families are trying to be flexible and “go with the flow” in certain situations, but we want to know when there are small issues so we can address them and nip them in the bud. So if you are concerned about something, please contact us so we can address the issue before it grows into a real sticking point.
Minute Women has been heavily involved in the community for the past 50 years. We are members of the Burlington and Lexington Chambers of Commerce as we believe strongly in supporting locally owned businesses. We are also an accredited member of the Home Care Alliance of Massachusetts. The accreditation is a set of policies and rules that Minute Women must abide by to stay in good standing with the Alliance. We are actively involved in sponsoring and donating to local ASAP centers like Minuteman Senior Services, which help lower-income families in the Middlesex County area. Finally, we are members of the National Aging In Place Council of Massachusetts (NAIPC). The NAIPC’s mission is to be a resource to the community and educate adult children and their parents on what their options are when it comes to aging-in-place, whether that be at home, an assisted living community, or a nursing home. Our low-cost fall and emergency detection system is another way we plan on giving back. Our goal is to offer this to lower-income families who can not afford these types of services. Through grants and donations, we will be able to provide services to seniors who don’t have the money to pay for emergency detection devices. In addition, Minute Women staff are happy to speak with ANYONE who needs advice and help to navigate the senior care industry. You can never have enough good karma in this world, and we believe in the motto ‘givers gain’ where helping others will in turn bring positive outcomes for us. Even if you are not ready for services, but just need advice or information on the different options out there, we are happy to help you and refer you to professionals in our industry that may provide you the care and services that best fit your situation. Fundamentally, we are here to help people, regardless of any business we may or may not conduct. Our philosophy of helping and giving back is why we have been open for over five decades.