How to see through to the heart of an elder-care agency

In all settings, in-home care or residential, high-quality elder care depends on three critical factors: staffing, flexibility and track record.

As you shop around among providers, it's one thing to ask the basic questions I talked about in my last column: prices, services, how a company operates. Today, in my ongoing series on how to choose elder care, I'm suggesting you get "under the hood" and see how the engine really works. Here are questions to ask:

Staffing: Older people need consistency, gentleness, continuity and a caring attitude from those who care for them. But caregiving can be a difficult job. It takes patience; a strong back; special skills; and a flexible, caring personality. Not everyone can or should do it.

In-home care, what goes on "behind closed doors" is more hidden than at any nursing home or assisted-living facility. Good skills are important, but so are integrity, reliability and common sense.

That's why the best home-care and home-health agencies hire their staffs carefully, looking not just for competence, but honesty, reliability and commitment.

Then, because high turnover is widespread and labor shortages are at a crisis and getting worse every year, they support and honor their staff in order to keep them.

"Staff is the backbone of any home-care agency," says Sam Miller, co-owner of CareForce of Lynnwood, a licensed home-care agency. "We choose our staff carefully, then to ensure the best care for our clients, we support and care for the people who care for them."

In my last column, I suggested the basic questions to ask — competency tests, training and background checks — to make sure an agency hires good people. Equally important, here are questions to help you gauge an agency's commitment to its employees:

• What do you do to retain your employees? The answer may or may not include good wages (although it helps, since many in this industry make close to minimum wage). Other answers: good working conditions, a choice of assignments, overtime and awards for good work.

• Does the agency pay benefits for all staff? Benefits such as health insurance, vacations and sick leave?

• How long has key staff worked here? This includes the general manager, marketing person, supervisors and other administrative staff. Because turnover is so high in elder care, you at least want stable management.

• What are your quality-assurance mechanisms? How do you handle complaints?

Flexibility: Change can be tough on older people, more so for those who are very frail or have memory loss. If the staff changes once a year, OK. if it happens every two weeks, it's not.

You want to select an agency that can change gears as its clients' needs change. Can it provide light-duty companion care as well as heavy care, including lifting, bathing, dressing and end-of-life care? Does it offer nurse delegation services that allow staff (in our state) who are not nurses to be trained to administer medications, do glucometer testing for diabetes, for example, or colostomy care?

If the answer is no, this might still work if you're planning to use home care for just a short time, but it's important to know from the beginning.

Track record: The history and reputation of any company tell us a lot. Consciously or not, most of us practice "brand loyalty" by buying from companies we trust. A company that offers elder care has a history and reputation, too, which tell you its corporate values: Is it in the business of making money and taking good care of people, or just making money?

The trouble is, it's really hard to find this information. Our government collects it, then keeps it a virtual secret. They don't tell you it's available or make it easy to use.

The Department of Health (DOH) regulates home-care and home-health agencies.

You can obtain a small amount of information about any agency in the state by looking at:

• Licensure status: www3.doh.wa.gov/hsqa/fsl_lookup/

• Survey and complaint histories: Call 360-236-2917. Information about any current complaint cannot be divulged while an investigation is under way. However, you can learn about past investigations and survey results by filing a Freedom of Information request by phone at this number. It takes a while to process.

• For information on home-health agencies that accept Medicare: Go online to www.Medicare.gov, then "Compare Home Health Agencies in Your Area." It's a difficult Web site to make sense of, but a little information is better than nothing.

To lodge a complaint about an agency, call DOH's Hotline: 800-633-6828. Be aware that it can take a good 24 hours to hear back.

The Department of Health isn't able to tell consumers nearly enough about the track records of in-home agencies, but there's good news: A complete revamping of its computer system is in the works and will hopefully be online and accessible to consumers by 2008. What's available now isn't much, but it will get you started.

Liz Taylor's column runs Mondays in the Northwest Life section. A specialist in aging and long-term care for 30 years, she consults with families and their elders. E-mail her at growingolder@seattletimes.com or write to P.O. Box 11601, Bainbridge Island, WA 98110. You can see all of her columns at www.seattletimes.com/growingolder/.