Knowing what to look for and what to expect when making homecare arrangements for someone will ensure that you make decisions that are in their best interest. First of all, you need to find a reliable homecare agency serving the area in which your parent or relative lives. The hospital will normally provide you with a list of private duty homecare agencies and may even point out one or two that they have personally used and found to be highly professional. The doctor or social worker will also discuss with you the number of hours of homecare that your parent or relative will require once he/she is discharged. This will probably vary from 8 hours to 24 hours a day for 5 to 7 days a week. If the patient who needs the care is over 65 years old Medicare will provide 4 hours of homecare services per day from Monday to Friday. No service is provided on weekends. If, as per the doctor's recommendations, your parent or relative needs 12 hours of care per day then a private pay aide will have to fill in the remaining 8 hours per day during the week and the entire 12 hours on Saturdays and Sundays.

Making Proper Home Care Arrangements

•	Making homecare arrangements in itself is not an easy task either for the family member or the patient. If, you live far away however, you may not be able to make the trip and may be obliged to make the arrangements from a distance. For someone living in California and making the arrangements for a mom who lives in New York this can be quite a difficult task. However, with the help of a very good agency, a lot can be accomplished via phone, fax or email.
•	From an agency's standpoint, one of the first things to deal with is to ensure that the patient is discharged into a clean and safe environment. This is easier said than done. Many older people tend to pile things up, refuse to throw anything away resulting in a very cluttered living space that is extremely unsafe. You can make arrangements with the agency to send in a housekeeping crew to clean up the home and get rid of the clutter. In such a situation however, if the next of kin is not present, a third party will have to be called in to ensure that everything is done with their permission. This most certainly cannot be your mom's best friend who lives one door away from your mom and has more clutter than your mom does - it will be tough to convince her to have anything thrown away! The third party could be representatives of the building management who would be the eyes and ears of the client. Our housekeeping crew will get rid of boxes, newspapers, magazines, cans and so on that have been piled over the years and have become a safety hazard. Depending on the condition of the home this could take a crew of 3 people 2 - 5 days to clear and clean up the environment. Once this is done home care can begin.
•	In choosing an aide for the Client, our agency tries to get as much information as possible about the client in order to carefully match the personality of the client to that of the aide. All the aides are certified and are screened.

Duties of a Home Health Aide:

The duties of a home health aide consist of:

•	Oral and personal hygiene
•	Laundry of the Client
•	Preparing meals for the Client
•	Doing food shopping
•	Light Housekeeping, which means keeping the kitchen area and all other areas around the client clean. Heavy housekeeping such as cleaning the windows and blinds is not part of the aide's job description. The agency can provide housekeepers to do such work.
•	Accompany to doctors' appointments

If a next of kin is unable to be there at the time of discharge, the agency will arrange to have an aide pick-up the patient from the hospital to take him/her home.

Making sure that the patient adapts gradually to home care is very important. The transition is very difficult especially for the patient who has been extremely independent. The doctor may have recommended 8 hours of home care per day for 7 days. You, as the next of kin, may feel that as you do not live in close proximity to your loved one, you would rather hire aides for 24 hour care 7 days a week to avoid any mishaps. Having 24-hour home care service, however, means having an aide in the home round the clock and for any patient who is opposed to home care we certainly would not recommend this in the initial stages. It would agitate the patient greatly and hinder his/her progress and make the process of winning him/her over even more difficult. It is very important in such instances to introduce home care very gradually.

In this case, for example, we would advise starting off with just the 8 hours of care in the first week whilst monitoring the mood and emotional state of the patient. Usually, the defenses of the patient start relaxing slightly in the second week which means that live-in services can be introduced for the week-end only at the end of that week. Now, the patient is gradually getting used to the aide's presence and services and is actually starting to show some acceptance of their presence. Increasing the live-in services day by day can now be measured steadily and within two months the patient should have full live-in service. By this time, you can be sure that the patient and aides are practically inseparable! For male patients who are adamant about not having home care, we normally recommend a male aide who would gradually win them over as a companion or even a friend with whom they could watch a basketball game or talk sports and politics, etc. This usually works very well but there is always a transition period before the patient shows full acceptance to this new lifestyle.

The aide is required to report everything to the agency. The aide clocks in and out everyday if he/she lives out. The live-in aides call in everyday to give a report. Any aide that has to go out for any reason, either to buy groceries or to accompany the patient to a doctor's appointment must call the agency when leaving and on returning to the house.

SERVICES IN DIFFERENT HOUSEHOLDS

When nursing care is provided to a client that lives a very different lifestyle such as in the case of a socialite, the job description may be different as the structure of the home is very different. These clients live on estates and will have other staff on hand to do some of the work that the caregiver would be required to do in other homes. Here, the client will normally have a chef or a cook on staff to prepare all meals which may have to adhere to the dietary restrictions of the client, if any. The laundry cannot be handled by the nurse as it needs special care and treatment which is taken care of by the housekeeper or the laundress.

The clients from these types of households very often request that the caregivers dress in regular clothes instead of the white uniforms. These are people who lead very busy lifestyle, attending a lot of events and doing a lot of entertaining. They do not want anyone to know that they are in ailing health. Therefore, they find it very objectionable to have the caregiver attending to them in uniform. Here, the nurse is responsible for the total care of the client including the personal and oral hygiene of the client. The nurse will also act in the capacity of a semi-butler, answering the phone of the client and screening the calls before passing them on to the client. Some of the calls will not be passed on to the client as per the instructions the caregiver has received. The utmost discretion is needed by the nurse to ensure that the dignity and self esteem of the client is maintained at all times. The requirements of the job may change or may differ depending on the client that is being serves. For example, where a nurse is assigned to take care of a socialite the nurse may be kept busy the whole day, accompanying the client to the salon to do her hair and for manicures and pedicures and in attending different social events. Since the nurse's clothes may not be appropriate for many of these events the client normally provides a small budget for the nurse to buy suitable clothes which will also cover the dry cleaning expenses.

In cases where the acuity level of the client is low the attending nurses would be required to be in uniform at all times.

Homecare ensures that the patient is not displaced from the environment that he/she is familiar with and used to. Keeping a person in their own environment where their dignity and self-esteem can be maintained at all time is very important. After all there is no place like home!