What Is Non-Medical In-Home Care?

Non-medical in-home care is sometimes referred to as caregiving, or its pejorative, sitter services.  It normally entails both personal care and homemaker services.  Personal care comprises bathing, dressing, feeding, toileting (or incontinence), ambulation, and hygiene.  Homemaker services include meal preparation, light housekeeping, laundry, bed linens, errands, shopping, and transportation.  Medication reminders (not dispensing) is frequently germane to the industry.  Non-medical in-home care may be short-term or ongoing; services are delivered wherever an older adult resides, from private homes to hospitals to senior communities, including assisted living, independent living, nursing homes, and multi-level retirement communities.  Importantly, non-medical in-home care is delivered either unilaterally or in conjunction with home health, hospice, or senior community care.  Funding for non-medical in-home care is usually private pay or long-term care insurance.  Other payer sources may include veteran benefits, state assistance programs (Medicaid waiver), reverse mortgages, and some forms of specialty assistance.

Caregiving may be informal (unpaid and delivered by family or friends) or formal (paid).  This insider’s tip article deals with formal caregiving.  The first consideration is that families should never hire independent caregivers unless they are willing to honor the employer obligations that the IRS deems they must.  It is wise to hire an agency—an employer—to avoid the tax and insurance liability they otherwise would face.  Any company that does not pay employment taxes is a registry and should be avoided.  Moreover, an employer agency can deal with a multitude of issues, including unforeseen scheduling needs, that private employers may not be able to adequately address.  Families hiring a caregiving agency would be well-advised to never hire a company that refers to its caregivers as “sitters.”  Sitters routinely underperform and can never meet the myriad expectations of families dealing with the emotional stress and pressures inherent with caring for an aging loved one.

A common perception among prospective customers is that all non-medical in-home care companies are essentially alike, since they all draw from the same labor pool.  Surprisingly, this same perception even exists with many caregiving agency owners and executives.  With a host of new caregiving companies that have opened since the recession of 2008, this article hopes to dispel this myth with a brief analysis from an insider’s point of view.

The assumption that a common labor pool dooms companies to equivalency is patently false.  Regardless of industry or employment opportunities ranging from executive to direct labor, all companies draw from the same labor pool.  The issue is not the labor pool; it is, rather, being extremely selective in whom a company hires.  It is just as challenging to hire a great president, salesperson, or bookkeeper as to hire a great caregiver.  Hiring the right people, especially in the service sector, and not sharing them with competing companies can give a company a significant and insurmountable edge over companies whose hiring standards are far from optimal.

Do not all non-medical in-home care companies do the same thing?  This is akin to asking does Motel 6 do the same thing as Ritz-Carlton, since both provide short-term lodging for visitors.  The answer is of course an emphatic no.  Personal care service providers can provide anything from underperforming “sitters”; to self-employed subcontractors who expose their employers to IRS scrutiny; to disreputable abusers of a compromised senior’s rights and property; to wonderful caregivers who become an extension of the families served.  The primary issue is not what is done but how the service is performed.  No company can deliver good service from employees not inclined to provide it.  The best companies understand this and painstakingly hire the best workers.  A superior caregiving agency should consistently reject over 75% of the caregiver applicants seeking employment.

Core competency and business model.  Every company has a core competency; if it has more than one, it likely will not be expert at any.  Delivering exemplary non-medical in-home care for older adults is a daily challenge requiring focus and attention to detail.  A good caregiving agency’s business model must be a service one, not a medical one, as the agency’s service is neither medical nor home health. 

To be distinctively different, a company must first believe and then perform.  If we return to the belief among many owners and general managers in the non-medical in-home care industry that providers are essentially the same, is it not logical that that belief alone relegates their companies to pedestrian status?  Vision and expectation of outcomes must be channeled top down but delivered bottom up.  Caregivers must know what their job is every day by virtue of the agency’s vision.  Their service ultimately is self-expression married to this customer-focused vision.  This is the best formula for an agency to distinguish itself.

Training, orientation, vision, and problem resolution must always be focused on customer outcomes.  Non-medical in-home care is an attractive industry to entrepreneurs because the demographics suggest high potential.  There is a monumental difference between potential and reality.  Hiring the right caregivers, orienting them to a dynamic vision, training them to have the tools appropriate to any circumstance, and then resolving inevitable problems are a collective challenge few companies will be able to master.  There must be methodology based on both metrics and intuition, and this methodology will either prove itself in execution or fail.  Performance in non-medical in-home care is largely determined by the quality of this methodology.

Of paramount importance is the fact that referrals drive business in this industry.  When the well-being of an older adult is at stake, family members typically seed advice from health care providers and other trusted family advisors.  The validation of trust inherent in these referrals will ultimately make or break a service provider.  Referrals always put into play the reputations of the referral source and the company referred.  Exceeding expectations or failing miserably will inevitably deliver consequences, good or bad.  The best caregiving agencies are extremely sensitive to the trust of their referral sources.  Service outcomes necessarily carry great weight in every instance because an agency’s integrity and its business are on the line. 

Cary Rotter
President
Comfort Keepers—Greater Memphis and Northwest Mississippi