Lets Talk Visit Minimums

If you are interested in the Client Directed Home Care Invoicing Program, its likely you have heard the term “Visit minimums”. A visit minimum refers to the shortest amount of time a caregiver can be scheduled for any one visit. For example, if an agency has a 3 hour visit minimum, the shortest shift you could book with a caregiver would be 3 hours in continuous length. Agencies that are part of the invoicing program in Alberta can range anywhere from 1 hour to 6 hours for minimum visit lengths.

You may be wondering why visit minimums exist. Its time to de-mystify visit minimums, let talk!

Labor Laws

Alberta has homecare worker specific legislation. This legislation requires that Caregivers be paid for a minimum of 2 hours of work for each period of employment throughout the day, even if the working time was less than 2 hours. (For a full review of the caregiver specific legislation click here)

All agencies are bound to this legislation and staff cannot choose to decline these minimums, nor can an agency choose to dismiss them.

Traditional Model

Clients who are part of the traditional model of home care are not subject to visit minimums, and this is due to the models design which bundles client care in geographical service areas. Agencies in the traditional model are able to assign workers to see many clients within a community guaranteeing that staff will meet this minimum with quantity of work. This benefit is incredible for clients with short care needs, but does come at the cost of choice and consistency.

When care is bundled this way, it means visit times cannot be specific, and choice of caregiver cannot be guaranteed. Bundling care means your visit time is tied to the visit times of other people. It means your caregiver is tied to multiple clients and care is prioritized by medical need. Your preferences just cannot be incorporated without disrupting care for others.

Lets look at this practically.

Imagine you have care scheduled daily from 0800-0830hrs (Homecare’s most requested time slot!) but the agency who has your care just got a new client from AHS that needs care at 0800hrs because they have a day program to attend and must leave on the DATS bus. Your coordinator is going to have to move your visit to 0830 to fit that new client into the schedule. But not just your care, your coordinator is now going to have to shift EVERY client in that caregivers schedule for the rest of the day, by 30 minutes. They may even have to re-assign you to a new worker if there are other visits that cannot be moved due to medical reasons. This happens frequently, and despite the best efforts of coordination and care teams at agencies, it can often feel like a loosing battle trying to provide consistent care in this model.

Another quirk of bundling care is that the care is task based. If caregivers have completed all the tasks on your care plan, they can move on to the next client and are not required to stay for the full shift length. However, they will still be paid for the visit as it was scheduled. In my experience this incentivizes rushing. Some agencies also practice overlapping visits, which means scheduling multiple clients for the same time slot. This practice makes scheduling easier for their Coordinators, but managing workload extraordinarily challenging for caregivers.

I would like to note that often caregivers in the traditional model feel they have no choice but to rush, as their schedules are sometimes so packed they are overlapping. It would not be fair to blame a field staff for something that is fundamentally a systemic issue of the model

Client Directed Model

In the client directed model, we do not bundle care. We work with families to recruit and retain a caregiver for them who meets their specific needs including their visit time preferences. We are able to accommodate families requests for changes in visit times because the caregiver you are have is not typically scheduled for back to back visits. Our model is also not entirely task based. While our care plans do include regular tasks, staff are able to take initiative to help with additional tasks, socialize with the client, and are not incentivized to rush. Unless you request it, staff do not leave prior to their visit end time.

At ember we have a two hour visit minimum for our clients because your caregiver(s) are your own. This model is really tailored towards quality rather than quantity, and a two hour visit minimum meets Alberta’s labor standard.

Visit minimums can certainly be a drawback for some families if they have short or frequent care needs, however it is important to understand the “why” when pondering their existence in the space. For those who want their caregivers hand selected, value connection and care that is on your schedule, we cannot bundle care.

Preparing For Home Care- 6 Things to Consider

There is actually very little you likely need to do to prepare your home for a caregiver, however there are many things you can do to make your home more accessible for you or your aging loved one, and a few things you should expect before starting care.

Safety Assessment

Before a caregiver can come out into your home, a safety assessment will be completed. Most likely this will be done by an AHS case manager, but private agencies do them as well. During this safety assessment they will be looking initially for obvious things, like pets, unsecured firearms, mold, rodents, pests, fire hazards, bio hazards and general community safety. They will also look for simple things, like tripping hazards in the home, smoking in the home or whether there are assistive devices present, like grab bars in the bathroom, walkers, canes, raised toilet seats, etc. Their role is to identify and reduce risk of injury for both the client and the caregivers who will provide care in the home.

Consider Your Pets

Pets can be an amazing source of comfort and companionship for those who have them. Should you have a pet in your home, know that AHS and the traditional home care model agencies have policies that require pets to be secured away from their caregivers during their visits. Securing your pet in a crate, in another room, with a baby gate, or outdoors will be required. Please consider where you will keep your pet during your visits. 

This can prove to be a challenge for some clients with mobility issues, especially if their agency has variable visit times. You may have to work with your caregiver to call when they arrive to limit the time your pet is secured.

Should you choose the client directed model, there are agencies who will allow friendly pets to be free during care and some that can even offer pet care as part of their visits (Like us!). Be sure to ask about pet policies if this is important to you.

Slips Trips and Falls

Slips trips and falls are the most common type of injury for homecare workers, as well as our clients. A lot of that is due to our weather! We get lots of melt and thaw cycles in Edmonton, and it can be hard to keep up with the Ice.

No matter the homecare model you choose, you will need to ensure you have reliable snow removal. If you have financial constraints, there is a program called Special Needs Assistance For Seniors through the Gov of Alberta which can cover up to $1200 per year for snow removal and landscaping. Check out the program by heading to this website: Special Needs Assistance for Seniors | Alberta.ca

Your case manager can also help you with making sure you have the right equipment in your home. Grab bars, shower chairs, walkers, wheelchairs and lifts are all things which can reduce your risk of falls, but also help your worker stay safe. There is funding available for Albertans through Alberta Aids to Daily Living. If you want to go this route, please do not purchase your assistive devices prior to speaking with them and getting approval.

Helpful Technology

There are a few things you can invest in to make your life a bit easier aging in your home. While none of these are required, sometimes having them can make things more comfortable.

Smart doorbells (like the RING doorbell) are doorbells with microphones and cameras built into them. When someone comes to your door and rings the bell they will pop up onto your mobile phone. This way you can see who is there, and speak with them if you are not sure who you're looking at. This is great for homecare because you will see your staff and be able to identify them before letting them in.

Simple things like having a light with a motion sensor outside can not only dissuade criminals, but be useful for your caregiver. You do not have to remember to turn on the lights when it gets dark because it will turn on for you once your staff arrives, keeping them safe after hours.

If you have a loved one with dementia, we have certainly noted lots of families having issues with them turning the thermostat up or down in the home. If this person lives alone, that can be a big problem. A smart thermostat (Like a NEST thermostat) can be set remotely and locked to prevent people from having issues with their homes comfort.

Also, a smart smoke detector can connect to a loved ones phone. Again, if you have a loved one with dementia living alone, it may be helpful to have that installed so families will be made aware if it goes off (it works for both carbon monoxide and smoke)

Dementia can also pose problems with wandering. It can be very scary to have a loved one who wanders and may not find their way home. There are lots of options for wearable GPS trackers which also include fall detection which can be put on belt buckles, watches or necklaces.  The Livingwell Companion Go is just a good example of one available in Canada for a reasonable price point. The University of Waterloo has a comprehensive list of devices on their website here: Locator devices for people at risk of going missing | Aging and Innovation Research Program (AIRP) (uwaterloo.ca) should you wish to compare.

Agency Needs

While an agency wont need too much changed in your life to get started, they do need a few things available for their staff. Take a look at the list below for a breakdown of what a caregiver needs to provide care:

• A place for your caregiver to wash and dry their hands, including soap and a clean hand towel

• If you have oral medication, agencies typically require they be bubble packed by your pharmacy

• Some clients may need a door or medication lock box

• Staff typically need a safe place to park their vehicle

• The tools you need for them to provide care (For example, stockings if you require stocking assistance)

Aids to Daily Living

This is a program through the Alberta government that can help seniors with medical expenses. A comprehensive list of things that can be covered is available here: AADL – Benefits covered | Alberta.ca. This is a cost sharing program where clients pay 25% of the cost up to $500/year. However low income seniors do not have a co-pay. There is no income cap for this program, so it is beneficial for all seniors to take advantage of it!

You must be assessed by your case manager to qualify so don’t hesitate to speak with your AHS case manager about accessing funds if you need them.

Homecare can be immensely beneficial for those who wish to age in their own homes. If you are in need of help, know it is just a call to 811 to get things started. Take advantage of the amazing choices available to you in this province!

Getting Started - How to Access Homecare

When its time to get started with homecare, you may not know where to start. Thankfully, its actually quite easy to access care in Alberta, as long as you know what to expect! I recommend reading through our previous blog about Homecare model choices if you don’t already know all the choices available to you in Alberta.

Call 811

 In Alberta you do not need to see a doctor to access homecare. All you need to do is pick up your phone and call 811 (Family and friends can do this on behalf of someone as well)

When you call 811 they will take your information and pass it through to a case manager at AHS. A case manager is a licensed professional (an RN, a Social Worker, or an Occupational Therapist) who’s role it is to assess the needs of those who request homecare, approve care, and careplan creation where needed.

Once they receive your request for care, they will call you to discuss your needs. If they feel you may qualify for care, they will arrange a date and time for them to come out into your home and complete an in home assessment (Sometimes known as a RAI assessment)

Complete a Home Assessment

Your case manager will come out to your home to complete an interview and safety assessment. Expect this to take anywhere from 2-3 hours. They will ask you what you need help with, and what type of help you already have available to you.

It may be helpful to have a list of tasks you need assistance with. We have a handy checklist here: Care Checklist

We recommend people be honest about their needs when being interviewed. Think about your bad days when you don’t have help. What do those days look like? What would be helpful to you for care? Keep in mind, AHS is unlikely to be able to approve home support visits, but more likely to be able to approve personal care needs or respite care. Your case manager will make a comprehensive list of all the care you need. They will then use an algorithm to calculate the total hours of care you are approved for.

After Approval

During your home assessment, you will need to speak with your case manager about what home care model you are interested in. If you choose the traditional model, your case manager will develop a careplan for you after your assessment and submit it to the agency contracted for your area. You will then receive a phone call from that agency to introduce themselves and tell you who will be coming to provide your care, and when.

Should you choose the Client Directed model, your case manager will provide you with a letter outlining the total monthly hours you have been approved for. You then can select an agency to provide that care from the approved homecare providers in your area (Handy search tool available here). Your chosen agency will come out into your home to develop a careplan with you and speak to you about what type of caregiver you are looking for. They will match you with a caregiver after finding the right fit for your home. Some agencies, like ember, allow you to have a meet and greet with your potential employee prior to commencing care.

With the self managed care model your case manager would provide you with a letter outlining your total monthly hours and rates of funding, and you could proceed with recruitment of your own staff.

Choices

Should you start any one model and decide it is not the right model for you, you can simply call your case manager and request to switch models at any time. No matter what model you choose, you should expect your case manager to re-visit you at least once per year for an annual re-assessment of your care needs.

Depending on the urgency of your needs, the time between calling 811 and having a caregiver at your doorstep can be anywhere between a week to a month and a half.

We recommend folks introduce homecare into their lives sooner rather than later if they are beginning to need some help. A good care provider will work with you to maintain your independence rather than doing everything for you. If you know someone struggling to accept help, know you are not alone. Many families find the transition into accepting help in their homes challenging. We can help!

Homecare Model Choices in Alberta

The first thing you need to know before accessing homecare is that you have choices! In Alberta, there are three publicly funded models, and one private option.

No one model is better than another. They all have merit and value, so you should choose the model that is best for your own needs. If you choose a model and don’t like it, don’t worry. You also have the right to change models if the one you are using is no longer working.

Lets walk through your options. If you are interested in a quick guide, follow the link here to a printable version: Homecare Models in Alberta

You have a world of choices in Alberta!

Traditional Model

The Traditional model is the model you will be offered automatically if you don’t ask about an alternate model. It is the largest and most accessed homecare model in Alberta, servicing thousands of people in the city of Edmonton alone.

 In the traditional model, AHS awards contracts to private home care providers for specific geographical areas. Every community in Alberta has an assigned home care agency. Should you or your loved ones choose to go with the traditional model, your care will be assigned to whatever home care agency has the contract for the community you live in.

 Homecare visits in this model range from 30 minutes to 24 hours in length. There is no cost for client to access this model, as it is completely funded by the government contracts.

Benefits to this model

•  Can accommodate short or frequent care needs (For example, 30 minute visits 4 times a day for toileting)

• Zero cost for care

• Families that do not have the desire or capacity to choose their own agency do not have to do so

• Very large staffing pools available for care

• Providers are contractually obligated to provide the authorized care

 Drawbacks

•  Your staff will leave when they are done their tasks. There is no socialization built in or room for additional tasks

• Staff see many clients in a day, sometimes up to 30 if they are in a facility. This can lead to time fluctuations. Therefore time specific visits are not able to be accommodated

• No guaranteed choice of caregiver attributes such as gender, language preference, or personality traits

• Caregiver consistency is not guaranteed- It should be noted, this is the number one complaint in the traditional model. 58% of Albertans receiving homecare feel unsatisfied with the number of different caregivers sent to their home*

• Lower client satisfaction with the model (ranges between 50-70% depending on the agency you are assigned*)

• Cannot “fire” your agency if you are unhappy with their care

• Careplan is rigid and changes must be modified by a case manager

• Since staff are paid once they complete tasks, not for time in the home, it can incentivize staff rushing

Client Directed Home Care Invoicing Program

The client directed program allows clients and their families to choose their own approved private home care agency. This program is publicly funded, meaning the agency you choose will direct bill Blue cross for your care. If you are interested in this model, you should ask your case manager about it, otherwise it is likely not to be initially mentioned. This model is great for clients with complex care needs, clients who are lonely, and clients who need longer visits.

Benefits

• Ability to choose caregiver attributes such as language, gender, and personality traits (for example, quiet and peaceful vs talkative and outgoing)

• Ability to have time specific visits

• Ability to have pets free during care

• Careplans built with you, not for you

• 90% satisfaction rate (2019 pilot program results)

• Can “Fire” your agency if you don’t like them

• Consistency in caregivers and continuity of care can be guaranteed

Drawbacks

• Minimum visit lengths (Range from 2-5 hours, again depending on what agency you select) meaning short visits are not accommodated in this model

• Depending on agency selection, there may be a co-pay cost (Co-pay ranges from $0 up to $15/hr depending on what agency you select)

Self Managed Care

Self managed care allows families to hire their own staff, manage their own schedules, and create their own careplans. This model is typically the model of choice for younger people who have chronic illness. as it allows them the most autonomy over their care and staffing. If you are interested in self managed care, mention it to your case manager. They will not likely talk about it unless you inquire.

Benefits

• Ability to choose caregiver attributes

• Ability to have time specific visits

• Ability to have pets free during care

• Consistency in staffing

• Create your own careplan and train your own staff

Drawbacks

• Recruitment is your responsibility

• Scheduling is your responsibility

• No back up caregivers unless you hire them

• Payroll is your responsibility, including WCB and payroll taxes

• Funded at a lower rate than other models, meaning you may have trouble being competitive with your wages unless you are willing to supplement out of pocket

Private Care

You can always choose to forgo the public system, and hire a private agency to provide your care. This has all the benefits of the Client directed program, with the added bonus of being speedy in terms of getting care started. Agencies may be able to start private care same day if needed. Private care can prove costly rather quickly if you are not prepared, so I recommend every family explore their public funding options first. A good agency will always explain and help you exhaust public funding options before moving to private.

Benefits

• Ability to choose caregiver attributes

• Ability to have time specific visits

• Ability to have pets during care

• Consistency in staffing

• Very fast start times (Could be same day)

Drawbacks

• Care is not covered by the public model. This can be costly. Bill rates range from $32/hr to $56/hr

• Minimum visit lengths (Ranges from 2 – 5 hours)

• Unapproved agencies are not regulated

There is no one “right” model. If you need help choosing, please don’t hesitate to reach out to us to walk through your options. As always, we wayfind the healthcare system for all who reach out to us, whether you choose ember or not!

 *Health Quality Council of Alberta (2019). The Alberta Home Care Client Experience Survey. The Alberta Home Care Client Experience Survey < Health Quality Council of Alberta (hqca.ca)

Choosing a Homecare Agency

With all the choices out there, it can be intimidating to select a Homecare agency. While every family may have different priorities and preferences in what they are looking for in a provider, everyone is looking for quality care. It is unfortunate, but some homecare agencies in your area may not be reputable. We have seen families taken advantage of with restrictive contracts, hidden fees, unethical staffing practices, and upselling private care that is publicly funded. That being said, there are some amazing agencies out there! Here is a quick guide to avoiding predatory practices and screening for your best home care fit!

Check The Directory

First, lets talk about the Client Directed Home Care Invoicing Program. In Alberta, if you are approved for homecare services you can choose to select your own home care agency. This amazing program is called the Client Directed Home Care Invoicing Program. Once you are approved for care, you can begin the selection process by heading to the Blue Cross website here: Client Directed Home Care | Alberta Blue Cross®

There you can see a list of approved agencies in your area, filter results based on bill rates and minimum visit lengths.

In order for an agency to participate in the client directed program they must be insured, have WCB coverage for their staff, provide vulnerable sector checks for their employees, and provide you with a copy of what they bill Blue Cross for your care.

I recommend to all folks searching for a Homecare Agency to utilize this tool, as there is at least some oversight of care agencies through these agreements.

Google Reviews

Google reviews are a great tool to use to see what others have to say about the agencies you are considering. Take some time to read through both the good and the bad reviews posted online. If an agency does not have their reviews public, I would want to know why.

Check Their Website

It is always a good idea to check out any potential agencies website. See if they have any information about their owners. Are they locally owed and operated? Does their leadership team have a homecare background?

While websites are typically carefully curated by agencies, it is still a great launching place to start your information gathering.

Ask Your Local Senior’s Society

Senior societies can be a wealth of information for those looking into homecare. Not only can they often make recommendations of agencies, they can often assist in steering you away from agencies that have a bad reputation in your area. Don’t hesitate to call and speak with your local senior’s society, even if you are not an active member.

Call and Interview

Once you have selected agencies you are interested in, your next step is to call and start interviewing. It may be useful to have a list of questions prior to making your calls. Click here for a handy checklist of Agency questions: Agency Interview Questionnaire

Depending on your needs, you may want to focus on different questions but we recommend at least asking the following questions:

1) What is your hourly bill rate?

2) What is your minimum visit length?

3) If I need help accessing public funding for my care, will you help me?

4) What qualifications do your staff have?

5) What is your cancellation policy?

6) What is included in your contract? Am I able to cancel my contract without cost?

7) Who owns your agency? Do they have a background in homecare?

A good agency will always include “wayfinding” which is a term for helping you access public funding for your care. You should never have to pay for this service, and agencies should be enthusiastic about helping you not pay out of pocket.

A 24 hour cancellation policy is pretty standard in the industry, however anything above and beyond that could cause unnecessary charges and is worth avoiding. Likewise, the best agencies in the province have contracts that do not tie you in beyond a 24 hour notice period. Please read contracts carefully and never sign anything that makes you feel uncomfortable.

Look for an agency that is run by leaders who have extensive home care experience. That experience inside the system will ensure your agency knows the standards of practice in the industry and should allow them to be well connected should you need assistance wayfinding.

Finally, if at all possible, interview more than one agency. While you are free to switch agencies at any time, it is almost always better to start out with a quality agency rather than having to uproot later.

Here at ember, we are happy to help folks navigate our healthcare system. If you need help selecting an agency or getting started with homecare and you don’t know where to start, call us. We are a small, locally owned and operated home care agency with heart. We will get you where you need to go.