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There have been some changes in recent years regarding private 'hiring'. Some state licensing guidelines and available access have changed a bit, so I thought it might be helpful to update my notes. Licensing and information vary by state.
For example, in Massachusetts, in order to verify that a CNA is state licensed, you have to actually call the state office for licensing. They can tell you over the phone whether a license is current (including background check) and whether there have been any consumer complaints about the person, or license infractions.
The person who answered the phone when I was checking out replacement candidates for my client said that Massacusetts was planning to go online with this information this year. In Florida where I usually work and am licensed, all this information is available readily on line. You need to check your own state's information sources, but all states will have this information.
Another new development is the more widspread use of 'Level 2' background screening for home care help. In Florida the standard used to be 'Level 1' which was a check with the state police. That was the standard when i first got licensed. Now the preferred standard is to have Level 2 security check, which includes fingerprinting and FBI verification. I recently had this myself, to keep current. The state has a database of those who pass level 2. Unlike the on-line CNA license verification, though, this database is restricted so you have to call the state.
Using Florida just as an example, here are some updated 'hiring' tips. If you are looking for home care for your loved one, whether through an agency, personal referrals, or especially through advertisements including free on-line ads, you should be sure to:
A. Verify that the caregiver you are considering is Florida licensed. Here is the link to the Florida database - check it out. http://ww2.doh.state.fl.us/irm00praes/PRASLIST.ASP
-- /> You should do this regardless of the source, whether a friend, an agency, newspaper ad, or especially a free internet ad.
-- /> Florida requires a background check in order to be licensed.
-- /> Professionals listed on the database have had at least a 'Level 1' Florida State Police background check, and just more recently 'Level 2' screening, which includes fingerprinting and verification by the FBI.
-- /> The Florida healthcare professional database shows a record for any consumer complaints or disciplinary actions against caregivers. Again, check out the site.
B. I would recommend that caregivers in your home have a Level 2 background check (ask them), which as I noted includes fingerprinting and verification by the FBI.
-- /> Older CNA licensing requirements were for Level 1.
-- /> Unfortunately, the Florida database for Level 2 verification can currently only be accessed by registered institutions and agencies.
-- /> You would need to actually call the state for verification.
-- /> While you are at it, suggest that the state make Level 2 background check access available to individual consumers.
C. Be aware that while some states do have state-wide licensing for HHA's, Florida is not one of them.
-- /> For example, I have a state-issued HHA certificate from New York, which tested and licensed HHA's, much like Florida's CNA licensing. In Florida, only CNA's are state licensed.
-- /> Individual agencies can and often do train caregivers they place, and award them 'HHA certificates'.
-- /> Again this 'HHA certificate' is not regulated, and there is no record of background screening or consumer complaints.
-- /> HHA certification is better than no training, but it is not equivalent to licensing. Be concerned if the HHA certification is advertised differently.
D. Make sure your homecare CNA has a malpractice insurance policy.
-- /> This is known as 'professional liability' insurance
-- /> If you engage the CNA, get a record of the insurance carrier
-- /> Insurers will avoid caregivers with a risky history or those that they can't track.
-- /> This is a must, even if the caregiver comes from a recommended agency, registry or other source
E. Use caution, but also avoid less than professional agencies, registries, or individuals who use scare tactics to influence you.
-- /> There are many caring and compassionate caregivers who are licensed and insured who are deserving of your trust. They will not disparage other professionals.
-- /> Florida has good licensing and monitoring and a good public database compared to other states. Use those resources.
F. Be aware that there are IRS guidelines regarding hiring 'employees' and 'independent contractors'.
-- /> Don't be intimidated or discouraged by this. See my website for more information.
-- /> Look for licensing and professional liability insurance, and operation as a 'business'
G. If you have Long Term Care insurance especially, you can get more hours for your daily reimbursement rates from properly qualified independent contractors.
-- /> Florida long-term care policies have standard provisions for using licensed private caregivers
-- /> You can be reimbursed directly and then pay the caregiver, or you can designate that the caregiver be paid directly. Ask your insurer.
H. Don't forget that professional caregivers are special people. The best truly love their work.
-- /> At the same time, as much as we all like to cut costs, we can't expect something for nothing
-- /> Qualified professionals generally won't be swayed by offers of 'room and board' in place of pay
-- /> It usually does not cost any more on an hourly basis to hire a highly qualified person than an unqualified one
-- /> With proper license checking, you can get higher quality people than you can get elsewhere, at affordable cost.
There used to be a popular commercial that said educated consumers are our best customers. For more complete notes on earlier version of 'hiring privately', see my ElderCareNotebook notes.