How do home care agencies bill you?

The home care I have for my mom, bills me weekly with the name of the HHA and her hours. You always want to see the hours because suddenly a Friday evening is now considered weekend time with a $1.00/hr increase. I have specific times when they come and go and they have to call in by a landline phone from my home so that clocks their time. I have seen where one has stayed an hour after her time and I was billed for that in which I raised the roof. Some will take advantage of the situation so I review each weeks bill very carefully. My advice is to interview a few agencies, meet a few of the home care people that will be taken care of your love one and stay around very closely to home and pop in often different times of the day and night. You just may find them sleeping while your mother is running around the house naked... Always review that bill before sending the checks. Good Luck

Living South, the issue of doctor visits is an important one. I raised this as well in terms of the schedule with the agency I'll probably go with, and was assured that they could be flexible. But saying one thing that's not in their contract is another, so when I rewrote the contract I added a flexibility clause for scheduling.

Another potential agency bit the dust yesterday when I found out the "account exec" contrary to my instructions directly called my father, twice. If he can't follow instructions now, I don't want to waste any more time with him. I hate these aggressive marketers and guys with fancy titles and their attitude that caregivers seem to be dumb women and need to be enlightened by them, would-be Wall Streeters. Yuck.

Katie, I'd be more interested in learning the details of your itemized bill. Is it specific time spent on specific projects, something like that? Such as x hours spent on dishwashing, or cleaning, and x hours spent on bathing assistance?

I hadn't even thought of an itemized bill. Thanks for sharing that information.

The one I talked to yesterday didn't mention the mileage costs about driving, but I'm sure that they charge. I have a relative who works for the council on aging and she gets 30 cents per mile. If they don't drive their own car then they would have to drive mine
( and then I wouldn't have a car to go anywhere! )
I have to decide between a private caregiver and an agency. I was worried about any liability for an accident in the home, but I may have to go with an individual.
I asked the agency if they could come if one parent had to go to the ER, for instance, and sit with the other parent - they said 'oh we don't do emergencies.'
(Then what would I do - take the other parent to the ER also?)
This one agency also said a minimum of four hours per day and that they wanted to come every week same day - not sure how I am supposed to schedule a doctor visit only on one particular day?
Parents are just a bit over the limit for Medicaid and everyone says that I need some respite, but trying to ferret out which agency or which individual is getting kind of stressful as well. The agencies around here seem to charge around $20 - 30 per hour.
Mom doesn't want 'strangers' in the house, so I need to get this right and find the right person - cannot afford to have them come in but maybe 3 times a month.

The agency I used provided two caregivers. Approx 10 hrs per day.

I was constantly having to remind them that I wanted the invoices weekly. The first month or two they wanted me to be in a monthly billing cycle. It was just too much. Since the bill was reimbursed by the insurance company...I didn't want to have thousands of dollars in the "float"

I required a hourly itemized bill.

Not a dumb question at all! If my mother needs in-home help (which she already does, for shower monitoring), it will be an agency. I had no idea how the billing works (my friend who used in-home helpers for her parents used freelancers).

I don't think my mother could understand the contract, quite frankly. I will not sign anything for her, so one of the Golden Boy brothers will have to come down and tkae care of it (also take care of payment if she can't -- she has the $ but doesn't like to write checks anymore, etc.). My mother made two of them the successor trustees for her trust, so they can do the financial stuff.

Interesting to know how expensive it can be to take elders to medical appointments. I have been forced to do that, and get little appreciation for it (plus, it takes hours...).

(I was "forced" to take her car in exchange for being her taxi driver...I put limits on it from the beginning -- transportation to medical/dental appts. and Mass plus one shopping trip/week -- which wasn't taken well. At this point I have MORE than "earned" her car, but she (and one Golden Boy brother!) still think *I* made out from the deal!)

It's not at all a dumb question.

Isn't it funny how squeamish we can feel about asking when it comes to money? But after quality control - how are staff vetted? What qualifications do they have? - what are your charges and how do you organise billing are basic and obvious questions which you shouldn't feel at all embarrassed to ask. Why not ring round a few and get their terms and conditions in writing?

I don't think it's unreasonable for an agency to make sure of their money before they incur substantial costs by sending a caregiver to somebody's home for a month. Sad but true that they have probably encountered families who kick up a fuss afterwards and refuse to pay, and the agency could very quickly find itself hundreds or even thousands of dollars out of pocket.

A reputable agency will bill either weekly or monthly in arrears, giving an itemised invoice. You can give them the kind person's name and contact details for billing purposes; or you may find that the agency prefers the payer to sign the contract. Has this person agreed only in principle, or is it a stronger commitment than that?

The agency I use bills weekly and I aim to cut a check within 5-days

My friend uses an agency which required a deposit for bi-weekly billing

Is the person not able to pay the bill themselves? There may be funds available from Medicaid if the person qualifies for that program and number of hours each week very limited. Though it varies from state to state.

They usually bill monthly if an agency. Yes, they usually require a deposit.

It's not a dumb question at all. In fact, I was surprised at how aggressive some agencies can be about getting paid, as I've been look for private duty help as well.

From what I've seen of their contracts, one may take payment by credit card, others will only take cash or check. One wants authorization for automatic charges, apparently with no billing documentation as it's not mentioned in the contract.

Another sends invoices and expects payment w/I 10 days.

Most want up front deposits equivalent to 2 weeks' worth of service. The deposit is held in a non-interest bearing account until service is all through, then it's either applied toward the last amount due, or it's refunded. I have yet to see a contract specifying time limit within which the deposit is refunded. Could be immediate, could be whenever they feel like it.

There also are no provisions that the funds are to be held separate, as a deposit only, and not used for operating costs.

Be aware also that transport to medical appointments can be costly. From what I've seen and read, per mile cost ranges from $.4x to $.8x. I think over $.80 a mile is really gouging.

There are liability issues as well. One company wants up front indemnification and waiver of liability for anyone who drives the client's car for appointments, shopping, whatever. Another mandated that the caregiver be added as an insured on the client's vehicle policy.

If there's one consistency from what I've learned, it's that these companies and agencies don't put the client first. They have egregious contracts and focus on what they're getting out of the relationship.

I hope there are others out there that are service oriented, and that I can find one soon as I'm not impressed with what I've seen so far.