Workplace Wednesday

Home Care

Home is where the heart is…and most of the patients! Home care is the FASTEST growing segment of healthcare in America…and for good reason! When you are sick…where do YOU want to be? Yep, home. And your patients do, too.

It takes a special person (like YOU) to work in someone else’s home. Your unique combination of being able to work with limited supervision and a desire to give all of your attention to one person makes you the ideal employee as a home care CNA!

Overview

As a home care CNA, you will be caring for one (usually) patient in their home. Remembering that you are a guest in their home is key to a successful patient/caregiver relationship. Being able to adapt the way you usually do things to their preferences, keeping busy during the slow times, and being able to maintain professional boundaries while still showing care and compassion takes a special kind of caregiver.

Home care CNAs often work in isolation, away from other medical professionals. Other than an occasional trip into the office, or a rare supervisory visit, it is usual to have little contact with other medical team members. So, home care CNAs need to be internally motivated, self-starters, and not require a lot of supervision to get their job done.

There are two types of home care assignments: visits and shifts. Visits means that you will see multiple patients in the same day, offering care in small time increments (usually around an hour) then moving on to the next patient. Shifts means you spend several hours with the patient in their home. Many home care agencies offer both types of schedules.

“Caring about others, running the risk of feeling, and leaving an impact on people, brings happiness."

Harold Kushner

Working in home health brings very specific challenges, and great rewards. Read below for some specifics.

1. Pace

Healthcare in a home setting is slower-paced. You don’t have a ton of call lights going off or 10 patients that need your attention all at the same time. Instead, you have one patient that needs your undivided attention. This suits you perfectly.

But, although the pace is slower, it doesn’t mean that there is nothing to do. Home Care CNAs are in the patient’s home to help with anything and everything that the patient needs help with. Personal care tasks like bathing, dressing, grooming, feeding and toileting are certainly a part of your normal day to day routine, just like any other setting. But you may also responsible for helping the patient maintain a clean environment, socialization activities, easy meal preparation and (in some cases) even transportation and laundry. When the patient is awake, there will be a lot to do to keep them clean and comfortable and see that all their needs are being met. But when they are resting, you will also be responsible for light housekeeping, meal preparation and other common household tasks. Home care CNAs shouldn’t have a lot of “down time” because if you have time to lean, you have time to clean.

You need to be comfortable in an unstructured, non-clinical environment, and leave your personal issues at home. Having the discipline it takes to get the job done, even when no one is watching, will also be required. From personal care to promoting a safe and clean home, everyone can count on you!

2. Type of Patient

Home care clients can vary greatly from really sick to just needing a helping hand. Every patient is different, every home is different and every approach will need to be different.

Home care generally comes in two varieties: short visits and longer shifts.

CNAs that are doing visits will be scheduled to see multiple patients in a day. You will need to complete the care required for Patient 1 before leaving that home and traveling to see Patient 2. How long you will remain with each patient will depend entirely on how much care that person needs and what you are assigned to do. Some visits can be as short as 30 minutes (for shower assists) or as long as 2 hours (for more complex care). Remember, care is individualized based on what the patient needs, so there is no “one size fits all” home care plan.

If you are a home care CNA that works in a patient’s home for an entire shift, you will be spending hours with that patient, probably because they require much more care or supervision.

Being able to go with the flow is in your blood. Discovering what the patient needs from you, monitoring for changes in the patient’s condition, listening to stories, engaging them in activities and keeping them clean and happy is your mission in life, and doing it all with a smile on your face is as natural as breathing to you. Your deep respect for your patients and their possessions shows clearly with every patient interaction.

3. Number of Patients

Home care is where it’s at! One patient to care for, one patient that can receive all of your attention, one patient that you can really get to know.

On some rare occasions, a home care CNA might have two patients living in the same home, but that is usually rare. Since one patient is the norm, you can take your time with each skill and not feel rushed like in other settings.

Even home care CNAs who do visits only have one patient at a time to focus on. Imagine…only ONE patient! No call lights. Just one patient at a time to devote all your time and attention to. To finally be able to take the time to make sure it’s done RIGHT, not just RIGHT NOW.

4. Oversight and Supervision

Home Care CNAs must be self-motivated. They are usually working alone with the patient, without a supervisor on site to make sure you stay on task and get everything done. This is not a good setting for procrastinators.

While still part of a healthcare TEAM, they won’t interact with other team members very often and have to be able to handle isolation.

But the most challenging part of a Home Care CNAs job is often the supervision of their work patterns by the patient’s FAMILY, or even the patient themselves. This is an important consideration when thinking about a career in home care. You are in someone’s home. They are paying for your services. They will want things done a certain way, maybe differently than you would want it done yourself. You have to be able to adapt your skills to their preferences to be successful in home care. Oversight and supervision from patients and families is often way more challenging than oversight by a nurse.

5. Length of Patient Interaction

Visits as short as 30 minutes to 24 around-the-clock live-in care and everything in-between. Home care works around the patient’s needs.

Every situation will be different, and the needs of the patient may change with little notice. When an agency notifies you of a possible assignment, they will tell you whether it is a visit or a shift. Make sure, if you commit to a shift, that you can work the entire shift. The patient (or their family) is depending on you. Reliability is one of the most important traits required in home care.

6. Schedules and Shifts

There is a lot of flexibility and variation in home care schedules. This type of work is often preferred by parents of young children or adults returning to school because of the flexibility in hours or shifts. You can work visits around your schedule, or take on a short 2 hour shift between classes. Since every patient is different, and will have different needs, there is a home care assignment out there that can work around the most challenging schedule needs you might have.

Some patients need a live-in caregiver to stay around-the-clock. This type of assignment isn’t for everyone, and requires a special person. But, if right for you, will include room and board in addition to a salary. The salary is generally lower because of the room and board. This can be advantageous in certain circumstances, though. Most home care, however, will be provided in visits or shifts.

7. Pay and Benefits

Home care usually does not offer the highest pay for CNAs, but they aren’t the lowest paying, either. It’s all about the type of work you will need to do with the patient! But remember, you are only taking care of one single patient, so the pay offered may be a bit lower than in settings where you have to care for MANY patients at the same time.

Home care CNAs that work visits will be paid per visit. This means the faster you provide care, the more patients you can see in a day and the more money you will make. Home care CNAs that work shifts will be paid an hourly rate for the time they are with the patient (just like other positions). The length of the shift will depend on the patient’s needs. In most cases, your rate (per visit or hourly) will depend on the type of care required by the client. More complex care will require a higher rate of pay. The rate of pay will also depend on benefits such as paid time off, tuition reimbursement, health insurance, etc. The more benefits offered, the lower the hourly rate of pay will be.

Something to note, however, is that some home care companies do not classify the CNAs working for them as employees. If you are classified as a subcontractor, you will be responsible for withholding and filing your own payroll taxes (which can be quite

8. Learning New Skills

Home care CNAs are there mainly to provide personal care skills and maintain the patient’s environment. Personal care skills like bathing, dressing, feeding, grooming and toileting are not considered clinical skills, so the pay rate is often a bit lower.

Generally speaking, there are very few new skills that would be required. In rare instances, you might have to learn how to work new equipment (like mechanical lifts, prosthetics, electric scooters/wheelchairs, etc.) that the patient uses on a regular basis. Home care CNAs need to be flexible and willing to learn, to better serve that individual client. But they also need to be aware that the majority of care provided is non-medical personal care. 

9. Opportunity for Advancement

Home care offers very little opportunity for advancement.

Summary

It pays to pick the right workplace…and your personality will have a huge impact on your overall success. Often, we have unrealistic expectations and the reality doesn’t live up to what we THOUGHT the work would be like. Knowing what to expect and making sure you have the skill set to perform well will go a long way to ensuring your success, no matter WHERE you decide to work in healthcare!

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