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Nobody loves a “yes man”.

Your best friends are the ones who will tell you the truth because it’s what you need to hear instead of telling you what you want to hear.  We’ve all seen stories lately of celebrities who really could have used a few more people around them to tell them the simple word no.

Sometimes, when you are looking for the right home care agency, you need to hear the word no as well.

It doesn’t matter how long you’ve been in the business as a home care provider.  If you are doing things right, then not every client is for you.  The key to long term success is recognizing what the right client for you is and learning to say no to clients that will result in bad relationships, regardless of how much business they are trying to give you.

Back before Orville Redenbacher ventured out into various snack products, they used to run a commercial that summed up their philosophy to making popcorn.  “Do one thing and do it better than anyone else.”  This same creed should apply to every business, especially in home care.

In Arizona, in home care is classified in two categories, medical and non-medical.  Medical home care agencies should be licensed with the Arizona Department of Health Services and meet the requirements set forth by state regulations.  Non-medical home care agencies do not currently have a regulatory agency or guidelines.  The business license hanging on their walls is no different than that of McDonald’s or Home Depot.  We don’t want Home Depot making Big Macs, nor do we want McDonald’s selling us shower heads, so it’s important that a home care company define itself and do what it represents.

So does this mean that it makes more sense to classify your agency as non-medical, then simply provide medical services and avoid the regulatory inconveniences?

For many companies, the answer is simply yes.  As a prospective client, however, this lack of honesty should be a warning sign that the company does not hold to the theory that says “Just because something is legal, does not mean it is right”.  Most people have no idea what the difference between medical and non-medical is.  Let’s clarify some of those;

1.  Medications

This is the most common blurred line if you will.  Non-medical home care agencies can remind clients to take medications that are already set up in medication organizers, or assist a client with no cognitive impairment to open pill bottles and hand them the number of pills the client requests.  Non-medical home care agencies should not, regardless of the qualifications of the care provider, be setting up medication organizers or making any determinations about dosage or if the medication is appropriate.  That should be left to pharmacy technicians or medical home care agencies.

2.  Nurse Supervision

This is a clever marketing scheme designed to make clients feel more comfortable, but if you are providing non-medical services, what is the relevance of a nurse?  If the agency is assisting with bathing, dressing, meal preparation, light housekeeping, laundry, transportation and medication reminders, having a nurse supervise is the equivalent to going to a wound clinic to have a band-aid put on a torn cuticle.

3.  Full Lifts

This is a quick way to end up with a worker injury, a client injury, and a large amount of liability.  It is critical that the agency you choose define the limits of assisting with transfers, positioning, etc.  If getting the client out of bed safely requires two people, then either a capable family member or friend helps, you hire two caregivers for that period, or you consider equipment such as a hoyer lift.  This is an area where the premise of never saying no can result in serious ramifications.

4.  Behavioral Issues

We all recognize that with some cognitive deficits can come odd behaviors.  Some of these can be pleasant enough, such as repeating questions or telling the same story over, but some can be anything but pleasant.  Verbal harassment, physical harassment and sexual harassment are issues that caregivers face working with clients with dementia.  But non-medical home care is simply not the appropriate avenue for someone with significant behavioral issues.  You will find that a company that takes on these clients will go through a significant number of caregivers, or send caregivers that will either tolerate anything or respond back when provoked.  None of these options ends in a positive way.

There’s no question that when you are trying to secure care for a loved one, the word no is not high on the list of what you want to hear, but understand that the company who is willing to tell you no when it could cost them business is probably more interested in the care of your loved one than their bottom line.