Honing in on Homemaker Services – Podcast

Jason Dorow 

Hi, everyone, and welcome to another episode of the Champions of Homecare Podcast. Today we’re talking about homemaker services. A lot of people access these services, David, and there are several different types of homemaker services to consider. 

David Hancox 

Yeah, it’s true, Jason. And first of all, let me just say it’s nice to see you again. I know I’ve been away for a while, so it’s nice to be back here with you, and nice to see you. And you know, homemaker services is a very important service and is very valuable to a lot of people, and to help us break it all down so we can give people some good, valuable information, we are welcoming back our guest from the very first episode of this podcast series, and that is Tyler Langenfeld, Accra’s Senior Program Director of Strategic Development. So let’s just jump right in, Tyler. Welcome back. How you doing? 

Tyler Langenfeld 

I’m doing great. In fact, you know, month after a month, this podcast coming, it kept coming out, and I kept seeing all these return guests and I wasn’t one of them, and I was like, Did I say something wrong? I thought we had a good time that inaugural podcast. So I was relieved and happy to get the invitation. 

David Hancox 

Well, you know, your agent called, so we knew we had to get you back. Let’s just, let’s start at the very beginning, as Julie Andrews would say, and let’s just talk about, what are homemaker services and what makes them unique?

Tyler Langenfeld 

Sure, well, I mean, simply put, homemaking services are services that help a person manage the general cleaning and household activities. But of course, there are levels to that statement. You know, different things will fall under general cleaning and household activities, and I know we’re going to get into all that shortly. The services themselves, they’re unique in the sense, because, as you mentioned, homemaking services is technically one service, but it’s really three different services underneath the heading of homemaker. And depending on which version of homemaking services you’re accessing that’s really going to drive you know, what the homemaker can do, what license the services fall under, what’s the paperwork that’s required, what’s the application? I mean, is there training? And really at the end of the day, knowing the differences between the three versions of homemaker and knowing what the requirements are and what is allowed, that can really help people select a version of homemaking services that’s really best for them. And again, I know we’re going to get into all of that. I’m very excited. So again, thanks for the invitation.

David Hancox 

Absolutely, and we’re glad you’re here. Tell us first of all, who qualifies for homemaker services? Yeah. How does one go about becoming qualified?

Tyler Langenfeld 

Sure. Well, a person is eligible for homemaking services if they are accessing services on one of the disability waivers or either the elderly waiver or the alternative care waiver. So if they’re on the waiver and one of these two things are true, so the first one is simply the person needs support to manage the general cleaning and household activity. So think of somebody who lives alone, and they just need assistance with cleaning and managing their household. The second situation is a little bit more complicated. That would be if there’s a primary caregiver, you know, the person who is regularly responsible for the cleaning and the household activities. If that person or persons is unable to manage them or is temporarily absent, you may be eligible for homemaking services. So think of a parent whose child is accessing waivered services, and then we hire a homemaker who comes into the home and helps them manage the general cleaning. And this is another way in which homemaking services can be unique. It may be your child who is receiving the waivered services and the direct care, but the homemaking services could be seen as an assistance to the family or that primary caregiver that I mentioned if, in fact, that is the situation that is making you eligible for the services. And finally, one last point on this question. And I know this is going to get into the weeds a little bit, but bear with me. The case managers out there that are listening, they’ll know what I’m talking about here. So in some situations, the homemaking services are technically in place to free up the primary caregiver in order for them to provide unpaid habilitation to the individual receiving services. Again, the idea being that, you know, we’re going to free up that primary caregiver through homemaking services, so then they can go work with the individual on developing skills necessary to live in their home and community. Some waivers have a requirement for habilitation or skill building. And some families, they choose to deliver the, it’s called the habilitative component. They choose to deliver that themselves as unpaid supports. So the homemaking services are intended to free up that family member so they can do that. So lots of different ways somebody becomes eligible for homemaking services. You know, all the different waivers. And there’s a few different reasons why somebody would want to add homemaking services to their menu.

David Hancox 

Well, you know, Tyler, the explanation you were giving there is fascinating to me, because really, what it’s describing to me is yet one more service that’s available to individuals with disabilities or their families that ultimately prevents, or can prevent, that out of home placement that if this particular service wasn’t available, in addition to the personal care attendant services they may be receiving, or other types of supportive services that may they may be receiving, that the homemaker services, in addition to that, can also help prevent that more costly and isolating out of home placement. So that’s very exciting to know, right? And you also mentioned that there are three versions of homemaker services. So what are those different versions? And why are they necessary? And what are they? And talk a little bit about the difference between those.

Tyler Langenfeld 

Yeah, sure. And you know, again, as you just mentioned, there’s three different versions of homemaker and this is, it gets a little bit complicated, but not at first. So take a deep breath. You know, here we go, a case manager can approve basic homemaker, and that’s S5130, it’s just the procedure code behind the scenes, but that’ll be –

David Hancox 

When you say, I’m sorry to interrupt you, when you say case manager, you mean the county case manager? 

Tyler Langenfeld 

Yes, absolutely, the county case manager or the contracted case manager. So the individual who approves the services that the individual wants on their waiver, great. So if that person, they can approve basic homemaker. And you know what is basic homemaker? It’s light housekeeping and laundry. So essentially, cleaning and laundry is what we say. It’s pretty straightforward. It’s not a licensed service. It’s like, I say, cut and dry. However, if that case manager wants to expand the job description beyond cleaning and laundry, to add things like arranging for transportation, meal prep, shopping for food, clothes, and supplies, and maybe some simple household repairs. Basically, if they want the homemaker to be able to cook and run errands, that’s what we usually hear people say, I want them to cook and run errands. All the case manager has to do is add two little letters to that code that I mentioned earlier, turn that S5130 into an S5130TF, and that authorizes a service called homemaker home management. Now that sounds simple enough, but of course, it’s not, because homemaker home management is actually a 245D licensed service. Now, for the life of me, I don’t know what it is about the tasks of cooking and running errands that suddenly means that we’ve crossed a line into a service that requires licensing. But we have so we do it, and now that means all the 245D licensed requirements for the agency and the client, those are all in play now, as well as for the staff, things like the initial training, annual training, all of that. So those are the first two versions. So one more to go. The third version is one that we don’t see very often, but it’s called homemaker with assistance with ADLs. And ADLs are activities of daily living. This is again, cleaning and laundry, and then when needed, you could have that homemaker assist with things like bathing, grooming, dressing, you know, the individual’s activities of daily living. As we mentioned, this is also a 245D licensed service. But as I mentioned, we don’t see it very often, but we are able to provide all three versions. So I will sum up all that rambling very, very quickly. Basic homemaker is an unlicensed service that allows the staff to clean and do some laundry. Homemaker home management is a 245D licensed service that adds cooking and running errands to the cleaning and laundry. And finally, homemaker with assistance with ADLs is also a 245D licensed service, and that adds personal care to the cleaning and laundry. I know that was a long answer, so thanks for sticking it out.

David Hancox 

Great answer, though, and very, very thorough. And I appreciate that, because it actually does prompt a question on my part. And Jason may have a question as well, but my question is, if someone chooses to seek to be qualified for homemaker services, and they get approved, and that person comes in to say, help with the cooking and the cleaning. There’s nothing to prevent the client from sharing in those responsibilities. I mean, they could cook and clean together, or would that disqualify the client?

Tyler Langenfeld 

No, absolutely, it’s a lot of these service are always about, maybe not officially, skill building, because there is a difference between an intensive service and a basic service. But there is a natural skill building that just takes place in all of these services. So if, if the homemaker is in there, and it’s the 245D version that allows them to cook, you know, there’s nothing preventing that. Being an active participant, the client, in the preparation of that food that’s just over the course of of them, you know, experiencing life together with that

David Hancox 

Great. I wouldn’t want a listener to deny themselves the opportunity to pursue homemaker services if they were sitting at home hearing this podcast and think, well, you know, I can do some of the cooking myself, so maybe I don’t qualify. So that’s why I asked the question. Make it clear for folks that even if you can participate in some, but but need support or assistance, you may still qualify for it. So does homemaker services, is it difficult to hire for individuals? And what’s the hiring process?

Tyler Langenfeld 

Great question. As I mentioned, it really comes down to whether the service is licensed or not. I mean, if you’re looking at that basic homemaker that we mentioned, the cooking or, I’m sorry, with the cleaning and the laundry, we’re talking about an employment application and a background study for the other two versions. I mean, it’s still going to be an application and a background study, but then all the 245D requirements, they’re going to kick in. So you know, what are those things? It’s training up front before the person can start that may be reviewing policies and answering some test questions as well as, you know, reviewing some client specific plans and paperwork. It’s nothing too overwhelming, but it is another step, and we certainly do not want that extra step to be the reason somebody does not complete the hiring process. So we try to make it as simple as possible. 

David Hancox 

Tyler, for people trying to navigate these three different versions of homemaker services and this hiring process who are maybe looking, I want to see the information laid out in front of me. This guy, Tyler’s great, he’s telling me how everything works, but I need to read the information; I want to talk to someone who can talk me through which route to go. Where should they go? Who should they call to start getting set up with homemaker services?

Tyler Langenfeld 

Well, I mean, you got a couple routes. I mean, if you think you can always go back to your county case manager and talk to them and just say, like, Hey, this is something that I’m interested in, or you could call Accra. I mean, I’m not gonna lie. We’re a bunch of nerds over here, and we love to talk services. And if you want to call and say, Hey, this is my situation. And you know, I do, I qualify. We don’t approve the service, but we might say, hey, you know what? Based on the conversation that we’re having based on the things you’re saying, it seems like it may be appropriate or it’s an option. You’re on a waiver, like we said, and you seem to be in one of those two situations that we’ve talked about that may make you eligible. So let’s reach out to your your county case manager together and just relay that information and and see what they say. We love having those conversations, because that’s our job. I often think about the case manager and how they have to know a little bit about a lot of things, and our job is to know a lot about a few things, and this is one of the things that we know a lot about. So use us to to convey that information, and we’ll see. But we always want to make clear that, you know, Accra or any other provider, we’re not the individuals that says yes or no. We don’t approve the service, that is the county function, and we respect that, but we certainly want them to make an informed choice or an informed decision, and so we’re happy to help, you know, give individuals all the ins and outs of the actual service to, I don’t want to say, make a case for it, but, you know, present all the information so to see if we have something they can get.

David Hancox 

Tyler, it kind of prompts another question: are there any common misperceptions out there about homemaker services that we want to make sure we touch on today in our conversation so that we can potentially dispel them?

Tyler Langenfeld 

Yeah, there’s a couple, and this is my favorite part of the podcast. So thank you for always giving an opportunity for us to do that. So I’ve got three for you. The first one is homemaker, home management and that homemaker with personal cares, the two, 245D versions for homemaker, those two versions of homemaker services, they include the elements of basic homemaker, cleaning and laundry. So why is this important? Every once in a while, we will get a case manager who will want to approve basic homemaker for the cleaning and laundry, and then also one of the other 245D versions of homemaker for those specific tasks and you do not need to do that. Cleaning and Laundry is included in both of the 245D versions. Think of them as an expansion of basic homemaker, okay? Another one that comes out is sometimes there’s some confusion about who is allowed to work as a homemaker and who is not. There is an overall waiver rule out there that states that relatives and legally responsible individuals who are the primary caregiver, they cannot be paid to provide a service that is intended to provide relief or support for them, and homemaker services is on that list. So basically, if you are a parent and your adult child is living at home, you may be providing some services to that child, but you could not be paid to do the homemaking, since that service is meant as a support to you. This is true for step parents as well. You cannot, you know, designate one parent as the primary caregiver, and so that means the other parent could be the paid homecare. Now you’re both primary caregivers, and the service is meant as a support for both of you and one other one. This is a big one.

David Hancox 

That’s an important one, yeah.

Tyler Langenfeld 

Yeah. And this one will come up a lot, actually, is people will confuse homemaker services with another service called chore services. Okay, I’ll put it this way, your homemaker is not there to rake your leaves, okay? Your homemaker is not there to shovel your driveway. They’re not there to paint a room. They’re not there to pack all your stuff because you’re getting ready for a move. Any of those, I guess, for lack of a better word, heavier household chores, or really anything that takes place outside, like lawn care, those tasks would fall under a service called chore services. So if you’re in need of something like that, you know, talk to your case manager. But you know, please don’t have your homemaker step in and do those things. I know, in the fall here, let’s not have any homemakers out there bagging leaves. Okay, that’s all I ask.

David Hancox 

Well, I’m glad you provided that distinction, because I can see why this would be confusing for folks, so it’s helpful to hear you describe it in such a very clear, concise and very descriptive way. So I think that’s very helpful. So, and how are these services paid for? Is this something the client pays for out of pocket? Is it something that’s paid for with their waiver dollars? How are the homemaker services funded?

Tyler Langenfeld 

Yeah, as we mentioned that, this is a waivered service. So the individuals that that we work with, they’re going to be on one of the disability waivers, or the elderly, or the alternative care waiver, and just like many of our other services here, but it is a waivered service. I know we have some services are waivered, some that are non waivered service, but homemaker is a waivered service. But if you’re receiving any of thewaivers, it’s on there, and, you know, give us a call and we can talk about it.

David Hancox 

Fantastic. Jason, any other additional questions that you have for Tyler?

Jason Dorow 

No, I’m shocked we didn’t have Tyler on for 12 episodes. He’s made his case. You’ll not have to wait that long before his third appearance.

David Hancox 

It could be the Tyler Langenfeld show. 

Tyler Langenfeld 

You’re an ideas person. You’re an ideas person.

David Hancox 

Well, Tyler, thank you again for coming on today and discussing homemaker services and what I’m sure, for a lot of people, it can be very, very confusing. And again, the way you’ve shared it today and the information you’ve provided really makes it much more clear. And hopefully, our listeners out there who are not using homemaker services might find this something that they want to pursue. And again, it’s much more accessible to them based on the explanations and descriptions you’ve given. So thanks so much for being here with us today. It’s very helpful, very informative.

Tyler Langenfeld 

Thank you. And again, people don’t be shy. I mean, you may be receiving other services. So you might even be thinking, Well, I kind of already receive a service like that. We work with a lot of people who have homemaking services or receive another service that maybe is more of a direct care service, the homemaking services is approved, as, I don’t want to say, like a secondary service, but it’s in addition to help you get a full range of the services that you need and the supports. I mean, that’s the interesting thing for me, is, like how all the services fit together. I mean, deciding which version you should have of this or that. And if you’ll bear with me, I’ll give you an example, because I think about this stuff all the time, like, let’s say you got somebody who is receiving PCA services, and now that county case manager wants to add some homemaking services on top of that. Like we’ve been talking about this whole time. Well, which version of homemaker services do they want to add? I’m sure if they talk to the individual and say, Well, do you want your homemaker to be able to cook and run errands? Well, of course, they’re going to say, Yeah, that sounds great. I would love them to do that. So if I were that case manager, maybe then I’m leaning towards approving that 245D homemaker home management. That does bring all of those 245D requirements in, but this is where we come in. I mean, let’s say that we know that the person that they’re going to hire to work the homemaker services is already their PCA. If that’s the case, then we know that that staff can already cook and run errands as a PCA. So maybe sure, we should really be looking at basic homemaker because the individual will still get the extra support. All the approved tasks will be the same, but without those extra steps for the staff, the client and the agency. And that’s really what I meant at the beginning of this conversation with you know how important it is to know all the different ins and outs so you can find the one that is the most appropriate. We’re certainly not trying to avoid things to be clear, accurate, we can provide all three versions of homemaker, but that’s the nerdy part where we like to, you know, think about, well, what is the unique situation here? Well, maybe you want to consider, I know I’m just rambling. I could talk about this all day.

David Hancox 

No, but again, that’s an excellent example to use, because there are listeners out there that are going to find themselves in that very position. And so it’s great that you provided that additional information. Very, very helpful. And again, thanks for being with us today and for providing this information. And we look forward to your next visit, Tyler. We don’t know what the subject might be yet, but we look forward to your next visit.

Tyler Langenfeld 

Thank you. 

Jason Dorow 

Thanks, Tyler.

David Hancox 

As we get ready to wrap up here, we want to remind everybody, all of our listeners, that CFSS is coming. Its planned implementation date is October 1 of 2024. If you are not familiar with what CFSS is, if you haven’t started gathering information about that, please visit the Accra website in the search bar, just type in CFSS, and you’ll find a plethora of information about CFSS and the model that is going to be replacing current PCA services, both traditional PCA and choice PCA. So you can begin to educate yourself a little bit about this impending change in direct services. So thanks again for tuning in. Jason, any final words?

Jason Dorow 

Just to be clear on CFSS, David, there’s nothing else that clients have to be doing right now. They just need to get to the website, start familiarizing yourself. It’s not until October that you’re actually going to have to start taking any kind of action, and that will happen at your regularly scheduled assessment. 

David Hancox 

So correct – now you’re just getting acquainted, absolutely. And thank you for that clarification. I don’t want anyone to think that they’re behind the game, necessarily, but it’s a good idea to start educating yourself so that you can be aware, so that when your next next assessment date is due, that you’re a little bit more prepared to to participate in the process, because it really is about consumer choice, and we want to make sure that people are prepared and educated to make those choices. So thank you for that clarification. Make sure to follow us and review the Champions of Homecare podcasts, wherever you get your podcasts. And Jason, that would include where?

Jason Dorow 

Inlcude Apple podcasts, Spotify, YouTube, whatever your preference is, and hopefully we’ll see you there again soon.

David Hancox 

Fantastic. Thanks, Jason, good to see you again.