Advances in senior healthcare and geriatric care management are enabling more people to remain in their homes longer.

Where, in the past, many chronic conditions used to require early placement in a skilled nursing center, today with appropriate levels of medical supervision and assistance, a senior is often able to age in place with minimal intervention.

With the move toward increasing in-home geriatric care, however, some problems have cropped up. Many states do not require on-site supervision for home health aides, and training requirements vary widely.

In fact, only 29 of 50 states require home health agencies to be licensed at all.

The quality of in-home care has in recent years become a controversial, hot-button topic for senior health experts and home health industry lobbyists. Many states are cracking down on licensure and training requirements in order to improve the overall quality of care and ensure the safety of our aging populace.

California toughened its home care regulations this year.

Following the publication of a 2011 report detailing a lack of home health agency oversight, California has passed legislation to increase its monitoring of in-home care providers.

The report found fault with a system that failed to require background checks of individuals entrusted with providing care to vulnerable elderly Californians, allowing numerous cases of senior abuse to be perpetrated by unlicensed providers.

Subsequently, California's Home Care Services Consumer Protection Act of 2013 now requires home health agencies to conduct background checks on health aides, list them in an online registry, and provide at least five hours of training to employees.

Agencies must also obtain licensure from the state showing that they have complied with these requirements.

Hiring private home health aides can be risky if you don't do your homework.

Unfortunately, many seniors continue to hire private, non-agency health aides, and these workers are not required to submit to background checks or any oversight. The California report found that many home health providers offering services privately on Craigslist had criminal histories and often victimized the very people for whom they were tasked with caring.

We don’t yet have state regulation here in Ohio, so there are a few things you want to know about an agency or private caregiver before you hire a home health aide or nurse to take care of an elderly relative—

• If hiring privately, ask any potential candidate to submit to a background check (easily obtained from your county sheriff's office for a processing fee).
• You should ask the caregiver to provide you references from current and former clients. Make sure to check references even for home health aides or nurses that an agency might refer to you as well.
• If you hire through a home health agency, check that agency's licensure status (if your state requires licensure), as well as investigate any outstanding complaints made with your state's Centers for Medicare and Medicaid Services (CMS), the Joint Commission, your county health department, or the Better Business Bureau.
• Do not hire a home health aide who is unlicensed or untrained.

So what's the takeaway?

Aging in place isn't becoming more difficult due to this legislation—it's improving.

By establishing standards for eldercare and requiring competence and integrity from home health providers, we can make it safer for seniors to remain in their homes while receiving supportive care. This is where hiring a knowledgeable, experienced geriatric care manager can be so valuable.

If you are considering supportive care for an elderly relative who lives alone, you'll want a knowledgeable, certified eldercare provider.

Geriatric care managers are not the same as home health aides.

Although they typically hold advanced nursing or other health care degrees, they are more than skilled nursing providers—they are more like a supportive care concierge. They actively anticipate and address a client's physical and emotional needs and seek to make the day-to-day management of care more efficient, without becoming intrusive.

For minimal care needs, a geriatric care manager may simply be brought on board to perform regular wellness checks and to coordinate medication management, therapy compliance and assist with broad needs. For seniors in need of more assistance, a care manager may work to coordinate home nurse visits, physical therapy appointments and help you to develop an overall strategy for aging in place.