Riverstone Healthcare-FAQ

Frequent Asked Questions

What should I consider home care services?

People sign up for homecare medical or non-medical services upon their needs. Typically, for non- medical services, people request at least housekeeping and laundry, shopping and cooking, transportation, and medication assistance. Before you sign up homecare, you would like to know if a health condition puts you at risk of falling or self-neglect; or if you need medical assistance.

How can I feel secure if I'm alone at night?

Riverstone Home Care provides a 12-hour shift live-in program for your convenience. Lifeline Service is perfect for a senior who feels comfortable being alone at home at night but wants a safety security in case of falls or other emergencies. If you need help, you just press the button (usually a bracelet or a pendant). We will be right over. You pay a basic monthly fee and then on a call by call basis. For 12-hour shift live-in, Riverstone HomeCare team will have your personal assistant staff with you always.

What are my payment options?

Riverstone Home Care accepts checks, most major credit cards, or automatic draft from your bank account.

How am I sure that my caregiver will do their work?

When you set up service with Riverstone Home Care, we'll decide together on a Plan of Care. This is turned into a task checklist for your Personal Assistant. We monitor the work to make sure your caregiver is following this plan.

Do you have a shift minimum?

No. We have no shift minimum. Howeve, for live-in program, a client must sign up for a least 8 hours of service per week in any configuration.

Do you require a long term contract?

We request a 48 hour notice for a minor schedule change and a 2 week notice to cancel service.

How many different Personal Assistants will I have?

Our job is to make your experience pleasant and to have as few different Personal Assistants as possible. If the schedule calls for more than one Personal Assistant, we have the charting EMR (Electronic Medical Chart) system that allows one Personal Assistant to communicate and seamlessly transfer your service to the next colleague so that we can continue our service without disruption.

How quickly can you start service?

In most cases, we do initial assessment within 24-48 hours and can have the Plan of Care in place ready after the initial visit. In general, the requested service can be started within a week. We know how important to start service at you or your doctor’s request. Our HomeCare/Healthcare team will work closely with you and your medical providers for your convenience.

How much does Riverstone HomeCare cost?

Our fees range from $18/hour to $38/hour, depending on your job requirements. The Care Plan designed for your needs will determine the fees and requirements. To learn more about your service fee, please call our office for further detail.

The cost of service varies on a case-by-case basis. Riverstone Healthcare In-home Services coordinates billing with many payor sources, including Medicare (pending), Medicaid (pending), Managed Care insurances, Long-term Care insurances, and Workers’ Compensation. We also accept personal payment for services.

Please contact Riverstone Healthcare Services office for more information.

I have a Long Term Care Insurance Policy. Do you accept this for payment and will you help me use it?

Yes. Most Long Term Care Insurance Policies include a homecare benefit.

What services can Riverstone Home care caregivers provide in the home?

Riverstone Home Health is a WA DOH approved in-home services provider. Our caregivers can provide both in-home skilled medical and non-medical care. This includes, but is not limited to:

Non-medically skilled homecare

Sitter services

Homemaker assistance with Household services, such as housekeeping, shopping, meal planning and preparation, and transportation

Personal care such as assistance with dressing, feeding, and personal hygiene to facilitate self-care;

Companion care

Intermittent care

Care for people with disabilities

Daily living activities

Respite care

Medically skilled services

Private duty nursing

Therapies (i.e. physical therapy, occupational therapy, Speech therapy)


Wound care

Respiratory Services

Nutritional Services

Home Medical Supplies/Equipment Services

Pediatric care

Behavioral health care

What is Private Nursing Duty?

“Private Duty” is a broad term that encompasses all types of in-home care. It includes “custodial care”, “companion care”, and “live in care”. It also includes care provided by a nursing assistant, a nurse or another skilled professional, such as a physical therapist. Care is considered “private duty” when it is being paid for by a long term care insurance policy or by the patient or his/her family. It can be short or long-term and is often requested by patients that prefer to stay in the comfort of their own homes, rather than in a nursing home.

Private duty services range from companionship care to highly skilled nursing care, during periods ranging from a brief visit, to 24 hours a day. Private Duty caregivers are often enlisted to perform light home management, errands, meal preparation, housekeeping, or transportation to the grocery store, pharmacy or doctor’s office. Medical or ‘skilled’ Private Duty offers care to those who require medically intensive care for long-term chronic conditions, or skilled nursing care following a hospital stay, or at the end of life.

Examples of Private Duty Home Care

  • Nursing Care
  • Long-term Care of Chronic Disease
  • Ventilator Care/ Trach Care
  • IV Administration
  • Tube-feeding administration
  • Ostomy and Stoma Care
  • Grooming and dressing
  • Recreational activities
  • Incontinent care
  • Oral Care
  • Medication reminders
  • Bathing or showering
  • Light housekeeping
  • Meal preparation
  • Respite for family caregivers
  • Errands and shopping
  • Companionship
  • Reading email or letters
  • Transportation
  • Changing linens
  • Laundry and ironing
  • Organizing closets
  • Care of house plants
  • 24-hour emergency response
  • Family counseling
  • Phone call checks

What makes Riverstone Home Health different from other home healthcare providers?

Riverstone Home Health Services is committed to providing you with the best possible customer service. Our staff is available 24 hours a day, seven days a week. We offer free in-home consultations and home safety evaluations at the start of your program and routinely thereafter based on the client’s needs. Furthermore, our caregivers and healthcare professionals are regularly supervised and evaluated to ensure that Riverstone Homehealth’s high service standards are met.

How do I know if my caregiver is qualified?

Riverstone Home Health Services adheres to the highest standards for hiring our staff. Our caregivers undergo thorough interviewing, testing, and screening prior to employment. This includes performance of multiple background checks, reference checks, license verifications, driver record screenings, and a formal orientation.

Additionally, caregivers are regularly supervised and evaluated by management to ensure that you or your loved one is receiving the attention they deserve. We are highly skilled and sensitive to the physical and emotional needs of each patient.

What is nurse delegation?

National Council of State Boards of Nursing defines delegation as “transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains accountability for the delegation.”

Activities That May be Delegated

The nursing process can be utilized as a framework to support the RN in delegating patient care activities to support and assistive personnel. Prior to delegating, the RN assuming care of the patient is responsible for completing an assessment of the patient as well as reviewing the patient’s individualized plan of care. The RN should also verify proper training and competency evaluation of UAP before a task is delegated. Regardless of how simple the delegated task may seem, the RN is responsible for patient outcomes. Institutional policy and regulations from state boards of nursing and state departments of health may govern the activities of support personnel.

The following lists are examples of patient care activities that might be delegated:

Direct Patient Care Activities

Vital Signs

  • Take and record blood pressure, respirations, temperature, and pulse rate
  • ƒ
  • Obtain daily weight
  • ƒ
  • Apply leads and connect to cardiac monitor
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  • Obtain 12-lead ECG
  • ƒ
  • Perform chest compressions in life support situations

Intake and Output

  • Measure and record intake and output
  • ƒ
  • Collect specimens

Activities of Daily Living

  • Perform total or partial bed bath
  • ƒ
  • Perform perineal care
  • ƒ
  • Shave
  • ƒ
  • Wash hair
  • ƒ
  • Perform mouth care
  • ƒ
  • Change linen and assist with making occupied bed


  • Feed patient ƒ
  • Calculate and record calorie count

Skin Care

  • Perform back care
  • ƒ
  • Prepare skin for procedure
  • ƒ
  • Perform skin prep for operative procedure

Activity and Mobility

  • Assist in ambulating patient
  • ƒ
  • Perform passive and active range of motion
  • ƒ
  • Position
  • ƒ
  • Turn and reposition patient
  • ƒ
  • Assist with transfers

Respiratory Support

  • Set up oxygen
  • ƒ
  • Assist patient with using an incentive spirometer ƒ
  • Assist patient with coughing and deep breathing exercises
  • ƒ
  • Perform oral suctioning using an oral suction device


  • Set up patient room (suction canisters, cables for continuous cardiac monitoring,tubing for chest tubes)
  • ƒ
  • Orient patient to room environment
  • ƒ
  • Set up and calibrate hemodynamic monitoring equipment
  • ƒ
  • Obtain necessary supplies for sterile procedure
  • ƒ
  • Discontinue peripheral intravenous catheter
  • ƒ
  • Perform postmortem care

Indirect Patient Care Activities


  • Clean equipment in use and stored equipment
  • ƒ
  • Clean environment, including counter tops and desk tops
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  • Clean and defrost food refrigerators
  • ƒ
  • Clean patient care area after transfer or discharge
  • ƒ
  • Clean patient care area after procedures are completed
  • ƒ
  • Empty waste baskets in patient rooms and unit
  • ƒ
  • Empty linen hampers
  • ƒ
  • Remove meal trays
  • ƒ
  • Clean supply carts
  • ƒ
  • Clean and restock procedure rooms
  • ƒ
  • Make unoccupied beds


  • Deliver meal trays
  • ƒ
  • Obtain and deliver supplies
  • ƒ
  • Obtain and deliver equipment
  • ƒ
  • Obtain and deliver blood products ƒ
  • Check laboratory specimens for appropriate labeling
  • ƒ
  • Deliver specimens to clinical laboratory

Clerical Tasks

  • Place pages
  • ƒ
  • Place and answer phone calls
  • ƒ
  • Assemble, disassemble, and maintain patient chart
  • ƒ
  • Transcribe physician and nursing patient care orders
  • ƒ
  • Schedule diagnostic tests and procedures
  • ƒ
  • Order necessary office supplies and forms
  • ƒ
  • Sort and deliver mail
  • ƒ
  • Assist with unit orientation for float and registry ancillary personnel
  • ƒ
  • Prepare charges for unit-based billing
  • ƒ
  • Problem solve and locate lost charges
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  • Keep unit log books up to date with patient admissions, transfers, and discharges
  • ƒ
  • Maintain awareness of nursing bed assignments
  • ƒ
  • Update and retrieve information systems data

Stocking and Maintenance

  • Stock patient bedside supplies
  • ƒ
  • Stock unit supplies
  • ƒ
  • Stock utility rooms
  • ƒ
  • Stock treatment, examination, and procedure rooms
  • ƒ
  • Stock nourishments and kitchen supplies
  • ƒ
  • Check electrical equipment for inspections due dates
  • ƒ
  • Stock linen cart

Activities That May Not Be Delegated

Nursing activities that may not be delegated include:

  • Performing an initial patient assessment and subsequent assessments or nursing
  • interventions that require specialized nursing knowledge, judgment, and/or skill ƒ
  • Formulating a nursing diagnosis
  • ƒ
  • Identifying nursing care goals and developing the nursing plan of care in conjunction with the patient and/or family
  • ƒ
  • Updating the patient’s plan of care
  • ƒ
  • Providing patient education to patient and/or family
  • ƒ
  • Evaluating a patient’s progress, or lack thereof, toward achieving desired goals and outcomes
  • ƒ
  • Discussing patient issues with physician
  • ƒ
  • Communicating with physicians or implementing orders from physician
  • ƒ
  • Documenting the patient’s assessment, response to therapeutic interventions, in the patient’s plan of care
  • ƒ
  • Administering medications
  • ƒ
  • Providing direct nursing care

When to decide to have Nurse delegation?

Deciding to Delegate

A consideration of the likely effects and consequences is critical when deciding to delegate. Assessment of the following factors must occur before deciding to delegate a nursing activity to anyone, for example, RNs, LVNs, UAPs (The American Nurses Association (ANA) defines UAP as “an unlicensed individual who is trained to function in an assistive role to the licensed nurse in the provision of patient/client activities as delegated by the nurse.” Activities that may be delegated by RNs to UAPs are categorized as either direct or indirect patient care. ), or other healthcare team members.

Potential for Harm: The nurse must determine how much risk the activity carries for an individual patient.

Complexity of the Task: The more complex the activity, the less desirable it is to delegate.

Only an RN should perform activities requiring complex psychomotor skills and expert nursing assessment and judgment.

Amount of Problem Solving and Innovation Required: If an uncomplicated activity requires special attention, adaptation, or an innovative approach for a particular patient, it should not be delegated.

Unpredictability of Outcome: When a patient’s response to the activity is unknown or unpredictable (depending on how stable the patient is), it is not advisable to delegate that activity.

Level of Patient Interaction: Will delegation of a particular activity increase or decrease the amount of time the RN can spend with the patient and the patient’s family? Every time a nursing activity is delegated or one or more additional caregivers become involved, a patient’s stress level may increase, and the nurse’s opportunity to develop a trusting relationship is diminished.

How do I reach someone after hours?

Riverstone Home Health personnel are available to answer the phone 24 hours a day, seven days a week, including holidays and weekends. Our on-call RN or medical supervisor is accessible 24 hours a day, seven days a week. Call our office with any questions or concerns you have!

What is the difference between “skilled” and “unskilled” medical care?

“Unskilled” or “Non-medical” care typically refers to companion and personal care activities such as bathing, grooming, dressing, as well as assistance with meal preparation, light housekeeping, and running errands. It could also include medication reminders, assistance with ambulation, and transportation to medical appointments. These types of services are typically provided by Home Health Aides (HHAs) or Certified Nursing Assistants (CNAs), and can be arranged for anywhere from a few hours to 24-hours a day. “Unskilled” or “Non-medical” care is often sought by the elderly, new and expectant parents, individuals with disabilities, and those transitioning from a hospital or medical facility to home.

“Skilled” medical care follows a specific plan of care under the supervision of a Physician, Nurse (RN/LPN/LVN), or Therapist, and involves home healthcare services such as nursing care; physical, occupational, speech, and respiratory therapies; as well as social services and hospice care. Skilled medical care in the home can help provide a comforting solution to residing in a hospital, nursing home, or assisted living community.

Why should I hire Riverstone Home Health to care for my loved one rather than finding a caregiver on my own?

Hiring a caregiver can often become a confusing and frustrating process. With all of the choices that are available, it is important to be aware of some challenges that may arise should you choose to hire a caregiver on your own. With our team of experienced and compassionate healthcare professionals, we strive to ensure that your specific needs are met. And, Riverstone is proud to be recognized nationally as a leading provider of quality care. In fact, our homecare offices are accredited by the Accreditation Commission for Health Care (ACHC) for both our private duty nursing and certified home healthcare programs. We encourage you to learn more about the steps are involved in hiring a caregiver on your own , and how choosing Riverstone will allow you to focus on feeling happy and healthy, while we take care of the rest.

How do I get started?

Please call your Riverstone Homehealth office to get started. Our clinical managers will work with your primary Physician to develop a plan of care that meets your loved one’s needs. To start the home health care process, we will come to your home to address your concerns and answer any questions you may have.

What is home care and how does it differ from home health?

Typically "home care" refers to non-medical care such as companionship/homemaking services and personal care services, while "home health" refers to medically skilled care services, the provision of skilled nursing care and other care such as speech, physical or occupational therapy.

Do you provide services to those in nursing homes or assisted living communities?

Yes. Our services provide companionship or personal care to residents at assisted living communities and nursing homes who may desire additional attention or personalized care.

Is there a written plan of care for each client? Is it modified and if so, how often?

Whether or not you need medical or non-medical home health care services, Riverstone home health in-home service team develops an individualized and completely confidential Plan of Care for each client. The purpose is to document the type of care services needed and when the client would like to initiate care. Once the client, and family members, and local office agrees on the Plan of Care, the office staff will use that information to instruct your caregiver who will be delivering the service, establish the schedule and agree to the monitoring and communication.

Plans of Care are reviewed with the client and family at least every six months, but may be more frequent based on state regulations. The review is an important process to ensure the client is receiving the appropriate level of care and is pleased with the Caregiver providing the care.

What if my Caregiver is sick or on vacation?

Riverstone Home Health office employs a team of caregivers so that your care service will not be interrupted if someone gets sick or goes on vacation. If your Caregiver is unavailable, the Client Care Coordinator will arrange another caregiver and will contact you in advance of the change. The Client Care Coordinator will also introduce the interim caregiver to you and review your Plan of Care with the interim caregiver prior to service. Our goal is to ensure that services are provided as expected. Your safety and security are a top priority.

What are ADLs and IADLs?

Activities of Daily Living (ADLs) include the basic tasks essential for day-to-day functioning, such as bathing, dressing, grooming, eating, mobility and toileting. Many seniors who require help with such activities are largely independent, but may require help with one or two ADLs. In some cases, intermittent help from a family member or friend may be all that is needed. However, in many cases, particularly when family or friends are unavailable and the importance of scheduling these activities is critical, informal care arrangements may not be adequate.

Instrumental Activities of Daily Living (IADLs) are considered those activities which are less basic than the traditional ADLs. IADLs, nevertheless, are important in enhancing a client’s quality of life. IADLs include such activities as shopping, paying bills, cleaning, doing the laundry and meal preparation. Many seniors require assistance with IADLs rather than ADLs. Some seniors want someone to escort them when they are shopping and help them avoid situations that might cause them to fall. Other seniors may welcome assistance with their bill paying and medical appointments. Riverstone Healthcare offers an array of companionship and homemaking services to assist our clients with the IADLs. Please contact the Caregiver location nearest you or your loved one for more information.

What is the Skilled Medical Care offered by Riverstone Healthcare in-home services team?

If you or your loved one is recovering from an injury or recent illness, skilled medical care may be necessary. Riverstone Home Health care Services’ team of highly skilled nurses and therapists are available to provide the skilled medical care you or your loved one needs. Our team delivers a broad range of skilled care services to adult and pediatric patients in hospitals and medical facilities, long-term care facilities, assisted living facilities, and private residences. Home Health Aides (HHA) are also available to provide assistance with activities of daily living when relevant to an illness or injury.

Riverstone skilled home health care services include, but are not limited to the following*:

Skilled nursing care by a RN or LPN/LVN either on an intermittent, private duty, or hourly basis, including:

• Pediatric nursing

• Ventilator and tracheotomy care

• Care for chronic illnesses and injuries

• Brain and spinal cord injury care

• Orthopedic disorder care

• Diabetes management and care

• Short Bowel Syndrome care

• Genetic disorder care

• Implementing a clinical care plan

• Coordinating home medical equipment, pharmacy, and supplies

• Monitoring vitals

• Measuring height and weight

• Controlling infections

• Preventing pressure ulcers

• Performing dressing changes

• Palliative care

• Wound care

• Insulin therapy

• Pain management

Home Health Aide (HHA) services including:

• Assistance with personal care such as bathing, using the toilet, or dressing

• Providing assistance with ambulation, mobility, and transfers

• Preparing meals and feeding

• Preventing falls

Therapy services as often and for as long as it is medically necessary and reasonable, including:

• Physical therapy

• Occupational therapy

• Speech-Language therapy

• Pediatric therapy

Riverstone Home Health care in-home service team delivers highly skilled medical services that enable elderly, chronically ill, disabled, and recuperating patients to receive the medical care they need in the comfort and privacy of their home. All of Riverstone Home Health care services are provided with one goal in mind: To promote the highest degree of recovery, comfort, and independence.

We ensure our service is provided for the entire time it is needed and require that our care representatives are available 24-hours a day, seven days a week, so assistance is always at your fingertips.

What are Sitter Services offered from Riverstone Home Health care?

Riverstone Healthcare Services understands the difficulties that a family faces when a loved one is in the hospital or recuperating at home, particularly if that individual needs constant observation and care. Our professional and trustworthy caregivers are available to sit with you or your loved one in a medical facility or personal residence for as long as necessary.

Riverstone Home health care facility and in-home sitter services may include the following:

• Reminding (medication, dates, routines, etc.)

• Maintaining patient’s comfort level

• Assisting with meals and feeding

• Providing companionship and conversation

• Seeking assistance from the hospital/facility nurse when patient is in need

• Monitoring patient activity (i.e. ensuring patient stays in bed, IVs remain in place, etc.)

• Supervising patient through the night, ensuring family members that their loved one is safe when they are unable to be there

• Entertaining (games, crafts, reading, etc.)

• Assuring the patient will not be left unattended and will be accompanied by aide at all times

• Assisting with personal care activities (bathing, grooming, etc.)

• Assisting with mobility

• Performing light housekeeping

• Running errands (prescription pick-up, dry cleaning, etc.)

• Organizing and reading mail

• Grocery shopping

• Escorting to appointments and social events

• Assisting with pet care

Riverstone Sitter Services are available anywhere from a few hours to 24-hours a day. Riverstone also realizes that care does not always end when a patient leaves a hospital or medical facility. Should the need arise, Our caregivers are available to transfer care to the comfort of the patient’s home. Our Sitter Services are also available when a family caregiver is unable or unavailable to assist with their loved one’s needs.

What are the Household Services offered by Riverstone Home Health care?

There may come a point in time when performing everyday household tasks becomes more difficult for you or a loved one. Whether this is the result of a medical condition, disability, or simply part of the aging process, at Riverstone Healthcare Services, we understand how difficult this can be for a family. That’s why Riverstone offers household services. Our professional and trustworthy caregivers ensure you or your loved one is staying healthy and safe by providing assistance with many household activities, with services ranging anywhere from a few hours to 24-hours a day, 7 days a week. riverstone’s Household Services are a great option for beginning the process of using outside assistance within the home, while also providing a regular “check-in” for concerned family members when necessary.

Riverstone’s household services include, but are not limited to the following:

• Preparing meals and assistance with feeding

• Performing light housekeeping (laundry and ironing, garbage removal, dusting, organizing, etc.)

• Running errands (prescription pick-up, dry cleaning, grocery shopping, etc.)

• Organizing and reading mail

• Assisting with pet care

• Home safety evaluation

• Arranging appointments

• Aiding with reading

• Writing letters and correspondence


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