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A Family's Guide to Hiring the Right Senior Caregiver

Finding and managing in-home assistance can be a time-consuming and stressful venture for aging adults and their families. Many elders requiring long-term care rely on family members to help them, but approximately one-third of seniors get help from paid caregivers. With so many different options and places to look for the perfect caregiver, it may take some time, research, and effort to find someone reliable and trustworthy with the right skills to tend to your needs and situation. At the same time, it's also crucial to find someone that your loved one can feel comfortable with.

If you are just starting your search for the right senior caregiver, you may be wondering things like, "Where do I begin?", "Can I afford it?", or "How can my loved ones and I trust a stranger in the house?" This extensive guide will guide you through the process of hiring help at home, along with steps to consider when searching for quality home care to help you get rolling!

Expert Insight on Hiring Home Health Aides

Home health aides will have to be recognized as medical professionals

Benefits of Hiring a Personal Caregiver

It is always convenient to have family members help you whenever they can, but let's face it -- working full-time and possibly long-distance caregiving can take a toll on anyone. Providing the proper care and attention that an aging loved one needs can be hard, especially when being "on duty" both day and night is a must. Having to be vigilant 24 hours a day may make it difficult for loved ones to have time to sustain a healthy balance in life and tend to their own responsibilities.

Performing caregiving duties as a family member can not only be emotionally tiring, it can also be physically draining. For example, caring for someone who needs to be transferred from bed to wheelchair and vice versa can strain your back. Dealing with a loved one struggling with dementia may mean having to manage challenging behavior, wandering risks, and other dangerous actions like leaving cooking burners on. On top of all this, imagine having to complete everyday mundane tasks and chores like grocery shopping, banking, housekeeping, cooking, and more. Talk about stress-overload!

This is where hiring help could come in handy, and even help to maintain a healthy relationship between an aging loved one and a family member. Trusted caregivers can help by completing some of the tasks you are responsible for, allowing seniors to feel more at ease and freeing loved ones to have some time to themselves. Family caregivers are able to then have the opportunity to run their own errands, catch up on sleep, socialize with friends, and work. In the end, if the right caregiver is hired, everyone is relieved of some stress.

Personal caregivers can be hired to help you or your aging loved one with the following:

Personal Care, Household Care, Emotional Care, Health Care

It may take some time to build trust with an attendant. To ease into the process, many families will hire a housekeeper first. This will allow everyone to get the hang of someone coming in to help out with housework before accepting someone to assist with personal care.

What Types of Senior Care are Available?

The two common types of health aides include home health aides and personal health care aides. Home health aides provide basic health care, which encompasses tasks like controlling medication and verifying circulation pressure. On the other hand, personal health care aides assist with housekeeping and personal needs.

If you or your aging loved one is ill or disabled and requires medical assistance, a home health aide would likely be a promising choice. If you are looking for someone to help with bathing, dressing, eating, or other home tasks, then a personal care aide will be a better option.

Usually, seniors who don't live near their families will often spend a lot of time at home alone. Getting a personal care aide can be beneficial if you're looking for some companionship -- someone to talk to, share a meal with, engage in activities with, and more. Elders with Alzheimer's or dementia may also find it helpful to have companion care as they cannot be left alone.

Curious about all the different types of in-home care workers? The AARP goes through the differences extensively, explaining what each does and approximately how much each would cost respectively.

Pros & Cons to Hiring a
Home Care Agency vs. Individual Care Provider

Once you have decided to hire in-home help, it's time to decide on hiring an individual directly or going through a home care agency. If you have a personal recommendation from a trusted friend or loved one, then this would be the ideal way to get a quality caregiver or agency. References are very important when it comes to hiring the right caregiver. If you are still on the fence on which would suit your lifestyle best, consider the following pros and cons to hiring a home care agency and an individual care provider to find the best fit for your situation.

Home Health Care Agency

Pros

  • Depending on your insurance, you may have some of the costs covered.
  • A substitute caregiver can be sent if your usual is ill or on vacation.
  • Since there are many people working under an agency, there are wider skill sets to meet different needs. For example, if you specifically need physical therapy, you can get a caregiver who specializes in physical therapy through an agency.
  • The hiring process is a lot more streamlined and easier because you get help with several things. The agency handles all screening, hiring/firing, pay, and taxes so that you don't have to.
  • If you encounter any problems, the agency can help settle disputes.
  • Should you find that your caregiver is not a good ft, you can let the agency know and they can send an alternative.
  • On a time crunch? You can count on the agency to match you with a caregiver quickly with less research time on your end.

Cons

  • It can be more expensive than hiring an individual caregiver directly because the agency also helps with administrative tasks on top of placing a caregiver.
  • Some agencies experience high staff turnover, which means that you may have to adjust to different attendants.
  • Some attendants may not have consistent work hours, so the agency might hire several people to provide care. Again, this would require you to adjust to different attendants and be okay with multiple people entering your home.
  • Certain tasks may not be included or will incur an additional charge.
  • There is less individual choice when it comes to selecting attendants. You may want to inquire home health care agencies about their process for matching caregivers.

Individual Care Provider

Pros

  • It is generally more cost-efficient to hire someone directly than through an agency.
  • You can more likely build a strong one-on-one relationship with the attendant, and this makes the experience more personable and "family like."
  • There is individual choice when it comes to selecting your caregiver. You can take time to pick the one you feel will best provide for you or your loved one.
  • Enjoy more flexibility in tasks that can be performed.

Cons

  • It may not be covered by your health insurance.
  • If your attendant is sick or needs a vacation, you will have to arrange to find alternative help.
  • You wouldn't have anyone helping you with administrative duties like screening, hiring and firing, taxes, payroll, insurance, and disputes.

Steps for Getting In-Home Assistance

Looking to get started with finding the perfect attendant to provide in-home assistance? Start with the steps outlined below.

Determine the Type of Care Needed

Before you start calling around to get an idea of what your options are as far as caregivers and agencies go, you will benefit greatly from knowing exactly what you need from them first. So, start with making a detailed list of what your ideal caregiver would be doing, and what expectations you have. Some things to consider include:

  • What duties do you need your caregiver to perform and how often? Write down all the duties and frequency. Duties may include housekeeping, driving to doctor appointments, bathing, etc.
  • When is a caregiver needed, and how often? Is your schedule flexible?
  • Do you suffer from dementia or a serious condition requiring specialized care?
  • What are some qualities you look for in a caregiver to ensure a safe and happy relationship and home?
  • Since the caregiver will be spending plenty of time with you, it may be ideal to have one who shares similar beliefs, values, and background. These similarities may help you both bond and have a more comfortable relationship. Having too many pet peeves or dissimilarities can cause issues. For example, if your caregiver smokes at home, that could be a major problem if you don't want smoking at home.

Become Familiar with Costs

According to the 2017 Cost of Care Survey from Genworth, home health care and homemaker services cost about the same. On average, it's $21 per hour or $48,000 a year for a 44-hour work week.

Rates will vary depending on where you live, the kind of care you require, and the frequency. You can expect to pay a higher rate if you need assistance during holidays, evenings, and weekends. An aide with credentials who can provide a higher level of care, such as a nurse or certified nursing assistant, will also be more costly.

Home health care tends to be more expensive in rural areas where there are fewer available workers. For example, the Genworth survey found that in North Dakota and Alaska, home health care costs came out to almost $64,000 a year.

Know Where to Get Assistance

Being aware of where to find caregivers is a good start to hiring the right one. There are several ways you can find in-home help. Referrals and word-of-mouth are great ways to get input from people you know and trust in the medical community. You can also search online job boards like Craigslist to see available caregivers in the area looking for work, or place your own advertisement on online forums and local newspapers to get the word out. Last but not least, there are plenty of online elder-care matching services.

Below are some useful websites to peruse as you search for assistance:

  • Visiting Angels - Learn more about how home care works and find home care near you here.
  • Elder Care Locator - This is a public service of the U.S. Administration on Aging designed to connect you to services for aging adults and their families.

Research & Conduct Interviews

If you are hiring directly and not through an agency, you will have to do some research on the leads you've collected. See if you are able to find out more about what the caregivers have to offer by checking out their resumes and websites as applicable. Schedule phone interviews to speak with the ones you feel have potential. During the brief interview, you'll want to explain your needs and make sure that the candidate has experience and the ability to carry out necessary tasks. Once you've covered the basics, you can schedule in-person interviews with the ones you feel good about. Let them know that as part of the application process, you will be conducting a background check and verifying references. Request that the in-person interviewees come prepared with their driver's license, Social Security card, resumes, past addresses, and references.

Interviews can be tough because it is not easy getting to know someone in a short amount of time, especially someone who you will need to trust to be in your home and care for you. But, you can get a basic idea of what a candidate is like and whether they'll be fit for your needs by asking these questions during interviews:

  • What was your past experience working as a caregiver like?
  • What is your favorite part of being a caregiver, and your least favorite part?
  • How long have you been working as a caregiver?
  • Do you have any specialized training or experience I should know about?
  • What makes a good work experience for you?
  • Are you willing and capable of performing these duties? (Go into more detail about the duties you require)

Of course, everyone will have specific questions to ask depending on circumstances, but these are a good start.

During the interview, you will also want to let the caregiver know what to expect. Be up front about whom the caregiver will need to interact with (other family members at home or visitors, for example), the consequences of tardiness or absenteeism without notice, benefits and wages, vacations and holiday pay, etc.

There may also be important information about your personal circumstances that will benefit the potential caregiver to know about. For example:

  • Mobility problems
  • Diet restrictions
  • Likes and dislikes
  • Medication list
  • Behavior issues
  • Current medical status
  • Ongoing exercises and therapies

The more communicative you are, the more productive the interview will be for both parties. Before ending the interview, ask if the candidate has any questions and address them accordingly.

Looking for more information about the interview process? Below are some external resources that may be helpful:

Perform a Background Check

It is totally understandable (and recommended) to be picky about who you allow to provide in-home care. If you are hiring help through an agency, the agency should handle interviews and background checks. But, if you are hiring someone directly, performing a background check is an imperative step to responsibly hiring household help. Before conducting one though, you will need to get written consent from the candidate. Once you obtain consent, you can get a law office or private investigator to run background checks using their specialized databases.

Background checks screen credit reports, DMV records, and any criminal records for your safety. They will verify that the information provided at the interview is accurate. Any red flags will stand out, and you'll be able to narrow down your list of potential candidates accordingly. It can cost anywhere from $70-300 an hour to run a background check through a law office or private investigator. If you are looking for a more cost-efficient way, there are online background check companies that cost less.

Below are helpful external resources relevant to performing background checks worth checking out:

  • Fair Credit Reporting Act - Learn more about this act which requires you to ask for permission in writing before pulling a potential employee's credit report.
  • Medicare's Resource for Background Checking a Caregiver - This resource from Medicare is helpful for those looking for tips on performing a caregiver background check. They provide screening tips from the Family Caregiver Alliance in bullet form so it's easy to skim through to make sure you have a good grasp of what you should know.

Make Sure It's a Good Fit

Once you've decided on a caregiver, you may want to suggest a short term try-out period, for a couple days up to a couple weeks, to ensure the caregiver is a good ft. Having a non-family member in the home on a regular basis is always an adjustment, and you'll want to be sure no tensions build up due to a clash of personality types or habits. This period of time will of course be paid work for the caregiver, and you won't want to suggest a time period that is too long as that'd be unfair to the caregiver who will need to line up long term work, and they may not even be interested in a try-out period for that reason, especially after a thorough screening process.

How to Afford Household Help

The cost for household help can vary greatly depending on where you live in the United States, and what kind of care you are looking for. For example, full-time assistance can be quite expensive, but if you only need someone to help out for several hours throughout the week, it can be a lot more affordable.

Some long-term care insurance policies partially cover the costs of household help. You may want to inquire your insurance company to see what kind of benefits they have to offer. Depending on the policy, coverage may only apply for hiring someone privately, or only for hiring through an agency.

Low-income seniors may qualify for Medicaid (or Medi-Cal in California). Through this, they can get help through an in-home program called In-Home Supportive Services. The services may vary depending on your area, so it's best to check with your local Medicaid office to see what is offered where you live.

The cost of hiring a personal caregiver could also be tax deductible if it is considered medically necessary. You may want to discuss this with your tax accountant to see if this applies to you.

As far as the remaining costs go, relatives and family members of aging loved ones typically chip in to afford household help. Getting together as a family to discuss home health care service, the associated costs, and the means available to cover the costs can be useful in this case, to get everything organized especially if there are several family members involved in contributing.

Paying a Caregiver

An often looked over aspect of having someone provide at-home care is how to pay the person. If hiring through an agency, an ad, or a family member, you'll want to be sure expectations are laid out and boundaries are set.

  • Get Everything In Writing

    You'll want to be specific on the hours the caregiver is expected to work, what tasks they should perform, and when and how often they'll be paid. Setting these parameters upfront will prevent confusion or arguments, as everyone on both sides of the transaction will know what is to be done, and what would require additional pay.

    Further, a written contract signed by you and the worker, can be used in case you are ever audited by the IRS to show that the money was not a gift. If you're unable to prove this, then you could become ineligible for Medicaid the following year. The pay rate should also be in line with the market rate for your area. It'd raise suspicion if you're paying a caretaker, especially if they're a family member, a rate double or triple the average amount that other caregivers receive in the area. It'd also be bad if you were paying the caregiver far less than the market average.

    On the caregiver's side, they'll want to keep a record of the hours they worked and when they were paid, to have proof that they are hired help, as to not jeopardize the senior's Medicaid eligibility.

  • Check Your Insurance Coverages

    Accidents can happen at any time, and if one happens in your home and injures the caregiver, they could sue. If your homeowners insurance doesn't cover for worker injuries, then you're fnances could easily be put in disarray to cover the medical and/or legal costs related to the caretaker's injury.

    Check what your homeowners insurance covers to see if you're fully protected in the event of a caretaker being injured within your home. If not, then you'll want to increase the premiums and coverages to be sure your bases are covered. You'll possibly want to get workers compensation and disability benefits insurance if you're in a state that requires it.

  • Pay Your Caregiver As An Employee

    Paying under the table - undocumented and taxless payments - can cause issues with the IRS and lead to disqualification from Medicaid-funded nursing home care. That is a risk you should avoid, by putting forth the effort to pay your caregiver in an IRS approved manner. There are programs like Quickbooks Payroll that have easy systems for home-based care, where you can be sure you're paying in a legal manner that'll prevent any issues with the IRS. You'll also want to send your caregiver a W-2 if you pay them more than $2,000 in a single calendar year, or more than $1,000 in a 3 month period.

Final Thoughts

Hiring someone to help you at home can be nerve-wracking with so much to think about. But, once you do your due diligence and find the right one, you and your loved ones will be able to live easier and more balanced lives. Keep in mind that communication is key to a happy and well-run home. By maintaining open communication, expectations are clear from the get-go. This avoids potential strains with the attendant, and everyone will feel more comfortable.