If you are considering in-home help, you are not alone. Families are turning more and more to in-home help because of the growing aging population. As people age, some of the responsibilities and caregiver duties may become too much to handle. Hiring professional caregivers can be a viable and flexible option for many families.
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In this case, home care is quite different from home health care. Home care is an industry that has blossomed in response to the needs of people who are no longer able to get help through insurance. By contrast, insurance-covered home health is very time-limited and certain criteria must be met.
Home care, or personal care, offers caregivers (some certified and some not) who provide non-medical assistance to older adults. Although tasks vary by state, most of the work done by home care agencies consists of help with bathing and dressing, cooking, transportation, and companionship. States dictate what tasks caregivers can and cannot do.
If you’re unsure as to how to hire a caregiver for in-home help, here are some suggestions to help you get started.
Steps for Hiring Private In-Home Help
Hiring privately means that you are looking for a caregiver outside an agency. A friend or church member, or even a physician may recommend a caregiver who works by the hour and you pay them directly. Many families choose this option but may not be aware of the risks associated with this choice. If you decide to go this route, here are some steps and precautions to consider.
Most people tend to hire privately because of the cost associated with going through an agency. An agency has overhead and will charge more per hour than the caregiver you hire privately. Other people hire privately as a workaround to state regulations on what tasks a caregiver can perform. However, if you do hire privately, it is important to remember that you may be responsible for arranging payroll, scheduling, and a backup caregiver if your person doesn’t show.
Step 1: Background check and drug screening
A good friend recommends the person you are considering for hire. What’s the point of a background check? You trust your friend, right?
Background checks are critical for you to learn more about a potential hire outside of an interview. In some cases, there may be caregivers with less than savory business practices that continue to be hired by families. By conducting a background check, you can learn more about a potential candidate.
A random drug screening may be something you want to include as well. As a potential caregiver, it is important that they are able to respond to any immediate difficulty or change in a situation. Explain to a prospective caregiver that random drug screening is a requirement for employment. If they hesitate, move on to the next applicant.
Step 2: Liability insurance
Most caregivers are dedicated and responsible people. The unfortunate fact is, some caregivers steal from and exploit older adults. Not only that, but they can also sue for sexual harassment or personal injury. It is highly recommended that you talk to your insurance agent about liability insurance should you be sued or have to pursue legal action against a caregiver.
As unpleasant as it is to consider, talk with your agent about the following illegal actions or accusations:
- Physical abuse
- Sexual abuse
- Emotional abuse
- Physical neglect
- Medical neglect
- Theft and financial exploitation
Step 3: Confirm credentials
If the caregiver you are about to hire says they have a Certified Nursing Assistant certificate, ask to see it. Make sure to confirm any other credentials that a caregiver says they have.
Step 4: Verify employment
You will want to confirm and verify any type of employment they have had within reason, and you should include other private hire families as well. Ask for references and call families with a prepared list of questions.
Step 5: Ask about experience
If your state allows caregivers who are certified nursing assistants (CNAs) to perform certain tasks, like administering a glucometer test or drawing up insulin, ask about that experience.
You may also want to ask about their experience working with people who have dementia or other medical or mental health issues your loved one has.
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Steps for Hiring Agency In-Home Help
Hiring through an agency has many advantages, but the cost will be higher. The benefits are that an agency handles criminal background checks, drug screening, and payroll. They have a whole staff of caregivers who can fill in at a moment’s notice.
Depending on where you live, you could have lots of choices of companies which can be overwhelming. Our steps will guide you in making a great decision for you and your loved one.
Step 1: Is the agency licensed, bonded, and insured?
You will want an agency that has all three. Remember our tip on liability insurance? The advantage of using an agency that is bonded and insured is that they will handle any lawsuits. You may also want to ask what the monetary limits are to the insurance.
Also, if a caregiver is accused of stealing or any other illegal activity, the agency will investigate and take appropriate action.
Step 2: Understand the hourly cost of care
Find out what the hourly cost of care is and if there is a minimum number of hours required per week or day. It is also recommended that you ask about the cost of 24-hour care vs. live-in, if that service is available. Also consider asking about their staffing levels. Does the agency have sufficient staff for backup should it be needed?
Step 3: Ask about the training of staff
Most people don’t realize that states mandate training hours for caregivers. Some states require no training at all to become a caregiver working for an agency. Regardless of what the state requires, you may want to ask for a training schedule for the year.
A good agency will have a robust training schedule for its staff that improves caregiver’s skills and keeps them interested and invested in their job.
Step 4: Conduct a caregiver interview
One of the more important questions to ask is if you can meet the proposed caregiver before they start working with your loved one. This might seem like a given, but sadly, it is not. Many agencies tend to pick someone from their staff to start working immediately.
Request a meeting with the caregiver before they start working. It can be hard to predict how people are going to get along, but having that face-to-face meeting can be very enlightening. You might feel right away that the person is not a good fit, or you have a really good feeling about the agency’s choice. Ask that the caregiver be introduced to your loved one before they start their first shift. That will give you a chance to see how they interact with one another.
Step 5: Check on caregiver replacements
If a caregiver is a no-show or quits work, you will want to know how quickly a replacement can be found. Also, if you or your family member decides the caregiver is not a good fit, you may want to ask how that will be handled by the agency.
It is also suggested to find out how soon they will find a replacement. You can expect in most cases that a fill-in caregiver will be assigned to respond to the immediate need until a permanent person is found.
Step 6: Know how to address problems and concerns
There will be problems. Some may be minor and others more serious. You may have concerns about care or scheduling. T
he question is this: who do you call to voice concerns? Having one point of contact is preferable so you aren’t cycling through various people who don’t have any authority to solve the problem.
Step 7: Documentation of care and plan of care
Agencies have a variety of ways that their caregiving staff documents what they do each day. Their tasks should be consistent with the plan of care that is developed with you and a senior member of the staff. The plan of care is a flexible document that is subject to change depending on the care needs of your loved one.
Some caregivers have a simple checklist that they complete each day and leave in the family home in a binder. You shouldn’t have to go to the home each time to review these documents so ask if they can be scanned and emailed or faxed to you.
Other agencies may have online portals for family members to check on the status of care and communicate with staff.
Step 8: Treatment of caregiving staff
Last, and certainly not least, how much are caregiving staff compensated and what other benefits do they have? The home care industry is plagued by high turnover and much of this is due to low pay, poor or no benefits, and limited room for advancement.
An agency that values their caregivers will have a lower turnover which is good news for you. You may want to ask about pay raise, health insurance, bonuses, and travel reimbursement. Ask about how long caregiving staff have been with the agency.
Does the agency encourage staff to become Certified Nursing Assistants and if so, do they pay for that education?
Hiring a Caregiver For In-Home Help
Finding the right caregiver for your loved one is a process. You may find the perfect fit, only to have that person move on and leave you looking for someone else. Go into the experience knowing that the situation will most likely remain fluid.
By working with the above-mentioned suggestions, you can find a competent and responsible caregiver for your family member.
If you're looking for more on caregiving, read our guides on what to do when you need a caregiver for your mother and books about caregiving.