Hire the Right In-Home Caregiver

There’s no place like home for many elderly adults, according to a recent survey from the senior care organization Home Instead: about 94 percent of the 1,000 respondents said they wanted to age at home. It isn’t hard to understand why—staying in your own home as you age means staying within a familiar community of people and places, where you get to make decisions for yourself and maintain regular routines and existing friendships. But some older adults need help to stay in their current home, and this is where caregivers come in.

About 65 percent of older adults with long-term care needs rely on family and friends for informal practical support, such as helping with shopping and household chores. Another 30 percent supplement that care with paid assistance. “The latter may be more suitable for seniors who suffer from medical issues that affect their ability to care for themselves, and who need more extensive help with activities of daily living,” notes Mount Sinai social worker Sheila Barton, LCSW.

What Are the Options? The job description of paid caregivers varies according to several factors, says Barton. “These include the care needs of the patient, and whether the caregiver is working privately or through an agency,” she adds. Options include:

• Companion This option is suitable for people who don’t have the endurance to do household chores but are independent when it comes to personal care. “Companions may assist with housework, shopping, and cooking,” Barton says. “They also can accompany you to medical appointments.”
• Home attendant/personal care aide “These caregivers assist with household chores and meal preparation, but also help with basic personal care needs such as bathing, dressing, and grooming,” says Barton. “You might benefit from this type of help if you have some mobility issues but are able to follow directions and assist the caregiver in some aspects of your care.
• Home health aides are trained to assist patients with cognitive and/or functional issues. “They are skilled at transferring a person from bed to chair, and assisting in the personal care of those who are wheelchair dependent or bed-bound,” Barton explains. “Under the supervision of a registered nurse, a home health aide can change feeding bags, and perform basic range-of-motion exercises.

Private Hire Tips If you want to hire a caregiver privately, get personal recommendations if possible, since this does provide some assurance that the caregiver is reliable and trustworthy. Once you have some prospective candidates, jot down questions you want to ask during the interview—for example, you might ask how they interacted with previous clients, and what duties they are accustomed to carrying out. Be sure to clarify any additional tasks you would need them to do, such as cooking, shopping, and transporting you to medical appointments and/or the store.

It is important to keep in mind that many caregivers have had little training in caring for people with dementia. If you are seeking help for a partner or family member with dementia, make a point of asking each candidate about their experience with this type of client, and how they would manage somebody who might not be fully cooperative.

Even if you do manage to find a suitable caregiver based on word of mouth, you should take some security precautions. Ask to see photo identification (drivers license, passport) for anybody you interview. Also ask for references (ideally three, two of which should be former employers), and follow them up. A background check is also advisable, and can tell you if a potential caregiver has been convicted of elder abuse or other crimes in a different state (see What You Can Do).

Using an Agency When a paid caregiver is hired through an agency, the hourly charge is often more expensive than if you are hiring privately. “There are advantages that come with the additional expense,” Barton says. “For example, home health aides who are hired through an agency must have training—this typically involves a 75-hour course offered by the agency itself or by paraprofessional training school.” Agencies also offer a level of supervision you won’t get with a private hire: a registered nurse will screen you, and develop a care plan that the caregiver must follow.” She adds that back-up is also on hand. “If an agency caregiver calls in sick, the agency must supply a substitute caregiver.”

If you’re going through an agency, verify that it carries out background checks and drug screening on its employees—some research suggests that nearly half of caregiver agencies fail to perform these vital security precautions. Also check whether the agency regularly evaluates the quality of care provided by its employees, and how that supervision is carried out (for example, will a supervisor visit you at home to ask you about the care you’re receiving?).

Meeting the Cost Medicare funds home caregiver services only in conjunction with short-term, intermittent, skilled services such as visiting nurses, home health aides, and physical/occupational therapists. “These services are covered up to a maximum of 20 hours a week depending on the care needs of the patient,” Barton says. “Medicare does not cover long-term home health aide services.”

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