What You Need To Know Before Hiring In-Home Help
HomeWell Care Services
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Nov 09, 2022
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It is easy for family and friends, as well as professionals, to suggest finding someone to help with housekeeping tasks and
care responsibilities. Having someone else take on some of your housekeeping or personal care tasks might sound appealing to you too. But what does it mean to
have someone in your house “to help” you? Where do you begin to find someone? Can you afford it? How do you respond to your loved one who proclaims that they
don’t want “a stranger” in the house? What services do they provide? This fact sheet will help guide you through the process of hiring help at home.
Do I Need Assistance?
Long-Distance caregiving, working full-time, and caregiving and/or caring for someone 24 hours a day/7 days a week will take
a toll on anyone. With a loved one who needs personal care and who can’t be left alone, you must be vigilant and “on duty” day and night. With constant
care and companionship responsibilities, you may have very little time to yourself. If you are caring for someone who needs to be transferred from bed to
wheelchair or out of a chair when sitting, you may be at risk for injuring your back. For those caring for a family member living with dementia, you may be
also be dealing with challenging behavior, wandering risks, or actions that might be harmful or dangerous such as leaving cooking burners on. If you don’t
have time to do the shopping, banking, and taking care of your own medical needs, you are at risk for stress-related illness. Are housekeeping routines
and cooking being done with great difficulty or being left undone? Consider your needs as a caregiver and the needs of the person you are caring
for. Here are the main areas to assess:
·
Personal care: bathing, eating, dressing, toileting, grooming
·
Household care: cooking, cleaning, laundry, shopping
·
Health care: Medication management, physician’s appointments, physical therapy
·
Emotional care: companionship, meaningful activities, conversation
Hiring help can relieve you of some of the tasks you are responsible for, freeing you to have some time for yourself.
Having trusted help can give you the opportunity to run errands, go to the doctor for yourself, catch up on sleep, and socialize with friends. For long-distance
caregivers and working caregivers, help can provide the care and assistance needed when you can’t be there on a daily basis yourself. Interestingly,
caregivers have found that in some instances the person receiving care can be more cooperative with someone other than the primary caregiver, so that, for
example, taking a shower might not be the battle that it can otherwise be. Engaging an attendant can help to preserve your relationship as daughter or
partner, rather than always having to be the chore person or taskmaster. Attendants come in fresh for a certain number of hours and therefore have the
energy to be engaging and encouraging in a way you might be too exhausted to do around the clock.
Hiring help might not only be a necessity but a gift you can give yourself.
My Loved One Only Wants Me to Help
It can be hard for your loved one to accept
help from a stranger. Initially, it will be important for you to be present to
help the attendant and the care receiver to establish a successful
relationship. You can show the attendant how you do things, so the help that is
given will feel familiar and comfortable. Let your loved one know that YOU need
help and that this is something they can do to help you care for them. Reassure
your loved one that hiring help does not signal that you are going to abandon
them.
If your loved one lives alone, you might hear,
“I don’t need any help.” Suggest that it will make YOU feel more comfortable
knowing someone is their part of the day. You can also suggest that they “just
try it for a week.” This will give your loved one some control in decision
making and help them be open to having an attendant.
The transition to an attendant might be easier
if the attendant shares a similar cultural background or language. The care
receiver may have a preference for a male or female attendant. However,
wonderful attendants come from all backgrounds and being open to a caring,
competent attendant from a different ethnicity or cultural background than your
own can lead to rewarding bonds.
Sometimes the best way to get an attendant
accepted is to hire a “housekeeper.” Care receivers are often more open to
having someone come in and “help” with the housework before they are willing to
accept someone to help with personal care. This gives your loved one time to
become familiar with the attendant and build trust.
“I Don’t Want a Stranger in My House!”
We all react differently to interacting with
someone we don’t know. For some people, meeting someone new is an enjoyable and
interesting opportunity. But for others who are naturally more reticent or are
feeling vulnerable due to their illness, there is great reluctance to exposing
their private life and personal living space.
Hiring someone through an agency will give you
some choice for attendant selection. Most agencies have done background checks
and bonded the people who work for them—be sure to ask if this is the case. And
if you feel uncomfortable with the person who is sent, you can always ask the
agency to send someone else. But typically an agency will attempt to match the
attendant to your specific needs and requests, so if you aren’t immediately
comfortable with the attendant sent, consider giving it a day or two to warm up
to them.
Caregivers and care receivers often worry that
their belongings will be stolen. This does happen, but it is much rarer than
you might be led to believe. Lock up or take out of the house any especially
valuable belongings, such as heirloom jewelry, just to make yourself less
anxious about this happening. Keep track of cash and checks/checkbooks/credit
cards. If hiring through a home care agency report any concerns you might have.
If hiring privately, schedule a time to discuss the concerns directly with the
caregiver. If your loved one has dementia, they may report an item as “missing”
when it is only misplaced or stashed away.
How Do I Find Help?
There are formal and informal ways of finding
an attendant. The formal way is to contact a Home Care Agency located near to
where your loved one lives. A long list of agencies will be available in most
urban and suburban communities. This can make it difficult to figure out who to
contact first. Far fewer agencies serve rural areas, limiting options for
hiring care. People who can help you select the right agency for your needs
include your doctor and their staff, your friends/family who have used an
agency, and others in your community whom you trust, such as your faith community,
your local senior center, etc. Also, check for agency reviews from trusted
online sources, and consider contacting your local Area Agency on Aging to ask
whom they hold contract(s) with for their clients.
Key Questions To Ask:
·
Is the agency licensed by the state? (Many but
not all states require licensing to operate a Home Care Agency). Ask how long
they have been in business.
·
Are the workers licensed and insured? How does
the agency train, supervise, and monitor their workers?
·
Request that the agency send you a packet of
information that describes their services, fees, and a list of references. This
will give you an opportunity to review the information before sitting face to
face with an agency representative.
·
What are the aide’s credentials? Check with
the credentialing body to confirm.
·
Where has the aide worked previously? Ask for
two to three references from former or current employers.
·
Always contact the references asking about the
care competency, compassion, and reliability of the worker.
·
Is the aide legally eligible to work in this
country? Ask to see verification (passport, green card, etc.)
What Will It Cost?
If you hire a Home Care Agency, they will
establish the pay rate. Agencies will charge a different amount, depending on
the kind of care that is needed, e.g. personal care versus dementia care. Also,
an agency might have a minimum number of hours, for example, only 4-hour
shifts. Or they will do a 2-hour shift but charge more per hour. For people who
need full-time care, the options are a “live-in” who does the full 24 hours, a
live-in plus an 8-hour shift for someone who needs someone to be awake and
available during the night, two 12-hour shifts for people who may need someone
awake at night, or three 8-hour shifts for someone who may need extra help due
to heavy care needs.
How Can I Afford It?
Hiring in-home help can be expensive,
particularly if you need full-time help. However, if you only need four hours
once or twice a week, it can be more affordable—the hourly cost varies
depending on where you live in the United States.
If the care-receiver has a long-term care
insurance policy and the service provided meets the policy criteria, the
benefits can offset the cost. Check the policy for how many days of care are
required before the policy will start to pay. Determine whether there is
coverage for hiring someone privately, or only for hiring through an agency.
Some policies require that the attendant be a HHA, LVN (licensed vocational
nurse), or CNA, and others do not.
The cost of a hired attendant might be tax
deductible if it is considered medically necessary. Check with your tax
accountant to see if this is the case in your situation.
If the care receiver is low income and
qualifies for Medicaid (Medi-Cal in California), they may be able to get help
through an in-home program called In-Home Supportive Services (IHSS). Check
with your local Medicaid office to see what services are available in your
area. Medicaid benefits differ by state.
This type of care is an appropriate
expenditure for use of the care receivers’ personal savings. Often a family will
also contribute as needed to help cover the cost. Holding a family meeting to
discuss the need for the home care service, the cost of the care and the means
available to cover the cost can help surface concerns from family members, and
gain support to help cover the expense.
Some communities have a sliding scale or
low-cost home care through specialized funding. Contact your local Area Agency
on Aging (AAA) to see what is available in your community. The Medicaid In-Home
Supportive Services (IHSS) office may have a registry that is open to the
public and can give you referrals for pre-screened attendants. Under Title IIIE
of the Older Americans Act, funding distributed through your local Area Agency
on Aging (AAA) offers help paying for respite care (temporary relief) and other
caregiver related services. Faith communities and some senior service agencies
also might be able to help you find lower-cost attendant care in your area.
How Do I Find the Right Person?
When hiring help, it is important to be clear
about what it is you want the attendant to do. Write a job description that
spells out the things you need help with and make a detailed list of the tasks
you want to be done. Clarity is essential to effective communication and mutual
understanding. For example, if you want help with housekeeping, list the kind
of housekeeping duties that need to be performed—vacuuming, cleaning the
bathroom, washing dishes, doing the laundry, etc. Be clear about any specific
ways that you want these duties performed, e.g. wash white items and colors
separately. If you want personal care, does the care receiver need help with
dressing, grooming, bathing, toileting, transferring? If you want someone to
just “be there,” does the care receiver like to take walks, watch TV (what
shows?), talk, go out to lunch, play golf, read, be left alone (some people
like chatty attendants and some people do not)? If there is a pet, does it need
to be taken for a walk, do you want the poop in the backyard cleaned up, the
kitty box cleaned out? (Check with the attendant for allergies to pets or fear
of certain animals.). It is very important to find out the attendant’s
experience with dementia if you are hiring someone to care for a loved one with
cognitive impairment. Give examples of situations you face and ask how they
would handle them. (See below: “Write a Job Description”)
Three general certifications exist for home
care attendants. One is an HHA—home health aide, the second is a CNA—certified
nursing assistant, and the third is an LVN—licensed vocational nurse. They are
trained to provide most levels of care in the home except for care requiring a
registered nurse, e.g. giving an injection. Each state has different laws on
what attendants can and cannot do, such as dressing changes on a wound or
giving medications. In most settings, an attendant can put the medications in
the care receiver’s hand, but the care receiver must take the medications on
their own. However, there might be rules on who can set up the media-set with
the pills in it, and whether or not the care receiver must take them out of the
media-set on their own.
Always check references.
Always do a background check.
(See FCA fact sheet Background Checking: Resources That
Help)
Interviewing
If you are hiring through an agency, you can
shorten this process. If you need help right away, always go through an agency,
as hiring privately takes time and energy to secure the right person or team of
people. Often an agency representative will come to the house and interview you
to find out what type of help you are seeking and will try to match you with
the person in their employee pool who best meets your needs. However, having
your job description will still be helpful in working with the agency.
Initial interview/screening can be done by
phone. Ask for a resume and references. With those who seem like they would be
right for your situation, you can set up an in-person interview either at your
loved one’s home or at a nearby coffee shop if you prefer. If appropriate, the
care receiver should be present at the interview, as their input is important.
Other family members or concerned individuals may also be present. Their input
can help you make a good decision. The job description can be emailed to the
applicant as a way to start the conversation.
Here are some initial questions for the
interview:
·
Why are you interested in this position?
·
Tell me a little about yourself.
·
Where have you worked before?
·
What were your duties? Here is the job
description for this position.
·
What is your favorite kind of client? What
pushes your buttons?
·
Is there anything in the job description that
you are uncomfortable doing?
·
How do you deal with someone living with
memory problems? Give an example.
·
Describe your experience making meals for
other people.
·
How do you handle people who are angry,
stubborn and/or fearful?
·
Do you have a car? Would you prefer to drive
your own car or our car in transporting? I’ll need to see proof of insurance
and a current driver’s license.
·
What is your experience transferring someone
out of bed or chair and into a wheelchair?
·
What is your availability? Days? Hours?
·
Can you give me two work-related and one
personal reference I can contact?
·
I’ll need personal identification that
verifies that you can work in this country. Please bring it with you so that I
can make a copy.
If the care receiver is present, watch the
interactions between the attendant and the care receiver. Do they only respond
to you, or do they include the care-receiver in their answers? If the care
receiver is not present, you might want to invite a top candidate back to meet
the care receiver before making a final job offer.
Immediately after the interview, write down
your impressions. Include input from the care receiver, if they were present,
as well as any other family/friends who were a part of the interview. Check
your gut. How you feel about someone can go a long way in your finding the
right person. Check the references. Have a list of questions to ask about their
experience in working with this attendant.
Communication
Your relationship with the attendant, the care
receiver’s relationship with the attendant, the attendant’s relationship with
you, and the attendant’s relationship with the care receiver are all very
important. Good communication is essential for a good relationship. Schedule
regular times to meet and discuss concerns, problems, and/or changes. Changes
in care needs are to be expected. If there are added responsibilities or
changes in who is living in the house, for example, these need to be discussed
with the attendant. It is important to make expectations clear and to provide
adequate training to meet those expectations. If there are problems, write out
what is not working and come together on solutions that both of you sign. Keep
communication current; address problems as soon as they arise. If you hire an
attendant privately, it is important you feel comfortable both providing
training and firing the worker if necessary. The higher the trust, the better
the relationship. Trust comes through honest and open communication. If the
attendant is doing a great job, be sure to tell them. A smile and well-deserved
praise can make a big difference. None of us likes to feel our work is not
appreciated. When you find the right person for your caregiving needs, they are
worth their weight in gold. Wishing you success in finding the best help to
match your caregiving situation and make your journey as a caregiver more
manageable and fulfilling.
Resources
Family Caregiver Alliance
National Center on Caregiving
(415) 434-3388 | (800) 445-8106
Website: www.caregiver.org
Email: [email protected]
FCA CareJourney: www.caregiver.org/carejourney
Family Care Navigator: www.caregiver.org/family-care-navigator
Family Caregiver Alliance (FCA) seeks to
improve the quality of life for caregivers through education, services,
research, and advocacy. Through its National Center on Caregiving, FCA offers
information on current social, public policy, and caregiving issues and
provides assistance in the development of public and private programs for
caregivers. For residents of the greater San Francisco Bay Area, FCA provides direct
support services for caregivers of those with Alzheimer’s disease, stroke,
traumatic brain injury, Parkinson’s, and other debilitating health conditions
that strike adults.
Other Organizations and Links
Eldercare Locator- Resources for older adults and their families eldercare.acl.gov
Aging Life Care Association- Provides help in locating a professional care manager www.aginglifecare.org
Elder Financial Protection Network- Works to prevent financial abuse of elders and dependent adults www.elderfinancialprotection.org
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More Than Care: Creating Brighter Days at Home
Discover how Comfort Keepers' Interactive Caregiving approach helps Minnesota seniors stay active, engaged and independent while aging at home.When families first begin looking into home care for an aging parent, they often think about the practical things.Who can help Mom prepare lunch? Who can drive Dad to an appointment? Who can help with laundry, grocery shopping or the everyday tasks that are becoming more difficult?Those things matter. But good home care can be about much more than completing a list of chores.For older adults, the way help is provided can make an enormous difference.Having someone prepare a meal is helpful. Preparing that meal together, talking about a favorite recipe and sitting down to enjoy it together can turn an ordinary task into a meaningful part of the day.That idea is at the heart of Comfort Keepers' approach to in-home care.Doing With, Not Just Doing ForComfort Keepers calls its approach Interactive Caregiving.The philosophy is simple: whenever possible, caregivers do things with older adults rather than simply doing everything for them.Why does that matter?Because independence isn't only about whether someone can live alone. It is also about continuing to make choices, participate in everyday life and feel a sense of purpose.Imagine an older adult who has always enjoyed cooking but can no longer safely prepare an entire meal alone.A caregiver could simply make dinner.Or the caregiver could invite that person to choose the recipe, wash vegetables, stir ingredients, set the table or share stories about meals they used to make for their family.The task gets accomplished either way.But the experience is completely different.Everyday Activities Can Have MeaningSome of the best moments don't require elaborate activities.They happen during ordinary days.Folding towels together can spark a conversation.Looking through an old photo album can bring back wonderful memories.A trip to the grocery store can provide exercise, social interaction and a chance to get out of the house.Listening to favorite music can brighten an afternoon.Working on a puzzle, taking a short walk or watering plants can provide stimulation and a sense of accomplishment.For many older adults, these seemingly small moments help create structure and purpose in the day.That's particularly important for someone who may no longer drive, work, attend as many social activities or see friends as frequently as they once did.Companionship Is Part of CareLoneliness can sometimes develop quietly.An older adult may still be living successfully at home, but the days can become increasingly isolated.Friends move away. A spouse may have passed away. Driving becomes difficult. Winter weather in Minnesota can make getting out even harder.Eventually, someone who once had a busy social life may spend much of the day alone.Companion care can help provide something families sometimes underestimate: regular human connection.Comfort Keepers caregivers can spend time talking with clients, sharing meals, playing games, listening to music, taking walks and helping seniors remain involved in activities they enjoy. The Osseo Comfort Keepers office also provides assistance with errands and transportation to appointments and social activities.Sometimes the most important part of a caregiver's visit isn't what gets checked off a list.It's the conversation that happens along the way.Maintaining Routines Can Help Preserve IndependenceMost of us have routines that make our days feel normal.We drink coffee in a favorite chair.We read the newspaper in the morning.We feed the dog at a certain time.We go to the same grocery store or attend the same church.As people age, maintaining familiar routines can become increasingly important.Home care can provide enough assistance to help older adults continue those routines rather than giving them up simply because certain parts have become difficult.For example, someone who no longer feels comfortable driving doesn't necessarily have to stop meeting a friend for lunch.Someone who needs help walking doesn't necessarily have to stop enjoying the backyard.Someone who struggles with meal preparation doesn't have to give up favorite foods.The right assistance can help bridge the gap between "I can't do that anymore" and "I can still do this with a little help."Personalized Care MattersNo two older adults are exactly alike.One person may love conversation and outings. Another may prefer gardening, music or quiet afternoons doing puzzles.Some people need help primarily with companionship and household tasks. Others may also need personal care, mobility assistance or more frequent support.That's why effective home care should never feel one-size-fits-all.Comfort Keepers develops individualized care plans around each client's needs and can provide services ranging from companionship and meal preparation to transportation, personal care, respite care and more extensive assistance.The goal is to provide the right amount of help while encouraging the older adult to remain involved in their own life.Families Benefit From the Relationship, TooAdult children often carry a tremendous amount of responsibility.They may be coordinating appointments, shopping for groceries, checking medications, helping around the house and calling several times a day to make sure everything is okay.And they're doing all of this while managing their own jobs, children, spouses and responsibilities.Professional home care can provide another trusted person in the older adult's life.That support can give family members greater peace of mind while also allowing their time together to feel more like family time again.Instead of every visit revolving around chores, there may be more time to simply sit down, talk and enjoy one another.Creating Brighter Days at HomeAging at home successfully isn't just about being safe.Quality of life matters, too.It means continuing to laugh.Continuing to participate.Continuing to make choices.Continuing to enjoy favorite activities.And continuing to feel like yourself.Sometimes, a little assistance is what makes those things possible.Comfort Keepers of Osseo serves older adults and families throughout Osseo, Maple Grove, Plymouth, Brooklyn Park and surrounding Minnesota communities with personalized in-home care designed to support independence, engagement and meaningful everyday moments.Because at its best, home care isn't simply about helping someone get through the day.It's about helping make the day worth looking forward to.Learn more about Comfort Keepers and find additional Minnesota senior resources through Seniors Blue Book or call us at 763-273-4207.
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