What You Need To Know Before Hiring In-Home Help

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: info@caregiver.org


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