It is easy for family and friends, as well as professionals, to suggest finding someone to help with housekeeping tasks andcare 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 tohave 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 theydont 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 takea toll on anyone. With a loved one who needs personal care and who cant be left alone, you must be vigilant and on duty day and night. With constantcare and companionship responsibilities, you may have very little time to yourself. If you are caring for someone who needs to be transferred from bed towheelchair 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 bealso be dealing with challenging behavior, wandering risks, or actions that might be harmful or dangerous such as leaving cooking burners on. If you donthave time to do the shopping, banking, and taking care of your own medical needs, you are at risk for stress-related illness. Are housekeeping routinesand cooking being done with great difficulty or being left undone? Consider your needs as a caregiver and the needs of the person you are caringfor. Here are the main areas to assess: Personal care: bathing, eating, dressing, toileting, grooming Household care: cooking, cleaning, laundry, shopping Health care: Medication management, physicians appointments, physical therapy Emotional care: companionship, meaningful activities, conversationHiring 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-distancecaregivers and working caregivers, help can provide the care and assistance needed when you cant 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, forexample, taking a shower might not be the battle that it can otherwise be. Engaging an attendant can help to preserve your relationship as daughter orpartner, rather than always having to be the chore person or taskmaster. Attendants come in fresh for a certain number of hours and therefore have theenergy 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 HelpIt can be hard for your loved one to accepthelp from a stranger. Initially, it will be important for you to be present tohelp the attendant and the care receiver to establish a successfulrelationship. You can show the attendant how you do things, so the help that isgiven will feel familiar and comfortable. Let your loved one know that YOU needhelp and that this is something they can do to help you care for them. Reassureyour loved one that hiring help does not signal that you are going to abandonthem.If your loved one lives alone, you might hear,I dont need any help. Suggest that it will make YOU feel more comfortableknowing someone is their part of the day. You can also suggest that they justtry it for a week. This will give your loved one some control in decisionmaking and help them be open to having an attendant.The transition to an attendant might be easierif the attendant shares a similar cultural background or language. The carereceiver 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 yourown can lead to rewarding bonds.Sometimes the best way to get an attendantaccepted is to hire a housekeeper. Care receivers are often more open tohaving someone come in and help with the housework before they are willing toaccept someone to help with personal care. This gives your loved one time tobecome familiar with the attendant and build trust.I Dont Want a Stranger in My House!We all react differently to interacting withsomeone we dont know. For some people, meeting someone new is an enjoyable andinteresting opportunity. But for others who are naturally more reticent or arefeeling vulnerable due to their illness, there is great reluctance to exposingtheir private life and personal living space.Hiring someone through an agency will give yousome choice for attendant selection. Most agencies have done background checksand bonded the people who work for thembe sure to ask if this is the case. Andif you feel uncomfortable with the person who is sent, you can always ask theagency to send someone else. But typically an agency will attempt to match theattendant to your specific needs and requests, so if you arent immediatelycomfortable with the attendant sent, consider giving it a day or two to warm upto them.Caregivers and care receivers often worry thattheir belongings will be stolen. This does happen, but it is much rarer thanyou might be led to believe. Lock up or take out of the house any especiallyvaluable belongings, such as heirloom jewelry, just to make yourself lessanxious about this happening. Keep track of cash and checks/checkbooks/creditcards. 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 thecaregiver. If your loved one has dementia, they may report an item as missingwhen it is only misplaced or stashed away.How Do I Find Help? There are formal and informal ways of findingan attendant. The formal way is to contact a Home Care Agency located near towhere your loved one lives. A long list of agencies will be available in mosturban and suburban communities. This can make it difficult to figure out who tocontact first. Far fewer agencies serve rural areas, limiting options forhiring care. People who can help you select the right agency for your needsinclude your doctor and their staff, your friends/family who have used anagency, and others in your community whom you trust, such as your faith community,your local senior center, etc. Also, check for agency reviews from trustedonline sources, and consider contacting your local Area Agency on Aging to askwhom they hold contract(s) with for their clients.Key Questions To Ask: Is the agency licensed by the state? (Many butnot all states require licensing to operate a Home Care Agency). Ask how longthey have been in business. Are the workers licensed and insured? How doesthe agency train, supervise, and monitor their workers? Request that the agency send you a packet ofinformation that describes their services, fees, and a list of references. Thiswill give you an opportunity to review the information before sitting face toface with an agency representative. What are the aides credentials? Check withthe credentialing body to confirm. Where has the aide worked previously? Ask fortwo to three references from former or current employers. Always contact the references asking about thecare competency, compassion, and reliability of the worker. Is the aide legally eligible to work in thiscountry? Ask to see verification (passport, green card, etc.)What Will It Cost?If you hire a Home Care Agency, they willestablish the pay rate. Agencies will charge a different amount, depending onthe 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-hourshifts. Or they will do a 2-hour shift but charge more per hour. For people whoneed full-time care, the options are a live-in who does the full 24 hours, alive-in plus an 8-hour shift for someone who needs someone to be awake andavailable during the night, two 12-hour shifts for people who may need someoneawake at night, or three 8-hour shifts for someone who may need extra help dueto 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 hoursonce or twice a week, it can be more affordablethe hourly cost variesdepending on where you live in the United States.If the care-receiver has a long-term careinsurance policy and the service provided meets the policy criteria, thebenefits can offset the cost. Check the policy for how many days of care arerequired before the policy will start to pay. Determine whether there iscoverage for hiring someone privately, or only for hiring through an agency.Some policies require that the attendant be a HHA, LVN (licensed vocationalnurse), or CNA, and others do not.The cost of a hired attendant might be taxdeductible if it is considered medically necessary. Check with your taxaccountant to see if this is the case in your situation.If the care receiver is low income andqualifies for Medicaid (Medi-Cal in California), they may be able to get helpthrough an in-home program called In-Home Supportive Services (IHSS). Checkwith your local Medicaid office to see what services are available in yourarea. Medicaid benefits differ by state.This type of care is an appropriateexpenditure for use of the care receivers personal savings. Often a family willalso contribute as needed to help cover the cost. Holding a family meeting todiscuss the need for the home care service, the cost of the care and the meansavailable to cover the cost can help surface concerns from family members, andgain support to help cover the expense.Some communities have a sliding scale orlow-cost home care through specialized funding. Contact your local Area Agencyon Aging (AAA) to see what is available in your community. The Medicaid In-HomeSupportive Services (IHSS) office may have a registry that is open to thepublic and can give you referrals for pre-screened attendants. Under Title IIIEof the Older Americans Act, funding distributed through your local Area Agencyon Aging (AAA) offers help paying for respite care (temporary relief) and othercaregiver related services. Faith communities and some senior service agenciesalso 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 clearabout what it is you want the attendant to do. Write a job description thatspells out the things you need help with and make a detailed list of the tasksyou want to be done. Clarity is essential to effective communication and mutualunderstanding. For example, if you want help with housekeeping, list the kindof housekeeping duties that need to be performedvacuuming, cleaning thebathroom, washing dishes, doing the laundry, etc. Be clear about any specificways that you want these duties performed, e.g. wash white items and colorsseparately. If you want personal care, does the care receiver need help withdressing, grooming, bathing, toileting, transferring? If you want someone tojust be there, does the care receiver like to take walks, watch TV (whatshows?), talk, go out to lunch, play golf, read, be left alone (some peoplelike chatty attendants and some people do not)? If there is a pet, does it needto be taken for a walk, do you want the poop in the backyard cleaned up, thekitty box cleaned out? (Check with the attendant for allergies to pets or fearof certain animals.). It is very important to find out the attendantsexperience with dementia if you are hiring someone to care for a loved one withcognitive impairment. Give examples of situations you face and ask how theywould handle them. (See below: Write a Job Description) Three general certifications exist for homecare attendants. One is an HHAhome health aide, the second is a CNAcertifiednursing assistant, and the third is an LVNlicensed vocational nurse. They aretrained to provide most levels of care in the home except for care requiring aregistered nurse, e.g. giving an injection. Each state has different laws onwhat attendants can and cannot do, such as dressing changes on a wound orgiving medications. In most settings, an attendant can put the medications inthe care receivers hand, but the care receiver must take the medications ontheir own. However, there might be rules on who can set up the media-set withthe pills in it, and whether or not the care receiver must take them out of themedia-set on their own.Always check references.Always do a background check.(See FCA fact sheet Background Checking: Resources ThatHelp)InterviewingIf you are hiring through an agency, you canshorten 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 ofpeople. Often an agency representative will come to the house and interview youto find out what type of help you are seeking and will try to match you withthe person in their employee pool who best meets your needs. However, havingyour job description will still be helpful in working with the agency.Initial interview/screening can be done byphone. Ask for a resume and references. With those who seem like they would beright for your situation, you can set up an in-person interview either at yourloved ones home or at a nearby coffee shop if you prefer. If appropriate, thecare receiver should be present at the interview, as their input is important.Other family members or concerned individuals may also be present. Their inputcan help you make a good decision. The job description can be emailed to theapplicant as a way to start the conversation.Here are some initial questions for theinterview: 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 jobdescription for this position. What is your favorite kind of client? Whatpushes your buttons? Is there anything in the job description thatyou are uncomfortable doing? How do you deal with someone living withmemory problems? Give an example. Describe your experience making meals forother people. How do you handle people who are angry,stubborn and/or fearful? Do you have a car? Would you prefer to driveyour own car or our car in transporting? Ill need to see proof of insuranceand a current drivers license. What is your experience transferring someoneout of bed or chair and into a wheelchair? What is your availability? Days? Hours? Can you give me two work-related and onepersonal reference I can contact? Ill need personal identification thatverifies that you can work in this country. Please bring it with you so that Ican make a copy.If the care receiver is present, watch theinteractions between the attendant and the care receiver. Do they only respondto you, or do they include the care-receiver in their answers? If the carereceiver is not present, you might want to invite a top candidate back to meetthe care receiver before making a final job offer.Immediately after the interview, write downyour 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. Checkyour gut. How you feel about someone can go a long way in your finding theright person. Check the references. Have a list of questions to ask about theirexperience in working with this attendant.CommunicationYour relationship with the attendant, the carereceivers relationship with the attendant, the attendants relationship withyou, and the attendants relationship with the care receiver are all veryimportant. Good communication is essential for a good relationship. Scheduleregular times to meet and discuss concerns, problems, and/or changes. Changesin care needs are to be expected. If there are added responsibilities orchanges in who is living in the house, for example, these need to be discussedwith the attendant. It is important to make expectations clear and to provideadequate training to meet those expectations. If there are problems, write outwhat is not working and come together on solutions that both of you sign. Keepcommunication current; address problems as soon as they arise. If you hire anattendant privately, it is important you feel comfortable both providingtraining and firing the worker if necessary. The higher the trust, the betterthe relationship. Trust comes through honest and open communication. If theattendant is doing a great job, be sure to tell them. A smile and well-deservedpraise can make a big difference. None of us likes to feel our work is notappreciated. When you find the right person for your caregiving needs, they areworth their weight in gold. Wishing you success in finding the best help tomatch your caregiving situation and make your journey as a caregiver moremanageable and fulfilling.ResourcesFamily Caregiver AllianceNational Center on Caregiving(415) 434-3388 | (800) 445-8106Website: www.caregiver.orgEmail: info@caregiver.orgFCA CareJourney: www.caregiver.org/carejourneyFamily Care Navigator: www.caregiver.org/family-care-navigatorFamily Caregiver Alliance (FCA) seeks toimprove the quality of life for caregivers through education, services,research, and advocacy. Through its National Center on Caregiving, FCA offersinformation on current social, public policy, and caregiving issues andprovides assistance in the development of public and private programs forcaregivers. For residents of the greater San Francisco Bay Area, FCA provides directsupport services for caregivers of those with Alzheimers disease, stroke,traumatic brain injury, Parkinsons, and other debilitating health conditionsthat strike adults.Other Organizations and LinksEldercare Locator- Resources for older adults and their families eldercare.acl.govAging Life Care Association- Provides help in locating a professional care manager www.aginglifecare.orgElder Financial Protection Network- Works to prevent financial abuse of elders and dependent adults www.elderfinancialprotection.org
