Hiring Home Care Help

If your loved one lives at home—and you can’t be there to provide daily care—a skilled or semi-skilled home care worker may offer the solution to many of your caregiving problems.

If your loved one needs assistance with medication, bathing, dressing, cooking, housekeeping, transportation, or other daily activities, and you can’t always be there to help, you might want to consider hiring a home care worker. Before you consider hiring help, however, ask yourself a few questions. How long do you need the services? Will half a day be enough? Until you get home from work? Round-the-clock care? And what type of help would be best for you and your loved one?

  • A housekeeper or chore worker performs basic household tasks and light cleaning.
  • A homemaker or personal care worker provides personal care, meal planning, household management, and medication reminders.
  • A companion or live-in provides personal care, light housework, exercise, companionship, and medication reminders.

A home health aide, certified nurse assistant, or nurses’ aide provides personal care, help with transfers, walking, exercise; household services that are essential to health care; and assistance with medications. In addition, a home health aid will report changes in your loved one’s condition to a supervising RN or therapist; and will complete appropriate medical records.
Once you’ve decided on the type of help you need, you can either hire someone yourself—by placing an ad in a local newspaper or taking recommendations from family or friends—or you can go through a home health care agency. Home health care agencies focus on the medical aspects of care and provide trained personnel, such as nurses and physical therapists. Medicare may pay for these services, if they are ordered by a physician.

When Hiring Help Through An Agency, Find Out:

  • If the agency is JCHAO (Joint Commission on Accreditation of Healthcare Organizations) accredited and Medicare certified.
  • Which services are covered by Medicare.
  • What type of employee screening the agency performs.
  • Whether you or the agency will be responsible for paying the worker.
  • Whether you or the agency is responsible for supervising the worker.
  • What types of general and specialized training the workers have.
  • Whether the same person will care for your loved one each day.
  • Who to call if the worker fails to show up.
  • What fees the agency charges and what types of care each fee covers.
  • Whether the agency offers a sliding fee scale.
  • If fees vary for care provided during nights, weekends, or holidays.
  • The minimum and maximum hours of service.
  • Any limitations on tasks performed or times of day when services are furnished.

When Hiring Help On Your Own:

  • Screen all applicants carefully.
  • Ask for identification and check references.
  • Be sure that the home care worker has the necessary qualifications and/or training.
  • Ask to see training certificates, particularly if your loved one has special medical needs such as insulin injections.
  • If your loved one needs to be transferred from a wheelchair, make certain that the aide knows how to do this safely.
  • If the prospective aide does not know how to bathe a person in bed or perform safe transfers—but seems to be otherwise qualified—he or she can be trained.
  • If your loved one needs round-the-clock care, you might consider hiring live-in help. In exchange for room and board, these aides usually will work for less than aides who come in for only a few hours.
  • Check with your insurance company about coverage for a full-time home care worker, and contact the appropriate agencies concerning social security taxes, unemployment insurance, and workmen’s compensation. If you don’t want to deal with these complicated withholdings on your own, accountants and companies that specialize in payrolls can perform these functions for you.
  • If public transportation isn’t available and your loved one isn’t eligible for free or low-cost transportation, try to hire someone who drives, since this can save you substantial amounts of money in taxi or commercial van ride fares. If the home care worker is going to drive your car, be sure to check with your insurance company concerning any limitations on your policy.

Your Interview With The Prospective Home Care Worker Should Include:

  • A full discussion of your loved one’s needs and limitations.
  • Full disclosure of the applicant’s caregiving experience and his or her expectations.
  • The names, addresses, and phone numbers of people who have previously employed the applicant. Be certain to check all such references.

Once You Have Hired A Home Care Worker:

  • Protect your loved one’s private papers and valuables.
  • Make arrangements to pick up the mail yourself.
  • Check the phone bill, and credit card and bank statements for unauthorized use. Professional caregivers have access to a variety of sensitive materials, so it’s best to keep a close eye on your loved one’s finances.
  • Communicate frequently to ensure that the worker is carrying out his or her responsibilities for your loved one.
  • Explain what you want done and how you would like it done, keeping in mind that the home care worker is there to
    care for your loved one and not the rest of the family.
  • If the worker lives in the home, make sure that he or she has living quarters that give you, your loved one, and the worker the maximum amount of privacy possible.
  • Be clear about the worker’s salary, the pay period, and reimbursement for money the worker may spend for gas, groceries, etc.
  • If the home care worker has a car, discuss use of the worker’s car on the job, insurance coverage for the worker’s car, or other travel arrangements.
  • Discuss the subject of vacations, holidays, absences, and lateness, as well as the amount of time each of you should give if the employment is terminated.
  • If you work and must depend on the home care worker on specific days and times, emphasize the importance of being informed as soon as possible if the home care worker is going to be late or absent. It is wise to have a list of home care agencies, neighbors, or family members who can be called upon on short notice.
  • Inform the worker about your loved one’s dietary restrictions; provide a list of contacts in case of an emergency; review security precautions and keys; and discuss your loved one’s medication requirements.
  • Once the home care worker is on the job, hold periodic meetings to discuss any problems the worker or your loved one may have, and find ways to resolve them. It pays to be positive and open in resolving difficulties. In most cases, they can be corrected.

© Copyright FamilyCare America, Inc. All Rights Reserved.

Adapted from Elder Action: Action Ideas For Older Persons and Their Families. Caregivers, Caregiving and Home Care Workers, developed by the Administration on Aging.

Caregivers Handbook

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