For older adults, in-home non-medical care might
be the key to independence. However, the
quality of care depends on the quality of the
caregiver. When looking for in-home care, finding
the best service can be a challenge. This
article offers suggestions on what to look for when
hiring a caregiver.
What is In-Home Care?
In-home caregivers provide assistance with
activities of daily living (ADL) such as meal
preparation, dressing, grooming, medication
monitoring, transportation and light housekeeping.
These services should not be mistaken for home
health services, which offer skilled, medical
services by licensed professionals such as nurses
and therapists. While in-home caregivers may
be trained and/ or certified, they focus mostly on
activities of daily living and are not required to
perform complex health care related tasks.
Programs such as Medicare, or Medicaid (Medi-cal)
cover Home Health Services, but do not usually cover
non-medical services. There are some long-term
care insurance policies that cover non-medical
in-home care services. Review your policy to
determine whether in-home care is covered by your
Looking For Quality In-Home Care
There are a number of ways to find in-home care.
Referrals from health care professionals and others
who have used in-home care may be the best source of
quality care providers. You can either hire
the caregiver directly as an employee, or use an
Independent or Freelance Caregivers can be
found in the Situations Wanted section of the
newspaper. Or, you can advertise for caregivers in
the Help Wanted section.
There are advantages and disadvantages to hiring
a freelance caregiver. Families often cite lower
cost as the major benefit. However, when
hiring a freelance caregiver, bear in mind costs
related to being an employer. Employer taxes,
insurance and Worker’s Compensation will need to be
paid. Tax withholdings and payroll tax reports
will have to be made. In most cases, freelance
caregivers do not qualify as “Independent
Contractors” according to tax and labor laws. Trying
to save costs while violating tax and labor laws can
put your family at great risk. Fines can be
levied and back taxes plus penalties can accrue. Work related injuries might not be covered by your
homeowner’s insurance. Live-in caregivers who use
your home as their main residence may be considered
a tenant. This may complicate things should you need
to terminate this person’s service. You should
always consult with tax insurance and legal
professionals if you choose to hire a freelance
Another very important aspect of hiring a
freelance caregiver is safety. Has this person
been convicted of a crime? What is their work
history? Be sure to have the applicant list their
experience and training. Check their references.
Employee application forms are available at office
supply stores, and can be used for each potential
employee. It is also important to verify that this
person can legally work in the United States. A form
called the I-9 should be kept on file for the
employee. Fines ranging from $250 to $2,000 can be
imposed on those who hire illegal immigrants. Also,
be sure to have a written agreement with the
caregiver to avoid potential wage and labor
For peace of mind, you may want to use agencies
or registries that offer pre-screened caregivers for
you to hire directly. Using a screening
service does not relieve you of your responsibilitie
s as an employer if you hire the caregiver directly.
Agencies and companies who do background checks can
be found in the Yellow Pages or on the Internet.
Another option for finding caregivers is
through an agency. In-home care agencies usually
offer licensed and bonded staff that perform a
variety of tasks. While it may be more expensive to
hire a caregiver through an agency, you will not be
responsible for costs such as accounting, insurance
and taxes. When choosing an agency, be sure to ask
about what services are provided. Find out about the
company. How long have they been in business? Are
they with the Better Business Bureau? Check their
references. Compare costs, services and features
that they offer. Do not be afraid to ask
questions. Remember, you are the client, and
ultimately you must feel comfortable and confident
with the caregiver’s services.
Questions to Ask When Hiring a Caregiver
When interviewing potential agencies and
caregivers, there are many important things to
What services are provided?
may provide light housekeeping, transportation, meal
preparation, medication monitoring, personal care,
and assistance with ambulation. Some agencies
provide higher levels of care such as incontinence
care, heavy transfers and Alzheimer’s care.
Have the agency clearly state in writing what
services are provided.
Can they work a schedule
according to your needs?
Some agencies have minimum
numbers of hours per shift. Some offer shift rates.
Some charge more for holidays, nights and weekends.
Ask which holidays are observed by the agency.
What are the costs? How are payments handled? What
is the cancellation policy?
charge by the hour, while others may charge by the
job or shift. You should outline in writing what you
are getting for your money. Some agencies require a
deposit before services begin. Find out what the
deposit covers and their refund policy.
Additionally, ask about their cancellation policy.
Some agencies require advanced written notice of
cancellation. Prices can vary widely. The
cheapest is not always the best option. It pays to
shop and compare.
What is the
caregiver’s employment status?
caregiver is the employee of the agency, then the
agency is responsible for bonds, taxes and
insurance. Be wary of agencies that claim the
caregivers are “independent contractors.” In most
cases, caregivers do not qualify as “independent
contractors” according to tax and labor laws. Their
fees may seem low, but you could be deemed the
employer and assume the employer’s responsibilities
for taxes and insurance. Trying to save costs while
violating tax and labor laws can put your family at
great risk. Fines can be levied and back taxes
plus penalties can accrue.
injuries may not be covered by your home owner’s
insurance. There are no surety bonds that would
cover “independent” caregivers for theft, dishonesty
or negligence. The same considerations hold true if
you hire an individual “freelance caregiver.”
Check with your legal and tax advisor if you choose
to go this route.
What is the agency’s /
caregiver’s track record? How long has the
agency been in business?
Call the Better Business
Bureau to see if the agency has any complaints on
file. Obtain and verify references (especially
for freelance caregivers).
How much skill and
experience do the caregivers have? Does the agency
have skills and experience requirements for their
What kind of training do they give
to their caregivers? Experience usually relates
directly to skill. If your loved one has a special
need, such as Alzheimer’s care, be sure the
caregiver has experience and knowledge in this area.
What is the caregiver’s background? Does the
agency perform a criminal background check on their
caregivers? Are fingerprints taken? Can they legally
work in this country? What is their driving history?
For freelance caregivers, you can do a background
check yourself. The Department of Motor Vehicles can
provide driving records and the County Courthouse
can do criminal records checks. Resources can also
be found in the phone book or on the Internet. Be
wary of caregivers reluctant to provide background
Is the agency bonded, licensed and insured?
to see copies of the agency’s business or other
required licenses, liability insurance policy,
Worker’s Compensation insurance policy and surety
bond. Keep copies for your records in case of
a future need.
Is there a cost for assessments?
An initial assessment is vital to determining the
type of care your loved one needs. Some
agencies charge fees for assessments.
interview the caregiver before starting service?
want to find a caregiver you feel comfortable with.
Ask about the agency’s policy regarding interviewing
caregivers. Most offer this for free, while some
charge a fee.
What is the caregiver replacement
policy? If your worker is sick or quits, are
emergency call services available?
There should be a
plan in place if your caregiver can’t work. Ask if
you can replace a caregiver if there is a problem
and how soon you can have a replacement.
many caregivers work for the agency?
important to determine the agency’s ability to find
a replacement caregiver if needed. Smaller
agencies have fewer workers to call for
replacements. Larger agencies have more workers to
You may have more questions to ask
potential caregivers. Write them down and keep notes
on the responses. Finding the right caregiver can be
a tedious process, but you will feel better knowing
you have done your best. It is a very important
decision to bring a caregiver to your home. With the
right information, you can determine which agency or
caregiver is right for you.
Friedrich holds a Bachelor’s Degree in Gerontology
and certification as a Residential Care Facility for
the Elderly Administrator.
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