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 insurance.

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 agency.

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 caregiver.

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 disputes.

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 consider:

What services are provided?

Caregivers 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?

Some agencies/caregivers 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? 

If the 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.

Work related 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 caregivers? 

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 information.

Is the agency bonded, licensed and insured?

Ask 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.

Can you interview the caregiver before starting service?

You 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.

How many caregivers work for the agency? 

This is 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 choose from.

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.

Jennifer Luna Friedrich holds a Bachelor’s Degree in Gerontology and certification as a Residential Care Facility for the Elderly Administrator.

 

 

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