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Shopping for the Right In-home Help

By Eileen Beal, MA

 

When Mom and Dad are struggling to keep up with the chores, activities or medications that help them maintain their independence and health, the solution to their situation (and your concerns) could be as simple as bringing in someone to provide in-home care for a couple of hours a day.

But not before you and they have had a frank discussion about the kind of help, support and services they need – and will accept.  “You want them to feel they are a part of the decision-making process, that their wishes and wants are honored and respected,” says Mary Ellen “Mel” Roberts, LCSW, a certified care coordinator at Oklahoma City-based Elder Care Solutions.

Start by asking your loved ones (and yourself) the following questions:

  • What days and times, and in what situations, might you need help?
  • How much money is available to pay for outside resources, and will your insurance – including Medicare or Medicaid – cover any costs?

Home care vs. home health aide

Home care aides provide assistance with housekeeping and chores (meal preparation, shopping, errands, etc); socialization and companionship; and may also provide some personal care (bathing and grooming).  In some areas, they are called personal care assistants.

Home health aides – increasingly certified nursing assistants (CNAs) and/or state tested nursing assistants (STNA) – provide medically-related care (check blood pressure and glucose levels, dress dry wounds, empty colostomy bags, etc.); assist with therapeutic treatments prescribed by a physician; supervise medication administration; etc.

“The client’s needs and the aide’s skill-level determine what the aide’s [hourly] fee will be.  The more skills the aide has, the higher the cost,” says Debbie Adams, RN, the Director of  the Cleveland, Ohio-based Western Reserve Area Agency on Aging’s Community Services and Support Program.

Write a job description

Using the information you’ve gathered from discussing and assessing your loved ones’ needs, write a detailed job description.  “Care expectations vary from client to client, so having everything in writing means everyone knows, and meets, expectations,” says Lucy Andrews, the nurse/CEO at Santa Rosa, California-based At Your Service Home Care.

A detailed job description doesn’t just “clarify expectations;” it should also influence whether to hire on your own or through an agency.

With an agency, the aide has been trained, screened and checked  – for everything from DUIs to TB –and bonded.  And they are supervised.  “That,” says Adams, “includes surprise home visits.”

But there are other benefits, too.  “Clients have back-up if the scheduled caregiver can’t be there.  And an agency handles all the paperwork:  reimbursement forms, payroll, taxes, workers compensation, insurance,” says Andrews.

“And,” adds Roberts, “if you aren’t happy with the person, all you do is call the agency and say, ‘This isn’t working.’”

Hiring on your own means asking people you trust for word-of-mouth referrals and/or posting help wanted ads.  Increasingly, you can do that at on-line sites like the PHI National’s Matching Services Project http://phinational.org/policy/resources/phi-matching-services-project).  And you’ll also be doing the screening, interviewing, supervision, scheduling and paperwork.   But, there’s an upside, too.  “It’s usually easier to partner with the person who’ll be coming in, and you will usually be paying less, too,” says Adams.

Do a thorough interview

If you decide to go through an agency, use the questions at the Eldercare Locator (http://www.eldercare.gov) to screen and vet the agency.  Then, use the following questions to interview the candidates they suggest and/or you find on your own:

  • Can you provide me with your full name, address, phone number, current photo ID and Social Security number so that I can run a background – including credit – check? (If you’re interviewing an agency candidate, request contact information only.)
  • Can you (your agency) provide me with copies of current documentation related to personal insurance, bonding, workers compensation, and your current health status (TB test, immunizations, etc.)?
  • Can you (your agency) provide me with current documentation related to specific services (dementia care, CPR, etc.) you are trained/certified to provide?
  • Can you (your agency) provide me with references related to past clients and employers.
  • How long have you been providing care?
  • Why did you leave your last position? 
  • What are your expectations if I hire you?
  • What hours and days will you be available?
  • What hourly rate do you expect, and how do you expect to be paid?
  • How do you like to get feed-back and suggestions?
  • What do you like and dislike about home care?

You should also ask situation-specific questions, such as: Since my mother is Jewish, can you prepare kosher foods?  Since my father doesn’t speak English well, what’s your competency in (fill in the blank)?  Since we get a lot of snow here, how reliable is your car?  (Note: All the “thorough interview” info is from interviewees and two books cited in the source resource list:  How to Care for Aging Parents (pps. 155-161) and The Caregiver Helpbook (pps. 177-181)).

In addition, download the United Hospital Fund’s “Home Care: A Family Caregiver’s Guide” and “A Family Caregiver’s Planner for Care at Home”. Both are full of tips and strategies for running a good interview, and for addressing the challenges that could come with employing an in-home caregiver.

Additional sources and resources

Web sites

AARP: Needs Assessment checklists
Family Caregiver Alliance: Hiring in-home help
Family Caregiver Alliance: Handbook for long-distance caregivers

Books (all have excellent sections/chapters on hiring in-home care)

ElderCare 911: The Caregiver’s Complete Handbook for Making Decisions
Available here 

The Caregiver’s Helpbook: Powerful Tools for Caregivers
Available here

The Comfort of Home: An Illustrated Step-by-Step Guide for Caregivers, 3rd Ed
Available here

 

Eileen Beal is a Cleveland, Ohio-based writer who has been writing about caregiver issues for more than a decade.  This article was written with the support of a MetLife Foundation Journalists in Aging Fellowship  grant administered through New America Media (www.newamericamedia.org) and the Gerontological Society of America (www.geron.org)

 

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