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
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
“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
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
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,
- 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
- 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
- What do you like and dislike about home
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
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
The Caregiver’s Helpbook: Powerful Tools for
The Comfort of Home: An
Illustrated Step-by-Step Guide for Caregivers, 3rd
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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