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18 Fearless Years


Gary Barg - Editor-in-chief Help Finding the Right Help

One of the greatest challenges we face as family caregivers is what to do when in-home assistance is needed.  First, we have to, more likely than not, overcome our loved one’s objections to having someone in their home helping them (other than you).

Yet, once you have your loved one on board (if possible) about having in-home support, the challenge becomes one of making sure you are hiring the right people for the job.  A recent study was funded by the National Institute of Health called “Hiring and Screening Practices of Agencies Supplying Paid Caregivers to Older Adults” by Lee A. Lindquist, MD, MPH, MBA, et al, at the Division of General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. The authors sought to assess the validity of the screening practices that agencies used in hiring caregivers to send out on assignment.

Four hundred and sixty home care agencies were contacted by interviewers posing as prospective clients seeking a caregiver for an older adult relative in Illinois, California, Florida, Colorado, Arizona, Wisconsin and Indiana.  Only 6.7 percent required the caregiver to be certified as a Certified Nursing Assistant in order to be hired. Agencies were surveyed about their hiring methods, screening measures, training practices, skill competencies assessments and supervision. The study concludes that using an agency to hire paid caregivers may give older adults and their families a false sense of security regarding the background and skill set of the caregiver working in their home.

Dr. Lindquest suggests asking the following 10 questions before hiring a caregiver agency.

  1. How do you recruit caregivers and what are your hiring requirements?

  2. What types of screening are performed on caregivers before you hire them? Criminal background check? Federal or state drug screening?

  3. Are they certified in CPR or have any health-related training?

  4. Are the caregivers insured and bonded through your agency?

  5. What competencies are expected of the caregiver you send to the home? For example, lifting and transfers, homemaking skills, personal care skills (bathing, dressing, toileting), training in behavioral management, cognitive support.

  6. How do you assess what the caregiver is capable of doing?

  7. What is your policy on providing a substitute caregiver in the event a regular caregiver cannot provide the contracted services?

  8. If there is dissatisfaction with a particular caregiver, can he or she be replaced “without cause”?

  9. Does the agency provide a supervisor to evaluate the quality of home care on a regular basis? How frequently?

  10. Does supervision occur over the telephone, through progress reports, or in person at the home of the older adult?

We know lots of great agencies around the nation who are extremely diligent in their hiring practices and we also know plenty of situations where in-home care was successfully handled by independent aides.  Regardless of which route you take to hire assistance, the truth is that you are the boss and as in any successful endeavor, a few basic rules apply: knowledge is power, the only inappropriate question is the unasked one, and, most important of all, trust your instincts.

Here’s more information to help you hire and manage your home care aide.

When Caregiving is Not Enough - Finding Good Homecare

Hiring Private Duty Home Care Workers: Why Work through an Agency?

Your Home Health Care Aide: Establishing a Positive Relationship

Paid Aides—An Agency’s or Your Own?

Living With Your Home Health Care Aide


Please share your experiences in hiring and managing health care aides.


  Gary Barg
Today's Caregiver magazine
Tuesday July 31, 2012


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