In-Home Caregivers: How to Find and Hire The the Right Caregiver

As we age, the time may come when many of us may need a caregiver, whether it is a temporary arrangement after surgery, or a permanent way to avoid moving into an assisted living facility.  You may need the caregiver for yourself, or for someone in your family.  When the need arises, do you know how to find one and what services they can be expected to handle?  How can you be confident that you can trust the person you hire?  What do you need to do to avoid financial and legal problems?

These are all important questions for patients and their families to ask themselves before hiring a caregiver.  The more you educate yourself and the better you prepare to benefit from the service they provide, the smoother things will go for both the patient and caregiver.

What Services are Performed by Caregivers?

Caregivers can be expected to help a patient with their normal activities of daily living. This can include:

Dressing and bathing
Personal hygiene
Ambulation or transferring between a bed and wheelchair
Help with medications
Shopping and food preparation
Light housekeeping and laundry
Transportation to medical appointments or for personal care

In addition, having a caregiver will reduce your loneliness, because they will have conversations with you and may even play card games or engage in similar activities, all of which can help you postpone dementia.

Best Way to Find a Caregiver

In order to avoid the risks involved in using an unlicensed caregiver, it is best to use an in-home care agency which is licensed in your state.  These companies have to meet their state's requirements regarding training and background checks.  

If possible, it is important for a family member to supervise the hired caregiver, especially at first.  According to inhomecare.com, the average state-mandated training hours for certified caregivers is approximately 75 hours of study.  Some states require even less time; others require more.  Essentially, this means caregivers must participate in only about two weeks of training.  

Before leaving your loved one with a hired caregiver, or hiring one for yourself, you will want to make sure the person fully understands their duties, including how to properly dispense medication, prepare meals the patient will enjoy, manage the transition in and out of chairs and beds, assist in dressing the patient, know how to use common home appliances, and is capable of helping the patient use the toilet, etc.  Do not leave a patient alone with a caregiver until you are completely satisfied that the person is able to handle all their routine duties, as well as any emergencies which could arise.  

In addition, make sure you write down a detailed fact sheet for the caregiver.  It should include instructions on how they can best help the patient, including allergies the patient may have, medications they take, contact numbers for doctors, neighbors and family members, and any other information you think would help the caregiver.   Even if you are the patient, make sure you put all this important information in writing. This will help the caregiver know what to do in the event you are injured or have a medical emergency and are unable to communicate your needs. 

In hiring a caregiver, you will also want to use an agency which has been approved by the American Board of Home Care.  Their goal is to "uphold the trust you have placed in them to review, check, and ensure the best quality of home care providers looking over your family, friends, and patients."

You can contact the American Board of Home Care at:

(877) 436-5259
www.americanboardofhomecare.org

Finally, it wouldn't hurt to do a Google search of your own on the caregiver, to see if this person has been mentioned negatively online or has been accused of any crimes. If you suspect they may have had a past problem, bring up the issue with the agency for an explanation.  You would not want to put yourself or a family member in the care of anyone who could be dangerous, or take financial advantage of a fragile person.

What If a Family Member Offers to be the Caregiver?

In some cases, a member of your family may be the best caregiver.  In this case, it would be smart for both the patient and the family member to sign a Long-term Care Personal Support Services Agreement.  In this way, everyone knows exactly what care will be provided, how often, and during what period of time.  In addition, it also will clarify what financial compensation they may receive, and whether this compensation will come from the person receiving the care, other family members, or the state.

A family member may be uncertain exactly what services they need to provide and how to keep track of everything.  You might find it helpful to get a copy of the "Caregiver's Workbook:  Checklists and Worksheets for Family Caregivers."  (Ad) It could help reduce your stress and keep you organized. 

In many cases, state governments will pay caregivers through Medicaid to assist low-income patients who qualify for in-home care. Having a written agreement will show the state where the money is going and what services are being provided.  The checklists and worksheets mentioned in the book above can also help you prove to Medicaid that you are performing the necessary tasks, and the hours you are working.  

Having a written agreement and agreed compensation will also reduce misunderstandings among heirs over the reduced amount of money which they might inherit, as a result of the financial compensation paid to the caregiver.

What Should be Included in the Agreement for a Family Caregiver?

If a friend or family member is going to be paid to provide the care, everyone should see this as fair and reasonable. In order to do that, the caregiver agreement should include the information listed below.  You may want to consider having an attorney draw up the agreement.

* It should be a written agreement.
* It should cover only services which will be provided after the agreement is written; not services provided in the past.
* It should provide for reasonable compensation which would not be greater than would be charged by a licensed caregiver service in your area.
* It should stipulate the types of care which will be performed and the hours the caregiver will work.
* It should specify who will pay the caregiver and how frequently. 
* It should be flexible and include the statement that the services provided may change as mutually agreed upon by the parties.
* There should be a clause allowing either party to terminate the agreement in writing.
* There should be a "backup" person listed in the event the primary caregiver is temporarily not able to provide their services (for example, if they become ill themselves).
* It should cover any additional factors such as room and board, if the caregiver lives with the patient, income tax withholding, medical insurance for the caregiver, vacation pay, etc.
* It should require a detailed log of duties performed, to justify their salary

Advantages of a Family Caregiver

Although having a family member perform the caregiver duties can cause jealousy and problems with other family members, it can also provide an extra level of care which might not be appropriate if the family hires a professional caregiver.  Some of these extra duties include:

Dealing with household and medical bills
Handling other finances
Going to medical appointments and assisting in making medical decisions

Whether you decide to go with a professional caregiver or have a family member provide that service, it will make life much easier on everyone to know that appropriate care is being provided either temporarily or permanently for yourself or a frail or ill member of your family. 

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How to Hire a Home Care Agency

At some point, nearly everyone who lives long enough is going to need a little extra help.  If you or your loved one does not need to live in a skilled nursing or memory care facility, a home caregiver may be able to provide all the assistance you or your family member needs.  Whether you are hiring the person for yourself, a spouse or a parent, what are some of the issues you need to consider in choosing the right caregiver and agency?

Choose a Licensed Caregiver Agency

Although it may be tempting to hire a private individual as a caregiver, it can be a risky move.  Most district attorneys and law enforcement officials have dealt with cases in which valuables or money were stolen by unlicensed, private caregivers.  In addition, an unlicensed caregiver is more likely to ask for "loans" or not be qualified to provide proper care, especially in an emergency.  They may have had little or no training or experience in dealing with medications, lifting people who have fallen, knowing when to call 911 or handling other situations.  A better solution is to deal directly with an agency which is bonded and responsible for training and assisting you in choosing the appropriate employee for your situation.

What to Look for in a Licensed Caregiver Agency

The State of California has a Home Care Services Consumer Protection Act which requires agencies to meet certain requirements.  Even if you live in another state, these are guidelines you should look for in any agency you may choose to employ:

*  They should conduct background checks on their employees
*  They should provide an employee dishonesty bond
*  They should provide training (although in California only 5 hours are required)
*  They should carry liability insurance
*  They should keep records on any reports of suspected abuse
*  They should provide workers compensation coverage for their employees

What to Look for in the Caregiver Who Comes to Your Home

Whether you are hiring the caregiver for yourself or a family member, you want to make sure they will be a good fit and able to handle the job.  You should insist on meeting the caregiver before they begin working alone with you or your family member.  There are certain issues to consider:

*  You need to recognize that a caregiver is NOT there to provide medical care.  The caregiver is employed to provide needed assistance with activities of daily living such as grocery shopping, cooking, feeding, bathing, dressing, dispensing medication at the appropriate times, or moving the client from the bed to a wheelchair or making similar transitions.  They may also drive them to medical appointments and social engagements.

*  The caregiver should be a self-starter, recognize when something needs to be done, and be willing and energetic enough to do it.

*  The ideal caregiver should have a caring personality.  They should smile often, be willing to give a hug occasionally, listen to repetitive stories, and laugh at the funny ones.  Since they may be the only person their client sees regularly, they need to be able to fill of the role of both caregiver and friend.

*  They should be willing and able to keep their client as active as possible, helping with their physical therapy exercises and enabling them attend their favorite social events or fitness classes.

*  The caregiver should be observant and intuitive, able to recognize when "something doesn't feel right."  They should be comfortable letting other family members or medical personnel know if they suspect there is a problem and be ready to call 911 in an emergency.  They should also be good communicators and able to explain any changes they see. 

*  They should be diplomatic and discrete in dealing with other family members, especially if their client is dying, goes on hospice or becomes stressed when certain relatives are around.

What You Can Do to Help the Caregiver

Whether you hire a caregiver for yourself or a family member, there are steps you can take to make their job easier and more beneficial for the client.

* Give the patient the opportunity to have input in choosing the caregiver.  They are the one who will spend their days with this person and you want to hire someone they will enjoy being with.  The patient also needs to be involved in compiling the instructions which will be given to the caregiver, so they feel they still have ultimate control over how they will spend the final months or years of their life.
*  Provide the caregiver with a detailed list of medications and when each one should be taken.
*  Provide a list of the patient's favorite foods and recipes, as well as any mealtime preferences and food allergies.
*  Explain sleeping, television, music and other preferences to the caregiver.
*  Make sure the caregiver knows who is and is not allowed in the home with the client.
*  Have the physical therapist or other medical personnel show the caregiver any exercises the client should be doing, the proper way to move the person and other important details of their care.
*  Give the caregiver a list of emergency numbers ... family members, doctors, therapists, etc.
*  Put all this information and anything else which you think will be important in a binder which the  caregiver can refer to if they have any questions.  This is especially important because occasionally the caregiver may become ill and a substitute caregiver will take their place. 

You should also make arrangements to have bills paid, taxes done and other business matters handled by someone other than the caregiver.  The caregiver should not be expected to take care of these things, so another family member, conservator, or public guardian will need to handle these matters if you or your family member becomes unable to handle their financial affairs.

If you need more information about retirement planning, common medical issues, where to retire, Social Security, Medicare, changing family relationships and more, use the tabs or pull down menu at the top of the page to find links to hundreds of additional articles.

Watch for my book, Retirement Awareness: 10 Steps to a Comfortable Retirement, which will be released by Griffin Publishing in 2018.

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