How to Hire In Home Care for A Loved One

Family caregivers cannot do all things all the time. Recognizing when you need outside help is good for you and your loved one.

What’s the difference between types of in-home care workers? 

Personal Care Assistants (PCAs) are not licensed and have varying levels of experience and training. They serve as helpers and companions — providing conversation, bathing and dressing, neighborhood walks, light housekeeping and meals. They can offer transportation to shopping and appointments, as well as prescription pickup. Training requirements vary by state, and some states do not have formal requirements. PCAs are the least expensive care providers, but they are typically not covered by Medicare or other types of health insurance. The median hourly wage is $10.54, according to the Bureau of Labor Statistics (BLS), but the hourly charge for this and other in-home health service can be considerably higher in tight markets and urban areas. Expect PCA services to be an out-of-pocket expense. 

Home Health Aides (HHAs) monitor the patient's condition, check vital signs and assist with the necessary parts of daily living, including bathing, dressing and using the bathroom. HHAs also provide company, do light housekeeping and prepare meals. HHAs are trained and certified, and requirements differ from state to state. The median hourly wage is $10.87, according to the BLS.
Licensed Nursing Assistants (LNAs) and Certified Nursing Assistants (CNAs) observe and report changes in the patient, take vital signs, set up medical equipment, change dressings, clean catheters, monitor infections, conduct range-of-motion exercises, offer walking assistance and administer some treatments. All medical-related tasks are performed as directed by a Registered Nurse (RN) or Nurse Practitioner (NP). CNAs also provide personal patient care — such as feeding, dental help, bathing, bathroom assistance and home tasks that include changing bed linens and serving meals. Median hourly wage for LNAs is $12.78, according to the BLS. 

 
Skilled Nursing Providers meet federal standards for health and safety and are licensed by the state. They manage, observe and evaluate your family member’s care, and provide direct care that nonmedical and home health aides cannot — including administering IV drugs, tube feedings and shots; changing wound dressings; providing diabetes care; and providing caregiver and patient education. Some are trained in physical therapy, occupational therapy and speech therapy. Medicare covers home health skilled nursing care that's part time and intermittent, and arranged by a Medicare-Certified Home Health Agency (CHHA). Median hourly wage is $21.20, according to the BLS.
Registered Nurses (RNs) hold a nursing diploma or associate degree in nursing (ADN), have passed the NCLEX-RN exam administered by the National Council of State Boards of Nursing (NCSBN) and have met all the other licensing requirements mandated by their state’s board of nursing. They provide direct care, can assist doctors in medical procedures, offer guidance to family members, operate medical monitoring equipment and administer medications.

Step by Step: Hiring a Caregiver

Step 1.


With your loved one, write down needs and limitations, level of assistance needed, likes and dislikes, expectations and doctor recommendations. If your family member is covered by long-term insurance, Medicare or Medicaid, you’ll need a doctor’s report confirming that the need for in-home care. Medicare does not cover personal care if it is the only care needed.

Step 2.


Find a trustworthy, compassionate and responsible caregiver. Do you feel best going through an agency? Friends? A registry?


If the answer is:


An agency


Regardless of whether your family member is Medicare-eligible, compare and research agencies in your area by using the Medicare guide to patient-rated agencies and arrange a consult. Before you sign an agency contract, review our checklist of important questions. Ask them. 

Upsides:
Prescreened workers. Caregivers have undergone and passed a background check.
Relevant experience. Agencies are likely to have some caregivers with experience in caring for people struggling with the same illness or condition affecting your loved one.
Backup care. If the caregiver is sick or doesn’t work out, an agency usually can find a replacement quickly.
Addressing problems. Concerns and complaints are reported to and handled by a supervisor.
Fast upgrades. If care level or diagnosis changes, most agencies can quickly provide a worker with more training.
No paperwork. You pay the agency. They take their percentage, pay the worker, and handle payroll, taxes and scheduling.
Liability protection. If a caregiver is injured on the job, the agency covers the cost. 

Downsides:
Expense. You pay more — sometimes substantially more — for an agency-provided caregiver.
Limited negotiation. Individuals are generally more flexible about hours, overtime and duties than agencies.
Minimum hours. Many agencies do not allow a part-time schedule.
Little choice. The agency chooses the worker, who may or may not mesh well with you or your family member.


Option 1: Ask friends and neighbors who have employed caregivers for recommendations, names, phone numbers and hourly rates of those they found to be outstanding. Get specifics. Your neighbor’s priorities might not be yours.


Option 2: Consult the community. Leave your name and number and the particulars of the job — including needs and hourly wage — with the receptionists at nearby houses of worship, senior centers, local gyms, yoga studios and community centers.


Option 3: Call your Area Agency on Aging and ask if they have recommendations.


A registry


Local — and sometimes state — employment registries will have lists of available nurses and aides in your area. You call the person directly. 

Upsides:
Flextime. It is more likely you will find a part-time caregiver or one who can work an unusual schedule.
Spend less, pay more. Without the higher agency fee, you may be able to pay more for a more skilled or experienced provider.
Your rules. Agency caregivers must follow agency rules. With a nonagency caregiver, the two of you and the person needing care can figure out what works for everyone.
Better fit. You may be more likely to find a caregiver who speaks a second language, shares interests with the care recipient or has personality traits your loved one will appreciate. 

Downsides:
Time. A DIY search and screening can take days to weeks. Agencies often can arrange next-day care.
Emergency coverage. Sick days, vacation or a fast departure for a new job can upend everyone’s schedule. There’s no fallback plan unless you arrange it.
You investigate. You will need to screen and verify credentials.
Paperwork. You are responsible for getting an Employer Identification number (EIN), and for withholding and paying Social Security, Medicare and unemployment taxes. You also must confirm that the applicant can work legally in the United States. 

 
Protection. Agencies insure their own. You may be held liable for an on-the-job accident unless you buy liability insurance that covers the caregiver. Workers’ comp — which covers lost wages and medical care — is required by some states and recommended in all by some legal experts.
Training. Agency health aides are trained. You may want to pay for a training class or refresher.
You’re the boss. The person who handles your complaints is you. 

Step 3.


You — and your loved one, if possible — should interview applicants together. Prepare written questions. Be clear and honest about job requirements.


A major consideration when hiring a caregiver is the associated cost. In some cases, you may be able to get help paying for in-home care.

  Dementia Signage for the Home

Lifting Safety for Caregivers

We may not recognize the risk we are putting ourselves in the moment of leaning over someone for an extended period of time. We may not feel any different a few minutes after lifting up a person from bed or transferring a person from a chair to a wheel chair, but inevitably, it hits us the next day. It's the subtle throb in the lower back when lying in bed or the stiffness in the shoulders when opening a door that makes us realize we've strained ourselves by our actions the day before.
It is imperative to learn how to maneuver your body into the correct and safe positions when caring for others so you don't injure yourself or them.

When you lift or move a person:

• Maintain the proper alignment of your head and neck with your spine.
• Maintain the natural curve of your spine; don't bend at your waist.
• Avoid twisting your body when carrying a person.
• Always keep the person who is being moved close to your body.
• Keep your feet shoulder-width apart to maintain your balance.
• Use the muscles in your legs to lift and/or pull.
• If the person is too heavy, get help!
There are also various lifting devices you can purchase to assist in lifting a person.

Gait belt

A gait belt is a belt typically made of cotton or nylon webbing with a buckle on the end. It is a small, affordable device used to move a person more safely than simply holding their hand. It wraps around a person's waist and the caregiver grasps the belt rather than the person to avoid strain on the back. It is most commonly used to move a person from a standing position to a wheelchair or from a wheelchair to a stationary chair.

Lift Chairs

Often disguised as recliners, these chairs contain electric motors for lifting the person into a standing position. They will also assist in sitting a person down and reclining them just like a La-Z-Boy -- all with a hand held control.

Sit/Stand or Full Body Lift

A sit/stand or full body lift is a hydraulic-powered medical and home health device used to safely and easily transfer a person for bathing or moving from a bed to a chair with minimum physical effort. These lifts are affordable and easy to roll from room to room.

Remember, you can't care for your loved ones if you don't take care of yourself! Practice safe lifting techniques or consider a lifting device to avoid injuries.

Dementia Signage for the Home

_______________________________

How to Get the Real Story from an In-Home Caregiver

Ah, wouldn't you like to be a fly on the wall sometimes while a caregiver is looking after mom or dad? You're not alone. Many of us rely on outside caregivers to take care of our older loved ones. Yet, we are unable to be there day-to-day to oversee how things are really going.

If you've ever wanted to make sure you're getting detailed information about your loved one's day from the helpers, follow these three guidelines:

1. Create a Sense of Teamwork. Some caregivers might be wary of the CKIC (Chief Kid in Charge), expecting you to position yourself as the big boss. Counter this expectation by creating a sense that you're on the same team. "The key is for the family caregiver to develop and express trust in the professional," says Judy Santamaria, MSPH, Director of the Family Caregiver Support Program at the Visiting Nurse Service of New York. "Establish that you are not looking to control your parent's life, but instead just want to be there to offer any support that is needed."
2. Provide Them with Medical Support and Resources. If your parent faces a specific ailment -- such as dementia, depression, Parkinson's -- "connect the caregiver to a doctor or medical professional in that specialty," says Santamaria. Include them in appointments when you can. Or, provide them with resources (e.g. online, book, seminar) on the ailment. This way, you can help them understand and better manage your parent's condition.
3. Keep the Caregiver Connected. Caring for someone else's parent can be a lonely business, especially if the parent is in frail condition or just not capable of or interested in engaging. Do what you can to make sure the caregiver gets to interact with others. "Offer companionship through social day care, or driving them to a friend's, or to your own house for visits," says Santamaria.

Since there might be particular situations in which a lucid parent instructs the professional, "don't tell my kids," you have to weigh the pros and cons of inserting yourself if you get wind of it. "In some ways, you have to respect a parent's right to self-determination and just continue to be there and offer support without trying to make caregivers feel you're trying to run their lives," says Santamaria. "That will build trust."

The bottom line is that you want to build a strong bond with caregivers so they'll feel comfortable being frank with you. Engage them with consideration and fairness. "I think most home health aides and home care staff would be happy to talk openly with you about their observations," says Santamaria. "This is true especially if they feel you'll handle that information with a level head."

Dementia Signage for the Home

________________________