How to Hire In-Home Care for Your Senior

Lisa Love's dad was adamant: absolutely no nursing homes or assisted living facilities. Yet it was clear that Joe would need a lot of help to stay at home. Much more help than Lisa and her four far-flung siblings could provide. At 83, Joe had become very unsteady on his feet, needed help getting dressed and moving around, and had never been one to cook or clean.

"My dad's a retired doctor, and let me tell you, he's a challenging patient," explains Love, who living closest, is the primary caregiver for her dad. "There was no way my husband and I could do it alone for long."

Love relies on a member of their extended family to help out, but realizes they may need more assistance in the future. "It's a difficult choice and a little overwhelming," Love admits.

"Opening your home and entrusting your loved one to a caregiver is big step, and one that must be undertaken with caution," explains Care.com's Mary Stehle, LICSW and Senior Care Advisor.

"While it's a relief to have help, caregivers often can feel anxious about handing over the reins. We have to accept that others won't do things exactly as we would," says Virginia Morris, author of How to Care for Aging Parents. "For the parent, it can be very stressful to let a stranger into their home. If possible, help your parent exercise some control by letting them help write the job description and select the caregiver," Morris suggests.

Here are some more tips for hiring an in-home caregiver.

Using an In-home Placement Agency
Using a senior-care agency to find help offers some clear advantages and considerations.

Pros:

• Most agencies screen applicants, offer training, and handle all the paperwork, such as payroll, taxes, and legal matters. In addition, even if you use a preferred caregiver through the agency, they'll have qualified back-ups in case your regular provider can't make it to work.

"Agencies are a really good option for many people, but they do charge a premium for their services," explains Stehle. "You'll also still need to be really attentive to both the agency and the individual caregiver once they're hired."

Considerations:

• Aside from the likelihood that you'll pay more for the convenience, some might feel using an agency is a little impersonal. After all, you're not fully in control and don't necessarily have access to all the information about the caregivers, their salaries, and other details.

As with any service, getting a personal recommendation is a very good idea, along with checking the better business bureau or your local government's senior care office for agency references. You should also ask each care provider candidate for references and background checks on file.

Finding a Private-Hire
Hiring in-home care directly has its own distinct considerations.

Pros:

• One advantage is the simple fact that you can really get a feel for the candidates in the industry and make a more informed decision about who might be a good fit.

"Many people feel more comfortable managing the hiring process themselves, because it is so very personal," acknowledges Stehle. "If you decide to find care for your loved one yourself, you need to carefully review potential caregivers."

Considerations & Tips:

Managing this sensitive process properly is an involved effort. Here are some for doing it right:

• Finding candidates. Find help through sites like Care.com, your network of friends, family and colleagues, social networks and religious groups. However, "you must do your due-diligence" says Stehle. "It's important to interview, call multiple references, run background checks, and trust your gut instinct," she explains.
• Care coordination. If you're hiring directly, you'll be responsible for finding back up care if your regular caregiver is unable to work. It's always a good idea to have some additional, screened resources on hand who you can call on an as needed basis.

General Check Points for All Caregivers

• Credentials & licensing. Note if the candidate not only has experience, but any relevant training or other credentials. Are they Red Cross certified in CPR and First Aid? Do they have any healthcare training-in nursing, for instance? In some states, in-home caregivers may be required to have certain licenses and certifications. You can check through your county or state regulatory agency's website. Ask for and review any relevant documentation.
• Background checks. It's extremely important to run a background check on potential hires, whether going with an agency or the individual. You can request unlimited caregiver background checks on Care.com and even purchase a more thorough Enhanced Background Check for a fee. You can also have background checks run independently on sites like HireRight or CrimCheck.com. Be sure to Google the person's name, and consider "friending"on Facebook to learn more about them.
• References. Ask for more references than offered and call them. Listen not only for outright complaints, but also for subtle hesitance to comment, which can sometimes indicate a problem. On the other hand, staying with clients for long periods of time is a good sign.
• Immigration Status. We've all read the headlines. Even prominent citizens can get in trouble for hiring an illegal immigrant. Request and document your caregiver's status using an I9 form.
• Legal Matters. "Many problems can be avoided with a clear contract," Stehle explains. Contracts should spell out employment terms such as:
  • ­ Duties and responsibilities: Hours, schedule, duties, privileges, meals, etc.
  • ­ Compensation and benefits: Rate, frequency, benefits including days off, vacation, benefits, performance review, etc.
  • ­ Transportation: Guidelines for using the family car and public transportation safely.
  • ­ Discretion and confidentiality: Your expectations about personal information.
  • ­ Notice and severance: What each party will be required to do if the job comes to an end.

    Read about how to write a contract. You can adapt our tips for in-home senior care.

• Finances/Taxes. Paying caregivers under the table, while tempting, is risky-and illegal. Read Nanny Tax Forms and Procedures: Are They Worth It?. A good alternative is hiring a payroll service provider like GTM and Paycycle.com. According to CEO and founder Guy Maddalone, "Household employers have unique tax and workers compensation insurance challenges, and we've been able to help them easily comply with the law at a very reasonable price."

Whether you use a home-health agency or go it alone, hiring in-home care is a sensitive process that requires a little thought. Take your time and do it right. You'll be glad you did.

Get tips on what to look for in a senior caregiver.