Hiring an in-home senior caregiver can be an overwhelming experience. There are so many types of caregivers to choose from, and if you’re new to the process, it’s easy to get confused about the level of care different types of in-home senior caregivers provide. My family experienced this firsthand this year after my mother-in-law needed unexpected surgery. Suddenly, she needed help at home, and my husband and I had to learn on the fly what is reasonable and unreasonable to expect when looking for in-home care.
“As health care costs rise, our loved ones and seniors are being cared for at home more often,” says Sheila Davis, a certified homecare and hospice executive in Wichita Falls, Texas, and the senior vice president of operations for Always Best Care Senior Services. “In-home care is still often provided by families, relatives and friends, but these days it can be harder to manage with increasingly busy schedules and long distances to travel.”
Before you hire an in-home senior caregiver, it’s important to set reasonable expectations about their role and the level of care you expect them to provide. In-home senior care is a vast industry incorporating a wide range of professionals who support seniors in a variety of ways. Here, senior care professionals break down the different kinds of in-home care providers and what you can expect when you’re hiring one to care for your aging loved one.
Non-medical personal care aides or companions
“Companion and personal care are generally considered non-skilled or non-medical care that does not require a nurse’s specialized expertise, training, and skills,” says Pamela Wilson, a certified senior advisor, senior care expert working with BrightStar Care and former caregiver in Golden, Colorado.
What companion caregivers do
These types of care aides may visit clients in-home for a few hours each day or they may work with one client full-time. They can provide emotional support and help with basic household and personal care tasks to help seniors function more independently. Sometimes these kinds of aides are also called homemakers or home care aides.
“Shift lengths and tasks vary depending on the care needs and care goals of the clients and their families,” Davis explains. Standard duties of an in-home personal care aide or companion may include:
- Light housekeeping tasks, such as doing laundry or washing dishes.
- Running errands.
- Preparing meals.
- Helping with grooming and dressing.
- Providing transportation.
- Offering companionship, such as playing games or reading.
What companion caregivers don’t do
Skilled medical care
While guidelines vary by state, non-medical aides and companions typically cannot assist with tasks that require medical training, Wilson says. For example, a non-medical personal care aide cannot assist with changing a catheter or applying dressings or bandages for a surgical wound.
Davis says the term “light housekeeping” is often misunderstood. “Most of the misunderstanding comes from the fact that we typically do not define housekeeping in our own homes in degrees of light, medium or heavy,” she says. “Light housekeeping should be thought of in terms of tasks completed by a personal attendant.”
Light housekeeping might include watering plants, dusting surfaces or emptying the trash, Davis says. It does not include more demanding tasks, such as:
- Moving heavy furniture.
- Washing windows.
- Scrubbing floors or carpets.
- Outside chores, such as shoveling snow or mowing the lawn.
Skilled personal care aides
The category of skilled personal care aides includes certified home health aides (HHAs) and certified nursing assistants (CNAs). Skilled care aides can perform many of the same tasks as non-skilled care aides. The difference is their level of training, which may allow them to also assist with medical tasks.
Skilled care aides may work under the instruction of a nurse or independently. “The benefit of having a nurse oversee or supervise the care of CNAs, HHAs or aides is that the aides can contact the nurse and receive recommendations when changes in condition occur,” Wilson explains.
What HHAs and CNAs do
According to Wilson, standard duties of a skilled care aide may include:
- Light housekeeping, such as washing dishes.
- Helping with bathroom tasks.
- Mobility assistance.
- Providing medication reminders.
- Grocery shopping and meal preparation.
Depending on their level of training and whether they are being supervised by a nurse, they may also be able to perform tasks like:
- Checking vital signs.
- Changing simple dressings after surgeries.
- Administering medications.
- Monitoring blood-glucose levels.
What HHAs and CNAs don’t do
Like non-medical personal care aides, home health aides and certified nursing assistants typically do only light housekeeping tasks. “Home health aides are not maids,” says Jami Carder, a registered nurse and clinical practice and training specialist for the Visiting Nurse Association of Cape Cod. “You wouldn’t ask your house cleaner to shower you, so it makes sense that your aide doesn’t want to scrub your floors.”
Highly skilled medical care
Even under a nurse’s supervision, there are tasks that cannot be delegated to a home health aide, Davis says. These include:
- Administration of medications by injection, except for insulin injections.
- Sterile procedures.
- Central line maintenance.
“A private duty nurse is a registered nurse who provides patients with one-on-one, long-term care in their homes,” explains Davis. “They take care of a patient’s basic, daily needs and help with chronic health problems. Private duty nurses aim to help patients stay within their homes and live happy, healthy and fulfilling lives.”
What private nurses do
According to Davis, standard duties of a private nurse may include:
- Managing chronic illness care.
- Administering medications.
- Educating clients about diet or creating diet plans.
- Diabetes management.
- Providing hospice care.
- Assessing changes in medical or health status.
- Creating and managing treatment plans.
- Helping with daily living activities, such as bathing or using the bathroom.
- Coordinating with other providers like occupational, physical or speech therapists.
What private nurses don’t do
“Because nurses are educators and provide a high level of support, clients can become reliant on the expertise of the nurse,” Wilson says. “However, they cannot and should not attempt to diagnose a condition or sway a client to make a particular decision about participating in medical treatments.”
The definition of nursing at the licensed practical nurse and registered nurse level excludes prescribing of medication or treatments and performing surgeries or related invasive procedures, Davis says.
Most housekeeping tasks
If you’re hiring a skilled medical caregiver, Carder says, then the bulk of their job should be skilled medical or therapy tasks, rather than basic care or household tasks. “Some agencies and caregivers are fine providing homemaking skills, but others aren’t,” she explains. “It’s best for all parties to lay down the ground rules ahead of time. This will prevent resentment down the line.”
Home health care professionals
Home health care typically includes nurses, doctors, or specialists, such as speech or physical therapists, that assist patients with recovery after a hospitalization or surgery. Often, this type of care is prescribed by the attending physician. “The important aspect for patients to understand about medically prescribed home health care is that it’s short-term and rehabilitative in nature,” says Wilson. “Support may be for one week or several weeks but never long term.”
What home health care professionals do
According to Wilson, standard duties of home healthcare practitioners may include:
- Educating clients about activities to maintain or rehabilitate health.
- Providing specialized support based on their training.
- Educating about medical needs, diets and medications.
- Assisting with wound care, physical mobility, safe transfers and bathing.
What home health care professionals don’t do
“Insurance reimbursed home healthcare is not the same as private pay support for day-to-day activities provided by CNAs, HHAs and non-skilled personal care aides,” Davis says. Some home health care providers may help with basic household tasks, such as changing bed linens or cleaning dishes, but it depends on their role and their employer’s guidelines.
Personal care only
Home health care workers may help with bathing, toileting, and dressing, Davis says, but that can’t be their only function. “A home healthcare agency may not provide an aide if the patient only requires personal care and does not need skilled care,” she explains.
“It’s important for home health care staff to educate clients at the initial intake session regarding the goals and the scope of the support provided to manage expectations of the length of the support that will be provided,” Wilson says. “The goal is returning the client to the prior level of physical functioning before the hospitalization or surgery.”
How to know if you’re asking too much
Care providers and agencies vary in what services they’re willing to offer. For example, says Wilson, “cooking” may mean something different to each care provider or agency. Additionally, not all caregivers are trained to work with conditions like dementia or Alzheimer’s.
“Because each care agency location can determine the type and level of services they offer and the level of training they supply, the idea of ‘standard in the industry’ should never be an assumption,” says Wilson.
The best way to know if your requests and expectations are within reason is to ask. “It is always better for a client to ask questions, be very honest about needs and discuss a match between expectations and the services an agency [or caregiver] can provide,” adds Wilson.
Before you hire a caregiver, their role, pay and other details of employment should be formally agreed upon, Carder says. Additionally, communication should remain open throughout their employment, and you should always be mindful to discuss new or changing expectations.
“Caregivers are people, too,” Carder says. “Just because you are paying someone to perform a job does not mean they are emotionally invincible. Words matter. Actions matter. Establishing a rapport of healthy dialogue before the job begins is the best strategy for a successful relationship.”