Watching a loved one’s Alzheimer’s disease or dementia symptoms get progressively worse is a tough scenario for any family to face. Even more challenging? Making the heart-wrenching decision to find help outside of the home when caring for them becomes too much.
But outside help isn’t your only, or even best, option, says Kyle Bossung, president and CEO of Senior1Care in Mishawaka, Indiana. You can consider hiring in-home memory care if your budget allows, he notes. “Staying at home can make a huge difference for someone living with dementia or Alzheimer’s,” he explains. “The environment is familiar, routines are easier to maintain and there’s less stimulation and disruption.” Conversely, moving a loved one with memory loss to a new home entirely can be incredibly disorienting, he adds. “Being able to receive care at home helps maintain a sense of dignity,” notes Bossung.
Of course, as Bossung notes, in-home memory care isn’t always the cheapest or easiest route. But when it comes to the comfort, safety and health of a loved one with Alzheimer’s disease or dementia, with the right caregiving hire, option for in-home memory care can be one of the best decisions you make for your family. Here’s how to hire memory care at home from start to finish.
Key takeaways
- Hiring in-home memory care, as opposed to care outside of the home, can help give individuals with Alzheimer’s and dementia a better sense of stability and fewer disruptions.
- Consider hiring in-home memory care through an agency to make the employment process more streamlined, however, it’s possible to find (and secure) workers yourself.
- Seek out candidates with experience in memory care and who showcase genuine interest in their work and a sense of empathy.
1. Decide what kind of care is necessary
When an individual has Alzheimer’s disease or dementia, their symptoms may manifest in varying ways. Perhaps they occasionally forget small self-care tasks, like tooth-brushing, or they frequently misplace items. Maybe they’re confused, anxious or irritable and angry. Naturally, how these signs manifest will probably dictate the type of care a person with either disease receives, explains Sarah Cook, president of Nanny’s and Granny’s, a Las Vegas-based caregiving agency.
For example, Cook’s mom and her dad both needed in-home memory care at various points. She said her mom had trouble with disorientation, so caregivers who focused on establishing calming routines and gentle redirection were key. For her father, she needed caregivers well-versed in handling (and redirecting) his frustration and anger.
Still, as Cook explains, there were certain universal qualities she scanned for: patience, emotional maturity, intuition and “people who could stay calm in challenging moments and truly connect with both of my parents as individuals,” she notes.
Bossung says a caregiver who knows how to stay cool in a crisis is also key — say, your loved one falls, forgets to turn off the stove or wanders outside. “Families want to make sure their loved one is safe, but they also want them to stay comfortable and surrounded by the familiarity of home,” he notes.
2. Determine a budget and check your eligibility for financial help
Before you start seeking out candidates, try to determine how many hours you’ll need someone around to help. As Amy Cameron O’Rourke, a dedicated care manager and author of “The Fragile Years,” points out, caring for someone with Alzheimer’s or dementia is a 24-hour job — someone really should be present day and night. (So, in a way, you can think of memory care like respite care in many instances: You have someone trusted fill in when you need a break.)
While the national median hourly cost of homemaker services is $30, and home health aides are $33, according to the latest Genworth and CareScout Cost of Care survey, that’s not always the standard in some cases. For example, your loved one’s dementia may have progressed to a point where they need considerable care, which might mean that the pay rate goes up. “Rates should reflect experience, duties and the level of memory care required,” says Cook. “Keep in mind that higher needs call for higher wages.” You can also try an online calculator to determine your total cost of care.
O’Rourke suggests seeing if you might qualify for any public benefits. That might include your Area Agency on Aging (AAA) or VA Clinic. Your loved one might also qualify for benefits if they’re on Medicare and Medicaid, but check your plan details to know for sure.
“Hiring a qualified caregiver should never come with guilt. It is one of the most loving things you can do, because it allows you to show up as your best self for the person you love.”
— Sarah Cook, president of Nanny’s and Granny’s, a Las Vegas-based caregiving agency
3. Consult your inner circle first
When starting your caregiver search, tap into your inner circle. “I always suggest starting with people you trust,” says Bossung. “Talk to your [loved one’s] doctor, close friends or people in your community who’ve walked this road before. You’d be surprised how many families have had to make similar decisions, and word of mouth is powerful.”
Additionally, O’Rourke says this is a good point in your journey to start thinking about the type ofof caregiver who would be a good personality match for your loved one. “Start with recognizing the personalities that do well with your spouse,” she recommends. “Are they lively and extroverted? Calm and introverted?” From there, you can look for someone who would be compatible with your loved one’s disposition.
4. Research local caregiving agencies or national organizations
When you opt for in-home memory care, you’re not just bringing in outside help for a loved one — you’re assuming the role of an employer, which includes hiring, onboarding, training and maintaining a safe, efficient workplace. It’s doable, but when you’re already consumed with caring for your loved one with Alzheimer’s or dementia, managing an employee might be the last thing you want, or even can, do.
The answer? Find an agency, like Nanny’s and Granny’s (Cook’s agency) or Senior1Care (Bossung’s agency). These organizations find (and screen) reliable talent, present them to you for consideration and manage all ins and outs of employment (taxes, payroll, insurance).
“We help families identify the right level of care, screen qualified caregivers and manage all the logistics — so families do not have to shoulder it alone,” Cook explains. “Referrals from friends, physicians or local senior centers can also be helpful, but working with a licensed and experienced provider makes the process much smoother and safer.” There’s a fee associated with agencies, but if you’re able to pay it, it’s well worth the cost in many cases.
Still, you have to find the right organization, Bossung says. “When you start looking at options, I recommend focusing on agencies that are well-established and have a strong reputation,” he suggests.
He recommends looking beyond an agency’s website and paying extra attention to certain details of your first conversation. Ask yourself: “How did they answer the phone?” and “Did they take time to understand your situation or just jump into pricing and logistics?” “A good agency should make you feel heard, supported and never rushed,” he notes.
Alternatively, O’Rourke is a big fan of AgingLifeCare.org, the website for a professional organization called the ALCA that focuses on connecting people with aging life care managers, trained professionals who specialize in the field of geriatrics.
6. Post on a job site and meet with candidates
If you want to find a caregiver without the help of an agency, and there’s no one in your circle you might want to hire, consider posting on a job site.
After you’ve secured a handful of potential caregivers to chat with, it’s a good idea to bring them to your loved one’s home for an interview, says O’Rourke. Better yet? See if candidates are OK with blocking off a morning or afternoon so they can meet with your loved one (and you can monitor their interactions). Here are a few basics to cover during each meeting:
Assess their memory care expertise and training.
There are multiple types of memory care trainings and certifications, including the Certified Dementia Practitioner training from the National Council of Certified Dementia Practitioners. It’s great if a potential caregiver has these, but according to Bossung, there’s no universal license for memory care. So while a cert is definitely a perk, if a stellar candidate doesn’t have one, don’t rule them out.
Another big benefit to working with an agency, perk Cook? They usually train their staff in memory care, so you know all the candidates you’re vetting are well-versed in the subject.
Ask the right interview questions.
When you meet with potential caregivers, be prepared with a list of smart, targeted interview questions. It also doesn’t help to have another person with you for a second set of eyes, per O’Rourke. Although you can find a comprehensive list of questions here, here are some of Cook’s favorites:
- How do you redirect someone who is confused or agitated?
- What experience do you have with Alzheimer’s or dementia care?
- How do you build trust with someone struggling with memory loss?
Beyond that, Cook says to “look for someone who is patient, calm and genuinely engaged. A strong caregiver will ask thoughtful questions about the client’s routine, preferences and history.”
“Look for someone who is patient, calm and genuinely engaged. A strong caregiver will ask thoughtful questions about the client’s routine, preferences and history.”
— Sarah Cook
Ask for references.
O’Rourke believes references are one of the most critical aspects of the interviewing and hiring process. “References, references, references!” she says. “Do more than read their reference letters. Ask for the names of other clients’ families they have worked with. If it’s through an agency, talk to the agency and the family they worked with.”
7. Set up a formal employment situation if you’re hiring on your own
When you partner with a caregiving agency for memory care, part of your payment goes straight to managing logistics, says Cook — finding quality candidates, screening them and determining pay and hours, to start. If you opt to hire a caregiver without outside help, plan to set up a formal employment situation. This includes the following:
Do a background check
You can request criminal records through your state Department of Justice (DOJ), but know that it won’t be released without the individual’s permission. Also, be sure to ask for some type of identification, like a driver’s license or passport, according to the National Caregiving Alliance.
O’Rourke also recommends checking with your homeowner’s insurance policy to see what coverage is available for accidents in the home or theft.
Land on the right pay rate and hours
Pay is reflective of a caregiver’s experience, their duties and the level of memory care required, per Cook. It might also vary depending on your location. “For example, in Las Vegas, typical care ranges from $25 to $35 per hour,” she explains. “Keep in mind that higher needs call for higher wages.”
As for setting hours, again, that’s really dependent on your unique situation. But Cook says that memory care in particular requires a lot of hours in the home (they’re not quickly coming in and out to clean, for example), so try to provide enough hours that the person can maintain some type of income. “We usually suggest at least a 30-hour weekly guarantee,” she says. “No one is going to take a shift that’s two hours.”
Ensure taxes, payroll and insurance are in order
Again, if you’re bringing on a caregiver on your own, they are considered employees. That means you’ll need an employer identification number and will need to report their earnings on a W-2 form for withholding Medicare, Social Security and unemployment taxes. You can also designate a caregiver as an independent contractor. In that case, they’ll file their own 1099-NEC form (or 1040-SR form for seniors) for tax purposes. (Here’s how to set up caregiver payroll yourself.)
You might also need to set up insurance to cover your employee, and workers’ compensation is often required in some states. Check with a local insurance broker to understand your state-specific requirements.
Whip up a formal employment agreement and list of job duties
Outline hours, duties, pay, time off and general expectations in an accessible document. “Even informal care should have a formal agreement,” Cook suggests.
O’Rourke agrees. “I like the idea of an agreement with a job description attached,” she says. “The job description should have as much detail as possible.” For example, it will dictate how often certain medications need to be administered, what activities of daily living (ADL) a caregiver should oversee and what meals to cook, if required. (Here’s a sample caregiver contract to potentially base yours on.)
8. Keep close watch the first week and scan for any red flags
If you can, and the potential caregiver is up for it, see if they might be willing to participate in a paid week-long trial period. During this time, you can assess the person’s interaction with your loved one and their overall working and communication style. “One of the biggest red flags is poor communication,” Bossung says. “If you’re not being kept in the loop or if your loved one seems more anxious, withdrawn or just not quite themselves, those are signs something’s off.”
Seeking and hiring memory care for the home is a major feat, and it might feel all-consuming at times, Cook acknowledges. Her mother and father both had dementia. The challenges she faced caring for them quickly led to her personal burnout, she says, which had a major impact on her relationship with her parents (as well as her mental health). But once she hired a qualified in-home memory caregiver, everything changed.
“You cannot pour from an empty cup,” she stresses. “Caregiver burnout is real and taking a break is not selfish. Hiring a qualified caregiver should never come with guilt. It is one of the most loving things you can do, because it allows you to show up as your best self for the person you love.”
