When you need to find a caregiver for a loved one, it can be hard to know where to start.
Questions abound and the number and gravity of decisions can be overwhelming. Do you use a home-care agency, hire on your own, or both? Are there safeguards to protect your loved one from being abused or neglected? What will it all cost and how will you pay for it?
Although every family has different needs, there are basic steps everyone should consider, says Jennifer Olsen, chief executive of the Rosalynn Carter Institute for Caregivers.
Start by identifying and ranking your care needs. A loved one may need help with housekeeping, errands or meal preparation only, or more involved help managing medications and bathing. Higher levels of care cost more, so don’t pay for a level of care that isn’t needed. And consider how important soft skills are, such as sharing a common language, cultural and religious backgrounds.
Recognize that you may not find everything that you’re looking for in one person, so you’ll have to prioritize, especially given the shortage of home-care workers, says Dr. Olsen.
Assess the costs
About 31% of the nation’s 53 million family caregivers have paid help, according to a 2020 report from the National Alliance for Caregiving and AARP. The national median cost for in-home care services was $26 to $27 an hour in 2021, according to Genworth, a long-term-care insurance company.
Some long-term-care insurance policies, Medicare Advantage plans, Medicaid, and Veterans Affairs cover in-home healthcare costs under certain conditions through licensed providers, and often provide a list of those providers.
If those outside sources don’t cover the entire cost, determine how much money you can spend on care, how long your funds will last and if there are ways to stretch them further.
Amy Goyer, the family and caregiving expert at AARP, says her first call would be the local Area Agency on Aging, which often can send someone out for a home visit and determine whether a family member is eligible for in-home support—such as home-delivered meals or housekeeping—free of charge or on a sliding-fee scale.
Those agencies can also refer family members to local adult daycare centers, which cost less than in-home care, and provide information on respite programs that may offer limited hours of free or low-cost services.
“Try to see what you can get at no cost and low cost and fill in the gap with paid care,” says Ms. Goyer.
Geriatric care managers, usually a licensed nurse or social worker who can help find home-care workers and coordinate services, can be costly at $100 to $150 an hour, although some charge a flat monthly fee and can take some of the strain off family members, especially those who aren’t nearby to oversee care, says Ms. Goyer.
Should you use an agency?
There are generally two ways to hire in-home care for older adults: through an agency or on your own.
There are pros and cons to each approach. An agency typically handles payroll, background checks, insurance, and training. It also provides backup care if someone calls in sick, although that can be hit-or-miss. Many agencies require minimum weekly hours of care, and some charge special fees for inclement weather. Turnover can be high.
Hiring someone privately, based on referrals from friends or trusted organizations, lets you decide on the best fit but also means handling payroll, taxes, and background checks, and no automatic backup care.
It’s important to request and check references, even from a friendly referral, to weed out candidates who aren’t trustworthy. Some families have video cameras, which they use mainly to check on loved ones to make sure they haven’t fallen, but can also be used to monitor care and protect against neglect or theft. If using a camera, you should let caregivers know they are there.
It generally costs less to hire someone independently so you may be able to afford more hours of care. Online payroll companies such as HomePay and Gusto can handle payroll and taxes, and some online home-health registry sites will screen candidates for possible matches. Hiring family members is an option through some state Medicaid plans.
Families can stretch dollars by using an agency for 10 hours a week and hiring privately for another 10, which also gives them a backup person, says Denise Brown, owner of the Caregiving Years Training Academy, which trains and certifies caregiving consultants.
Change course if it isn’t working
Marjorie Conner, an attorney in Alexandria, Va., used two home-care agencies but ended up hiring caregivers on her own to provide care for her mother, who lived with her. She had billing issues with the agencies, where the hours weren’t consistent with her own records. One agency caregiver began inappropriately telling her mom about her money troubles, says Ms. Conner, a conversation that she overheard on a baby monitor in her upstairs office.
She eventually hired two women based on the recommendation of friends. She used a payroll service to handle taxes. “They were both so lovely,” she says, and loyal, one coming to be with her mom the day she died in 2021. Ms. Conner stays in touch with both women, who have a network of friends and relatives who provide home care, and refers friends to them.
Put it in writing
Christina Irving, client services director at Family Caregiver Alliance, a nonprofit caregiver-support organization, suggests writing a job description. “It gives you a sense of what you are looking for,” she says, which can mean years of experience, certification, listening skills, interest in hobbies, or being pet friendly. If someone is providing transportation, make sure to ask for their Department of Motor Vehicles record and proof of insurance and a current driver’s license.
Even if you hire a friend or someone from your church or neighborhood, consider drafting a contract to spell out expectations in terms of hours, meal preparation, housekeeping and responsibilities. “Put things down so everyone is on the same page,” says Barbara Corley, of Corley Caregiver Consulting LLC in Circleville, Ohio.
What not to do
If someone has a disease like Alzheimer’s or Parkinson’s, don’t hire anyone who lacks knowledge or training on those conditions. If someone doesn’t have CPR training, don’t hire them until they do. If an agency can’t provide you with their procedures for how they provide backup care or how they monitor and evaluate performance, find another.
Above all, says Ms. Brown, of Caregiving Years Training Academy: “Don’t wait until the ‘OMG I need help now’ moment because when you really need help, it’s going to be hard to find the right fit,” she says.
This article was originally published in The Wall Street Journal on March 13, 2023, and written by Clare Ansberry. Image courtesy of WSJ/Sonia Pulido.
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