Ten Tips for Choosing a Caregiver for an Elder

This article was written by Timothy L. Takacs, Certified Elder Law Attorney.

Over 41 million Americans have a chronic health condition that limits their daily activities in some way, according to the Institute for Health & Aging at the University of California, and 12 million are unable to live independently. Of the one out of five elders who have attained age 85, more than half are impaired and need long-term care -- that is, the personal assistance that enables them to perform daily routines such as eating, bathing, and dressing.

Most people want to continue to live in their own homes for as long as possible. For those who are elderly and have disabilities, that may be possible only with outside help.

Most people who need help with their daily activities rely on unpaid care provided to them by family members and friends. More and more, however, seniors and their families are recognizing the benefits of hiring caregivers, to help stay in their homes longer, in comfort and safety, and to give families peace of mind. Likewise, many states and the federal government are now setting aside some funds to allow people who otherwise could not afford it to pay for outside help.

Here are 10 tips for choosing an in-home caregiver:

1. Assess your home-care needs.  Evaluate the help that is needed in the areas of health care, personal care, and household care. Do you need home health care, such as physical therapy or medication management? Do you need non-medical personal care, such as help with bathing, dressing, toileting, and meal preparation, or are you looking mainly for a companion or sitter? Do you need help with housecleaning, shopping, home maintenance, and running errands, or with bill-paying and managing your money?

2. Write a job description.  Write out a job description based on the help that is needed. Be sure to include:

  • Health care training needed (level and what type: Certified Nursing Assistant, Licensed Practical Nurse, Registered Nurse)
  • Driving (car needed or only valid driver's license)
  • Ability to lift care recipient and/or operate special equipment

3. Develop a job contract.  The job contract is based on the job description and should include:

  • Wages; when and how payment will be made
  • Hours of work
  • Employee's Social Security number (because you must report wages paid to the caregiver to the Internal Revenue Service)
  • Job description
  • Unacceptable behavior (such as smoking, abusive language, tardiness, etc.)
  • Termination (how much notice, reasons for termination without notice, etc.)
  • Dated signatures of employee and employer.

4. Know where to look for a caregiver.  Identify the pool from which you can find a caregiver. You may have neighbors or friends who would be good prospective caregivers. If you belong to a church, ask your pastor or minister for prospects. Family members are OK, but first and foremost, hiring, managing, and firing a caregiver are all business decisions, and for that reason, many family members don't make good paid help. Hire a professional caregiver if you can afford it. Don't waste your time looking in places where you won't find someone suitable for you.

5. Prepare for the interview.  Prepare a list of questions to ask. Have a list for any applicant, caregiver agency, referral source, or reference you may call during your search. If you don't know what questions to ask a private caregiver, call a caregiver agency. The agency should be helpful, because you are a prospective customer.

6. Interview applicants.  After you have screened applicants on the telephone, you should interview in person those who sound acceptable. Invite a friend or family member to sit in on the interview to provide a second opinion. Always observe interactions between the worker and the person who will be receiving care.

If you are interviewing a caregiver agency, ask to interview the in-home caregivers yourself. Many agency employees look good on paper, but will not be a good fit for you, for cultural, religious, social, or any number of reasons. You may just not like the person the agency has assigned to you.

7. Check references.  It is important to check references carefully, talking to everyone who is given as a reference. You are looking for someone who is dependable and reliable as well as someone who is qualified to do the work.

8. Get a criminal background check.  People who are paid by state funds usually must always pass a criminal background check. But even if someone does not have a conviction for a disqualifying crime (which would be identified through the background check), he or she may have convictions for offenses that would concern you or present a safety risk (using drugs; driving under the influence of alcohol or drugs; driving without a driver's license or insurance).

If you are hiring an agency or from an agency, make sure that the agency does criminal background checks. Many states' laws require a background check, but that doesn't mean it has been done.

9. Hire thoughtfully.  You want to hire a caregiver who has experience in the specific areas in which you need help. People who have Alzheimer's disease often need help with toileting and bathing, for example, so look for someone who has experience in working with elders with this illness.

Try to hire a licensed and bonded caregiver. If the agency is not licensed or bonded, you may want to look somewhere else. Likewise, that probably disqualifies your next door neighbor or churchgoing companion, who you may want to hire nonetheless because the person meets all of your other requirements.

10. Monitor.  Set up a schedule to monitor the quality of the services the caregiver provides. This is especially important for family members. Do this by making personal contact with the caregiver and regular home visits with the elder, and getting periodic reports from the caregiver and the agency.

Consider hiring an independent geriatric care manager to monitor if you are unable to do it yourself.

Have a backup plan in case the caregiver or the agency fails to follow through or problems arise.

Watch for signs of abuse, neglect, and exploitation and report suspicious activity to the agency and state authorities.

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