Hiring an In-Home Caregiver

When a person’s need for help with everyday activities goes beyond what family members can provide, it may become necessary to hire a professional caregiver. There are many things to consider in hiring an in-home caregiver for this very important job.

Understand Your Loved One’s Needs and Preferences

In order to find the right in-home caregiver, start by assessing your loved one’s needs. Some areas to consider are:

  • Personal Care: bathing, dressing, eating, grooming, toileting
  • Household Chores: cooking, cleaning, shopping
  • Mobility and Safety Considerations: driving, walking, going up and down stairs
  • Financial Responsibilities: paying bills, managing accounts and investments
  • Medical Needs: medication management, physician’s appointments, physical therapy
  • Emotional Needs: companionship, meaningful activities, conversation

If your loved one has medical needs, consider hiring an in-home caregiver from a certified Home Healthcare agency. Home Healthcare agencies are different than home care services. Caregivers from Home Healthcare Agencies are credentialed employees such as Registered Nurses (RN), Licensed Vocational Nurses (LVN) and Certified Nursing Assistants (CNA). They tend to be more expensive per hour, but Medicare may cover some of those costs. More importantly, they are trained professionals who will be better able to handle the medical issues your loved one is facing.

Care needs are often progressive. If your loved one is still fairly independent, you may be able to craft a multi-prong plan of care that includes additional, and often less expensive, alternatives to in-home care such as home modifications, grocery delivery services, pharmacy home delivery services, meals-on-wheels programs and adult day care programs.

It is also important to evaluate your loved one’s preferences when choosing a caregiver. Does gender or cultural background matter? Does the caregiver’s personality seem to work well with your loved one, or might it cause irritation?

Writing a Job Description

Once you identify the types of care needed, consider the skills that are important in meetings those needs. These may include:

  • Ability to drive safely
  • Ability to communicate fluently with your loved one
  • Ability to lift or transfer your loved one and/or operate special equipment
  • Experience caring for people with your loved one’s specific needs, such as memory impairment or physical disabilities
  • Health care training (CNA, LVN, or RN)

With your loved one’s needs and the skills required in mind, write a job description. What will the caregiver be responsible for, and what will they not be responsible for? Financial responsibilities such as paying bills, managing accounts and investments, or signing documents, should never be included in the caregiver’s job description, but should be reserved for someone in your family and/or your loved one’s trusted advisor.

Qualifying and Interviewing Caregivers

When considering an independent caregiver, it is important to evaluate the person’s qualifications, experience, and background. A criminal background check must be done, and references should be checked thoroughly. If possible, hiring an in-home caregiver that is licensed and bonded is recommended. If you are hiring an agency or care service, you are relying on them to qualify their employees for you, so check into the company’s hiring and staffing practices before committing to using them. Hiring through an agency will be more expensive, but they will also take care of a lot of the complex work of qualifying your caregiver for you.

Putting Safeguards in Place

To minimize any future problems, put some safeguards in place before bringing a caregiver into your loved one’s home.

  • Secure valuables and important documents, ideally in a location other than in the house, such as a safe deposit box.
  • Maintain a separate bank account with limited funds for reimbursing the caregiver for miscellaneous expenses.
  • Monitor the situation. Make frequent, unannounced visits to check on your loved one. Look for anything that is not going well- is your loved one’s house in order, are they eating and bathing regularly, are they taking their medications according to the prescribed regimens? If you are unable to monitor the situation well, consider hiring a geriatric care manager to do it for you.

Factors to Consider When Choosing Between a Home Care Agency and Independent Caregiver

Home Care Agency Independent Caregiver
Cost $18-25 per hour Usually less expensive
Hiring/Firing and Taxes Included Your responsibility, but resources like care.com can make the process easier.
Backup Caregiver Provides backup coverage should caregiver need time off Your responsibility, but resources like care.com can make finding a backup easier
Bonded and Insured Yes Rarely
Supervision Yes Your responsibility
Continuity of Care by the Same Caregiver Depends on agency Yes
Adhere to Loved Ones’ Preferences Limited Choose the most appropriate individual
Variety of Skills (skilled nursing care, physical therapy, occupational therapy) Have a pool of caregivers to fulfilling client’s changing needs Limited to skill set of hired caregiver

Sources include San Diego District Attorney’s “Safe Seniors” website and caregiver.org.

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About Monica Ma

Monica Ma, CFP®, CFA® is an advisor and the chair of the Investment Committee at Blankinship & Foster LLC. She helps clients build sound investment portfolios and develop strategic plans to reach their goals. Since Monica is passionate about sharing her knowledge with women and retirees, she co-leads the firm's Wise Women and Living Wisely Educational Series. Monica is a member of the International Community Foundation's Investment and Finance Committee. She has been living in San Diego since 2008 and enjoys travelling and cooking with her family.

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