At best, hiring an in-home helper for your aging parent or ailing spouse can improve both of your lives. Sometimes, it may make the difference between your loved one staying at home or entering a nursing home.
At worst, letting the wrong person in the door can place your loved one at risk.
Jane Teixeira, 48, of Pennington, N.J. (pop. 2,585), has seen both extremes. During the last three years, at least 20 part-time caregivers have helped Teixeira’s father care for her mother, who has late-stage Alzheimer’s disease. “A camera and some other items disappeared from my parents’ house,” Teixeira says. “One caregiver also borrowed money from my dad and never paid it back.”
Other caregivers have gone above and beyond. Teixeira recalls a snowy day last winter when the regular weekday aide couldn’t reach her parents’ home in Toms River, N.J. “The woman who normally works on weekends, who lives closer to my parents, got another neighbor to plow my parents’ driveway,” Teixeira says. “Then she came over and helped out my dad, even though it was her day off.”
Companion, homemaker or nurse?
A well thought-out plan can increase your odds of finding a caregiver who really cares. First, consider exactly what type of help your loved one needs. Home care services fall into four basic categories:
- Social care: companionship, conversation, activities
- Personal care: bathing, feeding, toileting
- Household care: cleaning, cooking, shopping
- Health care: medications, nursing care, physical therapy
For the latter, ask your doctor about special training or medical credentials the caregiver should have. “For example, if your parent is in a wheelchair, you need someone who can do a safe transfer from the bed to the chair,” says registered nurse Tara Cortes, executive director of the Hartford Institute for Geriatric Nursing at New York University.
Next, consider how you will pay for in-home help. Medicare may foot the bill if your loved one is homebound, is under a doctor’s care, and requires skilled nursing (such as catheter changes or tube feedings) or therapy services (such as physical or speech therapy). Private health insurance may cover some services as well. For other resources, check with your local Area Agency on Aging, United Way or a hospital social worker.
Some families end up paying out of pocket. “Costs vary widely,” says Joy Loverde, author of The Complete Eldercare Planner. “I’ve seen anywhere from $10 an hour to $300 a day.” Don’t be afraid to negotiate the fee or ask a sibling to chip in.
Choosing the right in-home helper
“The No. 1 way to find a caregiver is through referrals,” Loverde says. Let friends, co-workers and neighbors know that you’re looking. The two main options are hiring on your own or going through a job placement agency.
Hiring on your own often is cheaper, and it gives you more control. On the downside, Loverde says, you’ll have to screen applicants, pay taxes and workers’ compensation, and ensure that the employee is legally entitled to work in the United States.
An agency handles such administrative and legal chores for you. “It may also provide training for its staff,” Cortes says. But the convenience comes at a price. If you use an agency, make sure it’s bonded, licensed, insured and, if applicable, Medicare certified.
Once it’s time to interview prospective caregivers, have a written list of questions ready. Loverde suggests asking:
- What makes you interested in this kind of work?
- Is there anything about this job you would not be willing to do?
- How would you cover your shift if you were ill?
- What would you do in case of emergency?
Be prepared to offer information as well. “Give applicants a written job description so they can see your expectations in black and white,” Loverde says. The more you communicate now, the fewer surprises you’ll run into later.