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Hiring a Caregiver for In-Home Help: Finding the Best Fit

Claire Samuels
By Claire SamuelsSeptember 19, 2020
Elderly woman conducting an in-home interview with a potential caregiver candidate.

Your elderly relative has decided to age in place, and you’ve determined that in-home care is the best option to keep them happy and healthy. Now, it’s time to find someone compassionate, trustworthy, and qualified to provide that care.

Deciding on a caregiver can be difficult, especially if you don’t have experience hiring or interviewing. But following some key steps can help you find the right fit for your family member. 

Learn how to write a job description based on the level of care your loved one needs, how to decide between a home care agency and private caregiver, and what questions to ask in your interview. Understand home care contracts and the importance of communication throughout your caregiver relationship.

What does in-home care look like for your family?

Before starting your search for a home care aide, know what you’re looking for. Take careful stock of your loved one’s daily needs and make a detailed list of the tasks they’ll want completed. The more specific your list is, the easier it will be to find in-home care that checks all the boxes.

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What kind of help does your aging relative need from home care?

Home care isn’t one-size-fits-all. From companionship to 24/7 assistance, in-home care aides provide different services based on each family’s unique needs. When hiring home care, consider the following eight questions:

  1. Does your relative need help with activities of daily living (ADLs)? Which ones? Needing assistance with ADLs is a major sign that it’s time for in-home care. Some seniors who’ve chosen to age in place only require help with a few daily activities, like dressing, bathing, and meal prep. Others may need full-time assistance using the restroom, eating, and drinking.
  2. Do they need transportation? If your aging parent can’t drive, they may require help to and from doctor’s appointments and activities. Ask if caregivers are comfortable providing transportation. You can also request driving/accident records.
  3. Can your loved one move independently, or do they need to be lifted? If they have impaired mobility, your relative will need a caregiver who can lift them between a bed and wheelchair or carry them into separate rooms.
  4. Do they need housekeeping? Which tasks should be completed? After decades of maintaining their homes, many seniors are particular about housekeeping. Does your aging loved one just want help with strenuous tasks like changing light bulbs and cleaning bathrooms, or are they looking for an aide who will perform all household chores? If so, do they have any specific directions like separating laundry, polishing wood, or ironing linens? Write down housekeeping preferences and needs.
  5. Does your aging parent have pets to care for? It’s extremely important to notify home care aides and agencies about pets, due to possible allergies and phobias. Also record any ways you expect an aide to care for pets — will they be taking a dog on long walks, or just letting the pet into the back yard?
  6. Is your loved one experiencing dementia or cognitive decline? Some in-home care aides are specially trained to help seniors with Alzheimer’s disease or other types of dementia. Ask about an attendant’s experience with cognitive decline, and be upfront about your parent’s dementia behaviors. Disclose sundown syndrome, aggression, and any other common responses to dementia symptoms upfront.
  7. Do they need companionship? If your aging relative is fairly independent but experiencing loneliness or isolation, home care can be a great way to increase stimulation and interaction. If their primary need is companionship, be sure to conduct interviews alongside your loved one for a personality match. Do they prefer to sit and watch TV or do puzzles and go on walks? Do they have similar demeanors? Is there a language barrier? 
  8. Do they need medical care? Home care aides generally don’t have nursing degrees and aren’t able to provide injections, serious wound care, or other medical assistance. If your loved one has a chronic condition or requires medical care, look into home health, which is different from home care. Some in-home care aides are certified nursing assistants (CNAs). If your relative needs blood pressure monitoring, medication administration, or blood sugar maintenance, check for this certification.

Writing an in-home care aide job description with requirements

Based on the questions you answered above, compose a job description to share with agencies or independent aides. If you’re working with a service like A Place for Mom, we can guide you through the process with additional questions.

The Family Caregiving Alliance (FCA) suggests including the following in your job description:

  • Preferred certification. Will you require a certified nursing assistant, homemaker certification, etc.?
  • Driving needs. Will they be using their car or yours? Will you provide mileage reimbursement? Check with the DMV to confirm their driving record.
  • Mobility assistance. Can they lift someone from a bed to a chair? Are they comfortable with stair lifts?
  • Experience with people with memory or other cognitive impairments. Have they worked with clients with dementia before?
  • Language skills. Asking about language skills is especially important for seniors who are hard of hearing, or whose primary language is different from a caregiver’s.
  • Housekeeping. What tasks need to be completed? If meal preparation is requested, what types of food can they cook? Can they accommodate a special diet?
  • Pets. What pet care do you expect from the attendant?
  • Flexibility. Can they work a flexible schedule when necessary?
  • Smoking. Does your aging relative smoke? Is it OK for the caregiver to smoke near their home?
  • Hours. When do you need in-home care? Are you looking for day or night hours?
  • Wages. How do you plan to pay? Will you withhold taxes or hire by contract? What about sick leave, holidays, and insurance?
  • Meals. Do you provide meals and groceries for the aide and your loved one, or should they bring their own food? Do you want them to pick up groceries with reimbursement?

Who provides home care?

More than 2 million people work as paid caregivers for elderly and disabled Americans, and the industry is constantly growing, according to the Public Health Institute (PHI). As of 2019, home care workers are: 

  • 87% female
  • 62% people of color
  • 52% age 45 or older
  • 30% born outside the United States

Ways to find home care for your loved one

There are several channels you can explore to find a caregiver for in-home help, depending on your preferences. 

Using an in-home care agency

There are pros and cons to finding home care services through an agency. While you can be sure aides are screened and qualified, you may pay a little more.

Home care agency pros:

  • All caregivers have passed background checks and screenings.
  • Agencies can offer confirmed referrals and client histories.
  • If your loved one’s physical or mental health deteriorates, the agency may be able to quickly provide someone versed in more advanced care needs.
  • If a caregiver is sick, the agency can quickly find a replacement.
  • You pay the agency directly — no worries about taxes, liability insurance, or personal contracts.

Home care agency cons:

  • Home care pricing can be higher through an agency.
  • Your loved one’s care aide could change more frequently than if you hired an independent caregiver. 
  • Many agencies have minimum weekly hours to cover transportation costs. Generally this is anywhere from seven hours a week to 2-3 hours a day.

Using a home care registry or independent caregiver

Staffing services and private registries can help connect families with independent in-home caregivers. Hiring a private caregiver gives you more control over personality and schedule, but can be time-consuming.

Independent care aide pros:

  • You can prioritize finding someone whose personality and interests match those of your loved one for more personal companionship.
  • You may pay a lower hourly rate.
  • A more flexible schedule could be established to fit your needs.

Independent caregiver cons:

  • You likely must perform your own background checks and verify referrals.
  • You will have to set up an employer identification number for tax purposes and file extra forms.
  • There may not be backup coverage if your independent care aide is sick or unavailable.
  • Independent aides are generally uninsured for workplace injury. If something happens on the job, you’ll be financially responsible.

Personal and business referrals

A referral from a friend or family member can provide confidence about a caregiver’s competence, compassion, and personality. You’ll still have to screen and interview potential caregivers your friends recommend, but trusted references will give you a head start hiring a caregiver for in-home help. 

To find personalized referrals, you can:

  • Source your community. Ask neighbors if they’ve had any experience with in-home caregivers, or post on your community’s Facebook group for recommendations. You can also ask at your religious institution or workplace.
  • Contact family and friends. Maybe you remember a friend going through a similar search and being happy with their home care aide. Or maybe your in-laws worked with someone great.
  • Reach out to a business that considers your unique situation. Senior referral services like A Place for Mom take the time to know families before suggesting home care options. Reach out to our Senior Living Advisors for a free consultation about your loved one’s interests and care needs for personal recommendations.

Hiring a caregiver for in-home help: The interview process

Whether you’ve chosen to work with an agency or interview private caregivers, meeting with individuals one-on-one is the best way to ensure a care aide is a good fit for your family.

You can receive resumes and references via email, as well as conduct initial screenings over the phone or video chat. Once you’ve narrowed down your options, try to have your loved one present for interviews, and conduct final assessments in the home.

The FCA recommends asking the following questions during your interview:

  • Why are you interested in this position?
  • Tell me a little about yourself.
  • Where have you worked before?
  • What were your duties? Here is the job description for this position.
  • What is your favorite kind of client? Are there any people you feel uncomfortable working with?
  • Is there anything in the job description that you are uncomfortable doing?
  • How do you deal with someone living with memory problems? Give an example.
  • Describe your experience making meals for other people.
  • How do you handle people who are angry, stubborn, and/or fearful?
  • Do you have a car? Would you prefer to drive your own car or our car in transporting? I’ll need to see proof of insurance and a current driver’s license.
  • What is your experience transferring someone out of bed or a chair and into a wheelchair?
  • What is your availability? Days? Hours?

In addition, if you’re not working with an agency, ask for:

  • Two work-related and one personal reference to contact
  • Driver’s license and documentation that the care aide can work legally, such as work visa or proof of citizenship
  • Any licensing information to confirm a CNA, homemaker certification, or nursing degree
  • Personal information including birthdate, Social Security number, and address if you plan to move forward with a background check 
  • Signed waiver allowing you to perform a background check. The FCA offers resources to help with background checks.

After the interview

After you’ve completed each interview, write down your thoughts and feelings about the caregiver. Did they seem trustworthy and compassionate?

Ask your aging loved one about their impressions. Was there a connection, or did the interaction feel forced? Did the prospective caregiver treat them as an equal?

Also take note if the home care aide focused on your aging relative during the interview. Asking for a senior’s input and addressing them directly is a sign that the relationship will be beneficial for your loved one.

Sealing the deal: Writing a contract for in-home care

If you worked with an in-home care agency to select an aide, they probably have a standard contract prepared for you to sign. Some independent care aides have pre-written contracts as well. Read over these contracts carefully, or ask for a lawyer’s help, before signing.

If you’ve chosen a private aide who doesn’t use a template contract, you may have to create one. The contract formalizes your agreement and makes it official. It should be signed by both you and the caregiver, and can be notarized at the local post office, library, or notary service. If any problems come up, you can refer to the contract for potential solutions.

A home care contract should include:

  • A thorough job description agreed upon by both parties
  • Full names of the caregiver, care receiver, and employer (whoever will pay)
  • Contact information and social security number of the caregiver
  • Wage information, including hourly rates, holidays, sick days, and insurance
  • Information about reimbursement for mileage, groceries, etc.
  • Expectations for behavior, such as smoking, being on time, house maintenance, etc.
  • Paperwork requirements, like daily updates, medication logs, and other reports
  • Thorough description of any grounds for termination, and severance information
  • Dated signatures from all parties

How are things going? Staying connected with caregivers

The aging journey can be full of surprises. Sometimes care needs evolve rapidly; other times cognitive decline progresses more quickly than expected. Discuss changes, problems, and concerns with the in-home care aide frequently to see what resources they need to best help your loved one.

If there are any problems, address them as soon as they arise. For example, if your older relative prefers their dishes hand-washed or likes their bed made a certain way, let the caregiver know, rather than allowing time to pass because the issues seem small. Similarly, let the caregiver know when they’re doing a good job or exceeding expectations.

The most important qualities between families and caregivers are communication and trust. Clear communication leads to strong relationships, and honesty is imperative from both parties. Stay connected with your caregiver — learn more about them as they learn about your loved one, and understand that you’re in this together.

Claire Samuels
Author
Claire Samuels

Claire Samuels is a content writer at A Place for Mom. She worked with senior living communities throughout the Midwest before pivoting to writing. She’s passionate about sharing ways of living well at any age.

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