Make the best senior care decision

Before starting your search for a home caregiver, 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 require help with. The more specific your list is, the easier it will be to find home care that checks all the boxes.

What home caregiver services does your aging relative need?

Home care offers opportunities for personalization, explains Lori Eberly ^[01], a consultant for A Place for Mom and a former owner-operator of a multi-unit home care franchise. From part-time 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)? If so, which ones? Needing assistance with ADLs is a major sign that it’s time for 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, family visits, events, and activities.
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? If so, which tasks should be completed? Does your aging loved one just want help with small-to-moderate tasks like changing light bulbs and cleaning bathrooms, or are they looking for an aide who will perform all household chores? Take special note of all 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, note any ways you expect an aide to care for pets.
6. 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 social interaction. If their primary need is companionship, be sure to conduct interviews alongside your loved one for a personality match.
7. 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 care instead of home care.

Let our care assessment guide you

You will not need to create a job description to hire in-home caregivers through an agency. The majority of agencies have preset job descriptions and would not welcome a client or their family writing their own, explains Eberly.^[01]

However, in states that require a license for home care agencies, clients typically help to write a plan of care or care plan with the agency. This is why it’s important to know your loved one’s specific service needs for home care before speaking with agencies.

When you will need to write a job description: Hiring a private caregiver

The only reason you would need to create a job description on your own is if you are hiring a private, independent caregiver. In that case, you may want to consider including the following topics and requirements in your job description:

• Certification and licenses. Would you like them to be a certified nursing assistant, have a homemaker certification, CPR certification, etc.? Do they currently have any licenses?
• Experience. Do you prefer an in-home caregiver who has 5 years, 10 years, or even more years of experience in home care? Do they need experience in certain forms of care, e.g., mobility assistance?
• Exclusivity. Do you expect the caregiver to only work with your loved one during the contract period?
• Grounds for termination. What actions will result in the caregiver’s termination?
• Housekeeping. What tasks need to be completed? If meal preparation is requested, what types of food can they cook?
• Insurance. What insurance and what coverage levels will you expect the caregiver to carry while working with your loved one?
• 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.
• Meals. Do you provide meals and groceries for the aide and your loved one? Do you want them to pick up groceries with reimbursement?
• Mobility assistance. Can they lift someone from a bed to a chair? Are they familiar with stair lifts?
• Notice of contract termination. Will you require at least two weeks’ notice if the caregiver decides to no longer work with your loved one?
• Pets. What pet care do you expect from the caregiver? Does the caregiver have any requirements of their own when it comes to working with pets?
• Smoking. If your loved one smokes, is the caregiver OK with your loved one smoking in their presence?
• Supervision. Will you be using video cameras, such as those from Ring or Nest, to monitor your loved one’s home? If you are in a two-party or all-party consent recording state, consider consulting a local lawyer before including this in a job description.
• Vehicle operation. Will they be using their car or yours? Will you require them to carry specific insurance if they are using their vehicle? Will you provide mileage reimbursement?
• Wages. How much are you willing to pay? Is your rate competitive for the local market? How do you plan to pay? Will you withhold taxes?
• Work schedule. Can they work a flexible schedule when necessary? Do you have specific hours or times of day that the caregiver is required to be present? Is there hazard pay if your loved one requires care while being infected with COVID-19?

You may want to consult a local attorney as you draft your job description to learn more about legal requirements, rules, and laws in your state. Families should also consider consulting with an accountant to learn about the proper tax procedures when hiring and paying an independent caregiver.

As of 2021, the caregiver workforce – people who work jobs taking care of the elderly in their homes and in facilities – remains staffed predominately by women and people of color. The median age of a home care worker is 46 years old.^[03]

Roughly 2.3 million people work as home care workers in the U.S., and the number of jobs in the industry is constantly growing, according to PHI, a research and advocacy organization for care workers.^[02]

Home care worker shortage

The home care job sector has a “significant shortage” of workers, and this is expected to continue, as noted by PHI.^[02] This shortage of caregivers may be attributed to the following factors:

• High turnover rate
• Increased demand for home care services
• Limited growth of the labor force

It’s important to note that the COVID-19 pandemic placed additional strain on this industry in recent years.^[02]

The national hourly median cost for homemaker services was $26 per hour in 2021, according to the Genworth Cost of Care Survey.^[04]

Based on these hourly wages, 24-hour home care could cost an estimated $642 a day.

However, most people can get by with less than 25 hours of care per week and still have their needs met in their home, explains Eberly.^[01] At the rate of $26 per hour, part-time care may only average around $650 a week.

Talk with a Senior Living Advisor

There are two main ways to explore finding a caregiver — through a home care agency or privately through independent caregivers.

Using a home care agency

While home care agencies may have been more expensive than independent caregivers in the past, this has shifted recently with the shortage of workers and pandemic conditions. These days, independent in-home caregivers may charge the same, or even more, than home care agencies, notes Eberly. That said, choosing a home care agency has its pros and cons.

Home care agency pros:

• Background checks. All caregivers should have passed background checks and screenings.
• Backup care. If a caregiver is sick, the agency may be able to quickly find a replacement.
• Easier payment. You pay the agency directly with no worries over taxes or personal contracts.
• Reduced liability for families. You may limit your liability significantly by letting the in-home care agency handle issues like insurance.
• Rules and regulations. Licensed home care agencies typically have to follow strict guidelines.
• Supervision. The caregiver will typically have to abide by agency policies when caring for your loved one.

Home care agency cons:

• Greater contact exposure. A caregiver with an agency may visit many different clients each week, while an independent caregiver may be contracted to only work with your loved one.
• More than one caregiver. Your loved one’s caregiver could change more frequently than if you hired an independent caregiver.
• Service minimums. Agencies may have minimum weekly hours to remain a client. However, this varies between agencies.

Hiring independent caregivers

Staffing services, private registries, and local connections may help families find independent in-home caregivers. Hiring a private, independent caregiver may give you more control over personality and schedule, but it can also present an elevated level of risk and liability.

Independent caregiver pros:

• Flexibility. A more flexible schedule or set of services may be established to fit your loved one’s specific needs. Service minimums may not be required.
• You choose the caregiver. You can prioritize finding someone whose personality and interests match those of your loved one for more personalized companionship.

Independent caregiver cons:

• Consultant expenses. You may need to consult with a local attorney or accountant while working with an independent caregiver, especially when writing up a contract.
• Increased liability to families. “When you hire an individual, you assume all the risk,” explains Eberly.
• Issues with insurance coverage. Your loved one’s long-term care insurance may not cover home care provided through an independent caregiver. Check with their provider to understand their specific policy.
• No backup coverage. If your independent caregiver is sick or unavailable, your loved one may not receive care that day, or you may need to provide care in the caregiver’s place.
• Possibility of legal issues. Issues that are normally handled by a home care agency will instead be your responsibility. For example, if a caregiver is injured while providing care for your loved one, they may be able to sue you for damages.
• Safety checks fall on you. You will likely have to perform your own background checks along with verifying current certifications and employment referrals. You will need to provide the caregiver with a safe working environment, as well.
• Tax responsibility. You will need to follow appropriate tax laws. An accountant or tax lawyer may be able to help you understand your obligations.

You may be wondering how to find an in-home caregiver who will be a good fit for your loved one. It’s common to get personal referrals and read online reviews, but you should use caution with both.

Can I trust personal referrals when it comes to choosing a caregiver?

You should use caution in this situation. A referral from a friend or family member may provide information about a caregiver’s competence, compassion, and personality, but their certification, training, or licensure status may still be unknown.

You may still want to consider screening and interviewing potential caregivers your friends or family have recommended. Friends and family members may have good intentions, but they may not give you the full picture of what a caregiver is like on the job. Just remember to thoroughly review the potential caregiver’s qualifications on your own.

Can I trust online reviews?

Many websites, such as A Place for Mom, feature online reviews for home care agencies from real clients. These reviews can provide a perspective from people outside of your social circle, which can be a helpful viewpoint to consider. As with any review, you should consider the integrity of both the website and the reviewer.

Once you decide which route you want to take, the process of hiring through an agency or hiring an independent caregiver might look a bit different. Here’s some advice on where to start.

If you’ve chosen to work with an agency

Speak with representatives from local agencies to learn more about their services, procedures, and availability. You can ask an agency representative any relevant questions you want to help determine if they are a fit for your loved one. It’s vital to learn if the agency is licensed or if your state requires a license.

You will not be the only one asking questions as most agencies will also ask detailed questions about the client to determine their personality and exact needs. Be prepared to share information about your loved one’s habits and preferences to assist in the process.

If you’ve chosen to work with a private, independent caregiver

You will want to conduct an interview with the candidate(s) of your choice. Before the interview, it’s a good idea to speak to a local attorney to understand laws and regulations related to fair hiring practices that may apply to you.

The Family Caregiver Alliance (FCA) recommends asking potential caregivers these specific questions during your interview:

• Why are you interested in this position?
• Can you 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 while 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? ^[05]

In addition, you should request the following items from them:

• Two work-related and one personal reference to contact
• Driver’s license and documentation that the caregiver can work legally, such as a work visa
• Proof of licensing or certifications
• Personal information for a background check
• Signed waiver allowing you to perform a background check ^[05]

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

Ask your loved one about their impressions of the caregiver as well. Did the prospective caregiver or home care agency representative treat them as an equal?

This step will vary based on if you have chosen to work with a home care agency or an independent caregiver. The process is usually more intensive for those who have chosen an independent caregiver, as you may need to prepare your own contract.

If you have selected to work with a home care agency

They will most likely have a standard contract and other documents for you to fill out and sign prior to starting service. Make sure to read all documents in their entirety. You may want to have a lawyer review these documents for you prior to signing.

If you have selected to work with an independent caregiver

The independent caregiver may have pre-written contracts of their own. Read over these contracts carefully, or consult a lawyer, before signing. If the independent caregiver does not have a template contract, you may have to create one.

A home care contract should typically include the following information:

• A thorough job description agreed upon by both parties
• Full names of the caregiver, care receiver, and employer
• Contact information of the caregiver
• Wage information, including hourly rates, holidays, sick days, and insurance
• Reimbursement figures for mileage, groceries, etc.
• Expectations for behavior, such as smoking, being on time, etc.
• Paperwork requirements, like daily updates, medication logs, and other reports
• A thorough description of any grounds for termination and severance information
• Dated signatures from all parties

The contract formalizes your agreement and defines both parties’ obligations. It should be signed by both you and the caregiver and should be notarized. If any problems come up, you can refer to the contract for potential solutions. This can potentially save you from having to go to court should a dispute arise.

If you’re nervous to write up a contract on your own

You may want to hire a local attorney of your choosing to draft a contract instead of trying your hand at it. Legal experts may be able to provide specific suggestions to protect yourself and your loved one. There are many risky loopholes and important details to consider that may not be known to those without a legal background.

The caregiving journey can be full of surprises. Sometimes care needs evolve rapidly. 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.

The most important qualities between families and caregivers are communication and trust. Clear communication leads to strong relationships, and honesty is imperative for 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.

It can be overwhelming to navigate the many in-home caregiver options available yourself. You don’t have to walk this journey alone. Reach out to the Senior Living Advisors at A Place for Mom for a free consultation about your loved one’s unique care needs. These advisors can provide local solutions and personalized in-home care referrals, all at no cost to you or your family.