How to choose a home caregiver? A comprehensive guide for families.

According to a 2020 AARP report, nearly 1 in 5 Americans have provided care to an adult in the past year, highlighting the growing demand for in-home support. This guide will provide a comprehensive, step-by-step approach on how to choose a home caregiver to ensure your loved one receives the best possible care.

Quick Summary

Assessing a loved one's specific needs and budget is the first step when choosing a home caregiver, followed by deciding between an agency and a private hire, and finally conducting thorough interviews and background checks.

Key Points

• Start with an Assessment: Carefully evaluate the specific care needs, including daily activities, mobility, and companionship, to define the scope of the caregiver's role.

• Weigh Agency vs. Private Hire: Compare the cost, liability, screening process, and backup options of hiring through an agency versus hiring a private caregiver to see which best fits your family's needs.

• Conduct Thorough Vetting: Ensure agencies are licensed and accredited, and perform comprehensive background and reference checks for all candidates, whether from an agency or a private hire.

• Interview for Compatibility: Use the interview to assess a candidate's experience, communication style, and emotional fit with your loved one by asking specific, behavioral questions.

• Formalize the Agreement: Create a written contract detailing the job description, schedule, compensation, and emergency protocols to establish clear expectations and protect all parties.

• Maintain Ongoing Involvement: Stay engaged after hiring by maintaining regular communication, observing your loved one's well-being, and promptly addressing any issues with the caregiver.

Step 1: Assess Your Care Needs

Before you begin your search, it's crucial to have a clear understanding of what type of assistance is required. Involve your loved one in this process as much as possible to ensure their preferences are considered. Creating a detailed list of daily needs will be your compass throughout this journey.

Daily Living Activities (ADLs) and Instrumental Activities of Daily Living (IADLs)

Activities of Daily Living (ADLs) are the basic tasks of self-care. IADLs are more complex activities necessary for independent living. Here are some common tasks to consider:

• Personal Care: Assistance with bathing, dressing, grooming, and toileting.
• Mobility Support: Help with transferring in and out of bed or a wheelchair, walking, and fall prevention.
• Meal Preparation: Planning, cooking, and ensuring nutritional needs are met.
• Medication Management: Reminders or assistance with administering medication, as prescribed.
• Transportation: Driving to and from appointments, errands, or social outings.
• Companionship: Providing social interaction to prevent loneliness and isolation.
• Light Housekeeping: Tidying up the living space, doing laundry, and maintaining a clean environment.

Step 2: Agency vs. Private Hire

One of the most significant decisions is whether to hire a caregiver through an agency or independently. Both options have distinct pros and cons that impact cost, liability, and oversight.

Comparing Agency and Private Hire

Feature	Home Care Agency	Private Hire Caregiver
Cost	Generally more expensive hourly rate.	Can be less expensive hourly rate.
Screening	Thoroughly vetted, including comprehensive background and reference checks.	You are responsible for all screening and background checks.
Reliability	Provides a replacement caregiver if the regular one is sick or unavailable, ensuring continuity of care.	Backup coverage is your responsibility to arrange if your caregiver is unavailable.
Liability	The agency is the employer, covering taxes, insurance, and liability.	You become the household employer, responsible for all legal and tax obligations, liability, and workers' compensation insurance.
Training	Caregivers often have mandatory training and ongoing professional development.	Varies widely; you are responsible for assessing their training and skill level.
Oversight	The agency manages supervision and can intervene if issues arise.	You manage all aspects of supervision and conflict resolution.

Step 3: Finding and Vetting Candidates

Once you’ve decided on an approach, it's time to find potential caregivers. For agencies, you can gather recommendations from healthcare professionals, friends, or family. For private hires, word-of-mouth or online platforms are common starting points.

What to do with an agency

• Verify Certification and Accreditation: Ensure the agency is licensed and certified by relevant state and federal organizations. Check for national accreditation, which can indicate a commitment to higher standards.
• Check Reviews: Use online resources like Medicare’s Care Compare website to check star ratings and patient satisfaction scores.
• Request Credentials: Ask for documentation confirming the caregiver's training, background checks, and certifications.

What to do for private hire

• Perform Background Checks: A comprehensive check should include criminal history, driving records, and sex offender registry status.
• Contact References: Always contact multiple references to inquire about the candidate's reliability, compassion, and experience.

Step 4: Conducting the Interview

Whether meeting with an agency-provided caregiver or a private candidate, a face-to-face interview is essential for assessing compatibility and skills. Involve your loved one in this meeting to gauge their rapport with the candidate.

Key interview questions

• What is your experience working with clients with specific conditions (e.g., dementia, mobility issues)?
• How would you handle a medical emergency? What steps would you take?
• Describe a difficult situation you've faced with a client and how you resolved it.
• How will you communicate with the family about a client's well-being and any changes in their health?
• What do you enjoy most about being a caregiver?
• What training or certifications do you hold (e.g., CPR, First Aid)?

Step 5: Setting Expectations and Finalizing the Agreement

After selecting a caregiver, it’s vital to formalize the relationship to prevent misunderstandings down the line. If hiring privately, you will need a written contract.

Crucial elements for your agreement

• Detailed Job Description: Clearly outline the duties and responsibilities, based on your initial needs assessment.
• Schedule and Compensation: Specify the work schedule, pay rate, payment frequency, and any policies for vacation or sick leave.
• Emergency Plan: Include emergency contacts, medical information, and a clear protocol for medical emergencies.
• Trial Period: Consider a trial period to ensure the caregiver is a good fit for your family and your loved one.
• Communication Plan: Agree on a regular communication schedule, detailing who the primary contact person is and how updates will be shared.

Step 6: Maintain Ongoing Communication and Oversight

Your role doesn’t end once the caregiver is hired. Regular communication and check-ins are vital to ensuring the quality of care remains high and that everyone is satisfied with the arrangement.

• Regular Check-ins: Schedule regular meetings or phone calls with the caregiver to discuss your loved one's progress and any concerns.
• Observation: Pay attention to your loved one’s demeanor, hygiene, and overall well-being. Changes in mood or health can be key indicators.
• Respectful Communication: Address any issues promptly and respectfully. A positive, open relationship with the caregiver is key to a successful partnership.

For more information on legal and tax obligations, especially if hiring privately, visit the Family Caregiver Alliance website.

Frequently Asked Questions

What is the difference between a home care agency and a private caregiver?

An agency is an organization that employs caregivers, handling all hiring, training, and legal responsibilities. You pay the agency, and they manage the caregiver. A private caregiver is an independent contractor whom you hire directly, making you responsible for all taxes, insurance, and supervision.

How can I check a caregiver's references?

When checking references, ask about the candidate's reliability, punctuality, and ability to handle difficult situations. For an agency, you can often request references from current or former clients. For a private hire, insist on speaking with at least two or three past employers.

What kind of questions should I ask in the interview?

Beyond their experience, ask behavioral questions like, 'How would you handle it if my mother refused to take her medication?' or 'Tell me about a time you had to deal with a medical emergency.' Also, assess their communication style and rapport with your loved one.

How do I conduct a background check for a private caregiver?

For private hires, you can use accredited consumer reporting agencies to perform background checks that may include criminal history, sex offender registry checks, and driving records. Always obtain the candidate's consent in writing before proceeding.

What if the caregiver and my loved one don't get along?

If you hire through an agency, you can request a new caregiver. With a private hire, you would need to address the issue directly. In either case, it's best to observe the interactions carefully and have an open conversation to understand the source of the conflict.

What should be included in a caregiver contract?

A caregiver contract, especially for private hires, should detail the job responsibilities, work schedule, hourly rate, overtime policies, and how to handle missed shifts. It should also include a confidentiality agreement and clear grounds for termination.

How do I know what level of care is needed?

Start by assessing your loved one's ability to perform daily living activities (ADLs) and instrumental activities of daily living (IADLs). You can also consult with a doctor or a geriatric specialist to get a professional assessment of their needs.