Because
We Care
How Do I Hire a Home Care Employee?
Introduction
Today, one
in four American families cares for an older relative, friend,
or neighbor. An estimated 25 to 40 percent of women care for both
their older relatives and their children. Half of all caregivers
also work outside the home. It is no wonder then that caregivers
often need help. Depending on your work, living, and family arrangements,
there are a number of things you can do to make caregiving easier.
Ways to Make Caregiving Easier
- Work Options and On-the-Job Training Programs. If you are
a working caregiver, it is important to discuss your needs with
your employer. Telecommuting, flextime, job sharing or rearranging
your schedule can help to minimize stress. Increasingly, companies
are offering resource materials, counseling, and training programs
to help caregivers.
- Involving Older Children. Older children living at home may
be able to assist you and/or your older family member. Such
responsibility, provided it is not overly burdensome, can help
young people become more empathic, responsible, and self-confident
and give you needed support.
- Asking Other Family Members to Help. You can and should ask
other family members to share in caregiving. A family conference
can help sort out everyone’s tasks and schedules. Friends
and neighbors also may be willing to provide transportation,
respite care, and help with shopping, household chores or repairs.
Sources of Information
If you need additional information and assistance in caring for
your older relative or friend, you can contact:
- The National Eldercare Locator, funded by the Administration
on Aging. Eldercare Locator advisors can direct you to agencies
and organizations that can assist you. When calling the Eldercare
Locator at 1-800-677-1116, please provide the older person’s
address and ZIP code.
- The Area Agency on Aging serving your older relative or friends
community can provide information about in-home and community
services. Information also is available about benefit and assistance
programs for older persons with limited incomes. These include:
- Subsidized housing
- Food stamps
- Supplemental Security Income
- Medicaid
- The Qualified Medicare Beneficiary program, which covers
the cost of the Part A and B insurance premiums, deductibles,
and coinsurance for low-income older persons.
In addition, the AAA can direct you to senior center and adult
day programs. These programs are particularly helpful to working
caregivers who want a safe environment with planned activities
for their older relative.
- Senior centers serve active older persons and those who have
minor problems with mobility and activities of daily living.
- Adult day programs serve older persons with serious mobility
limitations, dementia, or medical conditions that require daily
attention.
- Many AAAs have a registry of home care workers from
which you can recruit directly as well as information on home
care agencies and volunteer groups that provide help.
- Hospital or Nursing Home Discharge Planners also can refer
you to home care agencies and home care workers.
Determining the Type of Care You Need
If you decide to hire a home care employee, you need to determine
how much and what type of help your older relative needs. Following
are descriptions of some of the types of home care personnel:
- Housekeepers or Chore Workers may be supervised by
the person hiring them and perform basic household tasks and
light cleaning. Chore Workers often do heavier types of cleaning
such as washing windows and other heavy cleaning.
- A Homemaker may be supervised by an agency or you and
provides meal preparation, household management, personal care,
and medication reminders.
- A Home Health Aide, Certified Nurse Assistant, or Nurses
Aide, often referred to as home health care workers, are
supervised by a home care agency's registered nurse and provides
personal care, help with bathing, transfers, walking, and exercise;
household services that are essential to health care; and assistance
with medications. They report changes in the patient's condition
to the RN or therapist, and complete appropriate records.
Sometimes, home care employees take on several of the roles described
above.
General Eligibility Requirements for Home Care
Benefits
Medicare may pay for home health care services through a certified
home
health care agency, if a physician orders these services.
Home health care agencies focus on the medical aspects of care
and provide trained health care personnel, including nurses and
physical therapists. For a patient to be eligible for services
paid for under Medicare, she must need skilled nursing assistance,
or physical, speech, and/or occupational therapy. Home health
care workers are a supplement to this care and usually help the
older person for three hours a day, several days a week.
If your older family member or friend needs additional hours
of care or requires custodial care, she may be eligible for services
under Medicaid. The state where she resides determines if her
income and assets qualify her for Medicaid covered services. Otherwise,
you or your older relative must cover the cost of having a home
care worker.
Home care agencies, which can be nonprofit or for-profit, recruit,
train, and pay the worker. You pay the agency. Social Service
agencies, in addition to home care services, may provide an assessment
of the client's needs by a nurse or social worker, and help with
the coordination of the care plan. If services are being covered
under Medicare, your doctor, care manager, or discharge planner
will probably make arrangements for a home health care agency.
Selecting an Agency
If you select an agency, ask the following questions. Those questions
starred with an asterisk should also be asked, if you are hiring
the home care employee.
- What type of employee screening is done?
- Who supervises the employee?
- What types of general and specialized training have the employees
received?*
- Who do you call if the employee does not come?
- What are the fees and what do they cover?*
- Is there a sliding fee scale?
- What are the minimum and maximum hours of service?*
- Are there limitations in terms of tasks performed or times
of the day when services are furnished?*
Unless your older friend or relative needs care for a limited
number of hours each day, the rates charged by home care agencies
for homemaker, home health aide services and van services for
transportation are often beyond the means of middle income families.
If this is the case, you may want to explore the option of hiring
a home care employee directly.
Hiring a Home Care Employee
Avenues for hiring home care aides include:
- Asking other caregivers for referrals
- Going to senior or other employment services
- Contacting agencies that assist displaced homemakers and others
entering the job market
- Advertising in the newspapers
Screen home care employees carefully to ensure that they have
the necessary qualifications, training, and or temperament.
Interviewing Applicants
Your interview with a prospective home care employee should include
a full discussion of the client's needs and limitations, with a
written copy of the job description; the home care worker's experience
in caregiving and his or her expectations.
Special Points to Consider
- If the older person needs to be transferred from a wheelchair,
make sure that the aide knows how to do this safely. If the
aide does not know how to bathe a person in bed or transfer,
but is otherwise qualified, it may be possible to provide the
necessary training, but make sure she can do it before hiring
her.
- Do not try to hire someone on a 7-day-a-week basis. No employee
can remain a good employee for long, if she does not have time
for her personal needs and interests. Additionally, aides who
live in or sleep over cannot be expected to be on call 24-hours
a day. If your older relative needs frequent help or supervision
during the night, you should hire a second home care aide, or
have a family member fill in.
- If your older relative needs a considerable amount of help,
live-in help may be available, which can be less expensive than
hourly or per day employees. However, keep in mind that you
will be providing food and lodging and that it may be more difficult
to dismiss live-in aides, especially if they do not have alternative
housing available. It also is important to ensure that the aide
has her own living quarters, and that she has some free time
during the day, sufficient time to sleep, and days off.
References
Have applicants fill out an employment form that includes their:
- full name
- address
- phone number
- date of birth
- social security number
- educational background
- work history
- references
Ask to see their licenses and certificates, if applicable, and
personal identification including their social security card,
drivers license, or photo ID.
Thoroughly check their references. Ask for the names, addresses,
phone numbers, and dates of employment for previous employers,
and be certain to contact them. If there are substantial time
gaps in their employer references, it could indicate that they
have worked for people who were not satisfied with their performance.
It is best to talk directly to former employers rather than accepting
letters of recommendation. With the applicant's permission, it
is also possible to conduct a criminal background check.
Job Expectations
When hiring a home care aide, it is important to list the job tasks
and to ask
applicants to check those they are willing to perform. You should
also discuss:
- vacations
- holidays
- absences
- lateness
- benefits and wages
- the amount of notification time each of you should give if
the employment is terminated
If you work and are heavily dependent on the home care assistant,
emphasize the importance of being informed as soon as possible
if she is going to be late or absent so that you can make alternative
arrangements. It is helpful to keep a list of home care agencies,
other home care workers, neighbors, or family members who can
provide respite care, if needed.
Be clear about:
- the employees salary
- when he or she will be paid
- reimbursement for money the aide may spend out of pocket
Needed Information
When hiring a home care assistant, it is helpful to spend a day
with him or her, so that you can go through the daily routine together.
At the very least you need to inform the home care worker, both
verbally and in writing, about the older person's:
- likes and dislikes
- special diets and restrictions
- problems with mobility
- illnesses and signs of an emergency
- possible behavior problems and how best to deal with them
- therapeutic exercises
- medications, when they are taken, and how to reorder them
- dentures, eye glasses, and any prosthesis
Also provide information, verbally and in writing, about:
- how you can be contacted
- contacts in case of an emergency
- security precautions and keys
- clothing
- medical supplies, where they are kept, and how they are used
- food, cooking utensils, and serving items
- washing and cleaning supplies and how they are used
- light bulbs, flash lights and the location of the fuse box
- the location and use of household appliances
Transportation
If free or low-cost transportation is not available, try to hire
someone who drives since this saves you substantial amounts of money
in taxi or commercial van ride fares. If the home care employee
is going to drive your family car, you must inform your insurance
company, and provide a copy of the aides drivers license
to your insurance agent. Your insurance company will check to see
if the license has been revoked, suspended, or if the aide has an
unsatisfactory driving history. If the home care assistant has a
car, discuss use of her car on the job and insurance coverage.
Insurance and Payroll
Check with your insurance company about coverage for a home care
employee, and contact the appropriate state and federal agencies
concerning social security taxes, state and federal withholding
taxes, unemployment insurance, and workmans compensation.
If you do not want to deal with these somewhat complicated withholdings
from the employee's salary, payroll preparation services can issue
the employee's check with the necessary withholdings for a fee.
Some home care aides work as contractors. Even in these cases,
you must report their earnings to the Internal Revenue Service.
Before employing an aide on a contract basis, consult your financial
advisor or tax preparer to make certain that you are following
the IRS rules that govern contract workers, since there can be
a fine line between who is considered to be an employee versus
a contractor.
Ensuring Security
Regardless of who cares for your elderly relative, protect your
private papers and valuables by putting them in a locked file cabinet,
safe deposit box, or safe.
- Make arrangements to have someone you trust pick up the mail,
or have it sent to a post box where you can pick it up.
- Check the phone bill for unauthorized calls, and, if necessary,
have a block placed on 900 numbers, collect calls, and long-distance
calls. You can always use a prepaid calling card for long distance
calls.
- Protect checkbooks and credit cards. Never make them available
to anyone you do not thoroughly trust.
- Review bank, credit card statements, and other bills at least
once a month, and periodically request credit reports from a
credit report company. Your bank can provide you with the names
and addresses of these companies.
- If you do leave valuable possessions in the house, it is best
to put locks on cabinets and closets and to have an inventory
with photographs.
Protecting Against, Identifying, and Handling
Abuse
Although abusive
situations are not common, you must be alert to the possibility.
They are one of the primary reasons why it is so important to
carefully check the references of a prospective home care aide.
You can help to prevent abuse situations by:
- Ensuring that the home care assistant thoroughly understands
what the position entails, your care receiver’s medical
problems and limitations, as well as behavior that could lead
to stressful situations.
- Ensuring that the home care aide is not overburdened.
- Keeping the lines of communication fully open so that you
can deal with potential problems.
Following are possible signs
of abuse or neglect:
- Personality changes in your older relative or friend
- Whimpering, crying, or refusing to talk
- Unexplained or repeated bruises, fractures, burns, or pressure
sores
- Weight loss
- An unkempt appearance
- Poor personal hygiene
- Dirty or disorganized living quarters
- Confusion, excessive sleeping, or other signs of inappropriate
sedation
If you suspect that an abusive situation exists, don’t
wait for it to be tragically confirmed. Find a way to check either
by talking to the older person in a safe situation or, if necessary,
by installing monitoring devices. If you witness, or are told
by a reliable source, about neglect; physical abuse; emotional
abuse, including yelling, threatening, or overly controlling,
possessive behavior, which often involves isolating the older
person from others; seek help, if necessary, and replace the home
care aide as quickly as possible.If the situation appears serious,
remove your care receiver from the premises and place him or her
with another family member or in a facility that offers respite
care. Always ensure that your relative is safe before confronting
or dismissing the worker, especially if you are concerned about
possible retaliation.
Once you have ensured your relative's safety, report the aide
to Adult Protective Services so they can take appropriate actions
to prevent the aide from gaining employment with other vulnerable
elders. If the abuse is of
a serious nature including, serious neglect, physical injury,
sexual abuse, or the misuse of the funds of the older person,
you should also contact the police.
Supervising a Home Care Worker
Once you have hired a home care worker, make sure that the lines
of communication are fully open and that both you and the worker
have a clear understanding of the job responsibilities to the
older person and to each other. Explain what you want done and
how you would like it done, keeping in mind that the home care
employee is there to care for the older person and not the rest
of the family.
If the home care worker lives in, try to ensure that he or she
has living quarters that provide you, the older person and the
assistant the maximum amount of privacy possible.
Once the home care aide is on the job, periodic and/or ad hoc
meetings can be held to discuss any problems the home care assistant
or the older person may have with the arrangement and to find
ways to resolve them. It is important to be positive and open
in your approach to resolving difficulties. In most cases, they
can be corrected.
However, if, after repeated attempts, you find that major problems
are not resolved satisfactorily it may be best to terminate the
relationship, and seek another home care employee. During this
time, it may be necessary for your older relative to reside temporarily
in a long-term care facility or for you to hire an aide through
an agency. It is best to have reserve funds on hand should such
an emergency arise.
While home care may not be less expensive than nursing home care
or assisted living, it offers older people the opportunity to
remain at home. What is more, it affords a degree of flexibility
and choice for the at-risk elderly that few other living arrangements
can provide.
Additional Resources and Reading Lists
The National Association for Home Care’s How to Choose
a Home Care Provider is an excellent resource that covers a range
of topics relating to hiring home care employees through an agency.
The information is also useful to those who choose to hire a home
care employee independently.
The National
Center on Elder Abuse is a major resource on elder abuse issues.
The NCEA web site includes fact sheets on major issues, caregiver
resources, and contact points in each state to report elder abuse.
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