Because We Care

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 friend’s 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 AAA’s 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.

1. What type of employee screening is done?
2. Who supervises the employee?
3. What types of general and specialized training have the employees received?*
4. Who do you call if the employee does not come?
5. What are the fees and what do they cover?*
6. Is there a sliding fee scale?
7. What are the minimum and maximum hours of service?*
8. 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

• 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

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

• 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, driver’s 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

• 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 employee’s salary
• when he or she will be paid
• reimbursement for money the aide may spend out of pocket

Needed Information

• 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

Insurance and Payroll

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

• 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.

Back to Previous | Main | Next >