Hire In-Home Help in 7 Steps

You feel alive to the degree that you feel you can help others.

~ John Travolta

Take these 7 steps to find someone you can trust

Often with aging comes the need to rely on “informal caregivers” (not paid usually family) for assistance, and nearly one-third of older adults require help from paid caregivers. The challenge is finding trustworthy and reliable people with the appropriate skills to fill in the caregiver gaps.

1) Assess the Type of Care You Need

Homemaker/companion care

This type of care typically includes light housekeeping duties like washing dishes, doing laundry, mopping floors and other chores. They might also run errands like shopping or pick up prescriptions, go on car trips and serve as a companion for isolated seniors.

Home health aide

A home health aide often takes on all the duties of a homemaker and tackles things like helping a person get dressed and out of bed. They assist with all the activities of daily living (ADLs) and Instrumental Activities of Daily Living (IDALs). This might be the right choice if your loved one has an illness or disability and needs medical attention.

Nursing care

A registered nurse works with a doctor on a treatment plan, often providing direct medical services like wound care, medication supervision, ostomy care, pain control and delivering IV treatments. This is just a small sample of the health care services that might be needed.

Hospice care

Terminal patients have limited time left, but that doesn’t mean they need to live with constant pain. Hospice care provides maximum pain relief for those who suffer from chronic issues. They also provide education, resource information, and support to family members and company for the patient in time of need.

2) Know What It Costs and Whether It’s Covered

Home health care and homemaker-type services have similar costs, about $21 per hour or $48,000 per year for a 44-hour work week, according to the 2017 Cost of Care survey from Genworth, a long-term-care insurance company.

You will pay a higher rate if you need help during evenings, holidays, or weekends. Hiring an aide, such as a nurse or certified nursing assistant, who can provide a higher level of care (changing a catheter, for example) does have increased cost.

Home care in rural areas, where there are fewer available workers is costlier as well. For example, the median annual cost of home health care is almost $64,000 in Alaska and North Dakota, the Genworth survey shows.

Adult Day Care can be cheaper. Genworth reported that the median annual cost for five days a week is $18,200. Adult day-care programs provide many of the same services you’d get from a home health aide or personal care worker, often in a senior center or nursing facility (see National Adult Day Services Association for information).

Medicare, the health insurance program for people over 65, doesn’t cover long-term-care needs, whether it’s assisted living, a nursing home, or in-home care. But for short-term medical needs, it does cover some in-home care. Medicare typically pays for services after a person has been hospitalized or has an illness or injury and a doctor certifies that he or she needs care for that specific condition at home. In addition, if you have long-term-care insurance or qualify for Medicaid, you might have coverage for some home care. But for most, this will be an out-of-pocket expense.

3). Know Where to Look for Help

Your Community- can glean much information by just talking to folks you know or run into.

Your community: Most people still rely on recommendations from family and friends, their doctor, or support groups. Word-of-mouth can be a good way to find a quality caregiver or a home health staffing

Your employer- About 13 percent of employers offer elder-care referral services, according to a study by the Society for Human Resource Management (Care@Work, which provides employee benefits, assigns a social worker to do a health-needs assessment and connects people to vetted providers).

Locator service- There are thousands of staffing agencies that specialize in home care. To find one in your area, check the federally funded Area Agency on Aging’s free home-care locator service. The National Association for Home Care & Hospice also has a free database listing thousands of home-care agencies.

Online- There are online elder-care matching services where home-care providers looking for work post profiles. You set the criteria and get a pool of candidates to contact. Some services do basic background checks. At some, you can pay for higher-level screenings; a criminal and driving record check, for example.

Find Help at Home with SeniorHeplers.com

Senior Helpers

4). Decide Who’s the Boss

Your next decision is whether to hire a caregiver through an agency or on your own. There are pros and cons to both. If you work with an agency, it will do the background screening, the hiring (and firing), and the tax and legal paperwork.

On the downside, you might have less choice over who comes to your home. The agency will give you whoever is available; you don’t get to select the person. Agencies often divide the job between several workers, which can make it difficult to develop a good relationship with a caregiver.

If you’re doing the hiring yourself, you can choose the person you think will provide the best care. It’s usually less expensive than using an agency because you don’t have to pay for all the services built in, but it’s more work, too. You will have to conduct the interviews, arrange a schedule, negotiate a salary, and spell out job responsibilities. If the home-care worker is sick, you will need to arrange for a backup.

You will also be responsible for the administrative tasks you need to do when you employ someone.

 5). Check Out Your Caregiver

Horror stories about elderly people being scammed by caregivers. But according to Leah Eskenazi, director of operations for the Family Caregiver Alliance, a nonprofit organization, says most people who hire in-home care aren’t ripped off or abused.

A bigger concern is whether the person you hire has the right training and is reliable, Eskenazi says. If you go through a home-care agency, ask about its screening process. Does it merely verify a worker’s identity, or will it do a thorough check—criminal history, driving record, and references?

If you’re hiring a caregiver yourself, do your own background check. Ask for references from former employers and call them all. Use a service to check criminal histories and driving records, and to verify licensing, use background-check services.

6). Ensure a Good Fit

Make sure your loved one is part of the interviewing and selection process. Ask how the caregiver has handled situations in the past. Ease them into the care by having the aide start gradually, perhaps a few hours a week, or ask the staffing agency for a trial period. A family member or friend should be there for the first few days to make sure things go smoothly. Check in frequently with your loved one and set up regular times to meet with the caregiver. Consider hiring a geriatric-care manager who can oversee the aides if you can’t or you don’t live nearby. You can find certified geriatric-care managers, who charge $50 to $200 an hour, through the industry’s professional association.

7). Right Way to Pay a Caregiver

 Don’t pay under the table. Untaxed cash payments with no records can get you in trouble with the IRS and be construed as “spend down” gifts, potentially disqualifying your parent from future Medicaid-funded nursing-home care.

Doing things right involves work. If you pay a caregiver $2,000 or more a year or $1,000 a quarter, you’ll need to give him or her a Form W-2. A CPA can help with these details. Or contact a service such as QuickBooks Payroll or SurePayroll, which offer turnkey payroll systems for home-based care. As an employer, it’s also up to you to check the worker’s immigration status.

Increase your insurance. If a regular caregiver is injured in the home and sues, your homeowner’s insurance might not cover all the medical or legal costs. “The resulting liability to you and your family could be financially devastating,” says P. Mark Accettura, estates and elder-law attorney in Farmington Hills, Mich.

Even when your homeowner’s insurance covers an injured worker in your home, it might not be sufficient to protect your financial assets. Check with your insurer about buying or increasing umbrella liability coverage. Depending on your state, you also might need to buy workers compensation and disability benefits insurance.

Have a formal arrangement. Laying out the hours, tasks, pay, and other factors are especially important if you’re paying a relative to do the work. A written contract can help you prove that the money paid wasn’t a gift, a key consideration for Medicaid eligibility later. It also makes it clear when the relative’s work ends, and the work of others begins, such as a paid evening caregiver.

“It has to be an arm’s length transaction,” says Debra Speyer, an elder-law attorney based in Bala Cynwyd, Pa. “The person writing the check should be different from the one receiving the money.”

A tax expert can lay out the most tax-efficient employment arrangement with a caregiving relative.

Generally, to pass muster with Medicaid, the hourly rate must be in keeping with market rates for unskilled home-care workers in your area. “If in your neck of the woods they’re getting $20 or $30 an hour, you can’t pay $80,” notes Bernard Krooks, an elder-law attorney in New York.

The caregiver should keep a log of when he or she works to jibe with the payments made. Payments made months or years after the work was done won’t pass muster with Medicaid, notes Paul T. Joseph, a CPA and elder-law attorney in Williamston, Mich.

“The money has to be paid after the agreement was put in writing,” he says. “Past consideration is no consideration.”—Tobie Stanger

 

Summary

Who Might Benefits from In-Home Care Services

Primary caregivers

Family caregivers may need some additional help with the care of their loved one for various reasons. They may need it during working hours, overnight and/or for respite hours. The care needed may also be too much for one individual to provide.

Persons with a disability

An individual with disabilities and/or their family members may need additional assistance.

Elderly individuals

A natural product of aging is often a loss of independence. Many people suffer from cognitive disorders or physical disabilities, limiting their ability to care for themselves.

Persons with dementia

Persons with dementia will arrive at a point where they can no longer care for themselves. Until that point, they may benefit from home care services.

Accident victims

After an accident, someone might need some extra help around the house. A broken leg can severely limit mobility, and a little help around the house during recovery can go a long way.

Terminal patients

Someone who is preparing for death has very specific in-home care needs. They need skilled nursing services and/or hospice care.

 

Editor’s Note: Some content reported from Consumer Reports magazine/by Donna Rosate Oct/2017. Also, thanks to Shelly Webb RN Geriatric Care Manager

 

Thanks, Patrick