“Hiring In-Home Help” – chapter 15 of “Caregiver Helpbook”

A course called “Powerful Tools for Caregivers” was developed by an organization in Portland. You can read general info about the self-care education program for family caregivers at powerfultoolsforcaregivers.org.

As part of the course, class participants receive a copy of a book titled “The Caregiver Helpbook.” Brain Support Network volunteer Denise Dagan is reading the book and will be sharing the highlights, for most chapters. If you’d like far more detail that Denise’s summaries allow as well as access to the book’s terrific worksheets, note that the book is available for purchase in both English and Spanish at powerfultoolsforcaregivers.org.

We’ve skipped chapters 10 through 14, as those didn’t really apply to many caregivers within Brain Support Network.

So, Denise is picking up with chapter 15, which focuses on hiring in-home help. As needs for the care receiver or the caregiver change, additional help may be necessary. Recognizing and accepting the need for outside help can be challenging for both the care receiver and caregiver.

Here’s Denise’s report on chapter 15.



Notes by Denise

The Caregiver Helpbook
Chapter 15 – Hiring In-Home Help

As needs for the care receiver or the caregiver change, additional help may be necessary. Recognizing and accepting the need for outside help can be challenging for both.
– Many people do not want strangers in their homes.
– Many feel that they alone will give the proper care to their family member.
– Perhaps care receivers want help from no one but a family member.
– Using day care centers to relieve both caregiver and care receiver may be viewed with skepticism.
– There are costs to consider as well as availability of and access to needed services.
– Sometimes ethnic, cultural or language barriers exist.

For awhile, services like home-delivered meals and medications, friendly visitors programs, or life-line emergency call services will fill the gaps. Eventually, as abilities decline, increased needs require more help in the home.

Start by realistically assessing the home care needs, including both those of the caregiver and care receiver. Consider:
– Household care: cleaning, laundry, cooking, and shopping.
– Financial care: paying bills, writing checks, maintaining insurance premiums, monitoring bank statements and credit cards.
– Personal care: bathing, dressing, eating, toileting, assisting with mobility.
– Health care: medication management, wound dressings, catheter care, giving injections, administering oxygen or providing rehabilitation services such as PT, OT or speech therapy.
– Emotional care: conversation, daily check-ins, companionship, transportation, visits to or from preferred faith communities.

You can get recommendations or referrals for in-home help through word-of-mouth, personal ads, churches, senior centers, registries of workers maintained by hospitals or private registries, aging offices, hospital discharge planners, social workers, and case managers.

There are two types of in-home care workers:
* Self-employed individuals who are hired directly by a family. Self-employed caregivers can be nurses, therapists, aides, homemakers, chore workers, or companions. In many states the last four categories are not required to be certified or meet government standards.
* People who work for home care agencies.


Hiring Self-Employed Caregivers

Be Prepared:
– Develop a job description, listing specific care needs, such as the need for lifting, dealing with a person who is confused or incontinent, pet care, etc.
– Decide what qualities and experience you want in a caregiver and if you can be flexible with those preferences.
– Know how much money you can spend.
– Have a written contract.
– State working hours and provisions regarding time off for illness or vacation.
– Define who in the family will be directing the care.
– Research and know legal, financial and tax issues. Determine who will be paying taxes, workers compensation, etc.
– State what type of notice is required if the worker quits or the care receiver no longer needs services.

Sample questions to ask the prospective caregiver:
– What is your caregiving experience?
– Are you bonded?
– Are you comfortable with me running a criminal background check on you?
– What are your expectations if I hire you?
– What classes or training have you had in caregiving?
– Why did you leave your last job?
– What do you like and dislike about home care?
– Can you provide three references from past or current clients?
– Is your license current? (as it relates to healthcare professionals)


Types of Agencies:

– Home care agencies prepare meals, assist with bathing, dressing, housekeeping, and sometimes shopping and transportation. The agency hires, trains and supervises their employees plus manages all payroll and labor law issues. Some states require these agencies to be licensed.

– Private Duty and Staffing Agencies are generally nursing agencies that provide nurses aides, homemakers and/or companions. The agency hires and is responsible for the care provided. A few private insurance plans may pay for private duty staffing, but they are quite rare. Sometimes, Medicaid and Veterans’ Services will fund this type of care. Medicare does not pay for these services.

– Home Health Care Agencies provide skilled nursing, PT, OT, speech pathology, social workers, and home health aides for personal care. They hire, supervise, and are totally responsible for their employees salaries, benefits, and caregiving standards. The majority are Medicare-certified, so Medicare will pay for their services. In addition to Medicare coverage, Medicaid, VA Services and numerous other health insurance plans, plus some long-term healthcare plans fund this type of care.

Home health care must be ordered by a physician and the patient must require skilled care such as injections, wound care, IV feedings, or certain therapies. In addition, the care must be delivered on an intermittent or part-time basis and the care receiver must be homebound during the period the agency is under contract. As soon as the care receiver no longer requires this type of care, Medicare and most insurers will cease coverage.

– Hospice Care Agencies are for the terminally ill who choose to stop curative treatment and focus on palliative care. Hospice care seeks to manage symptoms to provide comfort. A physician’s order is needed and he/she must certify that life expectancy is six months or less. If the person lives longer the physician can repeatedly re-certify to continue care.

Hospice is a fully funded Medicare benefit covering all medications hospital stays and equipment needed for management of symptoms caused by the terminal diagnosis. Many private insurance plans also cover hospice care, and the hospice philosophy is that services are provided regardless of ability to pay. Hospice also continues bereavement services, counseling, and support groups for the family for at least 13 months after the care receiver dies.


Comparing the Choices

There are numerous issues when considering whether to hire self-employed caregivers or to work though an agency. Obviously, those delivering the care must be qualified to meet the needs of the care receiver and caregiver for a positive and situation.

The table on page 179 lists some of the pros and cons of each type of care. It is adapted from the Family Caregiver Alliance’s Fact Sheet: Hiring In-Home Help (www.caregiver.org/hiring-home-help), which has further specifics on hiring in-home help. I highly recommend reading through it, especially before hiring self-employed caregivers.