Tips for Finding, Interviewing, and Keeping In-Home Help ©
By: Clare Absher RN, BSN
As a follow up to last month's article "Should I Hire In-Home Help Privately or Through an Agency", I will expand further as promised on how to go about finding and hiring a qualified caregiver in addition to keeping him or her. The two choices for finding in-home help as previously discussed are to hire a caregiver through a Home Health/Home Care Agency or hire a helper privately. This decision will have implications in terms of training, cost and other pros and cons referred to in the January article. Think carefully about your caregiving situation and what your priorities are. Do you want to get the biggest bang for your buck or is convenience what matters most? Does managing payroll and tax records seem complicated or having little or no control over who comes more of a detriment? Furthermore don't rule out the possibility of hiring an assistant from a home care agency and a private assistant in combination to care for your loved one.
When taking the path of hiring privately, first determine what type of caregiver your elder needs based on their level of care, preferences, and financial means. Most often frail elderly persons need a home care worker that has had some basic caregiving experience including performing personal care such as bathing and dressing, safe transferring or assistance with walking, and meal preparation and/or assistance with eating. If your elder is confused or doesn't require hands on care, then you may be able to manage with a sitter or companion that simply ensures their comfort and safety. If you're looking for some basic household assistance with cleaning, laundry and so forth, then a housekeeper or choreworker will suffice. Don't become confused by all the various terms used to describe caregivers, instead focus on finding someone with the appropriate qualifications and experience that meets your elder needs. A certified aide is not necessary when hiring privately and can be a potential advantage for expanding the applicant pool due to most agencies' stringent certification requirements. Regardless, once you determine what kind of assistance is needed, prepare a list of duties for the helper. This job description will later serve as a contract to be signed by the newly hired assistant and yourself.
The most difficult step, but by no means impossible, is actually finding the appropriate caregiver for the job. I will share a number of recruitment ideas that I've picked up a long the way while managing a local home care agency. By far one of the easiest and best ways is to have a personal recommendation from a trusted friend or relative. Word of mouth is often the most successful means, so be sure to ask neighbors, acquaintances from your church, clubs, and organizations where you are a member. If you belong to a support group, ask other family caregivers and if you don't belong, consider joining one even if it's just for this reason. Perhaps you personally know a nurse, social worker, or therapist in your community that can give you some leads or ideas. If your loved one has been hospitalized or in a nursing home/rehab facility, be sure to ask the professional health care workers you meet such as discharge planners or staff nurses, and especially other nurse aides. In the event your loved one has received Home Health services through a Medicare certified agency following an illness, make sure you inquire among those nurses and aides about possible referrals. Recalling from my experiences as a visiting nurse, it is quite common for home health professionals to be keenly aware of available caregivers and they are often familiar with community resources for locating help.
Additional options for finding caregivers include advertising in newsletters or on bulletin boards at local senior centers, retirement centers, churches, community colleges and any nearby schools of nursing. Call the local community college and speak with the instructors who teach Certified Nurse Assistant classes to request possible student referrals. Contact several local Home Health/Home Care agencies and ask the Nursing Manager if she can refer an aide that is interested in private work. Sometimes an agency will maintain a list of aides that they are willing to refer but for various reasons cannot employ them. Many communities have attendant registries that will provide names of home-helpers they have screened. They can be an excellent resource, although may charge a finder's fee that can vary greatly, so be sure to shop around. In certain situations, I have suggested that my clients consider hiring an independent worker for part of the time and staff with agency personnel for the remaining. Remember that it's never reasonable to expect an employee to work on a 7 day-a-week basis. The advantage of a joint caregiver arrangement whether arranged with two private workers or a combination of an agency and private worker, is the likelihood of more reliable staffing, reduced overall costs, and having a viable back-up plan in place.
Consulting with the local employment agencies, your Area on Aging, or local social services are other good resources for directing you to caregiver solutions. Older persons with limited incomes or qualifying for Medicaid, may be eligible for free or low cost assistance from nurse aides or choreworkers that is subsidized by their county or state. They may also refer you to volunteer services for help with transportation, home repairs, or meals on wheels. Post help wanted adds on message boards on other caregiver web sites. Check back here soon as we are currently developing a special classified area on CarePathways.com for finding caregivers and those seeking positions. Search the newspapers for caregivers seeking employment and place a help wanted add. If you advertise in the papers for help, screen the applicants carefully over the telephone and save time by interviewing only the qualified ones personally. Ask for identification, training or certifications, and check their references carefully prior to scheduling an interview.
The interview with the prospective caregiver should entail a full discussion about your elder's needs and limitations, as well as your expectations including a list of duties and responsibilities. Can they leave your loved one unsupervised, and if so for how long? Can they drive, do they own a car, and are they willing to transport your loved one on errands, appointments or other outings? If able to drive but don't have transportation, are they willing to drive your vehicle providing they are adequately insured? Ask about their specific work experience to verify that it matches the information obtained from reference checks. Are they CPR certified or do they have any other special training? In this day and age, I strongly advise conducting a personal background check with the written consent from the prospective employee prior to making the job offer. It can now be done conveniently on-line and for reasonable fees ranging from $15.00 to $90.00 depending on whether the search is done at the county, state, or national level. In addition for even less cost, a simple social security number, drivers license, or professional license can be verified on-line as well. A good company that offers these services is http://www.ussearch.com. Lastly, give credit to your instincts and place a lot of weight on your overall impression of a prospective caregiver.
When seriously considering hiring an individual be certain to allow some time to observe the caregiver and your loved one together during the interview. Be clear about the proposed salary, when he or she will be paid, vacations, holidays, absences, and lateness, amount of time both should give if employment is terminated. Most agencies charge at least a third more than you would expect to pay privately. Therefore call a few local homecare agencies' to check hourly rates, in order to establish a baseline. Once the caregiver is selected, it's not a good idea to agree to any under- the- table pay arrangement. Although paying the employee directly may seem easier, it can have devastating consequences ranging from IRS fines and penalties, to enormous medical bills resulting from a worker's job injury not covered by your state's Workers' Compensation Act. Protect yourself and the elder by reviewing and following the rules set forth in the IRS publication926, Household Employer's Tax Guide. An added benefit that withholding taxes afford is eligibility to deduct the aide's salary on your elder's tax return.
Once you've spent the time searching for, interviewing, and hiring a caregiver that you are pleased with and seems well suited for the job, it's in everybody's best interest for this person to be satisfied with the work arrangements in hopes that they will care for your loved one as long as needed. Taking care of the caregiver may be the last thing on your mind, but is probably the most crucial matter at hand. In closing, I'll leave you with some suggestions that may help enhance your caregiver relationship, prevent caregiver burn-out, and help things to run smoother for the benefit of your loved one's overall care.
- Make sure to lay down all the ground rules and review their duties presented earlier during the interview. Spend time orienting them to your home, the daily routine, and all aspects of your loved one's care.
- Treat them with the utmost respect, recognizing that this can be difficult and stressful work. Reinforce that you value their dedication and are entrusting them with an important job.
- Give frequent praise and positive feedback, as everyone needs to feel appreciated. Remember them on holidays with gifts, or occasional surprises such as flowers and candy, or dismiss them early sometimes.
- Include them in all aspects of your loved one's care as they are a vital part of the caregiving team. Listen carefully to their comments, observations, and update them on changes concerning any of the care.
- Give credit for their experience and knowledge and encourage them to share some tricks of the trade with you. Recognize that another's approach although different at times may have positive results.
- Consider feelings, preferences, and needs and make them feel welcome in your home. Realize and try to understand that they have personal lives with their own problems outside of your home.
- Be as flexible as possible about caregiving routines and accommodate time off requests, as this will go a long way to promoting ongoing loyalty. Negotiate when possible about conflicting schedules that arise.
- Pick your battles and don't sweat the small stuff. Focus on the big picture making certain that the overall care of your loved one remains the foremost priority.