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Tips for Finding and Interviewing a Private Caregiver

By: Clare Absher RN, BSN

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The two choices for in home care are home care agencies and private caregivers. The decision will have implications in terms of training, cost and other pros and cons referred to in private caregiver vs. home care agency. Think carefully about your caregiving situation and what your priorities are. Do you want to get the biggest bang for your buck? Is time and convienience most important? Does managing payroll and tax records seem complicated? Do you want more control in the caregiver selection process? Furthermore, don't rule out the possibility of hiring a private caregiver in combination with a home care agency to care for your loved one.

When taking the path of hiring a private caregiver, first determine what type of aide your elder needs based on their level of independence, preferences, and financial means. Most often, frail elderly persons need a home care worker with prior 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 can properly care for your elder. A certified aide is not necessary when hiring privately and can be a potential advantage for expanding the applicant pool. Regardless, once you determine what kind of assistance is needed, prepare a list of duties for the caregiver. This job description will later serve as a contract to be signed by the newly hired assistant and yourself.

Finding a Private Caregiver

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.

Word of Mouth

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.

Actively Promote Your Job Opening

  1. Advertise in newsletters or on bulletin boards at local senior centers, retirement centers, churches, community colleges and any nearby schools of nursing.
  2. Call the local community college and speak with the instructors who teach Certified Nurse Assistant classes to request possible student referrals.
  3. 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.
  4. 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.
  5. Post help wanted ads on senior care websites.

Consult with Local Resources

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. 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. Before scheduling an interview, ask for identification, training or certifications, and check references carefully.

Consider Hiring a Home Care Agency Part-Time

In certain situations, I have suggested that my clients consider hiring an independent caregiver for part of the time and hire a home care agency for the remaining time. 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.

Interviewing a Private Caregiver

Assessing Personal Character

When seriously considering the route of a private caregiver, your first and main priority should be finding someone who is kind, compassionate, and caring. You can begin to assess a person's character during the initial interview. Listen to how they talk about their own family and friends and encourage them to share any previous caregiving experiences. There are often subtle clues which can be detected in the tone of their voice as well as what they actually say. Be sure to observe them first hand interacting with your loved one...

  1. Do they smile a lot?
  2. Do they touch their hand or shoulder?
  3. Do they make an effort to talk with them?
  4. Do they listen attentively?
  5. Do they respond appropriately?
  6. Are they thoughtful about including them in the conversation when others are around?

Assessing Competency and Reliability

Your next consideration is likely to be the competency and reliability of a potential employee. Can they manage all aspects of the care necessary? Will they show up on time or at all? When hiring privately, your best bet is to not only obtain several references of past employers, but to question them specifically about dependability and performance. Ask questions like...

  1. Do they give reasonable notice when unable to work?
  2. Can they safely transfer and assist an elder with walking?
  3. Are they gentle when bathing an older person and take especially good care of their skin?

When possible, try to get at least one private family reference from a former client, as they will share a great deal more information about the employee then a company will offer due to their corporate policies. Many private caregivers have taken care of a number of other clients in the past and a good candidate will eagerly wish to share this information with you. If they are new to the private arena, don't be discouraged and unwilling to offer them a chance, especially if they have prior experience.

It is an excellent idea to schedule a trial period to evaluate a caregiver's reliability as well as their competency. The obvious advantage here is that you can observe their caregiving skills first hand as well as their compatibility. If you approach it from the angle that this arrangement is for the benefit of both parties involved, hurt feelings may be spared. Make it clear from the beginning that your arrangement is a trial period for a specific amount of time only so the client, family, and caregiver can become comfortable with each other before a final decision is made.

Job Expectations

Other than getting to know the caregiver, the interview should entail a full discussion about your elder's needs and limitations, as well as your expectations including a list of duties and responsibilities. Some questions to keep in mind…

  1. If it is safe for them to leave your parent unsupervised, and if so, for how long?
  2. Can they drive, do they own a care, and are they willing to escort your loved one to errands, appointments or other outings?
  3. If they are able to drive but do not own a car, then are they willing to drive your parent's vehicle providing they are adequately insured?
  4. Does their explanation of work experience match the information obtained from reference checks?
  5. Are they CPR certified or do they have any other special training?
  6. Will they give written consent to conduct a personal background check?

Background checks can be done conveniently on-line and for reasonable fees. One example is US Search. For even less cost, a simple social security number, drivers license, or professional license can be verified on-line as well.

Job Salary and Legal Issues

Be clear about the proposed salary, when he or she will be paid, vacations, holidays, absences, and lateness. Discuss the amount of time that should be given by either party if employment is terminated. Most agencies charge at least a third more than what you would expect to pay privately. Therefore, call a few local homecare agencies to check hourly rates and 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. 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 of withholding taxes is eligibility to deduct the aide's salary on your parent's tax return.

Lastly, give credit to your instincts and place a lot of weight on your overall impression of a prospective caregiver.