The decision to hire a caregiver privately, versus through an agency, is a big step for the family of an older adult. It is for the older adult as well. Bringing someone into your loved one’s own home, and getting to know them while they care for them and help them remain independent takes a leap of faith. It often works out very well and new friendships are formed that can forever alter everyone’s lives. But there is more to it than a leap of faith. How do you, as a caregiver, assure a good outcome in hiring a caregiver for your loved one? Here are some things to consider:
Understand Your Loved One’s Level of Care
What do they need help with? Personal care? Driving? Shopping? Meal Preparation? Medication Management? Socialization? Housekeeping and laundry? Are they safe to be alone some part of the day, and only need assistance for certain activities? Will there be heavy lifting involved? Make a list of the areas your loved one will need assistance. You will need it to define the job and to interview candidates.
Define the Job
After itemizing your loved one’s care needs, decide on a weekly budget and the hours for a caregiver. Will it be a seven day a week job? If so, will you be looking for two caregivers to cover the whole week? What are your loved one’s preferences? If they have a chronic illness with special needs, are you looking for someone with that specific experience?
Finding Candidates to Interview
Where to look? While we live in an online world, there remain traditional methods of hiring. Ask around. Church members, friends, neighbors. Local geriatric care managers often know caregivers with whom we have worked, and if you know a care manager, this is a good call to make. (The caregivers I have worked with often let me know when they are in between assignments and ready to be hired by a new family.)
Having said that, there are also online options for posting your position. Carelinx.com and care.com are two. Do you know of others?
Sitting Down to Interview
When meeting with potential caregivers, do the following: ask as many questions as needed to get a sense of the candidate(s); be clear about the expectations for the job – daily and weekly responsibilities, schedule, days off, personal preferences of the care recipient. Get at least three references. For the candidates you like, call each one of their references for a complete background check.
Final Steps for Hiring
Found one or two candidates you really like and feel are right for the job? The remaining steps for hiring involve negotiating an hourly rate, and determining how the caregiver(s) will be paid (i.e. cash, check, direct deposit).
Final Steps – Have Your Ducks in a Row and Don’t Forget Taxes and Insurance
It is advisable to consult your accountant for guidance in managing your tax liability as the employer of a privately hired caregiver. Also consult with your insurance agent for your home owner’s policy regarding domestic employees.
Visiting Over the Holidays and Discovering Your Elderly Parent is Not Functioning So Well
This may have already happened in your life. Perhaps you were with an elder relative at Thanksgiving and he/she just was not functioning as well as in the past. You, and/or your family members know you must respond in some way, but, what to do? Or, with Christmas coming, you know you need to implement some changes, or discuss the issue with your elderly loved one.
There is no one way to address the myriad of issues that can occur, but assessing your loved one’s safety in their living environment is a good place to start. When safety is compromised, it is important to act quickly, and appropriately. Engage your elderly loved one to get their perspective, and to understand their wishes for their care. Discussing this with them will also help determine if they are understanding the risks that you see. If there is local family who can become more involved, that is a great place to start. Determine who can do what and how much time they can provide. Determine what your loved one’s needs are, i.e., meal preparation, shopping, driving, doctor’s appointments, socialization, housekeeping, in-home care. Sometimes, when possible, it is best to think this through by first considering the short term, and then the long term. Especially in the case of health emergencies, resolving the immediate health issues where possible, and then determining a plan for the long term.
Regarding the long term, if matters seem overwhelming and you are unfamiliar with the resources in your loved one’s area, consider consulting with a specialist in elder care. The local Area Agency on Aging (www.n4a.org/) can help with identifying resources, as can a geriatric care manager (www.caremanager.org). Getting a geriatric assessment can help you look throughly at the situation and also enlists the assistance of an outside professional in the field of aging. Sometimes employers provide an elder care benefit, so check to see if yours does, and access the benefit if you have it.
The bottom line, this is often the time of year when we find things are not what they were with the elders we love. We must act in their best interest by assuring their safety and well-being.
The National Association of Professional Geriatric Care Managers (NAPGCM) stipulates
that a care manager, in order “to provide the highest quality of service to clients,
should develop a flexible care plan that is developed in conjunction with the
older person and/or client system.”
A care plan should be comprehensive. The following are the major subject areas of a comprehensive care plan as outlined by the National Association of Professional Geriatric Care Managers.
1. Reason for Assessing the Care Recipient
2. Demographic Information
3. Medical History/Medical Needs
4. Cognitive Needs
5. Activities of Daily Living & Instrumental Activities of Daily Living
7. Assessment of Care Recipient’s Support Structure
9. Medical Benefit Coverage
10. Legal Needs
11. Emergency Planning
A Care Plan should then provide:
1. Recommendations, which should include identified areas of concern, in areas of:
Personal care (ADLs)
Household management (IADLs)
Nutrition Cognitive/Memory Impairment
Depression/Mental well being
Primary caregiver burnout
2. Description of Risks, Issues, Problems, or Area of Concerns
3. Services to resolve areas of concern.
4. Recommending Next Steps: care manager’s suggestions to accomplish recommendations, including a timeline for accomplishment.
Today I attended the memorial service for a caregiver who worked with a younger adult client. This man, unfortunately for all who knew him, died less than four weeks after being diagnosed with cancer. It is a shock to everyone who knows him, and many of us are still looking for him to call or e-mail or show up for his job as caregiver. For as a caregiver and a human being, he was one of those rare persons – kind, giving, patient, funny, and easy going, and, as I learned at the memorial, a gifted prankster. But best of all as a caregiver, he had that “certain something.” He loved what he did as a caregiver, and he did it with enthusiasm, creativity and total commitment. He believed in giving himself thoroughly. The person he cared for knew she had someone special, a “one in a million.” He brought a quality to her life that she had not known, and reminded me that caregiving may be a job, but for the gifted caregiver, it is a calling.