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How to hire an in-home caregiver

Most people want to continue living in the familiar surroundings of home. However, difficulties with even simple everyday tasks can sometimes prevent them from doing that. Family members or friends may offer to step in and help. Sometimes it becomes necessary to hire a caregiver to come into the home, on either an intermittent or daily basis, to provide much needed assistance.

Many agencies provide this type of "in-home assistance". It is also possible to hire private-duty individuals to provide this assistance. Using an established agency can provide a certain amount of convenience. Typically the agency recruits, screens, hires, trains, supervises, and pays the employee - relieving you of those responsibilities. Additionally, some agencies might be able to accept Medicare, Medicaid or private insurance as payment for services provided. One disadvantage to using an agency is there may not be a guarantee that the same worker will be coming to your home each time.

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Selecting an Agency

If you select an agency, ask the following questions. Those questions starred with an asterisk should also be asked if you are hiring a private in-home caregiver:

  • What type of employee screening is done?
  • Who supervises the employee?
  • What types of general and specialized training have the employees received?*
  • Who do you call if the employee does not come?
  • What are the fees and what do they cover?*
  • Is there a sliding fee scale?
  • Do they accept Medicare, Medicaid or private insurance payments?
  • Do they have liability and bonding insurance?*
  • What are the minimum and maximum hours of service?*
  • Are there limitations in terms of tasks performed or times of the day when services are furnished?*

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Hiring an In-home Caregiver

Avenues for identifying potential in-home caregivers include:

  • Asking your physician, nurse, or social worker for referrals
  • Asking other families in similar situations for recommendations
  • Going to senior or other employment services
  • Contacting agencies that assist displaced homemakers and others entering the job market
  • Advertising in the newspapers

Screen home care employees carefully to ensure that they have the necessary qualifications, training, and or temperament.

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Interviewing Applicants

Your interview with prospective in-home caregivers should include a full discussion of the client's needs and limitations, with a written copy of the job description; the home care worker's experience in caregiving and his or her expectations.

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Special Points to Consider

  • If transferring from a wheelchair is needed, make sure that the worker knows how to do this safely. If the worker does not know how to bathe a person in bed or to transfer them, but is otherwise qualified, it may be possible to provide the necessary training, but make sure she can do it before hiring her.
  • Do not try to hire someone on a 7-day-a-week basis. No employee can remain a good employee for long if she does not have time for her personal needs and interests. Additionally, workers who live in or sleep over cannot be expected to be on call 24-hours a day. If you or your loved one need frequent help or supervision during the night, you should hire a second home care aide, or have a family member fill in.
  • If you or your loved one need a considerable amount of help, live-in help may be available which can be less expensive than hourly or per day employees. However, keep in mind that you will be providing food and lodging and that it may be more difficult to dismiss live-in aides, especially if they do not have alternative housing available. It also is important to ensure that the worker has her own living quarters, and that she has some free time during the day, sufficient time to sleep, and days off.

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Have applicants fill out an employment form that includes their:

  • full name
  • address
  • phone number
  • date of birth
  • social security number
  • educational background
  • work history
  • references

Ask to see their licenses and certificates, if applicable, and personal identification including their social security card,driver's license, or photo ID.

Thoroughly check their references. Ask for the names, addresses, phone numbers, and dates of employment for previous employers, and be certain to contact them. If there are substantial time gaps in their employer references, it could indicate that they have worked for people who were not satisfied with their performance. Ask about those gaps. It is best to talk directly to former employers rather than accepting letters of recommendation. With the applicant's permission, it is also possible to conduct a criminal background check.

We strongly recommend that: 1) you request your in-home caregiver to register with the Missouri Department of Health and Senior Services Family Safety Registry, and 2) you complete a background check with the Missouri Department of Health and Senior Services Family Safety Registry for anyone you hire.

The Missouri Family Care Safety Registry was established to provide families and other employers with a method to obtain background-screening information maintained by various state agencies from a single source. The Missouri Department of Health and Senior Services created an electronic interface between the computer systems maintained by the Missouri State Highway Patrol, Missouri Division of Family Services, Missouri Department of Mental Health, and the Missouri Department of Health and Senior Services. Those wishing to hire a child-care, eldercare or personal care worker may contact the Registry using a toll-free access line (1-866-422-6872) and, for a nominal fee, obtain background-screening information about an in-home caregiver.

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Job Expectations

When hiring an in-home caregiver, it is important to list out the job tasks you expect to be performed and to ask applicants to check those they are willing to perform. You should also discuss:

  • vacations
  • holidays
  • absences
  • lateness
  • benefits and wages
  • the amount of notification time each of you should give if the employment is terminated

If you work and are heavily dependent on the in-home caregiver, emphasize the importance of being informed as soon as possible if she is going to be late or absent so that you can make alternative arrangements. It is helpful to keep a list of home care agencies, other home care workers, neighbors, or family members who can provide back-up, if needed.

Be clear about:

  • the employee's salary
  • when he or she will be paid
  • reimbursement for money the worker may spend out of pocket

When hiring an in-home caregiver, it is helpful to spend a day with him or her, so that you can go through the daily routine together. At the very least you need to inform the in-home caregiver, both verbally and in writing, about the older person's:

  • likes and dislikes
  • special diets and restrictions
  • problems with mobility
  • illnesses and signs of an emergency
  • possible behavior problems and how best to deal with them
  • therapeutic exercises
  • medications, when they are taken, dentures, eye glasses, and any prosthesis

Also provide information, verbally and in writing, about:

  • how you can be contacted
  • contacts in case of an emergency
  • security precautions and keys
  • clothing
  • medical supplies, where they are kept, and how they are used
  • food, cooking utensils, and serving items
  • washing and cleaning supplies and how they are used
  • light bulbs, flash lights and the location of the fuse box
  • the location and use of household appliances

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If the home care employee is going to drive your family car, you must inform your insurance company, and provide a copy of the worker's driver's license to your insurance agent. Your insurance company should check to see if the license has been revoked, suspended, or if the worker has an unsatisfactory driving history. If the in-home caregiver has a car, discuss use of her car on the job, any mileage reimbursement for trips, and insurance coverage.

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Insurance and Payroll

Check with your insurance company about coverage for an in-home caregiver. Contact the appropriate state and federal agencies concerning social security taxes, state and federal withholding taxes, unemployment insurance, and workman's compensation payments.

If you do not want to deal with these somewhat complicated withholdings from the employee's salary, payroll preparation services can issue the employee's check with the necessary withholdings for a fee.

Some in-home caregivers work as private contractors. Even in these cases, you must report their earnings to the Internal Revenue Service. Before employing an in-home caregiver on a contract basis, consult your financial advisor or tax preparer to make certain that you are following the IRS rules that govern contract workers.

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Ensuring Security

Regardless of who cares for you or your loved one, protect your private papers and valuables by putting them in a locked file cabinet, safe deposit box, or safe.

  • Make arrangements to have someone you trust pick up the mail, or have it sent to a post box where you can pick it up.
  • Check the phone bill for unauthorized calls, and, if necessary, have a block placed on 900 numbers, collect calls, and long-distance calls. You can always use a prepaid calling card for long distance calls.
  • Protect checkbooks and credit cards. Never make them available to anyone you do not thoroughly trust.
  • Review bank, credit card statements, and other bills at least once a month, and periodically request credit reports from a credit report company. Your bank can provide you with the names and addresses of these companies.
  • If you do leave valuable possessions in the house, it is best to put locks on cabinets and closets and to have an inventory with photographs.

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Protecting Against, Identifying, and Handling Abuse

Although abusive situations are not common, you must be alert to the possibility. You can help to prevent abuse situations by:

  • Thoroughly checking the background and references of a prospective in-home caregiver.
  • Ensuring that the in-home caregiver thoroughly understands what the position entails, your care receiver's medical problems and limitations, as well as behavior that could lead to stressful situations.
  • Ensuring that the in-home caregiver is well-trained and not overwhelmed by the task at hand.
  • Keeping the lines of communication fully open so that you can deal with potential problems.

Following are possible signs of abuse or neglect:

  • Unexplained personality changes in your older relative or friend
  • Whimpering, crying, or refusing to talk
  • Unexplained or repeated bruises, fractures, burns, or pressure sores
  • Unexplained weight loss
  • An unkempt appearance
  • Poor personal hygiene
  • Dirty or disorganized living quarters
  • Unexplained confusion, excessive sleeping, or other signs of inappropriate sedation

If you suspect that an abusive situation exists, don't wait for it to be tragically confirmed. Find a way to check either by talking to your loved one in a safe situation or, if necessary, by installing monitoring devices. If you witness, or are told by a reliable source, about neglect, physical abuse, emotional abuse, including yelling, threatening, or overly controlling, possessive behavior, which often involves isolating your loved one from others; seek help, if necessary, and replace the in-home caregiver as quickly as possible.

If the situation appears serious, remove your care receiver from the premises and place him or her with another family member or in a facility that offers respite care. Always ensure that your relative is safe before confronting or dismissing the worker, especially if you are concerned about possible retaliation.

Once you have ensured your relative's safety, report the situation to the Missouri Elderly Abuse and Neglect Hotline (1-800-392-0210) for investigation. If the abuse is of a serious nature including, serious neglect, physical injury, sexual abuse, or the misuse of the funds of the older person, you should also contact the police.

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Supervising an In-home Caregiver

Once you have hired an in-home caregiver, make sure that the lines of communication are fully open and that both you and the worker have a clear understanding of the job responsibilities. Explain what you want done and how you would like it done, keeping in mind that the in-home caregiver is there to care for you or your loved one, and not the rest of the family.

If the in-home caregiver lives in, try to ensure that she has living quarters that provide you, your loved one and the worker the maximum amount of privacy possible.

Once the in-home caregiver is on the job, periodic and/or ad hoc meetings can be held to discuss any problems the worker or the care recipient may have with the arrangement and to find ways to resolve them. It is important to be positive and open in your approach to resolving difficulties. In most cases, they can be corrected.

However, if after repeated attempts, you find that major problems are not resolved satisfactorily, it may be best to terminate the relationship, and seek another in-home caregiver.

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Additional Resources and Reading Lists

The National Association for Home Care's How to Choose a Home Care Provider is an excellent resource that covers a range of topics relating to hiring home care employees through an agency. The information is also useful to those who choose to hire a home care employee independently.

The National Center on Elder Abuse is a major resource on elder abuse issues. The NCEA web site includes fact sheets on major issues, caregiver resources, and contact points in each state to report elder abuse.

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