@HeatherM881052 Hi Heather! Hiring someone to help care for our loved ones really is such an important task - it can feel like a lot of pressure to find the "right" person. As you say, every family and every individual is unique so it's important to get clear about your and your loved ones wants/needs. When I was hiring people to help care for my grandparents, parents and sister, I always had to remind myself that no one will be me! No one will do every little thing exactly as I would. But, it's important to prioritize the things that are the most important.
There are several ways to go about it hiring someone to help care for our loved ones - i.e. a home health worker, paid caregiver, CNA, care aide etc. - there are different titles, so for right now I'll call them "paid caregivers":
Start by writing a brief "job description" that outlines what you'd like the paid caregivers to do. Think about what would make you feel they were doing as super job - from showing up on time to how they interact with your loved ones to their technical skills. Even if you hire via an agency, it will be helpful in explaining what you are looking for. It will also help you evaluate in the future whether or not the person hired is up to par.
You can hire a paid caregivers through an agency, or you can hire them directly. There are pros and cons to both approaches. On the one hand, agencies can handle insurance (if their services are covered), screening, hiring, scheduling and other personnel issues. On the other hand, agencies may cost more and continuously switch out workers, and you’ll still need to coordinate and monitor their work. If services aren’t covered by insurance, you could hire workers directly yourself. The costs will be lower, but you’ll have to find, screen, hire and monitor each person. and you'll need to get background checks before arranging for anyone to come to their homes. I have used both approaches in different situations.
1. Hire through an agency: You can find an agency by searching in the AARP online Community Resource Finder or asking a hospital social worker, your loved ones' doctor, their insurance or the area agency on aging for a list. When you contact an agency, always:
- Ask about fees and payment options (private pay, health or long term care insurance, the VA etc.)
- Get references for the agency and, if possible, for individual workers they want to assign to your loved ones.
- Check the Better Business Bureau (bbb.org), online services and state licensing and monitoring agencies for complaints, ratings or pending lawsuits.
- Ask where the agency finds its workers; how it screens, selects, trains and manages them; how much it pays the workers versus how much you pay for the services; and how complaints or poor service are handled.
- Be very clear about your expectations and the tasks involved.
- If you sign a contract or agreement with the agency, be sure you understand what you are signing. Some agencies will ask you to sign a form indicating that you will be responsible for fees if you loved ones can’t pay.
- Most agencies will not provide a resume, background info or even much notice of who they will send. But you should ask! Ask about a worker's:
- Experience - how many years/months have they been providing care? What types of health conditions do they have experience with? Have they cared for both men and women? In what settings have they worked (facilities, hospitals, home care etc.). Do they have CPR or first aid training? Are they trained to work with medical equipment from wheel chairs to oxygen? Are they able to do specific tasks like checking blood sugar? What is their favorite part of doing this work?
- Qualifications and training - what education/training programs are they currently in or have they completed? Do they have a college degree? Do they have any certifications or licenses? Are they CNAs (certified nursing assistants) or certified caregivers? (The certifications that are available vary from state to state.) Ask about any ongoing training the agency provides.
- Personality - are they upbeat, calming, energetic, patient, kind, motivational? How do they view the socialization aspect of their job? Think about what your loved ones need and will feel comfortable with.
- If the person the agency sends isn’t a good fit, don’t hesitate to ask for another person. I’ve learned the hard way that keeping an underperforming home care worker past the time when I knew she wasn’t doing a good job can cause problems, such as injuries to your loved ones. Even if you have to go through several workers before you find a good fit, keep asking—and change agencies if necessary.
2. Hire directly - You can ask for personal "word of mouth" referrals from family, friends, neighbors, co-workers or other caregivers. You can also use an online service or website that matches paid caregivers with people who want to hire them, either searching potential workers' profiles or posting a job listing. (Most of the online matching sites make easy for you to request and pay for background checks via their site). You might also find workers by posting a flier on community bulletin boards (either online or in person), coffee shops, local places of worship, the library, community centers, senior centers, adult day centers, doctors’ offices, hospitals, colleges and universities (try nursing, social work, physical, occupational or speech therapy students) or through a jobs placement program. Another option is to post an ad in the local newspaper.
- I suggest you first talk with a candidate on the phone, getting a feel for their experience, personality and availability. If you like them well enough on the phone, schedule an in-person meeting at a public place, such as a coffee shop, and talk more about the job, your loved ones' needs and determine if you think it would be a good fit. Then schedule one more interview for them to meet your loved ones so you can see how they interact, and your loved ones can see how they like them. Are they respectful and kind? Do they listen and communicate well?
- Questions to ask can include:
- What do you like the most about this type of work? What do you like the least?
- How would you handle...(describe possible situations that might come up in a caregiving situation such as an emergency, if your loved ones fell, had a heart issue, had a bad day, wanted to do something differently etc.)
- How do you think your past experience will help you care for my loved ones?
- What is your experience with...(go over specific tasks they will need to perform regarding medications, medical equipment, difficult behaviors, dementia, bathing, dressing, making meels, feeding, house cleaning, etc.)
- How do you feel about...? (pets, visitors, staying off your phone while at work, thinking of activities for my loved ones, keeping to a schedule or routine, housekeeping etc.)
- How will you enhance my loved ones quality of life?
- Will my loved ones be your only clients or will you be working for other families too?
- Will you be available for back-up care or last minute requests?
- Ask for at least 3 references and talk with each one on the phone or in person (emails can be fabricated).
- Get a background check done (via an online service or you can ask at the police department).
- Create a simple written caregiving agreement with the details of the job. Be very clear about your expectations regarding caregiving tasks, schedule, pay, time off, procedures for calling in sick, start/end date, pay policy if the job ends suddenly etc.
Regardless of whom you hire:
- If your loved ones are cognitively capable, get their input and make sure they agree with the choice of the worker to be hired. In some cases, if they are capable, they should really make the final decision. And over time, if they complain about the worker - listen! I've talked with many caregivers who regretted not listening and therefore kept a worker too long, leading to problems.
- Be sure to plan for at least several days of time with them to train them and familiarize them with your loved ones' routine. Observe and see how they learn and determine when they are ready to be on their own with your loved ones.
- Monitor their work - drop in unexpectedly. And if you are unable to do so, ask a family member, friend, neighbor, or pay a geriatric care manager/aging life care specialist.
I hope these tips are helpful. Please let me know if you have any more questions!
Amy Goyer, AARP Family & Caregiving Expert
Author, Juggling Life, Work and Caregiving and
Color Your Way Content When Caring for Loved Ones