Hiring a Caregiver Requires Research
By PAMELA YIP
Personal Finance Writer
Michael Hogue/Staff Artist
Dallas Morning News
Published: 06 January 2012 07:42 PM
When my father was diagnosed with lung cancer 12 years ago, I was faced with the prospect of hiring a caregiver for him.
The task was made even more daunting because he lived in California.
He was placed in hospice care, which Medicare covered, and I went back home to care for him. I never reached the point where I had to hire a caregiver, but that’s not the case for many families.
Twenty-nine percent of the U.S. adult population, or 65.7 million people, are caregivers of adults, the elderly or children with special needs, according to a 2009 report by the National Alliance for Caregiving and the AARP.
Many try to go it alone at first, then discover that they need help.
“There are so many cases where families just can’t do all of it,” said Lue Taff, geriatric care manager at the Senior Source in Dallas, which serves the senior community. “We see many instances where they need to hire an outside caregiver. There are a lot of people who have dementia who really need somebody to be with them all the time.”
Christy Bednar hired a caregiver for her 87-year-old husband, who has Alzheimer’s disease.
“I wanted him to be safe and comfortable and feel safe and comfortable,” she said.
She finds that having a caregiver helps reduce the stress on her and gives her time to be a competitive master swimmer.
“I said to myself right off the bat, if I’m going to be able to do what I need to do to take care of my husband as a wife, if I’m going to be able to treasure my relationship with him and be happy with him, then I needed to maintain my schedule,” said Bednar, 67. “I need that time in the water to be me.”
Here are things to consider when hiring a caregiver:
Using an agency
A critical decision you’ll face is whether to hire a caregiver yourself or go through a home care agency.
There are two kinds of home care agencies: one that provides medical services and therapy, and one that provides companionship, light housekeeping, transportation and meal preparation.
“The medical agency takes care of anything that requires a nurse, but they [your loved one] have to have a skilled nursing need in order to qualify for that,” said Kay Paggi, a geriatric care manager. “If you just need an insulin shot, you’re not going to get that covered. Medicare pays for a skilled nursing need.”
Medicare does cover some home health care, but those services are intended mainly for patients recovering from illnesses or injuries. The federal health care program just isn’t set up to meet the long-term day-to-day needs of the chronically ill.
The non-medical type of agency is not covered by Medicare. You pay for that out of your own pocket.
There are advantages and disadvantages to both hiring a caregiver on your own and using an agency, according to the Family Caregiver Alliance.
With a privately hired home care worker, the continuity of care by one person can allow a strong one-on-one relationship to develop between the worker and the person receiving care.
Of course, this can also happen through an agency when there is a commitment to using the same caregiver.
Your chances of keeping the same worker are enhanced if you can provide a routine schedule for caregiving, said Lori Nesler, owner of Comfort Keepers in Dallas, which provides in-home companionship and care services.
“I tell my clients, ‘If you can establish a routine, that allows the agency to better staff vs. saying, ‘Let me call you tomorrow and tell you what I want next week,’” she said. “Tell us the days and hours that someone would need us for.”
A privately hired caregiver is usually less expensive than one hired by an agency.
“The one big major disadvantage is they do typically cost more than a private provider because you’re paying for the agency supervision and agency overhead,” said Kathy O’Brien, senior gerontologist at the MetLife Mature Market Institute, which studies aging issues.
On the other hand, if a privately hired worker is sick, no substitute is readily available as there is with an agency. However, before signing up, you should ask how quickly the agency will send a substitute if your regular caregiver can’t come one day.
Also ask how a home care agency would try to match a caregiver with your loved one, Paggi said.
“How do they handle caregivers who don’t match with the client?” she said. “Will they send someone else?”
A home care agency also will handle the background check of caregivers, as well as payroll and tax duties. Those tasks would fall to you if you hired a caregiver yourself.
Get recommendations
Ask friends or colleagues for recommendations or consider hiring a geriatric care manager to help.
“Otherwise, it’s always a pig in a poke,” said Bob Hogue, 75, whose last caregiver came via referral from the Senior Source’s Geriatric Care Management program.
“It worked like a charm,” he said. “I was spoiled rotten, and I can take a lot of that.”
If your loved one is being discharged from a hospital, ask your doctor or the staffers handling the discharge for agency referrals.
Another source is organizations that specialize in a specific disease, such as the Alzheimer’s Association.
Interview candidates
Here are critical questions to ask potential caregivers:
How much experience do they have in caregiving?
If your loved one has a specific health problem, such as Alzheimer’s, ask if the caregiver has experience in caring for patients with that disease.
How compatible is the caregiver’s personality with your loved one’s?
“Trust is key,” said Bednar, who said her husband is a “very sociable person.”
“He likes to talk about himself, and it’s important that his caregiver be interested in him, be ready to listen to stories about his life,” Bednar said.
How would the caregiver handle a challenging situation with your loved one?
“You want to know how creative this person is,” Taff said. “A question I always ask people is, ‘If you’re dealing with someone with Alzheimer’s, if they don’t want to eat or take a bath, how would you handle that situation?’”
Is the caregiver an employee of the agency or an independent contractor?
“I wanted an agency that had employees because I thought that would mean better control over the whole situation,” Bednar said.
Caregiving is demanding. If circumstances require you to hire a caregiver to assist with someone you love, your priority should be the security, happiness and safety of that individual.
But don’t try to be a hero and go it alone.
“It’s important for you to be involved,” O’Brien said. “But it’s also important for you to take care of yourself and your health because if you get sick and something happens to you and you’re taking on more than you’re able to handle, it’s not going to be good for your mother, either.”
Resources for advice
Here are some sources of information and help with hiring a caregiver:
The Senior Source: Has many programs that help caregivers and older adults. Those include geriatric care management, elder support, the Nursing Home Ombudsman Program and the Money Management Program. www.theseniorsource.org or 214-823-5700
The Family Caregiver Alliance: Has good fact sheets and information that focuses on specific problems. www.caregiver.org
National Association of Professional Geriatric Care Managers: Has tips on how to select a geriatric care manager. www.caremanager.org
The National Alliance for Caregiving: A nonprofit coalition of national organizations focusing on issues of family caregiving. www.caregiving.org
I am the eldest son of elderly parents who lives 1,500 miles away them. My mom has been a Type 1 Diabetic for 65 years; My dad has the early stages of Alzheimer's. They are now in assisted living.
