Hiring Caregivers for the Home - What You Need to Know.

When frail or elderly parents start having difficulty with every day tasks, it is generally recommended that a private caregiver be brought into the home to assist with ADLs (Activities of Daily Living). These activities can be related to assistance with ambulation, bathing, dressing, driving, eating, finances, food preparation, housekeeping, laundry, medication assistance, shopping, telephone, toileting, and transportation. But before you hire someone, you will need to consider the person's medical and mental status, environmental and safety issues, psychosocial and financial issues which must be considered before deciding that keeping your parent living safely in his/her own home is going to be the best option. A Geriatric Care Manager (GCM) has the expertise to complete a comprehensive assessment to assure the decision is made.

Once your decision is made to age in place at home, a qualified caregiver overseen by a geriatric care manager who has the clinical knowledge to establish a professional plan of care and offer direction to the caregiver would be in the best interest of the older adult. Caregivers of all types do not have the education to function independently without supervision by a qualified professional such as a GCM. How to tell the difference in credentials of your prospective caregiver?

Certified Nursing Assistants (CNAs) have medical training and must pass an exam to get certified. CNA's can check vital signs, care for wounds, have knowledge of transfer techniques, and can help with activities of daily living such as bathing and dressing. CNA's typically have received training under a nurse at a facility such as a hospital or nursing home and can assist with household tasks and meal preparation as well.

Home Health Aides (HHAs) may have some formal training provided by their employer but have not taken a certification exam. They can assist with ADLs but have not had formal training on medical issues unless they have been taught through their own experience. They can also assist with light housekeeping, transportation, and meal preparation.

Companions usually will not provide direct patient care but are available for companionship. They can assist with cooking, cleaning, shopping, transportation, and stimulating activities and outings.

Hiring a caregiver through word of mouth is usually the least expensive option and the one most used but this arrangement can create legal liabilities for the family because the family becomes the employer. For example, the family can be held liable for injuries that may happen on the job. If you choose to hire a private caregiver, have the GCM conduct a background check, check prior employment history and references. If you hire them as an indepdendent contractor you will need to file a 1099 on any wages over $600 yearly. If you hire them as an employee, you will be responsible for paying taxes and benefits such as Social Security and Medicare and federal withholding and unemployment tax. Remember, hiring privately may leave you without a backup if this person leaves unexpectedly or becomes ill. Sometimes there are unscrupulous persons who will take advantage of vulnerable clients, so do not skip any of the steps above. If you have found someone on your own who has met the above criteria it may be a good idea if you have a geriatric care manager oversee the caregiver and make spot visits from time to time to make sure there are no problems if the family lives in another state.

Hiring from an agency may be just a bit more expensive because the agency will pay FICA taxes, cover worker's compensation insurance, and will screen potential employee backgrounds. You will want to make sure the agency bonds and insures their caregivers, that caregivers have received training on CPR and first aid skills, and that the agency has a large number of caregivers offering you a guarantee of a substitute caregiver if your primary is sick or on vacation. A good agency will have a RN who follows up on the plan of care, and will oversee and offer advice to the caregiver.

Remember these employees are not your friends. You may be friendly when you come to town for a visit, but keep it professional. If your employee thinks of herself as your friend, she may take liberties of a friend, not an employee of your vulnerable parent. Make sure there are clear expectations as to what she should be doing at all times. Have them use a notebook for progress notes or observations daily. Have a GCM develop a plan of care and have the caregiver keep a record of how she is following the plan of care. Make sure they are clear about the personal care that should be provided.

Most of the calls received at A Good Daughter Elder Care Management are when a parent has a crisis following a fall or hospitalization. At first, a parent will not acknowledge they need a stranger in their home but children need to convince their parents they need in home care. Use a GCM to mediate the safety issues for an aging parent. GCMs recognize how to respectfully allow the older adult to feel in control of their lives while helping them recognize that accepting help actually allows them to maintain their independence.

To find out how a geriatric care manager can help with your aging parent's need for more help as they age in place, go to our web site: http://www.agooddaughter.com or email: olga@agooddaughter.com We are available via our toll free number: 800-963-3877 on a 24 hour basis, seven days a week, 365 day a year for emergencies.