Additional Resources Mentioned
Tip 1: Assess Your Loved One’s Needs
Before you begin searching for a caregiver, it’s important to thoroughly understand what kind of support your loved one requires. This assessment will guide all your subsequent decisions about the type of caregiver, frequency of care, and specific qualifications needed.
Consider these key areas when assessing needs:
- Activities of Daily Living (ADLs)
- Medical Needs
- Household Management Tasks
- Safety Concerns
- Transportation and Mobility
- Companionship Needs
Tip 2: Determine the Type of Caregiver and Frequency Needed
Based on your assessment of needs, the next step is determining what kind of caregiver will be most appropriate and how often they’ll need to provide care.
There are three main categories of paid caregivers, each with different training levels and capabilities:
- Companion Care
- Certified Nursing Assistant (CNA)
- Skilled Nursing
After determining the type of caregiver needed, consider how often you’ll require their services:
- Daily care (part-time or full-time)
- Several days per week
- Specific times of day (mornings, evenings, overnight)
- 24/7 care.
You can mix different types of caregivers based on specific needs:
Tip 3: Understand Your Financial Resources
Before actively seeking paid caregiving support, it’s important to get a clear picture of what you can afford and what financial resources are available to you.
Review Your Financial Resources
- Savings and investment accounts
- Long-term care insurance policies
- Regular income sources
- Family financial contributions.
Explore Available Benefits
- Medicare
- Medicaid
- Veterans Benefits
Consider Family Contributions
Tip 4: Decide Between Agency or Private Hire
One of the most significant decisions you’ll make is whether to hire a caregiver through an agency or directly as a private caregiver. Each approach has distinct advantages and challenges.
When you work with a caregiving agency:
- They Handle Administrative Tasks
- They Provide Backup Coverage
- They Offer Training and Supervision
- They Assume Liability
Private Hire Benefits
- It’s Usually Less Expensive
- You Have Complete Control
- There’s Often More Flexibility
- You May Find Through Word-of-Mouth
Private Hire Challenges
- You’re the Employer
- No Backup Coverage
- Limited Screening Resources
Tip 5: Evaluate potential caregivers thoroughly
Once you’ve determined the type of caregiver you need and whether you’ll hire through an agency or privately, it’s time to interview potential caregivers. This step is extremely important for finding someone who will be a good fit for your loved one.
Key Questions for Interviews
- Scheduling and Availability
- Qualifications and Experience
- Approach to Care
- Communication Style
Background Checks and References
Set Clear Expectations
Especially for private hires, establish from the beginning that the arrangement is on a trial basis.
Include Your Loved One When Appropriate
Next Steps: Care Plans and Integration
- Develop a written plan
- Develop an Integration Strategy
Read More in This Blog here
Full Episode Transcript
Sue Ryan
Is it time to hire a caregiver for your loved one? In this episode, we’re talking about the process of finding a paid caregiver. We’re sharing five tips.
Nancy Treaster
You’re hiring a caregiver for home or you’re hiring a caregiver to complement the care of your loved one in a community, either way the best thing you can do is get through as much of this process as possible before you desperately need a caregiver. Understand if you’re going to use an agency, understand if you’re going to go private, have an idea of who those caregivers might be because you never know when you’re going to get in a situation where you’re not going to have time to go through this process we’re talking about here in the ideal order and over the ideal period of time. So something to think about. If you’ve never hired a professional caregiver before, this process can feel a bit scary and a bit overwhelming.
And there’s lots of different options here. So with my father who had Parkinson’s, they live in a small town in middle Georgia, and the caregivers for other people with Parkinson’s were well known in the community. And they moved around from different Parkinson’s patients. And so my mother used private care the entire time because these caregivers were well known to everyone in the community. For my father-in-law, we’ll talk more about this later, but we hired caregivers through an agency that was approved by the VA. And here at home with my husband, I did a mix. I hired some through a care agency and some private care. So you may find that some combination of what we’re going to talk about in this episode works for you.
But either way, we’re going to walk you through the five steps that you should think through or consider as you look to hire an outside caregiver.
Now there are two things that we’re not going to talk about in detail today, we’ll mention them again at the end, but they are part of the process of bringing a caregiver into your care plan. One is to actually document and create a care plan. And the second one is to have a plan to introduce and integrate this caregiver into your care plan. So those two we’ll cover separately in other episodes.
For now, let’s jump into what it takes or what you should think about in terms of hiring a caregiver.
Sue Ryan
Tip one, assess your loved one’s needs. It’s time for us to thoroughly understand what kind of support our loved one’s needs. It’s time for us to thoroughly assess what kind of support our loved one’s need. And we created six different areas to consider.
First, activities of daily living, often called ADLs. Can they dress, bathe, feed themselves? Do they need help with sitting down, getting up, moving through the house, other areas of mobility? Can they use the phone if there’s an emergency?
Number two, medical needs. Do they need help with medication management, wound care, or specialized health monitoring?
Number three, household management tasks. Do they need help with laundry, housekeeping, meal preparation? Can they turn the lights on and off? Can they change the thermostat?
Number four, safety. Are you concerned about their safety when they’re home alone? Do they remember to unplug the iron? Do they leave the stove on? Can they safely use knives, cleaning products, personal care products?
Number five, transportation and mobility. Can they drive during the day and after dark? Is their mobility stable enough on their own?
And number six, companionship. Are they becoming isolated? Do they need to have more care around them? Do they need more social interaction? Do they need more activities to do?
And one last thing in this area as a reminder, we’ve talked about this before specifically in episode six called Home Alone. And we talked about deal breakers, that these four deal breakers are indicators that they are not safe living alone. I’ll just run through them very quickly. First, in case of an emergency, can they contact someone either by pressing a button or making a phone call? Number two, can they take their own medication? Number three, can they prepare a meal? Can they feed themselves? Can they hydrate themselves? Number four, so very important, do you feel they’re safe at home alone?
Nancy Treaster
So in addition to the home alone episode that was specifically around could your loved one live at home alone by themselves, these six areas that you discussed in tip one, are the way that we’re going to decide what kind of support we’re looking for from a caregiver, leveraging and understanding what kind of help we need, your loved one needs in those six areas.
So tip two is once you’ve evaluated the kind of care that you’re looking for, we want to determine the type of caregiver that you need and the frequency that you need that caregiver for. So there are three kinds of categories, if you will, of caregivers, paid caregivers.
One is just companion care. And a companion might come in just to be a social companion. They might do light housekeeping, meal preparation, maybe transportation. But they’re not trained like the second kind of caregiver, which is a CNA, certified nursing assistant. And a certified nursing assistant, just like it sounds, is certified. They’ve been through special training to manage those ADLs, activities of daily living, to help with bathing and dressing, incontinence, toileting, a lot of the things above and beyond just being a companion, but they will do the companion things as well, like housekeeping, meal preparation, transportation potentially as well. And then the third would be, do you need skilled nursing? And skilled nursing is often required for some of those medical needs we talked about like wound care or any sort of specialized monitoring like if they have a catheter or something like that. So the nice thing is once you determine what kind of care you need, let’s say you do have some skilled nursing needs, but maybe you only need skilled nursing twice a week for wound care and you don’t need it every single day. You can mix these kinds of caregivers together because there is a difference in how much you’re going to pay for the kind of caregiver that you get. So keep that in mind.
Sue Ryan
Absolutely. Yeah. One other area that I’ve observed a lot is we want to make sure we understand, especially early in the journey when our care receivers really still know what’s going on, we want to make sure we’re involving them and we’re communicating with them and we understand any of the desires or concerns they have in terms of requirements for someone coming in to provide care that are important to them. For example,
If it’s a man, do they prefer a man? Do they care about the culture of the person? Do they care about the age? So having a conversation before it matters is really helpful so that it’s possible you can move beyond that and you can also be honoring what’s important to them and make it as easy for them to transition as possible.
Nancy Treaster
You know, I agree with that. The one thing I would add is some care receivers, if you start talking about having care in their home, they’re just going to say, no, no, don’t bring anybody in. So that’s their preference. So you may or may not be involving them in the decision, but just for example, at my house, I felt like it was time to start introducing a caregiver into our home because I wasn’t desperate for one yet. I knew that we were getting close and I’d rather introduce someone slowly than be in a panic and need someone five days a week. So I started looking. I started calling care agencies and looking for a caregiver. Most of them had minimums of four hours. So four hours, one day a week. Well, first let me mention just in case the other people don’t realize this, most caregivers want eight hours, five days a week or something more consistent and longer.
I thought I wanted a male companion. That’s what I had in mind. Well, when I finally got down to who could come to my house, it was a female CNA. So she was a certified nursing assistant and she was a female. So my first reaction was, well, that’s not what I need, but fine, I’ll try her, right? Well, she came and honestly, didn’t take but a few opportunities for her to interact with my husband and help participate in his care for me to realize this was perfectly fine. I didn’t need a man. And having someone who was trained on more than just companionship wasn’t hurting me either.
So ironically, this person ended up being someone that I used seven days a week, eventually, who I just hired for four hours one day a week to start with. But I had to get over what I preconceived that I needed. Number one, it’s very hard to find a male caregiver just to start with. And number two, it’s very hard to find someone for a very small number of hour jobs. So just FYI for those of you who are beginning this process.
Sue Ryan
And I’ll add another point to the kind of things for us to consider and get beyond if we possibly can. One of my caregiving clients in coaching had a challenge and she called me about it and she said, I really don’t want a female caregiver. And I said, well, why not? And she said, well, I don’t want them looking at my husband’s privates. And I said, well, she doesn’t care about his privates other than whether or not they’re clean and they’re dry.
Nancy Treaster
Good, interesting.
Sue Ryan
So reevaluate whether that’s important because it’s going to be harder for you to find men as caregivers. You may be able to, but just give on. And so she thought about that and she called back a day or so later and she said, now I’m laughing at myself. I’ve just moved. I’ve been able to move beyond that. All she cares about is keeping him clean. So at any rate, it’s reasonable though. And I think the point to walk away with is it’s reasonable for us. We don’t have experience doing this. This is something we grew up with.
So go ahead and honor what these thoughts are that come up for us and then kind of talk about it and see what you can move beyond and see with your care receiver what they can move beyond.
Nancy Treaster
Right, very good point. So after we’ve decided what kind of caregiver we think we need and we’ve decided what our preference is and then maybe to your point what we can live with in terms of if we’ve, you know, typed them at all. We also need to be very clear about how frequently we need them to come and remember you can mix them up. So maybe you need companionship for five days a week but wound care two days a week.
Make sure you engage your family members as well because sometimes what you’re going to need here is a paid caregiver to do things that cross boundaries with family or capabilities with our family who’s been supporting you, but we’re moving beyond their ability to provide support either because something’s changing at home or because the hours have gotten to be too many. So include people and let’s be realistic on what family caregivers can do, willing to do, and what we need to pay a caregiver to come in and do.
Sue Ryan
That makes a whole lot of sense. And as we’re doing it, now we’ve decided that we are going to hire someone and bring them in, we’re going to have to pay them.
So tip three is understanding our financial resources. And before we start actively looking for paid caregiving support, we want to get a clear picture of what we can afford. What kind of options do we have? So we look at our financial accounts and our savings and long-term care and any insurance policies and things like that that we’ve got. And we review all of these components. One of the things that we did in a podcast episode number 28 called Home and Community Living Options is we went into a lot of detail about this, about the different kinds of financial considerations. So there’s a lot more in that podcast episode. We’ll put the link to it in the show notes.
We want to understand our financial resources. We also want to make sure we’re exploring all of the different kinds of benefits we have access to Medicare, Medicaid, and veterans benefits. And again, we recently interviewed elder law attorneys and that’s podcast episode 31 elder law attorneys. They go into great detail about what to look for and what’s important.
So it is very important for us to consider these. And then as you introduced Nancy, family contributions are to look at all of that, know, have conversations with our family, look at all of the different options. Is there anything that anyone in the family has the ability to contribute as we’re looking at this? And it also, for some people who may not be able to physically be there, a financial contribution is something that helps them feel part of caregiving support is really important. Our caregiving journey is a marathon. It is not a sprint. When we’re looking at what our costs are now, this is this phase of our journey. It’s very important for us to also be, as you introduced earlier, Nancy, it’s to be considering what costs may be coming down the road. For example, both with my grandmother and my dad, in the beginning, we were sure they were going to stay at home. My grandmother, we were able to do that through the entire journey. And my dad, it became realistic toward the end. That was not possible. What I did with my husband is I planned from the very beginning that it’s most likely that we’re going to be in a care community.
So I looked at the whole picture of what those costs could be so that I was making investments financially in the levels of care, understanding there would be others. You’re not going to necessarily need to go into a care community ever or in the beginning of the journey. You want to understand what the financial implications could be way before you need it.
Nancy Treaster
So true. With my father-in-law, for example, he was a veteran. And so we were able to leverage VA benefits. They come in and evaluate how much care they’re willing to pay for. He was granted 16 hours a week. So we split that into four, four-hour days of care paid for by the VA. And we used an agency that the VA approved of. So, you know, it was a good way of leveraging the best financial support we could get and introducing paid caregivers into the home and giving some reprieve to my mother-in-law who was doing most of the care otherwise as well.
Now that leads us into tip four, which is deciding whether or not you’re going to use an agency or whether you’re going to hire privately. Once again, won’t be surprised if you choose to do a mix. I did a mix at my house. And part of that is figuring out will some care be paid for by either Medicaid or the VA or some other long-term care insurance, where the contributions are going to come from may help you make that decision. Now there are benefits to an agency and there are benefits to hiring privately.
If you hire an agency, they’ll handle the background checks, they’ll handle paying the caregiver, the taxes, insurance, really the things that you’re responsible for as an employer. If the caregiver can’t come to work, they have processes for that. The caregiver will report to them and they will schedule a backup to come to your house. So they’ll fill in when your main caregiver can’t come to work.
And then most of them will offer some sort of specialized training for the caregiver. If you’re hiring an agency that has CNAs, most of the CNA training is actually done by the agency and their ongoing training is done by the agency. So they’ll take care of all the training as well. If you hire privately, it’s usually less expensive as much as $10 an hour. But of course,that’s not always, you pay the price on the other side for that. I’ll talk about that in just a second. You have complete control over who comes to your house, be that the good and the bad, because if they’re sick or they have an emergency, that becomes your emergency, because you have to find the fill-in for the caregiver. There’s no backup as there is with the agency. You do have potentially a little more flexibility. Most agencies have a four-hour minimum.
Some private caregivers actually also keep that four hour minimum in their requirements, but some of them will work with you. They’re looking to slide two hours into their day where they’ve got some open time in the morning and you might be able to get two hours a day for a few days a week instead of having to pay for four. So keep in mind, they’ll lead you, a caregiver will lead you down a path of what they’re willing to do that might be outside of the four hours requirement.
Nancy Treaster
The other good thing about private caregivers is like in my father’s situation, often you can find those through word of mouth. And so they come sort of pre-recommended. And there’s an advantage to that, obviously. Now, disadvantage is you are now the employer. So you’re responsible for all the things that go with that, like figuring out what you do about taxes? I already mentioned the scheduling challenges if they can’t come to work.
Just on the agency side, I want to mention again, I’ve used multiple agencies and you can’t assume that the training is the same across agencies. And that is, and you can’t even assume that based on price. We had one agency that we used that it was clear to me that their caregivers were much less trained than another agency we used. And when I went to increase the number of hours because we needed to go to 24/7 care, the agency that had less trained caregivers actually costs more than the other agency did. So just keep in mind, can’t, you gotta do your homework and ask all the right questions in order to figure out what’s being offered.
Sue Ryan
We learned a lot of this through trial and error. There was a lot of error involved, which is why we’re bringing this to you. And this leads us to tip five, which is conducting interviews to ask the questions so you are more confident in the person or persons who you’re choosing to have. And we’ve got kind of a list of questions. Now this is whether you’re going through an agency or you’re hiring private things that you want to really know about. And a big one that Nancy brought up is scheduling. We want to know what kind of schedules they have, what’s the backup and what are their minimum hours. Different agencies have different minimum hours and different private caregivers have different minimum hours. So all of those pieces of information are helpful. And then what kind of insurance do they have?
What kind of specialized training do they have? What kind of experience do they have with the diagnosis of our loved one? And that’s not necessarily a deal breaker because there are quite a few different diagnoses, but the more familiar they are around the type of diagnosis, easier it is.
Nancy Treaster
And so there are some care agencies that you’ll see who have specialized dementia care training. And so you can ask them, make sure they know what your loved one’s dealing with and say, you know, do you have specialized dementia care training? Because there are some who do.
Sue Ryan
Very good. We also want to understand their approach to care. And both Nancy and I have found that there is a big variance between caregivers and what they consider their approach to care. And so while it’s not necessarily one is right and one is wrong, there are different approaches you may be more comfortable with for what they are. So you really want to understand that. And you want to understand the communication style, because as we’ll talk about in another podcast episode,
A big part of the success of the relationship is how we communicate together and making sure we’re able to communicate and align with each other in our communication. And then also doing background checks. We want to make sure we’ve got those background checks.
Nancy Treaster
And you know, for agencies, Sue, if you’re hiring a caregiver through an agency, make sure you ask for this kind of information about the specific caregiver that they’re sending to your house. So there’s sort of what the agency does, which is a lot of what the questions Sue just asked. What is that? How does the agency handle these things? And then they will usually come to you with a couple of caregivers that they propose to send to your home. Ask them about that caregiver specific experience training and so on. Now, let’s say you’re going to hire privately. Some of these steps still can’t be ignored. So you’re going to want to evaluate the caregiver through references. Make sure you ask for at least three references and make those calls and talk to the people about the caregiver and ask for the pros about this caregiver as well as the cons about this caregiver. So that they’re forced to tell you some negative things about this caregiver. You get more insight out of that than probably anything. You need to do a background check if you’re hiring privately. And that can be done through online tools, typically around $50 from what I’ve been able to find, but worth doing. And the last thing that I wanna mention is make sure it’s clear, especially if you’re hiring privately, that you are taking this caregiver on
on a trial basis. And let me explain why. If you hire a caregiver through an agency, by default they’re on a trial basis. Meaning, if you’re not happy with the caregiver, you call the agency and say, don’t send this person to my house again. You don’t have to have a conversation with the person. So you’re off the hook for the confrontation and the difficult conversation. If you hire someone privately, and you don’t like them and don’t want them to come back to your house, you’re the one making the call and telling them that. So the more you set expectations upfront that this is a trial basis and a temporary situation, the easier that phone call is to say, I don’t think it’s working out. So something to keep in mind and also just make sure you’re setting up that expectation because you’ll feel better about the end result if you have to make that call. And don’t be surprised.
You’re not always going to like the first, rarely, you’re like the first caregiver who walks down the hall. So, you know, this is probably going to happen more than once.
Sue Ryan
When we’ve completed our research and we’re now down to the finalists, if it makes sense, we want to have a final interview and we include our care receiver.
Nancy Treaster
Yeah, good chance to see how they interact with the caregiver as well as getting their opinion, but you can see both.
Sue Ryan
We can see both and you will know the reason why we say it’s if it makes sense We know our care receiver and we know whether this is going to be something that makes sense It’s something for you to intentionally consider. All right, so you’ve got all those things done. You’ve gone through how to hire a paid caregiver. The next thing you want to make sure you have is a documented care plan and and a plan to introduce the strategy of integrating with
You’ve gone through how to hire a paid caregiver. Next, it’s very important to have a documented care plan and a strategy for how to integrate your care receiver into that plan.
We’re recording specific episodes to address both of those very important areas. And as soon as we have those recordings available, we’re going to put them into the show notes for this podcast episode.
Nancy Treaster
Yep, I like that too.
So let’s summarize. In this episode, we talked about the process for hiring a paid caregiver, whether you’re hiring them to bring them into your home or to complement your care in a care community. We talked about five tips.
We shared five tips. First, assess your care receiver’s needs.
Secondly, determine the type and frequency of care that you need to support your loved one. Three, understand your financial resources.
Four, decide whether you’re going to hire through an agency or hire privately.
And five, evaluate potential caregivers.
Now if you have tips on hiring caregivers, please put those out on our Facebook page or an Instagram page. We would love to hear your ideas as well. If you like this podcast, please share it with other people. Follow us, subscribe to it. We’d love that. That would be awesome.
Hiring your first paid caregiver can be an overwhelming experience, but you got this.
Sue Ryan
Yes you do because we’re all on this journey together.
Nancy Treaster
Yes, we are.
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