Making the decision to hire someone to care for a loved one is a big decision for most family members. It requires you to step back a bit, let a stranger take over some tasks, and trusting it to work out. It is not uncommon to feel anxious, some guilt, or both.This month, Elder Voice focuses on choosing a home care company
There are three ways of hiring home caregivers. You can hire privately, ideally through the recommendation of friends or family. You can use a placement agency.These companies charge you a fee to find and screen someone, but you become the employer. The third way is to use a home care company which employs the caregivers they send and which handles scheduling, payment, and other legal aspects.
Before you go any of the three possible routes, be clear about your needs and preferences. Write down the tasks you want help with, how often you want someone, and the times and days you want them. Below are some of the activities that many people hire someone to help them with.
Personal care
- Help with bathing, dressing, grooming, toileting, and medication taking.
Practical or household care
- Help with cooking, cleaning, shopping,laundry, etc.
Social care
- Help with stimulation, exercises, companionship, outings, driving, etc.
Mobility
- Help with walking, using a walker, transferring from bed to chair, on and off the toilet, fall prevention, etc.
Then think about how often you would like someone. Once, twice or three times a week? Every day? How many hours per day?
Once you have decided what you want help with, make a list of the skills and abilities you want a caregiver to have. Some of these might include:
- a car or at least a driver’s license
- a certain level of proficiency in English
- training in dealing with a specific condition such as Alzheimer’s, diabetes, or Parkinson’s
- specific skills, such as lifting people, using equipment, ostomy care or oxygen.
Essentially, you are writing a job description so you want it to be as clear and precise as possible. It is the guide that the caregiver will use.Make sure that it is realistic and achievable.
When you know who and what you are looking for, then you can look for a company. In greater Vancouver alone there are more than fifty, so it can be hard to choose. We urge you to get recommendations from friends, neighbours, etc. At Diamond Geriatrics we have a few select companies we work with, and can recommend. The biggest and best known companies are not necessarily the best ones for you. A smaller company whose owners are hands on and accessible, might be easier to deal with and more responsive to your needs. So when looking at a company, do more than just read the company brochure. Ask them some questions, such as the following:
- How long have they been in business?
- How do they screen their employees?
- Are they and their employees bonded and have had a criminal record check?
- What kind of feedback and reporting to you will they do?
- What kind of supervision of their caregivers do they provide?
- What are the skills and training and experience of their supervisors?
- What are the hours that they will respond to your calls?
- What kind of specific training do they give their caregivers and
- What exactly does that training consist of, such as number of hours.
- Do their caregivers have CPR certification?
- Are they part of a chain,one location or are they a franchise?
- What are the qualifications and background of the owners?
- Have they or the owners ever been sued or had complaints lodged against them through a professional association?
- What are their prices for the different kinds of caregivers. For example a companion might be less per hour than a care aide.
You can ask them for references, but most companies will have at least some positive references, so do not rely on them.
Also ask about relevant policies and procedures of the company. For instance, they may require that you use a minimum block of hours or number of days. If they want to supply more than you wish, look for a company that is able and willing to work with you for what you want. What kind of notice do you have to give to terminate with them? What is the policy if you want to hire one of their caregivers full time? If you want to cancel for a day,what are the requirements so you are not charged? Some of these will be in the contract they ask you to sign, so make sure you read it carefully.
The company representative should develop a comprehensive plan of service with you. To do that they will want to know about your loved ones medications, medical conditions, and abilities, likes and dislikes. Give the company representative the list of tasks you developed as well as the qualifications you want in a caregiver. Make sure they spend some time with you and with the person they will be providing care for so that the caregiver they send is a good fit.
The cost can vary from agency to agency. Most require a two hour minimum. Per hour costs start around $23.00- $25.00 per hour. They often have overnight and 24 hour rates as well. There may be a difference in the cost depending on the training, experience, and the skill and tasks you require. For instance you might have a companion, a Registered Care Aide, or a Licensed Practical Nurse.
After you have created a job description, ask to interview at least two people on your own. Choose the one you feel will be the best fit and only then have them start working with your loved one. When interviewing, you are trying to assess the “fit,” so you have to go by your gut instinct, but also read our article: “Hiring Live-In Caregivers” to think about the questions you might ask someone.
Often people start off with just once a week for two to three hours and then it gradually builds. Remember that if you hire someone for only one or two days a week, and then want more, that person may not be available.
Consistency in caregivers is quite important. You should insist that care be provided by the same person over time. This may partly depend on how many hours a week you are looking for–24 hours a day seven days a week will naturally require more people than three times a week for two to three hours at a time.
Remember, you are the employer and both the company and the caregiver are your employees. You have the right to tell the company if you do not think it is working out and why not. You have the right to ask for another caregiver. You also have the right to fire a company and engage another one if you are not happy. Your responsibility is for your loved one, not the company.
The anxiety that you might experience in hiring a caregiving is understandable. What we can tell you from our experience at Diamond Geriatrics, is that caregivers often become like a part of the family, loved and cherished by the people they are helping, and providing a warm and caring relationship that goes far beyond that of simply employer-employee.That relationship will benefit not only your loved one, but you as well.
Best Results: How to Work with a Caregiver
Introducing a caregiver can be difficult. Your loved one may react by saying they do not need or want one. They may feel insulted and invaded. Discuss it first if you can; it may take several conversations and may feel like a negotiation. Sometimes you have to ask that they try it for a few weeks. Sometimes you just have to tell them that someone is starting. Make your reasons ones that your loved one can accept–the doctor ordered it, you are needing to take care of your own health, your father needs help taking care of your mother.
Be present when the caregiver is first there to introduce them.As we mentioned in the article above, hiring a caregiving can produce a lot of anxiety for you until you know it is working. Pay attention, but also try not to hover, and allow the relationship to unfurl and know that the caregiver will have a different way of relating than you do.
Make sure that the caregiver has the equipment and information they need to provide care and so that they can act appropriately in an emergency. If they are giving medication the times should be specified. If they are giving meals, they need to know the times and possible menus. If there is a mechanical lift, make sure they know how to use it. If there are details about walkers, give instructions. They also need to have an emergency contacts list.
In the beginning, monitor what the caregiver is doing and how it is going. Be there at different times and without notice. If you are asking someone to cook, make sure you see and taste what they are cooking. If the caregiver is helping with bathing and dressing, watch them transfer your loved one and dress them a few times. Monitor the skin condition of your loved one.
Pay attention to how your loved one is reacting to the caregiver. After the person has been there for a while, pay attention to any signs of fear, changes in personality, bruises, etc. that may indicate some kind of abuse. Contrary to what people fear, abuse is very, very rare.
The caregiver should be documenting the care that they are providing in a way that is clear and reflects what you have asked for. They should also be documenting any “incidents” that occur that are out of the ordinary, for instance such as falls, changes in cognition or mood, if they are refusing to eat or take medication.
As we mentioned above, if you do not think that the caregiver the company has sent you is working out after a few weeks, discuss it with them and ask for another. You are the expert when it comes to your loved one.
Diamond Geriatrics provides supervision and monitoring of home care workers for you if you would like some help, or live out of town and are unable to do so on your own. By having someone not involved with the agency, you know that we are looking out only for you. Our care management provides a broad level of service that includes coordination, sourcing, advocating, and navigation of care.
