Should I Hire In-Home Help Privately or Through an Agency
Click here to view full article
by Carepathways & Homecarefiles
If you are a family caregiver and realize that you can't do it alone and help is needed, then congratulations are in order! This is undoubtedly a big step in the right direction and probably not a minute too soon. The wise decision to hire outside help is definitely not a sign of weakness or "giving up", but instead just using good common sense, realizing your limitations, and having a little foresight. Most families usually need some type of home care assistant to help with their loved one's personal care and activities of daily living. This might include assistance with bathing, grooming, dressing, meal preparation, feeding, medication assistance, walking and exercising, shopping and running errands, housekeeping, laundry, and offering companionship. Perhaps your loved one can't be left alone and needs supervision for safety reasons to allow time for yourself or to get away for a while.by Carepathways & Homecarefiles
In most home situations, a nurse aide or home health assistant will be able to provide this type of care and give you some well-deserved relief at the same time. Hiring a licensed nurse such as an RN or LPN is not necessary for custodial home care but rather only when skilled care is required. The question now becomes whether to hire this home care assistant through a local home care agency or privately hire someone on your own. There is no right answer to this question. I will discuss the pros and cons of both choices and try to offer some insight from my own professional experiences that may help with your decision.
Your first and main priority should be to find someone who is kind, compassionate, and caring. If you go the route of hiring privately, initially during the interview process you can begin to assess a person's character. Listen to how they talk about their own family and friends and ask questions that will encourage them to comment on others they may have cared for in the past. There are often subtle clues which can be detected in the tone of their voice as well as what they actually say. Be sure to observe them first hand interacting with your loved one...
Do they smile a lot?
Do they touch their hand or shoulder?
Do they make an effort to talk with them?
Do they listen attentively?
Do they respond appropriately?
Are they thoughtful about including them in the conversation when others are around?
A big advantage of hiring privately is that you are in charge of the selection process and ultimately make the final decision. A disadvantage is not having back-up help when your caregiver is unavailable. More concerning is actually finding an adequate number of caregivers for your consideration. How to go about finding and hiring caregivers can be a difficult task that I plan to address soon.
When considering a homecare agency employee, your approach should be similar during the initial stage. It is strongly advised to request a meeting with the caregiver that they are planning to send prior to the first scheduled day for service. Many agencies will not suggest this and it's up to you to ask. Most reputable agencies will try to accommodate this request if they are interested in providing a satisfying service. However should they be unwilling, or act as if this is an unreasonable request, or even an imposition as some may do, then definitely consider turning elsewhere for help. An advantage of using an agency is the possibility of several personnel choices to consider. It is also possible that an agency may offer a back-up caregiver in some situations when a regular one is not available. A distinct disadvantage is the likelihood that different caregivers may be sent causing a disruption in the ongoing care of your loved one or that they too may not have back-up help available. Your priority in either case has to be finding a good match for your loved one and having as much continuity of care possible.
Your next consideration is likely to be the competency and reliability of a potential employee. Can they manage all aspects of the care necessary? Will they show up on time or at all? When hiring privately, your best bet is to not only obtain several references of past employers, but to question them specifically about dependability and performance. Ask questions like...
Do they give reasonable notice when unable to work?
Can they safely transfer and assist an elder with walking?
Are they gentle when bathing an older person and take especially good care of their skin?
When possible, try to get at least one private family reference from a former client, as they will share a great deal more information about the employee then a company will offer due to their corporate policies. Many private caregivers have taken care of a number of other clients in the past and a good candidate will eagerly wish to share this information with you. If they are new to the private arena, don't be discouraged and unwilling to offer them a chance especially if they have prior experience. A lot of wonderful caregivers simply become frustrated with their jobs in understaffed nursing homes or other facilities. In this difficult line of work that carries a lot of responsibility and poor compensation, having the opportunity to work independently and for better wages is often the best option for many caregivers. Remember that personal or character references often don't carry much credibility unless you or someone you know happens to be acquainted with the individual.
It is an excellent idea to schedule a trial period to evaluate a caregiver's reliability as well as their competency. The obvious advantage here is that you can observe their caregiving skills first hand as well as their compatibility. If you approach it from the angle that this arrangement is for the benefit of both parties involved, hurt feelings may be spared. Make it clear from the beginning that your arrangement is a trial period for a specific amount of time only so the client, family, and caregiver can become comfortable with each other before a final decision is made.
The time saving advantage of hiring an in-home helper through an agency is that screening references, in addition to certification verification, criminal record checks, etc. are already completed as they are required at the time of hire. Licensed home care agencies are also required to supervise their aides, evaluate their performances periodically by RN's, and provide ongoing in service training. The burdens and responsibility placed on the agency instead of you, can reduce a lot of extra work, save time, and alleviate some anxiety. On the other hand, having considerably less input in the selection of your loved one's caregiver may cause additional stress and frustration. Further more it's possible that because of these same rigid hiring requirements imposed upon home care agencies that a competent caregiver may be ineligible for hire. Consider a common scenario when a devoted daughter cares for her ill mother or a granddaughter assists her disabled grandfather for a long period of time. She probably has a wealth of excellent hands on experience, but due to time, money restraints, or other responsibilities, is unable to attend school to become a certified nurse assistant. A homecare agency cannot hire her without prior certification, whereas you can overlook the formal training or certification and instead consider her valuable experience. While certification of nurse assistants dictates compliance with a state's training requirements, a kind and caring attitude cannot be taught.
Finally is the subject of cost and legal issues. It is usually a certainty that hiring privately is cheaper then going through an agency. The costs differences usually range around 20% to 40% less for private in home help. For example, if a local home care agency charges $15/hour, then you may be able to hire a private caregiver for about $10/hour. Be sure to ask the agency if there are any additional charges for nurse assessments, supervision, mileage, or other fees. When hiring private help, as the employer, paying additional expenses such as mileage, providing meals, or other details must be established from the onset. When 24-hour care is needed, a live-in caregiver arrangement may be more affordable by offsetting wages with providing room and board. It should not come as a surprise to learn that agency caregivers cost more then privately hired ones. Remember that an agency has expenses related to recruitment, hiring, orienting, payroll deductions, and ongoing supervision and training of their employees.
Other big concerns and issues to consider is the liability of a worker related to accidents in your home and potential theft of property. A licensed agency typically carries general liability insurance, workman's compensation for accidents on the job, and their employees are also insured or bonded to protect you against theft and damages. Verify specific liability coverage with an agency prior to contracting for services. As with the risks associated with having anybody in your home or on your property, it is important to know about the coverage on your homeowner or renter's insurance policy. It is also imperative that as the employer of a "household employee" that you be informed of your legal responsibility as it relates to paying taxes and social security. This doesn't have to be an obstacle to hiring help on your own, but warrants further understanding and investigation. I plan to address these legal concerns and requirements in my next article dealing with the actual finding and hiring of a private or independent caregiver. It should be pointed out however, that from my experiences as a nurse manager of a local home care agency, in home caregivers frequently acquire an unjust reputation of stealing from the elderly, when more often then not, it's a case of misplacing items. Although worry about theft is a common and legitimate concern, using good common sense by storing valuables away, may often avoid later misunderstandings or possible embarrassment.
Regardless whether you choose to hire help privately or through an agency, hopefully you will be fortunate enough to find a devoted caregiver. Becoming comfortable with a caregiver in your home may take a little while, however their immense value will be quickly realized. Good communication, clearly outlining work expectations and requirements, with an emphasis on positive feedback, will create a sound relationship and warm bond with your caregiver. Caregivers, as is the case with many of us, need to hear praise for good work and appreciation frequently expressed. This effort will in turn encourage your caregiver to develop a sense of loyalty and devotion to your loved one and family.
Date added: 03/29/2012
Do you have an article, video, or link you want listed? If so, then email us at homecare@optimumseniorcare.com