Most seniors I know want to “age in place” and stay in their home, even when their health deteriorates.
That can be challenging for family members whose jobs and responsibilities to their own families prevent them from staying with their loved one all the time.
One option is to hire an outside caregiver, either privately on your own or through a home care agency. There are pros and cons to both.
Before you hire anyone, assess what kind of care your loved one needs. Does your family member need help with bathing, dressing and other hands-on care, or activities such as shopping and cleaning?
Does he or she have cognitive problems that pose a safety risk?
The answers to these questions will help you find a caregiver who meets the needs of your loved one.
For some families, hiring an independent caregiver may be a workable solution.
“You can hire someone based on your judgment,” said Kathy O’Brien, senior gerontologist at the MetLife Mature Market Institute. “You may have more choices and flexibility in scheduling.”
And the person may be recommended by friends who are using or have used that person as a caregiver.
Typically an independent caregiver will cost less than one hired through an agency, but there are trade-offs, O’Brien said.
“That makes you the employer, so you would be responsible for paying and oversight and [employment] taxes,” she said.
“You need to do your own background checks and references,” O’Brien said. “If you go through an agency, you’re going to probably pay more per hour, but the agency is bonded and they provide oversight for the aides.”
If you go with an independent caregiver, plan ahead for the time when the person misses work.
“For individuals, if you have no backup, and if that person gets sick, then you’re out of luck,” said Lue Taff, geriatric care manager at the Senior Source in Dallas. “When you hire an agency, you always have a backup. The agency will send someone else. They try to give you the same caregiver, but some of them may not be able to guarantee that.”
You also have to worry about personal liability with an independent caregiver. For example, you could be sued if the independent caregiver is injured in your home.
“One of the possible concerns with the independent caregiver is they get injured in your home, and oftentimes your homeowner’s insurance may not cover an employee that you have in your home,” O’Brien said. “If they come through an agency, they should be employees of that agency and not your employee. That is one of the benefits of going through an agency.”
According to State Farm Insurance, a typical homeowner’s policy generally would cover a worker injured in your home, but check your policy.
You can find a good agency through word of mouth or by asking senior organizations.
You can also hire a geriatric care manager to find the right agency, or independent caregiver, for your loved one.
The manager can “make sure there is a good match and that the person understands the job,” Taff said.
“We also monitor the situation to make sure the person is doing what is expected,” she said.
Hiring a geriatric care manager will cost $95 to $150 an hour, on top of what you pay the caregiver, Taff said.
An independent caregiver may cost $12 an hour or more, Taff said. The average cost of an agency caregiver is about $20 an hour, O’Brien said.
“They can be quite expensive because you’re paying for the overhead, the supervision, the background checks,” she said.
But families who have used an agency said the good ones are well worth the cost.
“I have been fortunate enough that there are individuals through an agency who have been fabulous, absolutely fabulous,” said Lynn Bace of Dallas, who has two caregivers from an agency caring for her 89-year-old mother. “One comes in the morning and the other comes at night. We feel like they’re a part of our family.”
Families should be aware that Medicare doesn’t pay for independent caregivers, nor will it pay for ongoing long-term care provided by an agency.
“Medicare will only pay for intermittent care,” O’Brien said. “They might pay for a bath service to come in. They may pay initially for a couple of hours in the morning, a couple of hours in the evening for a period of time while the person is recuperating or rehabbing.”
Under home care, aides must be certified nursing assistants and come through Medicare-certified agencies with professional staff supervising their work.
But once Medicare determines that an individual no longer meets Medicare’s definition of having a skilled need, “they’re not going to pay anymore,” she said.
Bace, whose mother has dementia and limited mobility, said families should cast a wide net when searching for a home care agency.
“You’ve got to talk to a lot of people,” she said. “I was interested in someone who would be a support to Mom, not someone who came and wanted to read a book or sit and watch TV.”
Be clear with the caregiver as to what your loved one’s needs are.
“In my particular case, I was pretty clear about the kinds of support I thought Mom needed,” Bace said. “I was also very willing, when a person came [from an agency], to spend time with them to help them get acquainted with both Mom, where she was, where things were, and then communicate with them throughout that experience with Mom.”
In Susan Jarrett’s case, the caregiver who’s taking care of her 91-year-old father also took care of her mother before she died in 2010.
“We have been fortunate,” said Jarrett, of Dallas. “We got one with my mother and she is still here with my dad. We found someone who really cared.”
Her father, Fred Smitham, really likes his caregiver, whom Jarrett found through Home Instead Senior Care in Dallas.
“She’s a delight in so many ways,” he said. “The thing I like most is I can sense and feel that she really is interested in where she’s supposed to be – someone who’s willing to help in any way to make anybody as old as I am to live a life that’s pleasing to the person.”
In the end, the method you use to find a caregiver “is less important than what the need is you’re trying to fill and getting the right person,” Bace said.
“The quality of that individual is paramount,” she said. “You’re asking someone to basically be like the right hand with your loved one.”