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After an illness, injury or stay in a rehabilitation hospital, individuals may find themselves needing to hire a caregiver for personal care at home — especially if the individual lives alone or needs continued care as family members or children return to work or school.
It is natural for families to feel worried or overwhelmed when hiring someone to care for their loved one. However, by understanding care options and available resources, families can more easily navigate the process of finding a trustworthy and caring person to help at home.
Identify Your Loved One’s Care Needs
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To make hiring a caregiver as easy and smooth as possible, it is important first to think about the individual’s specific care needs. Create a checklist that outlines the specific tasks that may be needed, which will help create a job description for the caregiver.
Additionally, for individuals currently in the hospital, rehabilitation treatment teams can assess the type of care needed at home — and help train a caregiver before discharge.
Caregivers can provide support in the following areas:
- Personal care, including help with getting in and out of bed; walking or pushing a wheelchair; using stairs; dressing; bathing; personal hygiene including brushing teeth, shaving, hair care and applying makeup; using the toilet; eating; taking medication; or doing home exercises.
- Household tasks, including meal preparation, housekeeping, laundry, and outdoor work such as yardwork or shoveling.
- Shopping, such as buying groceries, picking up medicines or running other household errands.
- Providing transportation to activities, such as medical appointments, recreational activities, social events with family and friends, religious services or other outings.
Creating a realistic picture will help in finding a caregiver whose background, skills and personality meet the needs of the individual who requires care. Once the jobs have been identified, the process of finding a caregiver can begin.
Understanding the Options: Home Health Care vs. Non-Medical Home Care
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Based on an individual’s care needs, families will need to determine if home health care is required to continue medical services in the home, or if non-medical home care — also known as a private duty caregiver — is a better option. In some cases, individuals may benefit from both types of care.
Medical Home Health Care: This option provides short-term, in-home therapy services to continue an individual’s recovery at home, such as physical therapy, occupational therapy and speech therapy. Services also may include visits by a registered nurse a few times a week to check vitals, administer labs, provide wound care or assist with education around ongoing care.
Therapy may occur 2-3 times per week and sessions are usually 30-45 minutes. Home health may be covered by Medicare or insurance benefits and requires a physician’s order; prior insurance authorization may be required.
Non-Medical Home Care (also known as a private duty caregiver): In this option, caregivers provide assistance on activities of daily living — such as personal care, completing household tasks, transportation to errands or appointments — as well as providing companionship.
Caregivers typically are hired by the hour, ranging from 4-12 hours. Medicare and private insurance do not usually cover these services. Services are paid out of pocket or possibly through long-term care insurance if there is a private duty caregiver benefit.
Choosing A Caregiver: Using An Employment Agency vs. Finding a Caregiver Independently
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There are two main paths to finding a caregiver: families may hire a caregiver through an agency or find a caregiver on their own.
Using An Agency: Families can work with home health care agencies to find nurses or therapists. Additionally, they can work with employment agencies to find private duty caregivers. A big advantage to working with an agency is that if a caregiver is unable to work, the agency will arrange a substitute. Also, in many cases, payment is made to the agency, which pays the caregiver and assumes responsibility for withholding taxes.
There can be greater costs associated with using an agency, including both caregiver and agency fees, though families may be able to negotiate better rates based on hours. Agencies will have stricter guidelines about which tasks can or cannot be performed by caregivers.
Hiring a Caregiver on Your Own: Some families choose to hire a caregiver on their own, finding an individual from their community through a local newspaper, church newsletter, community group or word of mouth. Hospital bulletins boards, independent living agencies, local social media groups and online marketplaces are also great resources for finding caregivers.
Caregivers hired independently may have a lower hourly rate compared to using an agency; also, job expectations and training can be established directly between the family and the caregiver. However, without the support of an agency, it may take a family more time to find the best person, and there is no backup if the caregiver becomes sick or is unable to work.
Choosing the Right Caregiver: Tips for Success
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Once a family has determined the care that’s necessary for their loved one — home health care vs. non-medical home care — and whether they will hire a caregiver through an agency or on their own, there a few final tips for success:
- Conduct thorough interviews with several caregivers: Explore qualifications for the specific needs of the role, including previous caregiving experience, any necessary licenses, reasons for wanting the job, and openness to taking direction. Confirm reliability, identifying anything that may interfere with work, such as family obligations or other jobs, or limitations that inhibit the ability to perform the physical needs of caregiving. Finally, check compatibility so families feel confident the caregiver is compatible with them and genuinely invested in the care of their loved one.
- Check references: Part of the hiring process includes talking to the person’s references, checking both employment and personal references.
- Set up clear terms of employment: Ensure the agency and/or caregiver are clear on wages, pay schedule, work hours, scheduled time off and the job description — writing out tasks and expectations in specific detail.
- Foster open communication: Check in with the caregiver and your loved one on a routine basis to ensure everything is going well, and quickly address any concerns before they become larger issues.
This article is provided as a resource from the Henry B. Betts, MD, LIFE Center at Shirley Ryan AbilityLab. The LIFE Center is a multimedia education center that provides resources for people living with a range of cognitive and physical impairments, chronic conditions and diseases impacting function.
Visit the LIFE Center for more information for patients and families, to access our online resource library, and to contact our staff.
