Now is the time to begin planning to hire an in-home, long-term caregiver. In most cases, the tipping point is when you need help to navigate daily life. Most long-term care insurers (LTCI) only pay when you can’t navigate at least 2 of the 6 activities of daily life (ADL).
ADLs, and your ability to negotiate them, are the criteria LTCIs set for paying claims on your long-term care insurance policy.
If you struggle to complete at least 2 of the above functions, you may need to consider an in-home caregiver.
Knowing what you’re looking for in an in-home, long-term caregiver is essential. Consider writing a job description that lists the tasks you need help with. Being clear about what you want now will help you identify the kind of assistance you need.
Areas where you might need help include:
Think about the kind of help you need in each of these areas and spell out the tasks you want someone to perform for you. Give some examples of what type of support you need.
There are several classes of in-home, long-term caregivers. Now that you know the kind of help you need, you can consider your options.
Personal care aides are unlicensed, of varying experience, and have different kinds of training. In general, they work as helpers and companions. Duties include bathing and dressing, light housekeeping and meal preparation, transportation, pet care, and companionship.
Home health aides will monitor your physical condition, check your vital signs, and help with ADLs. They may also do light housekeeping and prepare meals. Home health aides have 75 hours of federally-mandated training and often must also meet state certification requirements.
Certified and licensed nursing assistants monitor and report changes in your health, set up medical equipment, take your vitals, or change dressings. Their medical-related duties are performed under the direction of an RN or nurse practitioner. Federal law requires a minimum of 75 hours of training, though individual states may have higher requirements.
Licensed practical nurses are state-licensed and must meet federal standards for health and safety. They evaluate, manage, and administer necessary medical care. They may also change dressings, provide diabetes care, and provide occupational, physical, and speech therapy.
Registered nurses have a nursing degree; have passed the National Council Licensure Examination; and have met all the state nursing board’s licensing requirements. RNs provide direct medical care, including operating medical monitors, assisting with medical procedures, and administering medications. They’ll also advise your family on your condition and needs.
If you have a home care agency near you, that is one place to start. Ask family and friends who have used an agency for recommendations. Other recommendation sources include your doctor’s office, your church, and your senior center. You can use the internet to check agency reviews or ask your local Agency on Aging.
Ask for an information packet that includes a description of services, references, and fees. Review the information carefully before meeting with an agency representative. You might also consider asking a trusted family member or friend to review the information.
An agency screens its employees or contract staff. If they employ staff, they’ll handle all the personnel details, including payroll and taxes. Check their liability and workmen’s comp insurance coverage. The agency will help with scheduling and resolve disputes.
On the downside, an agency may schedule more than one person for you or have high staff turnover. They tend to be more expensive than someone you hire directly, and they may charge more for some tasks.
Whether or not you’re Medicare-eligible, their website has a useful tool, Home Health Compare, to help you find and investigate agencies near you. The detailed information includes user reviews and the services the agency provides.
Sometimes called a private-duty registry, it helps you connect with in-home caregivers. As with an agency, you explain your needs; the registry will provide you with a list of in-home caregivers who match your requirements. At that point, it’s up to you to contact the workers on your list and negotiate directly with them.
Your friends, community, church, and senior organizations are good places to start. Local colleges with nursing or health aide programs are also places to check. You can also place a help wanted ad in the local paper or check there for caregiver ads.
With a registry or hiring directly, you’re more likely to find someone who meets your needs and, perhaps more importantly, is a more compatible fit. A registry caregiver may offer more flexibility than someone from an agency, such as part-time or hard-to-schedule times. Since you don’t have to pay agency fees, you may be able to spend less overall while offering a competitive wage, allowing you to get a more skilled and experienced caregiver.
The biggest drawback to hiring directly or through an agency is time invested. You’ll need to do the research, check references, interview, and, if necessary, fire. Handling it yourself also means you’re responsible for the paperwork: paying and reporting wages, taxes, liability insurance, etc. And, unless you have a plan for emergency help, you may be left without care in the event of illness, vacation, or sudden departure from employment.
To age in place, you’re going to need help eventually. Plan now for how you will hire an in-home, long-term caregiver. Be sure to check your long-term care policy to understand the benefits coverage.