A Reliable Home Aide Can Be Hard to Find

EDITOR'S NOTE: This article was originally published in the September 2012 issue of Kiplinger's Retirement Report. To subscribe, click here.

It can be tough to acknowledge that a loved one needs in-home care that family members can't provide. But finding a qualified paid caregiver may be even tougher.

Consumers who turn to agencies because they assume their health aides and personal care attendants are rigorously screened may be suffering from a false sense of security. In a recent study, researchers from Northwestern University Feinberg School of Medicine found spotty screening, training and supervision practices among these agencies. Many agencies, for example, don't perform drug screening or even check references before hiring.

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Whether hiring in-home help directly or through an agency, you must take it upon yourself to ask detailed questions about caregivers' background and training.

That's not always easy, since the need for in-home help may arise without much warning. Sometimes, "people will spend more time researching their cars" than selecting a caregiver, says Dr. Lee Lindquist, associate professor of medicine at the Feinberg School and lead author of the study.

Family members who intend to hire in-home help should start with a clear picture of the type of care that's needed, such as assistance with bathing and dressing, light housework, and transportation. A checklist such as the "needs assessment worksheet" at www.caregiverslibrary.org (click "Checklists & Forms") can help. Using such a list, you can write a job description with the qualifications the caregiver should have, such as a driver's license and car or the ability to lift the senior.

Next, ask friends or social workers for referrals to agencies or individual caregivers. When weighing an agency against hiring someone directly, consider your budget, time constraints and ability to find substitute care in a pinch. Consumers often pay $10 to $15 an hour for a caregiver hired directly versus $25 to $50 an hour through an agency, Lindquist says. Medicare doesn't cover custodial care, which provides assistance with daily activities such as bathing and dressing.

The added cost of an agency comes with some benefits. The agency typically handles payroll and taxes, sends substitutes when a caregiver calls out sick -- and, ideally, screens potential caregivers.

Consumers who choose to go with an agency should ask about screening and hiring practices, including state and federal criminal background checks, drug testing, and skill assessment. Ask to see a copy of all screening materials.

Also be sure that caregivers are insured and bonded through the agency, which offers some protections in case of caregiver negligence or theft. Consumers hiring caregivers directly can contact local law enforcement for information on conducting a background check.

Hire a Caregiver With Appropriate Training

There are no certification requirements for the most basic level of home care aides, who may provide help with household chores and personal care. Depending on the senior's needs, consumers might seek out caregivers with more formal training, such as home health aides who can administer medications. If the person receiving care has dementia, look for caregivers who have specialized education such as Alzheimer's Association training, says Christina Irving, family consultant with the Family Caregiver Alliance.

Agencies should provide meaningful supervision, such as in-home visits at least monthly, according to the Northwestern researchers. If you're hiring a caregiver independently and don't live with the person receiving care, you might arrange for relatives or friends to stop by for random in-home checks.

You don't have to accept the first caregiver that an agency sends over. Even a well-qualified caregiver may not match the senior's personality. "It's okay to say 'no' to individual workers or to talk to multiple agencies before making a decision," Irving says.

A geriatric care manager may help find in-home help. You can find a care manager in your area at the National Association of Professional Geriatric Care Managers (www.caremanager.org).

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