ElderCare Online
How to Hire a Home Care or Home Health Aide

By Nancy Bryce, Contributing Editor
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Finding the best home care aide for your situation requires a bit of preparation, effective research and interviewing. This article gives you some helpful tips and sample interview questions to help you with your search. The old adage, "Well begun is half done," applies here. Before you begin your search, you should have in mind what you expect the home care aide to do. Based on your needs, you will be able to narrow your search to those agencies and independent caregivers who can best serve you and your elder.

Locating potential agencies

Some of the best sources for finding quality home care are your doctor or hospital. You may also find help by contacting your state's departments of health, aging or social services. Review one of ElderCare Online's state-focused Neighborhood Networks for links to local services, including your county or regional Area Agency on Aging. These agencies can give you lists of accredited home care agencies and local assistance programs.. The National Association for Home Care website offers a home care agency and hospice locator database of more than 28,100 listings.

If your elder is being discharged from a hospital, rehabilitation facility or nursing home, the discharge nurse, social worker or administrator can recommend an agency (or agencies). It is always best to review a few options rather than the first one that comes along.

If you are finding that your elder needs assistance and has not been hospitalized, then you will have to do more of the legwork. It may also be prudent to ask family, friends and co-workers who may have gone through the search process and found a reputable home care agency. You may also want to check the yellow pages under "home care," "hospice," or "nurses."

Examining and Assessing Your Elder's Needs

While the need to bring in outside help may have crept up on you, it may also be a result of an unexpected medical emergency or other life change (such as the death of your elder's spouse). You or someone who is very close to your elder should spend some time with him/her to see first hand what tasks or activities your elder needs assistance with. Geriatric Care Managers, discharge planners at hospitals and social workers are skilled at assessing needs. You can also use the articles and checklists on this site to get a good idea of the range of issues involved.

*Are both personal care and house cleaning tasks needed?
*Are medical procedures, such as insulin injections, physical therapy or infusion therapy required?
*Make a list of specific chores and duties to be done throughout the course of a typical day or week. This list may later be used as a job description for an in-home caregiver.
*How many hours per day or week is care needed. Is care needed at specific times of the day (i.e., when you are at work).

Finding Assistance on Your Own

Some families may elect to find in-home care assistance on their own (i.e., without the assistance of a home care agency or other professional. The immediate costs may be less than from working through an agency, but the potential pitfalls are greater. For example, you would likely be responsible for conducting background checks, paying taxes and monitoring the quality of care. For a busy caregiver, these are extremely burdensome.

However, you may want to work with a family friend, church member or other close associate and willingly assume the additional management responsibilities. If you elect to find an in-home care aide on your own, keep in mind these points (as well as many of the points that directly refer to agency aides):

*Let friends and relatives know you are looking for someone. They may be able to make a personal recommendation.
*Contact local churches, synagogues, independent living centers, senior centers, Area Agencies on Aging and especially local colleges that offer program in nursing and social work. These local resources should be able to refer you or point you towards newsletters and bulletin boards where you can place an advertisement.
*The ElderCare Exchange on this website is a free bulletin board service for caregivers and professionals who serve them. You are welcome to place a free ad on the site at . Please let us know when the position is filled so we can remove the posting.
*Some communities have organizations that function as attendant registries. The level of screening completed on registrants and fees charged may vary, so ask first.

*An advertisement in a local newspaper may be necessary. At a minimum, include hours of assistance required, a brief description of the duties, telephone number and best time to call. Be careful about giving out the address of your elder (if they live alone).
*You may want to contact you local Area Agency on Aging or state Attorney General (See your state's Neighborhood Network). These government bodies may be able to give you information on how to conduct your own background check on applicants.
*If you are paying for care privately, there are specific responsibilities of employers of "household employees" -- remember NannyGate! Refer to IRS Publication 926, The Household Employers Tax Guide, for specific tax information. Check with your state Revenue Department for applicable state regulations and check with your insurance agent regarding coverage on your homeowners insurance.
*Always check the references of your top choices
*Always follow through with completing background checks

Signing a Contract With an Independent In-Home Aide

A good work contract should include several important items. These are only guidelines and your particular situation may require additional specific information. Please consult a legal professional or a sample contract for additional information. This list is for educational and illustrative purposes only.

*Name of employer and the "household employee"
*Wages and benefits (including meals, mileage, etc.)
*When and how payment will be made
*Hours of work
*Employee's Social Security Number
*Duties to be performed
*Unacceptable behaviors (such as smoking, abusive language, etc.)
*Vacation and holidays
*Emergency absence plan
*Termination guidelines (how much notice, reasons for termination without notice, etc.)
*Dated signatures of employee and employer

Choosing a potential home care agency

It is strongly recommended that you hire a home care aide through an agency. Although it may cost a little more money, in the long run it may be safer. Agencies screen employees by running background checks, checking references and checking credentials. "Agencies take away a lot of the headaches" in hiring a home care aide, says Ayana Edwards, Client Services Supervisor at Kelly Assisted Living, a home care agency in the Washington, DC area. Edwards points out that agencies not only hire employees but also handle things like taxes and worker's compensation. If you hire an aide that is not associated with an agency, you must ensure that you run the appropriate checks.

Once you have located several potential agencies, the next step is to set up interviews. It is important to interview the agencies, applicants, and references. Below is a list of questions you may ask each. You should adjust the questions to work for your individual situation.

Questions to ask the agency

* How long has your agency been serving the community?
* How do you select your employees?
* What kind of training do you offer and require of your employees?
* Are you licensed and accredited? By whom?
* Is your agency bonded? Are your workers bonded?
* Do you provide information explaining available services, eligibility requirements, and fees?
* Will the home care provider evaluate your loved one's home care needs? What is involved in this process?
* Is your loved one and family members included in developing a plan of care? Does the plan detail specific tasks the caregiver must carry out? Will the loved one and his or her family receive a copy of the plan?
* Will a supervisor oversee the quality of care the loved one is receiving?
* Who should the loved one or his or her family members call if there is a problem? Are there complaint procedures that should be followed?
* What procedures are in place to handle emergencies?
* How is client confidentiality handled?
* What are the financial procedures for billing, payment of fees and insurance coverage? Is a written explanation of costs and payment plan options available?
* Do you accept Medicare? Medicaid?
* Can you provide me with references for the agency and your employee?
* Do you uphold the Client Bill or Rights for healthcare?



Questions to ask the applicant

* Why are you interested in providing home care?
* Tell me about your past home care experiences?
* What kind of training have you had?
* Why did you leave your last position?
* Do you currently provide care for others?
* How flexible is your schedule?
* How much time can you commit to this position?
* Are there any duties in this position that you are unwilling or unable to do?
* Are you willing to do household chores such as cooking or light housekeeping?
* Do you like pets (if the person requiring aid has one)?
* Will you be able to drive my loved one to appointments or can you run the errands for him or her? Do you have a car? Do you have car insurance? Can you drive my loved one's car?
* What will you do if you are ill and cannot come to care for my loved one?
* What will you do if there is an emergency? Have you handled emergency situations before?
* How would you deal with someone who may resist your care? (This is an important question to ask if you are concerned about how your loved one may react to having a home care provider help him or her).

Questions to ask references

* How long have you known the applicant?
* Describe the applicants job description when he or she was with you?
* Did the applicant get along well with others?
* What are the applicant's strengths and weaknesses?
* Did you trust the applicant?
* Would you rehire the applicant?
* Why did the applicant leave?

Questions to ask yourself

* Are you and your loved one comfortable with the applicant?
* Does the applicant have the skills that the position requires?
* Do you trust the applicant, especially in emergency situations?
* Are the personalities of the applicant and your loved one compatible?

These questions should address the most important issues that you will have to deal with when hiring your home care aide. Do not be afraid to ask other questions that may come up in the course of an interview.

It is important that you pick a home care aide that will not only satisfy the needs of your loved one, but who can also get along well with him or her. Edwards says an added benefit of working with an agency is that "you can request someone else" if the relationship is not working out.

By Nancy Bryce with additional information provided by the State of Missouri

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