Choosing to hire a personal caregiver for a family member is often one of the most challenging and emotionally stressful decisions you will make.  Almost every family will eventually need to make decisions about how to care for a loved one as they age, become disabled, or struggle with illness.

We at www.selectacaregiver.com want to provide information to help you determine if now is the time to look for personal care for your loved one. 

Here are some questions to consider as you make your decision.

What are the needs of your loved one? -- When evaluating needs, we recommend examining Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs).  Carefully think about each activity that your loved one does in a typical day.  It helps to start early in the morning and continue through until the next morning.  Examining ADLs is important because they are often used as qualifiers for Medicaid funding or long-term care insurance. 

There are six basic ADLs: eating, bathing, dressing, toileting, mobility, and continence.

Is the individual able to…

• feed himself?
• properly bathe herself?
• dress and undress safely?
• use a toilet or bath seat without assistance?
• stand from a lying or seated position?
• transfer to and from her wheelchair?
• control bowel and bladder functions?

There are many IADLs. These activities aren't required for daily life, however they empower the individual to live independently in their home and community.

These activities include, but are not limited to:

• grocery shopping and other errands
• meal preparation, nutrition and cleaning up
• cleaning and minor household maintenance
• medication, dietary restriction, and other health maintenance
• participation in community or family activities
• participation in hobbies and interests
• managing and acquiring services and other resources
• child rearing
• caring for pets
• use of telephone and other communication devices
• household safety
• transportation
• financial management and other record-keeping

Assistance with IADLs may be necessary to maintain a comfortable lifestyle. Challenges with these activities can sometimes be indicators of future ADL needs.

What help are you able and willing to provide? -- Caring about someone and caring for them are different. Be honest about what assistance you are able and willing to provide. 

Are you looking for short-term or long-term solutions? -- Many family members make the mistake of looking for short-term solutions to long-term problems.  Is your loved one recovering from surgery for six weeks?  Are they scheduled for rehabilitation for six months?  Are they permanently disabled?  Do they have a progressive or terminal illness?  Try to match solutions to the length of expected care you will need.

Getting help answering your questions -- We recommend contacting local home care companies. Often they will provide an evaluation at no charge, helping you to identify needs.

Hiring a Home Care Company

Now that you have a good idea of the care you'll need, there important issues you will want to consider when hiring a home care company.  When shopping for a home care company, we recommend you also read our article "10 Questions for Selecting a Home Care Company" to help you get a better understanding of the company and the services they provide.

Recruiting a caregiver

Some home care companies will have built relationships within their community to help them in recruitment of caregivers, while others will use newspaper or radio advertising. This is a critical part of their business and improving recruitment is a primary focus. Don't be afraid to discuss the techniques the company uses for recruitment before purchasing services. 

Selecting a caregiver

There are two issues that present themselves when selecting caregivers.  Identifying high integrity individuals and matching the personality of the caregiver to the personality of the client. A quality home care company will attempt to identify the best match based on a number of criteria, one of which is personality. Some companies will allow you to interview a caregiver prior to them working in your home. Also, any high quality company should be willing to replace the caregiver where a conflict of personality exists. 

Home care companies, as a rule, should perform criminal background checks and substance-abuse checks.  Many companies will also use behavioral and personality profiles to screen individuals who may put your loved one at risk.  Finally, a good quality company will have caregivers that have worked for them with other clients so they will have firsthand knowledge of the caregivers’ capabilities and strengths.

Providing backup services

A quality home care company will be able to provide a replacement caregiver on relatively short notice.  When interviewing a home care company make sure to express to them the importance you place on continuity of service. 

Cost Versus Value

Frequently, families needing care have the perception that privately hired caregivers will offer them substantial savings over using an agency. There are several costs to consider before hiring privately. Additionally, your family assumes additional risk that may far outweigh any additional expense.

Things to consider when evaluating value for your dollar:

• caregiver wages
• cost of classified ads
• background check and drug screening expenses
• payroll taxes
• Workers Comp and liability insurance
• legal liability

A common misconception is that caregivers can be paid ‘under the table’ or as ‘independent contractors’. If your employee fails to claim or pay appropriate taxes the liability falls back to you as the employer.

Making Your Decision

Ultimately, the decision whether to purchase home care services from an agency, a home care registry, or to hire privately is yours. For the vast majority of families, choosing a quality home care company is a good choice to find a fair balance between cost, value, and risk. The key in this decision-making process is having all the information and comparing that to your family situation and level of comfort.