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Determine Needs Before Searching for a Caregiver

Author: Helen Dennis, Specialist on Aging

Question: My father-in-law is 98 years old, in good health but with poor eyesight.  After many years of taking care of my mother-in-law and now my father-in-law, I am tired.  To keep him at home, I need some help.  Where do I begin?  Many thanks.

Answer: Fatigue often becomes part of caregiving.  Kudos to you in recognizing when help is needed.

In your role as caregiver, you are joining approximately 49 million others who are caring for an adult at home.  About five years ago, that number was 44 million,  according to 2004 and 2009 studies by the National Alliance for Caregiving and AARP, funded by the MetLife Foundation.

The two studies reveal some additional changes:  Caregivers of adults and their recipients have gotten older.  In 2004, the average caregiver age was 46; today the average age is 49.  The age of the recipient also has increased, from 66-1/2 to 69.

The statistics only confirm what millions are experiencing – caregivers are aging, care recipients are aging and the need is only increasing.

Where to begin is a good question.  Here are some tips that may be helpful:

A first step is to determine what care is needed.  This can be done by a geriatric care manager who typically is a social worker who has experience with older adults.  To find one in your area, go to

You also could do this yourself by using a worksheet published in 2004 by Aging in Stride, created by Christine Himes and colleagues.  For each item, you are asked to indicate the type of need and who could fill that need, and then provide some follow-up notes for action steps.

The following items require assessment.  Is there a need for _____?

  • Help with activities of daily living, such as dressing, grooming and mobility
  • Preparation of nutritious meals
  • Doing laundry and other housekeeping chores
  • Transportation for doctors’ appointments, shopping, etc.
  • Yard work
  • Minor home repairs
  • Organizing and paying bills
  • Companionship

After you determine the need, consider your preferred work arrangement.  Here are two options:  Employ someone who works for an agency; or employ someone who works as an independent.  There are pros and cons for each.

Agency pros: Agencies are responsible for the screening, training and supervision of their aides.  If there is a problem, you contact the agency to remedy it.  Also, you don’t have to worry about withholding taxes and other employer responsibilities.  If for some reason the care provider does not show up, the agency provides a substitute. Most are bonded.

Agency cons: Typically, care providers from agencies are more expensive because agencies take a percentage to cover their overhead plus revenue.  Turnover may occur which can be stressful for those needing care.

Independent pros: These individuals may cost less.  And, if the same individual remains for an extended period, there is an opportunity to build an enduring relationship.

Independent cons: The interviewing, screening and checking of references are done by you or a family member.  If the care provider doesn’t show up, there usually is no back-up plan.  If the aide is hired as an employee rather than an independent contractor, the family has to meet all legal obligations such as withholding taxes and paying Social Security.

The next question is where to find these people.  An initial approach is to ask friends and family if they have engaged a care provider, and their experience with the individual and, if appropriate, the agency.

Now let’s get to interview questions for the home-care candidates and, if appropriate, the agencies for whom they work.  What is most important is to ask the right questions so you and your family can make the best decision.

The National Association of Home Care and Hospice – the nation’s largest trade association representing home-care agencies, hospices and home-care aide associations – has identified key questions to ask agency representatives or those actually providing the home-care services:

  • How long have you been serving this community?
  • Do you have literature that explains your services, eligibility requirements, fees and other sources of funding?
  • Do you have a Patient Bill of Rights?
  • How do you select, screen and train your employees?  Do you provide ongoing training?
  • Are nurses or therapists required to evaluate the patient’s needs?  Do they consult the physician or family members?
  • Will you provide a replacement if the person cared for finds the original aide incompatible?  Will there be a replacement if the scheduled person does not show up?
  • Do you provide detailed tasks or a care plan to be carried out by each professional caregiver?  Do the patient and family receive a copy?
  • Do you include the patient and family in developing the plan for care?
  • Do you monitor the quality of service?  How is this done?
  • Do you provide a bill that lists all of the services that were given?
  • How do you handle emergencies?  Are your caregivers available 24 hours a day, seven days a week?
  • If the patient or family has a complaint or problem, how does the agency follow up to resolve the issue?
  • How does your agency ensure patient confidentiality?

Here are a few more to add:

  • Can you give me one or two references?
  • Do you have reliable transportation?
  • As the care provider, will you be logging daily notes?  Will you share them with family members?
  • Will you be able to determine if the patient needs medical home care that requires an M.D.’s order and a plan of care?
  • Who is the contact person for questions about care?  For questions about billing?
  • What motivated you to choose this position as a career?

Finally, contact references such as doctors, discharge planners, patients, family members and community leaders familiar with the provider’s quality of service. Ask if they have a contract with the provider and if they received feedback from patients.

An objective of home care is to enable people to remain in their home, in an environment that supports their freedom and independence, for as long as possible.  Family dynamics, values and habits are all considerations in determining the right fit between caregiver and patient.  It might take a few tries.

The California Association of Health Services at Home (CAHSAH) at has a home-care locator that provides a listing of home-care agencies according to geography, type of payments accepted and services needed.

For information provided by H.E.L.P. on employment responsibilities that may arise when hiring household workers, click here.

Note:  For readers not caring for an older person, you might consider saving this column for the future.  As former first lady Roslynn Carter reminds us, there are only four kinds of people in the world: those who have been caregivers, those who currently are caregivers, those who will be caregivers and those who will need caregivers.

Thank you for your good question and best wishes in finding that right person or people to care for your father-in-law.

Copyright 2010 Helen Dennis. All rights reserved.

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