The vast majority of Americans would rather remain in their homes than move to an assisted-living facility, according to surveys by AARP. Hiring an in-home caregiver could make it possible to remain at home even after you no longer can live fully independently—but it’s a trade-off in challenges compared with a nursing home-type facility. The experience can be pretty horrible, in fact, if you don’t take the right steps.
Here’s how to select and manage an in-home caregiver…
As a first step, it is very worthwhile to have a professional geriatric care manager assess the senior’s needs. For example, does the senior mainly need companionship during the day? Housekeeping? Meals prepared and served? Medication doled out? Does he/she need help with activities of daily living, such as toileting, bathing and dressing? Are there health issues that require trained assistance, such as giving injections to a person with diabetes or assistance with physical therapy exercises? Do you need an aide who can drive—on outings, errands and to doctor appointments…and will you provide a car or will you require the use of the aide’s car? (The care manager also can recommend caregiver agencies and/or caregivers.)
This assessment usually takes about two hours at $100 to $150 an hour. The National Association of Geriatric Care Managers* (CareManager.org) can help you find a care manager in your area. Or ask local senior centers, Area Agency on Aging offices or the senior’s doctor if he/she can recommend agencies or care providers.
In-home caregivers can be hired directly or through an agency, but agencies are the safer and simpler option.
Hiring in-home help directly might save you a few dollars an hour, but in general, the savings are significant only for people who hire an undocumented immigrant and/or don’t pay the required taxes. Doing either of these things could lead to legal problems for both of you. (If you hire someone directly, that person will be your employee, creating insurance and tax obligations—you are required to pay payroll taxes, obtain the worker’s liability insurance and file employer tax forms with the state and federal governments.)
Hiring directly also means that you will have to conduct a background check on this person yourself and find a replacement on short notice if he/she is sick, needs time off, quits or is fired. Hiring an undocumented immigrant also makes it virtually impossible to run a full background check on the caregiver. That’s a big risk when you consider that this person essentially will be unsupervised in the senior’s home.
A reputable agency should handle all of these issues for you.
When you speak with an agency, ask the following…
Are you licensed by the state? Some, though not all, states require licensing—your local Area Agency on Aging office should know if yours does.
Are you a member of the American Association for Homecare? Belonging to this professional association suggests a commitment to professionalism (AAHomeCare.org).
Also ask about the process for requesting a new caregiver if the first one assigned doesn’t work out or is sick. You should be able to do this relatively quickly and easily.
Make sure the senior meets any potential caregivers during the interview process so that he will be more welcoming when you actually make a hire.
Be very clear with the caregiver about your expectations. Explain precisely what you want him/her to do. Are there specific household or personal tasks that should be prioritized? Is social interaction for the senior a priority?
Lack of communication about needs and expectations is a common cause of problems. If you want something done, ask. If you don’t like how something is being done, give instructive feedback.
Lock up all valuables, or move the valuables to the home of a trusted relative before allowing a caregiver to work in the home. Secure any checkbooks, credit cards and documents containing Social Security numbers or other personal data, too, and keep a close eye on accounts and credit reports for any signs of identity theft. These measures are important even if you eventually come to know and trust a caregiver.
Plan ahead for backup. It is best to hire multiple caregivers on a rotating schedule—possibly one for weekdays and one for weekends—if your caregiving needs are truly full-time. Even if you hire a live-in, no one can work 24/7. And even if the caregiver tells you that he wants to work every day to make more money, everyone needs days off for vacation, sick days and doctor visits. It will be easiest on your senior, both physically and emotionally, if his care is consistently provided by caregivers he knows and who are adequately trained in his needs.
Visit randomly. Close friends and relatives of the senior should drop in without warning occasionally when the caregiver is working to make sure that he is doing his job and that the senior is happy and safe in his care.
Extensive in-home support is expensive. In-home care costs an average of $18 an hour—around $19 if “personal care” such as help bathing, dressing and/or using the bathroom is required. These hourly rates vary by region and can easily reach $25 or more per hour in high cost-of-living areas. Agencies typically have four-hour minimums per day. Round-the-clock live-in assistance averages around $350 a day, nearly three times the price of the typical assisted-living facility. There might be additional onetime costs associated with remaining in the home as well, such as modifying the house to allow wheelchair access, installing an easy-access bathtub and grab bars throughout the home or adding a bedroom for a live-in caregiver.
*Jullie Gray is past-president of this organization.
If you’re hiring someone to take care of an elderly family member—or even doing it yourself—you may be in a precarious position. For many families, caregiving can quickly grow into a heavy financial burden, especially if you’ve had to quit your job to provide care. However, there are a number of government programs and tax breaks that can help you financially. Here are some options to explore…
A VA benefit available only to wartime veterans and their spouses is Aid and Attendance, which helps pay for in-home care as well as assisted living and nursing home care. This benefit also can be used to pay family caregivers. To be eligible, the person must need assistance with daily living activities such as bathing, dressing and going to the bathroom. And the person’s annual income must be less than $13,563 as a surviving spouse…$21,107 for a single veteran…or $25,022 for a married couple—after medical expenses. The person’s assets must be less than $80,000 excluding a home and car.
To learn more about these VA benefits, go to VA.gov/geriatrics or contact your regional VA office or your local veterans service organization.
If you can’t claim your relative as a dependent, you still may be able to get a tax break if you’re paying more than half his living expenses, including medical and long-term-care costs, and what you’re paying exceeds 10% (or 7.5% if you’re 65 or older) of your adjusted gross income. You can include your own medical expenses in calculating the total. See IRS publication 502, Medical and Dental Expenses (IRS.gov/publications/p502) for details.
