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Should I Hire In-Home Help Privately or Through an Agency
If you are a family caregiver and realize that you can't do it alone and help is needed, then congratulations are in order! This
is undoubtedly a big step in the right direction and probably not a minute too soon. The wise decision to hire outside help is
definitely not a sign of weakness or "giving up", but instead just using good common sense, realizing your limitations, and
having a little foresight. Most families usually need some type of home care assistant to help with their loved one's personal
care and activities of daily living. This might include assistance with bathing, grooming, dressing, meal preparation, feeding,
medication assistance, walking and exercising, shopping and running errands, housekeeping, laundry, and offering
companionship. Perhaps your loved one can't be left alone and needs supervision for safety reasons to allow time for yourself
or to get away for a while.
In most home situations, a nurse aide or home health assistant will be able to provide this type of care and give you some
well-deserved relief at the same time. Hiring a licensed nurse such as an RN or LPN is not necessary for custodial home care
but rather only when skilled care is required. The question now becomes whether to hire this home care assistant through a
local home care agency or privately hire someone on your own. There is no right answer to this question. I will discuss the
pros and cons of both choices and try to offer some insight from my own professional experiences that may help with your
decision.
Your first and main priority should be to find someone who is kind, compassionate, and caring. If you go the route of hiring
privately, initially during the interview process you can begin to assess a person's character. Listen to how they talk about their
own family and friends and ask questions that will encourage them to comment on others they may have cared for in the past.
There are often subtle clues which can be detected in the tone of their voice as well as what they actually say. Be sure to
observe them first hand interacting with your loved one...
Do they smile a lot?
Do they touch their hand or shoulder?
Do they make an effort to talk with them?
Do they listen attentively?
Do they respond appropriately?
Are they thoughtful about including them in the conversation when others are around? A big advantage of hiring privately is
that you are in charge of the selection process and ultimately make the final decision. A disadvantage is not having back-up
help when your caregiver is unavailable. More concerning is actually finding an adequate number of caregivers for your
consideration. How to go about finding and hiring caregivers can be a difficult task that I plan to address soon.
When considering a homecare agency employee, your approach should be similar during the initial stage. It is strongly
advised to request a meeting with the caregiver that they are planning to send prior to the first scheduled day for service.
Many agencies will not suggest this and it's up to you to ask. Most reputable agencies will try to accommodate this request if
they are interested in providing a satisfying service. However should they be unwilling, or act as if this is an unreasonable
request, or even an imposition as some may do, then definitely consider turning elsewhere for help. An advantage of using an
agency is the possibility of several personnel choices to consider. It is also possible that an agency may offer a back-up
caregiver in some situations when a regular one is not available. A distinct disadvantage is the likelihood that different
caregivers may be sent causing a disruption in the ongoing care of your loved one or that they too may not have back-up
help available. Your priority in either case has to be finding a good match for your loved one and having as much continuity of
care possible.
Your next consideration is likely to be the competency and reliability of a potential employee. Can they manage all aspects of
the care necessary? Will they show up on time or at all? When hiring privately, your best bet is to not only obtain several
references of past employers, but to question them specifically about dependability and performance. Ask questions like...
Do they give reasonable notice when unable to work?
Can they safely transfer and assist an elder with walking?
Are they gentle when bathing an older person and take especially good care of their skin?
When possible, try to get at least one private family reference from a former client, as they will share a great deal more
information about the employee then a company will offer due to their corporate policies. Many private caregivers have taken
care of a number of other clients in the past and a good candidate will eagerly wish to share this information with you. If they
are new to the private arena, don't be discouraged and unwilling to offer them a chance especially if they have prior
experience. A lot of wonderful caregivers simply become frustrated with their jobs in understaffed nursing homes or other
facilities. In this difficult line of work that carries a lot of responsibility and poor compensation, having the opportunity to work
independently and for better wages is often the best option for many caregivers. Remember that personal or character
references often don't carry much credibility unless you or someone you know happens to be acquainted with the individual.
It is an excellent idea to schedule a trial period to evaluate a caregiver's reliability as well as their competency. The obvious
advantage here is that you can observe their caregiving skills first hand as well as their compatibility. If you approach it from
the angle that this arrangement is for the benefit of both parties involved, hurt feelings may be spared. Make it clear from the
beginning that your arrangement is a trial period for a specific amount of time only so the client, family, and caregiver can
become comfortable with each other before a final decision is made.
The time saving advantage of hiring an in-home helper through an agency is that screening references, in addition to
certification verification, criminal record checks, etc. are already completed as they are required at the time of hire. Licensed
home care agencies are also required to supervise their aides, evaluate their performances periodically by RN's, and provide
ongoing in service training. The burdens and responsibility placed on the agency instead of you, can reduce a lot of extra
work, save time, and alleviate some anxiety. On the other hand, having considerably less input in the selection of your loved
one's caregiver may cause additional stress and frustration. Further more it's possible that because of these same rigid hiring
requirements imposed upon home care agencies that a competent caregiver may be ineligible for hire. Consider a common
scenario when a devoted daughter cares for her ill mother or a granddaughter assists her disabled grandfather for a long
period of time. She probably has a wealth of excellent hands on experience, but due to time, money restraints, or other
responsibilities, is unable to attend school to become a certified nurse assistant. A homecare agency cannot hire her without
prior certification, whereas you can overlook the formal training or certification and instead consider her valuable experience.
While certification of nurse assistants dictates compliance with a state's training requirements, a kind and caring attitude
cannot be taught.
Finally is the subject of cost and legal issues. It is usually a certainty that hiring privately is cheaper then going through an
agency. The costs differences usually range around 20% to 40% less for private in home help. For example, if a local home
care agency charges $15/hour, then you may be able to hire a private caregiver for about $10/hour. Be sure to ask the
agency if there are any additional charges for nurse assessments, supervision, mileage, or other fees. When hiring private
help, as the employer, paying additional expenses such as mileage, providing meals, or other details must be established
from the onset. When 24-hour care is needed, a live-in caregiver arrangement may be more affordable by offsetting wages
with providing room and board. It should not come as a surprise to learn that agency caregivers cost more then privately hired
ones. Remember that an agency has expenses related to recruitment, hiring, orienting, payroll deductions, and ongoing
supervision and training of their employees.
Other big concerns and issues to consider is the liability of a worker related to accidents in your home and potential theft of
property. A licensed agency typically carries general liability insurance, workman's compensation for accidents on the job, and
their employees are also insured or bonded to protect you against theft and damages. Verify specific liability coverage with an
agency prior to contracting for services. As with the risks associated with having anybody in your home or on your property, it
is important to know about the coverage on your homeowner or renter's insurance policy. It is also imperative that as the
employer of a "household employee" that you be informed of your legal responsibility as it relates to paying taxes and social
security. This doesn't have to be an obstacle to hiring help on your own, but warrants further understanding and investigation.
I plan to address these legal concerns and requirements in my next article dealing with the actual finding and hiring of a
private or independent caregiver. It should be pointed out however, that from my experiences as a nurse manager of a local
home care agency, in home caregivers frequently acquire an unjust reputation of stealing from the elderly, when more often
then not, it's a case of misplacing items. Although worry about theft is a common and legitimate concern, using good common
sense by storing valuables away, may often avoid later misunderstandings or possible embarrassment.
Regardless whether you choose to hire help privately or through an agency, hopefully you will be fortunate enough to find a
devoted caregiver. Becoming comfortable with a caregiver in your home may take a little while, however their immense value
will be quickly realized. Good communication, clearly outlining work expectations and requirements, with an emphasis on
positive feedback, will create a sound relationship and warm bond with your caregiver. Caregivers, as is the case with many of
us, need to hear praise for good work and appreciation frequently expressed. This effort will in turn encourage your caregiver
to develop a sense of loyalty and devotion to your loved one and family.
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