What You Need to Know About Hiring In-Home Caregivers

When your loved ones start struggling with everyday tasks, hiring a home care aide can help them remain in their home -- and take some pressure off the rest of the family. Here's help on finding the best care possible.

What is Home Care Aide?

In-home caregivers generally fall into three categories:

  • Personal care attendants (PCAs): Personal care attendants, also sometimes called personal companions, assist with household chores like cooking, cleaning, and shopping.
  • Home health aides: Home health aides generally assist with ADLs and may also be able to provide simple medical care.
  • Certified nursing assistants (CNAs): CNAs have some medical training and must pass an exam to get a license. They generally work under the supervision of registered nurses. In home care nurses can check vital signs, care for wounds, and help with everyday activities such as bathing and eating (you'll often hear these referred to as "activities of daily living," or ADLs).

Your First Hiring Decision: Agency Versus Independent

Hiring a home care aide through the classifieds or word of mouth is usually the least expensive option. But you should know that it might create unexpected liabilities for your family, which legally becomes the employer. For example, you'd be held liable for any costs related to an injury that happens on the job, including medical expenses and disability payments. This may not apply if you hire your worker as a contractor, but having a "freelance" aide rather than an employee may not create the long-term solution you're hoping for -- high turnover plagues this industry.

SEE ALSO: Find In-Home Care Help Near You

If you hire an in-home caregiver through an agency, hourly rates tend to be higher (often significantly higher), but the agency will pay the FICA taxes, cover the worker's liability insurance, and fill out the W-4 and W-2 forms. "Once you factor in taxes and insurance, it really comes out to close to the same price," says Jacqueline Dollar, a geriatric care manager in Des Moines, Iowa.

Also, because an agency has a stable of caregivers, you might be able to try out a few and find just the right aide for your situation. "With an agency, you also have the right of refusal," says Anita Silverman, a geriatric care manager in Lake Worth, Florida. "The agency can replace the person if the arrangement doesn't work out." An agency may be able to provide a substitute caregiver if your primary home aide is out sick or on vacation, which can save you a lot of frantic last-minute phone calls.

SEE ALSO: Find In-Home Care Help Near You

Keep in mind that agency caregivers are bonded and insured, and they're trained in the basics of care. They often have training in CPR and first aid, as well. Agency employees are expected to abide by an ethics policy and company rules. And agency CNAs may also have in home nurses checking in on them to make sure all is well and to offer advice.

Finding a Gem of an In-Home Caregiver

Whether you choose to hire independently or go through an agency, doing some homework on your candidates will help ensure that you hire a reputable worker.

Caring.com offers a comprehensive directory of non-medical home care agencies and home health agencies. You can search the directory to find local agencies and read consumer reviews about their quality of care. Another excellent way to find a high-quality agency is Medicare's Home Healthcare Compare tool, which allows you to search for agencies in your area that have met with Medicare's approval. The site gives a summary of statistics on the quality of each agency, such as "percentage of patients who get better at walking around," that you can use to guide your decision.

Also look for an agency that's licensed (if state law requires it) and that has liability insurance. Check to make sure the agency's caregivers are bonded and insured and that they're screened for communicable diseases, like tuberculosis, since the elderly are especially vulnerable to these.

If you hire someone yourself, it's a good idea to find an individual who has (or who once had) a home health aide license, so you know a registered nurse has trained the person in the basics of care. Also get a criminal record check from a service such as Intelius or SentryLink and always call references. There are always a few bad apples who'll take advantage of vulnerable clients -- make sure you don't unwittingly hire one. "If the person doesn't want to submit to a reference check, that's not the person you want -- it's a big red flag," says Dollar.

It's important to find an in-home caregiver your family will be comfortable with. When you're interviewing caregivers, include the person or persons who will need the care and make sure they interact well with the aide. Do they communicate well with each other? Are there language barriers? Do your loved ones enjoy the person's company? "Having shared interests can make a big difference," says Dollar. "One of my clients loved NASCAR and found a home health aide who did, too. They immediately hit it off."

Navigating the Paperwork

If you choose to hire an in-home caregiver independently, the first thing you need to decide is whether to treat the person as an employee or as a contractor. If you hire an employee, you'll be legally responsible for paying taxes and benefits such as Social Security and Medicare (FICA), income tax withholding, and unemployment tax. Payroll preparation agencies such as Paycycle and SurePayroll can help you with the accounting and paperwork.

If you hire the worker as a contractor, you'll still have to file a 1099 form with the IRS on any wages you pay over $600 per year. However, the aide would be responsible for paying her own taxes.

If you choose to hire independently, you may want to consult a lawyer and an accountant to make sure you're meeting your legal and financial obligations to the employee and to the state and federal governments.

Forming a Tag Team

If your loved ones need full-time care, you'll need to hire at least two caregivers. Nobody wants to work seven days a week, complications will arise in any aide's schedule, and turnover is really high in this field. Also, if you hire two in-home caregivers, they can trade off and you can protect yourself from being left in the lurch with no help. One way to ensure a smooth handoff is to schedule a half hour of overlap between their shifts so that they can debrief each other on any issues that may have come up during the prior day or shift. If they work on different days, ask them to keep notes in a designated notebook about changes in routine or any concerns.

If you hire the caregiver through an agency, ask about backup provisions for when your aide is sick or on vacation -- or if he or she quits the agency. Does the agency provide an alternate? Is there an extra charge for this service?

Setting Clear Expectations

"One big mistake people make when hiring an aide is to say, 'Your job is to take care of Dad,'" says Dollar. "That's not good enough -- you need a detailed job description." Do you expect the aide to cook? Clean? Do laundry? Pick up medications from the pharmacy and run errands? Will she bring her own lunch or cook and eat with your loved ones? Make your expectations clear. It's also important to tell the aide when her routine evaluations and raises will occur. If you put all these details in writing, you won't run the risk of disappointment once you've hired your aide, and you'll have better luck keeping her on board.

"You should also enlighten your loved ones about what they should -- and shouldn't -- be asking for," says Silverman. If the contract doesn't say the aide will wash the floors, don't expect it.

Setting clear rules about food and cooking is also important, says Silverman. "One problem I often see is that the way the aide eats may not be the way the person or persons she's caring for eat. You need to make sure an aide will shop and cook for your loved ones' dietary needs, not according to her own habits."

Keep in mind that aides are employees; don't try to make them your friends. "People are so happy to have help that they often treat the employee like a friend, and that creates problems down the line," says Dollar. If your employee thinks of herself as your pal, she may be more likely to take liberties such as bringing her kids or pets to work, or she may bridle when you assert your authority and request a change. The bottom line: Keep it professional.

Lisa Trottier

Lisa Trottier is a journalist whose rich background includes writing or editing on topics such as family issues, lifestyles, travel, food, and health for San Francisco magazine, Via magazine, and other publications. See full bio

5 months, said...

My wife and I are very busy with our work and barely have enough time to spend with our kids. My kids are very fond of their "gramma" and wouldn't want her away from them and neither do I nor my wife. We'll be sure to look into the legal compliance of the agency and also look into the background of the assigned caregiver. Thanks for the great tips! http://www.inyourhomecares.com/services

8 months, said...

I am a CNA and I would like to know how to find out what (by law or Medicaid Statutes) are required or expected of (from) a CNA performing home healthcare in an individual's home in the state of Georgia. I want to know where I can get the information from....if I can contact Medicaid directly or what. One of the expamples I'm referring to is dishes in the sink before they (the aid) gets there and the individual on the program is living with relatives and the relatives have a dog....are you responsible for the dog? The dog is not on Medicaid

9 months, said...

I'm looking for someone to take care of my Mother In-law on the weekends. The aid will need to work Friday, Saturday, and Sunday 24/7. My mother In-law had a stroke and is paralized on one side of her body, She cant move around on her own well enough to stay at home by herself. We need someone to care for her when her sister is working which is weekends. We need the aid to occasionally wash some dishes, and do her laundry. The aid will need to cook her meals, and visit with her. Occasionally she might be asked to run errands like picking up fast food, cigarettes, or light grocery shopping. She will also need to take my mother in-law to the doctors office for her appointments if needed. If you think you'd be interested, or if you know of a company that can help us find someone please let me know.

over 1 year, said...

You should fire the night aid and hire one who may perform the given task properly.

over 1 year, said...

I am good caregiver.I hate agency they charged me too much money.I have 9+ experience. My background is clear.If someone needs caregiver I am available.I am from Chicago.

over 1 year, said...

I know someone overseas that is a care giver, how can I apply for a work visa for live in caregiver for my parents?

almost 2 years, said...

My mother can no longer live on her own and I'm trying to find a certified nursing assistant to help her out. Thanks for the information about how agency CNAs may have some other nurse checking on them and offer advice. Hopefully, I can find a someone to live with my mother so that she can get proper care.

almost 2 years, said...

My mother can no longer live on her own and I'm trying to find a certified nursing assistant to help her out. Thanks for the information about how agency CNAs may have some other nurse checking on them and offer advice. Hopefully, I can find a someone to live with my mother so that she can get proper care.

almost 2 years, said...

It's time that I find my mom a caregiver. She has dementia and isn't with us anymore mentally. As a family, we want what's best for her, and that happens to be getting her some help. We want her to have the best caregiver possible. I like the tip you gave of making sure they are registered. Do you know if you have individual interviews with the nurses?

about 2 years, said...

What can I do if the patient is already to sleep

about 2 years, said...

There is no replacement of home.. And in the illness status, most deadly miss their home. In such case, it is god to go for personal caregivers. Whether it is child or senior citizen, there are number of personal caregivers.

about 2 years, said...

Are there any minimum requirements for a a person categorized as providing "home care" for a disabled or elderly person? In other words, can I allow a person with no training or experience to stay with me as a home care provider if they would help me around the house but not otherwise be allowed to reside with me as a roommate.

over 2 years, said...

Very helpful article, thank you! Do you know anything about whether military insurance pays for this type of care? (fyi in your last paragraph you used the word "brindle" and I think you meant to say "bristle.")

almost 3 years, said...

I had no idea that there was such a big difference between hiring an individual employee and hiring someone from an agency. I know that I would want to provide the best care possible for my mother, and it's important for me to find that care whenever possible. I hope that more people will look into this when they have to help their relatives. It's so important to provide the right care for them. We should definitely focus on that.

almost 3 years, said...

In joy working as a care give

almost 3 years, said...

Home care can take a lot of stress off of senior citizens as well as their kids. When my parents needed help, we were all pretty caught up with our work and families. We liked to visit on the weekends, but daily at-home support wasn't realistic for any of us. We felt a huge burden lifted when the home care started going over. At first I didn't know a lot about it, but as mentioned, these are people who have received proper training to handle the work. Thanks for your article!

almost 3 years, said...

I want someone to come in and help me take care of my mom

almost 3 years, said...

We are searching for someone to come into my mothers house n live with her and help with her cares. She is 94 and has early stage of dementia. How would I word a newspaper "Help Wanted" add? Thank you

over 3 years, said...

The success and failure of a relationship is communication. The agency must set the expectations of services to be provided and the family must share the expectations of services they expect to receive from an agency. I strongly encourage families to work with an agency. It can prevent so many headaches and provide an extra layer of protection to mom and dad receiving care. h

over 4 years, said...

Hello, If you are in need of in-home care providers, you may search for them within your region through our Senior Living Directory: http://www.caring.com/local/in-home-care (You can copy and paste the web address into your browser). Enter you city, state or zip code and you will receive a list of care providers in your area with related contact information. I hope this helps!