Hiring an In-Home Caregiver: A Step-by-Step Guide
Reviewed by: Dr. Brindusa Vanta, MD
Long-term care is a concept that many people may avoid thinking about. Whether you're 30, 50 or 65, or if you're currently living an active, vibrant and independent lifestyle, it may be difficult to imagine yourself in need of constant care or help with activities of daily living.
The truth is, however, that there are certain safety and health risks for older adults that may require intervention. According to the Centers for Disease Control and Prevention, for example, more than 25% of those aged 65 or older experience a fall every year. Falling once can increase the risk that someone will fall again, and these incidents can lead to issues such as head injuries, hip fractions and other injuries.
Other safety concerns include managing medication appropriately — and not taking the wrong medication. Getting enough nutrition and hydration is also vital, as is remaining social enough to avoid isolation and loneliness, which can lead to depression or anxiety.
While families can offer a lot of support and care, they can't always cover it all. Choosing the right professional caregiver to help support yourself or your loved one is very important.
Whether you're considering potential options for future needs or have a need right now for help with an older adult, the guide below can help. Keep reading to learn about in-home care, and get some step-by-step tips for hiring someone if this sounds like the right choice for your loved one.
What Is In-Home Care?
In-home care refers to services and support provided to someone in their own home. It can be given by family caregivers or by professionals hired by the individual or family.
Common in-home care services include assistance with:
- Managing medications
- Tracking vital signs
- Managing chronic diseases such as diabetes or heart conditions
- Travel to appointments
- Participating in social activities
- Maintaining mobility
- Exercise and fitness
Most older adults wish to remain in their own homes, or at least in family homes, as they age. AARP notes that 90% of adults over age 65 have this desire. However, as people get older, they often need an increased level of assistance that requires in-home care.
According to data published by the National Library of Medicine, individuals are more likely to experience physical and cognitive impairments as they age that make it unsafe for them to live completely independent. The same report notes that more than half of individuals age 85 to 89 have functional limitations or other needs that require family caregiving, and more than 75% of individuals age 90 or over require assistance.
What Are Some of The Benefits of In-Home Care?
An obvious benefit of home care is that older adults can age in place as they wish. Other benefits include:
- In-home care supports ongoing independence: In-home care encourages an older adult to remain in their own home and continue to do things for themselves as they can. Someone who loves to cook can continue to do so, for example, though a companion may remain in the kitchen with them to ensure safety. An older adult who can still dress and groom themselves but has a condition that makes them prone to falls can have the peace of mind of in-home care without giving up privacy or independence.
- It may be cost-effective: Full-time in-home care is less expensive than nursing home care, on average, though it's more expensive than the cost for assisted living care, according to Genworth's National Cost of Care Survey. However, for seniors that don't require full-time care, in-home options can be more cost-effective. Someone who might only need 20 hours of assistance a week, for example, can pay a fraction of the cost of assisted living or nursing home care.
- It supports family involvement: In-home care also encourages a family environment. Family caregivers may take shifts or support their loved ones in the evening or at other times of the day. They can use professional services to ensure everyone has time to live their own lives while maintaining an ongoing and caring relationship with their loved one.
- In-home care can be customized: In-home care is one of the most flexible options for long-term care. You can hire someone with the skills required to meet your loved one's needs while also supplementing with family care to help keep costs within budget.
How Do Home Care and Home Health Care Compare?
It's important to note that home care and home health care aren't the same things. Explore some major differences in the table below.
|Home Care||Home Health Care|
|Nonclinical levels of service||Includes clinical levels of service provided by RNs and other medical professionals|
|Primarily provide assistance with activities of daily living or companionship||Primarily provide medical services that would fall under skilled nursing and therapy categories|
|Professional care providers may offer companionship services, such as conversation, playing games or going on outings||Services don't typically include companionship options|
|No eligibility requirements for people paying out of pocket||Generally requires a doctor's order, even for those paying out of pocket|
|Paid for by the individual or family, long-term care insurance and some Medicaid programs||Covered by many private health insurance plans as well as Medicaid and Medicare|
|The frequency of service can range from a few hours a week to 24/7 service||The frequency of service is typically a few hours a week|
Because it doesn't involve a clinical level of service, in-home care is typically less expensive when comparing the hourly rate to home health care. However, home health care is often covered by more insurance options, so it might end up costing families less out of pocket.
Choosing between these two levels of care can be difficult. In-home care is right for people who need a little extra assistance with activities of daily living, supervision for safety purposes or ongoing companionship. Home health care is right for people who need medical intervention in their homes, such as injections, IV therapies, intravenous feeding, wound care and other services best provided by clinical professionals.
In some cases, someone might benefit from both in-home care to support ongoing hourly needs and home health care to handle a few hours a week of medical services.
How to Hire an In-Home Caregiver: Step-by-Step Instructions
If in-home care sounds like a good option for your loved one, you can provide some of it yourself. For example, several adult siblings may work out a schedule so that their mother or father has companionship for a few hours every day.
But, covering all your loved one's care needs can lead to issues such as family caregiver burnout and an undesired evolution in parent-child relationships. For example, around a third of all family caregivers say they don't get enough sleep, and 40% have chronic conditions of their own to manage.
In addition, not every family has enough people and enough time to cover their loved one's needs. Hiring in-home caregivers is one common solution to these struggles.
Finding the right in-home caregiver for your loved one is critical. You're inviting this person into your home and trusting them with the well-being of your family member, after all. Follow the steps below to successfully hire an in-home caregiver.
Step 1: Assess Your Care Needs
Begin by determining what care your loved one needs. Some questions to answer include:
- What does your loved one need assistance with specifically?
- How many hours do you need in-home care?
- What skills and certifications would make you most comfortable with any candidate?
When assessing care needs, do so as a family whenever possible. Involve your loved one so they can voice their needs and wishes. Include any adults who are also helping to provide care, as each person's schedule and willingness to help determines how much professional care you may need to pay for.
Step 2: Determine Your Budget
Look at your budget realistically to understand how much you can afford to pay a professional caregiver. You should also consider ways to pay for the costs, such as long-term care insurance, retirement savings or a reverse mortgage.
Important considerations in this step include:
- How much money you can set aside for this purpose
- How long you think you'll need to pay for the service
- How many hours a week you need or can realistically pay for
For example, say you or your loved one can afford $500 per week for up to 5 years. If you can find a service or caregiver that will accept $25 per hour, you can afford 20 hours of care every week. If you believe your loved one needs 30 hours of care, you might need to find more room in the budget or plan to have family and friends cover the remaining 10 hours per week.
Step 3: Launch a Search for Candidates
Once you know how much care you need and what you can pay for it, you can begin searching for candidates. Some steps to take here might include:
- Creating a job description that details your expectations
- Posting the job with potential pay in local classifieds and online job boards
- Posting about the position on social media and asking people to share it with anyone they think might be qualified and interested
- Reaching out to local home health agencies that also provide companionship and home aide services
Do some initial research to vet applicants or agencies. Read reviews online and ask family and friends for referrals. You might also speak to your loved one's doctor or other medical providers about options.
Step 4: Interview and Screen Candidates
After narrowing down applicants to those that seem promising, schedule interviews and conduct other screening steps.
Questions to Ask During Interviews
- What is their work history in similar roles?
- What traits make them a good caregiver?
- Can they tell you about a previous challenge they faced in caregiving and how they dealt with it?
- Do they have reliable and safe transportation?
- What do they feel is rewarding about caregiving?
You should also ask questions specific to your loved one's needs. For example, if the older adult in question has diabetes, include questions to determine whether applicants are familiar with the disease and the care protocols with it.
Additional Screening Steps to Take
- Call all references and ask questions about their experience with the caregiver.
- Conduct a criminal background check.
- If the caregiver has any credentials or licenses, check with state boards or other accrediting bodies to ensure they are legitimate and in good standing.
Step 5: Select Candidates and Begin the Contracts
Choose the candidate or candidates that seem to best match your needs and preferences. Depending on your needs, you might hire one candidate or several.
Put your expectations in writing. You can check out free templates for caregiving contracts via sites including:
Ensure someone is present to greet the new in-home care provider when they arrive for their first shift. Show them around the home and discuss all expectations. Introduce them to the older adult and ensure that everything is going fairly well before leaving them alone.
Step 6: Follow Up and Manage Expectations
Your job isn't done once you hire and train a new in-home caregiver. You should continue to follow up with them and manage expectations. Give both positive and constructive feedback, letting them know what's going well and what they might work on.
In the best cases, in-home care providers build lasting relationships with the families they work with. Regular communication and inclusion of the care provider in discussions foster that type of relationship.