My mother has dementia and my dad is pretty frail himself. While he refuses to consider assisted living for them, I have convinced him to at least think about an in-home caregiver. What steps should we take to find the best and most affordable care? -- Denise Daughter
Dear Ms. Daughter: While I understand your father's reluctance to completely give up his independence, he still shouldn't completely ignore the assisted living idea; in-home caregiving can oftimes be a much more complicated and expensive experience, as you'll learn during the process and subsequent comparison between the two arrangements. Among other resources, such as Bottom Line Personal's article, "Aging Wisdom," I've also first-hand experience with all options between my own mother and mother-in-law, as well as vicarious familiarity with friends' and readers' family members.
First, it's imperative you initially contact the National Association of Geriatric Care Managers at care manager.org to help you find a care manager in the area where your parents live. If, for some odd reason, there's no one around, then check with the local Area on the Aging office, senior centers, or your senior's physician to see if any of them can recommend agencies or caregivers. Be sure to have a "needs" list ready for discussion, including daily living help/bathing/dressing, cooking and cleaning, exercises, medications, driving, and so forth. The more a senior needs, the more expensive the caregiver.
Also important is hiring through an agency. (Obviously, if you know someone personally, then you may OK in the hiring department, except you'll be directly responsible for many tasks, such as creating insurance and tax obligations. For instance, you must file employer tax forms with the state and the Feds, among other jobs. Hiring through an agency saves you a lot of headaches.) And it goes without saying, NEVER hire an undocumented immigrant for various reasons.
So let's say you or another trustworthy person gets ready to meet with a reputable agency; what questions do you ask?
1. Do they have a state license? Even though some states don't require a license, such as Alabama, both Georgia and Tennessee do.
2. Are they a member of the American Association for Homecare? Check it out at AAHomeCare.org. Moreover, discuss the process by which the agency replaces a caregiver if the person doesn't work out for any reason. Realize you'll need to hire more than one person for backup for days off, sick days, appointments, etc., particularly if you need 24-hour help. Also, after a personal and in-depth interview with all prospective caregivers, be sure the senior meets the prospects before signing on any dotted line. Remember, a lack of communication before hiring and during employment can and will cause many problems - with your senior coming out the loser.
What are some of the more urgent actions necessary with in-home care? Valuables come to mind, whether jewelry, credit cards, personal data or other temptations. Move these to the home of a trusted relative before the caregiver comes to work. Keep an eye on credit card and bank statements, too, even if you come to trust the caregiver. Visit on a random basis just like you'd do if your family member was in an assisted living or (especially) nursing home. The safety and well-being of your loved one obviously means your own peace of mind.
Next week we'll discuss the cost of in-home caregiving and what financial aid is available.
Ellen Phillips is a retired English teacher who has written two consumer books. Email her at consumer firstname.lastname@example.org.