Navigating the Caregiver Hiring Process: Five Essential Tips / Alzheimer’s and Other Dementias

This is the Whole Care Network. Music Helping you tell your story one podcast at a time. Content presented in the following podcast is for information purposes only. Views and opinions expressed in this podcast are solely those of the host and guest and may not represent the views and opinions of the Whole Care Network. Always consult with your physician for any medical advice and always consult with your attorney for any legal advice. And thank you for listening to the Whole Care Network. Music Is it time to hire a caregiver for your loved one? In this episode, we're talking about the process of finding a paid caregiver. We're sharing five tips. Welcome. We are Sue Ryan and Nancy Treister. This podcast brings our years of experience in a variety of family caregiving roles to prepare you to navigate your caregiving journey. We're sharing our personal experiences, not medical advice. And because it's our passion to support you on your journey, we believe no topic is on limits. Let's get started. Music Whether you're hiring a caregiver for home or you're hiring a caregiver to complement the care of your loved one in a community, either way, the best thing you can do is get through as much of this process as possible before you desperately need a caregiver. So true. Understand if you're going to use an agency, understand if you're going to go private, have an idea of who those caregivers might be, because you never know when you're going to get in the situation where you're not going to have time to go through this process we're talking about here in the ideal order over the ideal period of time. So something to think about. If you've never hired a professional caregiver before, this process can feel a bit scary and a bit overwhelming. And there's lots of different options here. So with my father who had Parkinson's, they live in a small town in Middle Georgia, and the caregivers for other people with Parkinson's were well known in the community. And they moved around from different Parkinson's patients. And so my mother used private care the entire time, because these caregivers were well known to everyone in the community. For my father-in-law, we'll talk more about this later, but we hired caregivers through an agency that was approved by the VA. And here at home with my husband, I did a mix. I hired some through the through a care agency and some private care. So you may find that some combination of what we're going to talk about in this episode works for you. But either way, we're going to walk you through the five steps that you should think through or consider as you look to hire an outside caregiver. Now there are two things that we're not going to talk about in detail today. We'll mention them again at the end, but that are part of the process of bringing a caregiver into your care plan. One is to actually document and create a care plan. And the second one is to have a plan to introduce and integrate this caregiver into your care plan. So those two will cover separately in other episodes. But for now, let's jump into what it takes or what you should think about in terms of hiring a caregiver. Tip one, assess your loved ones needs. It's time for us to thoroughly assess what kind of support our loved ones need. And we created six different areas to consider. First, activities of daily living, often called ADLs. Can they dress, bathe, feed themselves? Can they need help with sitting down, getting up, moving through the house, other areas of mobility? Can they use the phone if there's an emergency? Number two, medical needs. Do they need help with medication management, wound care or specialized health monitoring? Number three, household management tasks. Do they need help with laundry, housekeeping, meal preparation? Can they turn the lights on and off? Can they change the thermostat? Number four, safety. Are you concerned about their safety when they're home alone? Do they remember to unplug the iron? Do they leave the stove on? Can they safely use knives, cleaning products, personal care products? Number five, transportation and mobility. Can they drive during the day and after dark? Is their mobility stable enough on their own? And number six, companionship. Are they becoming isolated? Do they need to have more care around them? Do they need more social interaction? Do they need more activities to do? And one last thing in this area as a reminder, we've talked about this before, specifically in episode six called home alone. And we talked about deal breakers, that these four deal breakers are indicators that they are not safe living alone. I'll just run through them very quickly. First, in case of an emergency, can they contact someone either by pressing a button or making a phone call? Number two, can they take their own medication? Number three, can they prepare a meal? Can they feed themselves? Can they hydrate themselves? Number four, so very important. Do you feel they're safe at home alone? So in addition to the home alone, just that we mentioned, that was an episode specifically around, could your care, could your loved one live at home alone by themselves? So that was good. But these six areas that you discussed in tip one are the way that we're going to decide what kind of support we're looking for from a caregiver, leveraging and understanding what kind of help we need, your loved one needs in those six areas. So tip two is once you've evaluated the kind of care that you're looking for, we want to determine the type of caregiver that you need and the frequency that you need that caregiver for. So there are three kinds of categories, if you will, of caregivers, paid caregivers. One is just companion care. And a companion might come in just to be a social companion. They might do light housekeeping, meal preparation, maybe transportation. But they're not trained like the second kind of caregiver, which is a CNA, certified nursing assistant. And a certified nursing assistant, just like it sounds, is certified. They've been through special training to manage those ADLs, activities of daily living to help with bathing and dressing, incontinence, toileting, a lot of the things above and beyond just being a companion, but they will do the companion things as well, light housekeeping, meal preparation, transportation potentially as well. And then the third would be, do you need skilled nursing? And skilled nursing is often required for some of those medical needs we talked about, like wound care or any sort of specialized monitoring, like if they have a catheter or something like that. So the nice thing is, once you determine what kind of care you need, let's say you do have some skilled nursing needs, but maybe you only need skilled nursing twice a week for wound care. And you don't need it every single day. You can mix these kind of caregivers together because there is a difference in how much you're going to pay for the kind of caregiver that you get. So keep that in mind. Yeah. One other area that I've observed a lot is we want to make sure we understand, especially early in the journey when our care receivers really still know what's going on. We want to make sure we're involving them and we're communicating with them and we understand any of the desires or concerns they have in terms of requirements for someone coming into provide care that are important to them. For example, if it's a man, do they prefer a man? Do they care about the culture of the person? Do they care about the age? So having a conversation before it matters is really helpful so that it's possible you can move beyond that. And you can also be honoring what's important to them and make it as easy for them to transition as possible. You know, I agree with that. The one thing I would add is some care receivers, if you start talking about having care in their home, they're just going to say no. No, don't bring anybody in. So that's their preference. So you may or may not be involving them in the decision, but just for example, at my house, I felt like it was time to start introducing a caregiver into our home because I wasn't desperate for one yet. But I knew that we were getting close and I'd rather introduce someone slowly than be in a panic and need someone five days a week. So we started looking for, I started calling care agencies and looking for a caregiver for, most of them have minimums of four hours. So four hours, one day a week. Well, first let me mention just in case the other people don't realize this, I didn't realize that's a really hard position to fill. Most caregivers want eight hours, five days a week or something more consistent and longer. So it was very difficult. So I thought I wanted a companion man. That's what I had in mind. Well, what when I finally got down to who could come to my house, it was a female CNA. So she was a certified nursing assistant and she was a female. So my first reaction was, well, that's not what I need, but fine. Let's just, I'll try her. Right. Well, she came and honestly, it didn't take but a few opportunities for her to interact with my husband and help participate in this care for me to realize this was perfectly fine. I didn't need a man and I needed and having more someone who was educated, who was trained on more than just companionship wasn't hurting me either. So ironically, this person ended up being someone that I used seven days a week, eventually, who I just hired for four hours, one day a week to start with. But I had to get over what I preconceived that I needed. Number one, it's very hard to find a man caregiver that just to start. And number two, it's very hard to find someone for very small number of our jobs. So just FYI for those of you who are beginning this process. And I'll add another point to the kind of things for us to consider and get beyond if we possibly can. One of my caregiving clients in coaching had a challenge and she called me about it. And she said, I really don't want a female caregiver. And I said, well, why not? And she said, well, I don't want them looking at my husband's privates. And I said, well, she doesn't care about his privates other than whether or not they're clean and they're dry. So reevaluate whether that's important because it's going to be harder for you to find men as caregivers. You may be able to, but just give on. So she thought about that. And she called back a day or so later and she said, no, I'm laughing at myself. I've just been able to move beyond that. All she cares about is keeping him clean. So at any rate, it's reasonable though. And I think the point to walk away with is it's reasonable for us. We don't have experience doing this. This is something we grew up with. So go ahead and honor what these thoughts are that come up for us. And then kind of like, you know, talk about it and see what you can move beyond and see with your care receiver what they can move beyond. Right. Very good point. So after we've decided what kind of caregiver we think we need and we've decided what our preferences and then maybe to your point what we can live with in terms of if we've, you know, typed them at all. We also need to be very clear about how frequently they need them to come. And remember, you can mix them up. So maybe you need companionship for five days a week, but wound care two days a week. So, you know, frequency and then what you need them to do when they do come, I think is also important. And then make sure you engage your family members as well because sometimes what you're going to need here is a paid caregiver to do things that where boundaries have just now, we're just now have boundaries with family or capabilities with our family who's been supporting you, but we're moving beyond their ability to provide support either because something's changing at home or because the hours have gotten to be too many. So include people and let's be realistic on what family caregivers can do, willing to do and what we need to pay a caregiver to come in and do. That makes a whole lot of sense. And as we're doing it, now we've decided that we are going to hire someone and bring them in. We're going to have to pay them. So tip three is understanding our financial resources. And before we start actively looking for paid caregiving support, we want to get a clear picture of what we can afford. What kind of options do we have? So we look at our financial accounts and our savings and long term care and any insurance. Policies and things like that that we've got. And we review all of these components. One of the things that we did in a podcast episode number 28 called home and community living options is we went in a lot of detail about this about the different kind of financial considerations. So there's a lot more in that podcast episode and we'll put the link to it in the show notes, but we want to understand our financial resources. We also want to make sure we're exploring all of the different kinds of benefits we have access to Medicare, Medicaid, veterans benefits. And again, we recently interviewed elder law attorneys and that's podcast episode 31 elder law attorneys. They go into great detail about what to look for and what's important. So it is very important for us to consider these. And then, as you introduced Nancy family contributions is look at all of that you have conversations with our family look at all of the different options. Is there anything that anyone in the family has the ability to contribute as we're looking at this. And it also for some people who may not be able to physically be there, a financial contribution is something that helps them feel part of caregiving support. Good point. Really important. Our caregiving journey is a marathon. It is not a sprint. When we're looking at what our costs are. Now, this is this phase of our journey. And what is important for us to also be as you introduced earlier Nancy is to be considering what costs may be coming down the road. For example, both with my, my grandmother and my dad. In the beginning we just we were sure we they were going to stay at home. My grandmother we were able to do that through the entire journey. And my dad, it became realistic toward the end. It's not possible. What I did with my husband is I planned from the very beginning that it's most likely that we're going to be in a care community. So I looked at the whole picture of what those costs could be so that I was in making investments financially in the levels of care understanding there would be others. You're not going to necessarily need to go into a care community ever or in the beginning of the journey you want to understand what the financial implications could be way before you need it. So true with my father in law. For example, he was a veteran. And so we were able to leverage VA benefits. And they come in and evaluate how much care they're willing to pay for but he was he was granted 16 hours a week. So we split that into four four hour days of care paid for by the VA. And we used an agency that we had to use an agency that the VA approved of. So, you know, it was a good way of leveraging the best financial support we could get and introducing paid caregivers into the home and giving some reprieve to my mother in law who was doing most of the care otherwise as well. Now that leads us into tip four, which is deciding whether or not you're going to use an agency or whether you're going to hire privately. Once again, won't be surprised if you choose to do a mix. I've I did a mix at my house. And so and and part of that is figuring out will some care be paid for by either Medicaid or the VA or some other long term care insurance where the contributions are going to come from may help you make that decision. Now there are benefits to an agency and their benefits to hiring privately. If you hire an agency, they'll handle the background checks. They'll handle pay paying the caregiver, the taxes, insurance, really the things that you're responsible for as a employer. If the caregiver can't come to work. They have processes for that caregiver report into them and they will schedule a backup to come to your house so they'll fill in when your caregiver can't main caregiver can't come to the to work. And then they most of them will offer some sort of specialized training for the caregiver. If if you're hiring an agency that has CNAs, most of the CNA training is actually done by the agency and their ongoing training is done by the agency. So, you know, that'll they'll take care of all the training as well. If you hire privately, it's usually less expensive as much as $10 an hour less expensive. But of course, that's not always, you know, there's you pay the price on the other side for that. I'll talk about that in just a second. You have complete control over who comes to your house, be that the good and the bad, because if they're sick and or they have an emergency, that becomes your emergency because you have to find the fill in for the caregiver. There's no backup with the as there is with the agency. You do have potentially a little more flexibility. Most agencies have a four hour minimum. Some private caregivers actually also keep that four hour minimum in their requirements. But some of them will work with you. They're looking to slide two hours into their day where they've got some open time in the morning and you might be able to get two hours a day for a few days a week instead of having to pay for four. So keep in mind, they'll they'll lead you a private caregiver will lead you down a path of what they're willing to do that might be outside of the four hours requirement. The other good thing about private caregivers is like in my father's situation, often you can find those through word of mouth. And so they're they come sort of prerecorded. There's an advantage to that, obviously. Now disadvantage is you are now the employer. So you're responsible for all the things that go with that, like figuring out what do you do about taxes already mentioned the scheduling challenges if they can't come to work. And just on the agency side, I want to mention again, I've used multiple agencies and you can't assume that the training is the same across agencies. And that is and you can't even assume that based on price. We had one agency that we used that it was clear to me that their caregivers were much less trained than another agency we used. And when I went to increase the number of hours because we needed to go to 24 seven care, the agency that had less trained caregivers actually cost more than the other agency did. So just keep in mind, you can't you got to do your homework and ask all the right questions in order to figure out what's being offered. We learned a lot of this through trial and error. Yes, there was a lot of air involved, which is why we're bringing this to you. And this leads us to tip five, which is conducting interviews to ask the questions. So you are more confident in the person or persons who you're choosing to have. And we've got kind of a list of questions. Now this is whether you're going through an agency or you're hiring private things that you want to really know about. And a big one that Nancy brought up is scheduling is we want to know what kind of schedules that they have. What's the backup and what are their minimum hours different agencies have different minimum hours and different private caregivers have different minimum hours. So all of those information pieces of information are helpful. And then what kind of insurance do they have? What kind of specialized training do they have? What kind of experience do they have with the diagnosis of our loved one? That's not necessarily a deal breaker because there are quite a few different diagnoses, but the more familiar they are around the type of diagnosis, the easier it is. And so there are some care agencies that you'll see who have specialized dementia care training. And so you can ask them, do you make sure they know what your loved one's dealing with and say, you know, do you have specialized dementia care training? Very good. We also want to understand their approach to care. And both Nancy and I have found that there is a big variance between caregivers and what they consider their approach to care. And so while it's not necessarily one is right and one is wrong, there are different approaches you may be more comfortable with also doing background checks. We want to make sure we've got those background checks. And, you know, for agencies, Sue, if you're hiring a caregiver through an agency, make sure you ask this kind of information about the specific caregiver that they're sending to your house. So there's sort of what does the agency do, which is a lot of what the question Sue just asked. What what is that? How does the agency handle these things? And then they will usually come to you with a couple of caregivers that they propose to send to your home, ask them about that caregiver specific experience training and so on. Now, let's say you're going to hire privately. Some of these steps still can't be can't be ignored. So you're going to want to evaluate the caregiver through references. Make sure you ask for at least three references and make those calls and talk to the people about the caregiver and ask for the pros about this caregiver as well as the cons about this caregiver. So that they're forced to tell you some negative things about this caregiver. You get more insight out of that than probably anything. You need to do a background check if you're hiring privately, and that can be done through online tools, typically around $50 from what I've been able to find, but worth doing. And the last thing that I want to mention is make sure it's clear, especially if you're hiring privately, that you are taking this caregiver on on a trial basis. And let me explain why. If you hire a caregiver through an agency by default, they're on a trial basis, meaning if you're not happy with the caregiver, you call the agency and say, don't send this person to my house again. You don't have to have the conversation with the person. So you're off the hook for the confrontation and the difficult conversation. If you hire someone privately and you don't like them and don't want them to come back to your house, you're the one making the call and telling them that. So the more you set expectations up front that this is a trial basis and a temporary situation, the easier that phone call is to say, I don't think it's working out. So something to keep in mind and also just make sure you're setting up that expectation because you'll feel better about the end result if you have to make that call. And don't be surprised. You're not always going to like the first, rarely, you don't like the first caregiver who walks down the hall. So, you know, this is something that's probably going to happen more than once. It's reasonable. When we've completed our research and we're now down to the finalists, if it makes sense, we want to have a final interview. And we include our care receiver. Yeah. Good chance to see how they interact with the caregiver as well as getting their opinion. But you can see both. We can see both. And you will know the reason why we say it's if it makes sense. We know our care receiver and we know whether this is going to be something that makes sense. It's something for you to intentionally consider. You've gone through how to hire a paid caregiver. Next, it's very important to have a documented care plan and a strategy for how to integrate your care receiver into that plan. We're recording specific episodes to address both of those very important areas. And as soon as we have those recordings available, we're going to put them into the show notes for this podcast episode. So let's summarize. In this episode, we talked about the process for hiring a paid caregiver, whether you're hiring them to bring them into your home or to compliment your care in a care community. We shared five tips. First, assess your care receivers needs. Secondly, determine the type and frequency of care that you need to support your loved one. Three, understand your financial resources. Four, decide whether you're going to hire through an agency or hire privately. And five, evaluate potential caregivers. Now, if you have tips on hiring caregivers, please put those out on our Facebook page or an Instagram page. We would love to hear your ideas as well. We sure do. If you like this podcast, please share it with other people. Follow us. Subscribe to it. Hiring your first paid caregiver can be an overwhelming experience, but you got this. Yes, you do because we're all on this journey together. Yes, we are.