January 6, 2013

Savvy Senior: To find in-home care, first determine needs

DEAR SAVVY SENIOR: What's the best way to find a good in-home caregiver for my elderly mother? -- Looking for Care

DEAR LOOKING: Finding a good in-home caregiver that's dependable, likeable, trustworthy and affordable can be challenging, to say the least. Here are some tips and resources that can help:

Before you start the task of looking for a caregiver, your first step is to determine the level of care your mom needs (see NCLneedsassessment.org for a checklist). If, for example, she only needs help with activities of daily living like preparing meals, doing laundry, bathing or dressing, a "homemaker" or "personal care aide" will do.

But, if she needs health-care services, there are "home health aides" that may do all the things a homemaker does, plus they also have training in administering medications, changing wound dressings and other medically related duties. Home health aides often work under a nurse's supervision.

Once you settle on a level of care, you then need to decide how many hours of assistance she'll need. For example, does your mom need someone to come in just a few mornings a week to help her cook, clean, run errands or perhaps bathe? Or does she need more continuous care that requires daily visits or a full-time aide?

After you determine her needs, there are two ways in which you can go about hiring someone: either through a home health agency, or you can hire someone directly on your own.

Hiring a certified home health agency to supply and manage your mom's care is the easiest but most expensive option of the two. Costs run anywhere from $12 to $40 an hour, depending on where you live and the qualification of the aide. This is also usually a better way to go if your mom requires a lot of in-home health care.

How it works is you pay the agency, and they handle everything including an assessment of your mom's needs, assigning appropriately trained and pre-screened staff to care for her, and finding a fill-in on days her aide cannot come.

Some of the drawbacks, however, are that you may not have much input into the selection of the caregiver, and the caregivers may change or alternate, which can cause a disruption in care and confusion.

You also need to know that while Medicare does cover some in-home health care services if it's ordered by a doctor, it doesn't cover homemaker services, nor will it cover personal care services, such as bathing and dressing, provided by a home health aide if that is the only care required. But, if your mom is low-income and qualifies for Medicaid, some services are covered.

To locate and compare Medicare-approved home health agencies visit www.medicare.gov/hhcompare, and call (800) 633-4227 and request a free copy of the "Medicare and Home Health Care" publication (#10969) that explains coverage and how to choose an agency.

Hiring an independent caregiver on your own is the other option, and it's less expensive. Costs typically range between $10 and $20 per hour. Hiring directly also gives you more control over who you hire so you can choose someone who you feel is right for your mom.

But, be aware that if you do hire someone on your own, you become the employer so there's no agency support to fall back on if a problem occurs or if the aide doesn't show up. You're also responsible for paying payroll taxes and any worker-related injuries that may happen. If you choose this option make sure you check the aide's references thoroughly, and do a criminal background check.

To find someone, ask for referrals through friends, doctor's offices or hospital discharge planners, check online job boards like craigslist.org, or try carelinx.com or carescout.com. Some states even offer registries (PHImatchingservicesmap.org) to help you locate good caregivers. Or, for a fee, a geriatric care manager (caremanager.org) can help find someone.

Send your senior questions to: Savvy Senior, P.O. Box 5443, Norman, OK 73070, or visit SavvySenior.org. Jim Miller is a contributor to the NBC "Today" show and author of "The Savvy Senior" book.

 

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