Time for home care. Can you share your advice?

Okay ... here's the run down:

I've offered care for 10+ yrs: hands-on caregiving (fr laundry to hygiene needs) to care mgmt (work w medical providers, attorneys, offering organizational mgmt, interview/hire cgvers... and much more). I'm POA / Soc Sec Payee Rep for friend now; did everything legally+otherwise (past 3-6 years) for friend, 89, whose in 2nd nursing home... requires me working w Ombudsman. regularly. My backgr includes counseling / reflective active listening (on a track to become family therapist). My skills sets are more in alignment w a social worker. I'm a certified massage practitioner.

HIRING_________________

1. Decide on finances and how much time / care needed:
- Call local agencies and ask what their hiring procedures are, i.e. do they do a criminal / fingerprint check? If not, go elsewhere. You are paying for them to do this / these background checks.
- Agency costs. Get all contracts in your name and have them sent to you.
2. If independent person, someone you trust close by will need to interview. This is essential for anyone you hire.
- If you cannot make these trips or stay for a while (1-4 weeks?), someone else needs to do. Do not allow your parents to make these decisions (by themselves).
3. People steal.
- consider cameras
- Require and check references
- Require criminal check / fingerprinting nds to be current. You or the person will have to pay (cost me around $40 twice - massage certification, vetted caregiver, and another time the agency/organization paid). so . . . 3 times.

* Get work referrals (volunteers or paid) fr college dept heads: social wk, geriatric, psychology, nursing program). Ask them to post your need.
CONSIDER________________
1. Do they need a live-in? Know this is an employee-employer situation (not just a caregiver providing care) and has many legal ramifications, i.e., Individual can sue you/r parents . . if you ask them to leave, they may not so sheriff needs to be called.
2. Do you parents have a church or networking organizations that can pitch in - volunteer or pay?
3. Is there any possibility of parents moving closer to you?
- in assisted living
- ind living facility
- Selling their home / if owned / could pay for their care in a senior community with levels of care.
INTERVIEWING____________
1. Create a form of questions to ask so you are consistent and have this organized.
2. Same with agencies. Ask for brochure, references.
3. Create a form that the caregiver to be considered - i.e., references, background, experience, how would they handle ... situation (give they a few situations and see how they would handle). FYI: many people doing this work have to - due to limited skill sets and English as a second language. They may do very well cleaning, laundry, cooking although they may not have personal care experience or much - and not know how to handle other types of needs: emotional / psychological. Even knowing when to call 911. Some wouldn't know. (Some may spend time calling their agency 'instead' and losing important minutes when a 911 call is / was necessary).
4. Provide potential caregiver a list of duties. Someone will need to go over these with the person. Write them down so everyone is clear and on the same page.
4a-Insist they DO NOT spend time (1) on their phones, computers, etc. Their attention needs to be focused on your parents / and whatever they are there to do. Even if it is talking to them. Many caregivers 'sit there' and do nothing because they can - get away with it.
5. Check in weekly or initially daily to see how things are going. Work with the hired person. They may be 'good' and need guidance and support.
NURSE_____________
They may get some of this care through Medi-Care / Medi-Cal, Medi - if diagnosed. I don't know.
- Why are you considering a nurse? what are their needs?
- The higher the professional the higher the cost.
- A nurse might be needed bi weekly to do a check-in - need to decide
Get everything in writi

strwbryblonde9: Until I could arrive from several states away to move in with and take care of my mother, I hired an LPN, who performed twelve hour overnight shifts. I do not advocate this as it was VERY difficult. The individual was a friend and actually worked pro bono for us.

strwbryblonde9, also make sure the caregivers are up-to-date on their flu and covid shots/boosters.

There are basically 2 ways to go about this.
Go through an agency.
You do not have to deal with paperwork, background checks, payroll, contracts.
Hire privately.
You do the paperwork, background checks, payroll, contracts, you fill spots when someone is off, calls at 7am when you expect them to be there at 7:30.

the cost will depend on what needs to be done.
If medications have to be given if you go through an agency they may require that you have a Nurse, or at least someone that is certified to give medications. What that requirement is may depend on the State you live in, or your parents live in.
If you hire privately you can instruct the person you have hired to give medications. There are fewer restrictions when you hire privately.

do they need overnight care?
does this need to be a 12 hour day for the caregiver? Or can they manage some morning and evening ADL's themselves? (ADL= Activities of Daily Living)

I will tell you the 2 BEST caregivers I had over the course of 4 years were 2 that had just gone through the CNA course at the Local Community College and were waiting for the next semester to start the Nursing School Program. I contacted the College and spoke with the Director of the program and she gave my info to 4 students and I ended up hiring 2 of them. Best decision I made!
I hired 2 so their class schedule could be worked around, so that they did not get burned out and if one could not come in the other could.
I was able to get my Husband up in the morning and into bed at night so I had the caregivers from 8 or 9 am until 3 or 4 pm.

While I said there are 2 ways there is a 3rd option.
Think about an Assisted Living Community that will have staff there for them and as they need more help that will be there and if there comes a time when 1 or both need Memory Care most AL's have a Memory Care unit.

My aging parents needed home care after a stint in rehab for my dad-he was very weak unstable, now had a catheter and several other medical issues. My mom could no longer take care of dad by herself. While dad was in rehab-a care planner mentioned/recommended an agency-our first time doing home care so we were unprepared for what followed once home care started.

I have many events I could describe about "care"dad received was for the most part horrific in the beginning. Caregivers doing all kinds of stuff to the catheter which caused almost weekly visits to urology to get something fixed, or checked for UTI. One care giver yelling at dad to produce a BM. Dad had memory issue so he would not have remembered this person yelling at him. Thankfully others were in the house to witness. Other person got into the checkbook and forged 3 checks for a total o $4,000. Bank could not identify the criminals due to covid and masks etc. The ring leader of the forgery was a family member of a caregiver who came to the house one day to help.....Mom refused to lock down her stuff, wallet, jewelry, check book, nick nacks. Mom was pretty demanding on how things needed to be done for dad-drove many ladies out the door never to return. Mom gave credit card to one Caregiver to get groceries-woman spent $500 on groceries for two old people and two cats. Workers smoking in the house when dad had oxygen... Agency did respond promptly and fired the workers in each case. Same agency hired a person who had a felony of abuse of an impaired person at another group home.-was in the newspaper. This information should have been on the woman's background check.... whether the agency looked that deep or decided to overlook I don't know. Lady never worked at my parents house. We looked into hiring another agency but they told us in dwelling permanent catheter was wound care due to the opening in the skin. Two groups in the same place was a nightmare-one group blaming sloppy work on the other one. Second agency would not touch the catheter-more problems with infection etc. Many times of worker deciding not to go to work today-last minute calls get someone to come who knows nothing about caring for dad and refused to read the chart and get the information she needed-bad attitude towards mom as worker is not doing it mom's way. I could not be involved very much as I was caring for my disabled sister at the same time-she had too many problems to be at home with me. After 3 years of the first agency my parents finally were in a more or less good place with regular workers for day and night shift. Some will sleep during the day and mom does not complain. Some night ladies also slept or ordered movies on the TV. Mom says some drank her wine too..... House got pretty filthy as workers were doing almost nothing to keep it clean-two cats making a lot of mess everywhere-when dad passed was a horrendous smelly mess to clean up. Mom and dad refused community care. I don't know how you can possibly get a good great group of home care on the first try.-how they look on paper is not necessarily how things will be in the home. I turn up unannounced and suddenly workers get up and get busy-mostly talking on the phone all day long.

Here's what I can tell you and I was an in-home caregiver for 25 years. I now have my own homecare business.

First question. Will insurance be paying for your parents homecare or are you going to be doing private-pay?
This makes all the difference. If it's through insurance you will probably have to go through an agency. If you do, ask to meet potential caregivers they may send in person before they hire them and you ask the questions.
If you're hiring privately you interview potential hires yourself and insist on work references that you can personally speak to on the phone in real time. Not a reference that someone wrote for them in the past or an email. On the phone having an actual conversation.
Insist on regular drug testing. The agency that does not regularly and randomly drug test their employees should not even be considered by you.
If it's going to be 24-hour care for your parents, DO NOT allow any caregiver to make your parents' house their official residence.
Always insist on more than one. Hire two who split the week.
Even though you and your brother will be helping out on weekends, hire the weekend caregiver too. It's a good idea.
Next, your parents' caregiver will not be an RN unless they are millionaires. In-home caregivers are supposed to be non-medical. Although some have like myself have special licensing from the state so they give meds and some medical care.
The level of care is based on their needs. Do they have dementia? Are they incontinent? Mobility issues? You have to be totally honest about their needs so the caregivers will know exactly what's expected of us. No one likes surprises in this line of work, and often family and agency isn't honest with the caregivers about how much care someone needs. Make sure they are.
As for securing valuables. How do you secure your own in the home? By use of a safe or strong boxes that you keep the keys to.
Allow a certain small amount of cash weekly (house money) or a credit card with a small limit for things like a take-out meal if your parents want or if the caregiver has to go to the store for them. This is a good arrangement. All other cards and checkbooks are locked up or removed. This works well.

Contact the Area Agency on Aging for the county where your parents live. Just "google" Area Agency on Aging ______ County, State. Also, for finding a home care agency go to https://eldercare.acl.gov . Another great website for information on in-home care is www.aarp.org/caregiving/home-care. They have a guide to in-home care that should be helpful.

Contact Medicare for guidance and help.

Yes to getting a fire-proof safe. Put everything small that can fit: IDs, credit/debit cards, insurance info, checkbooks, passports, investment info, titles, deeds, jewelry, prescription meds.

Make sure as many of their bills as possible are paid automatically online. Get a password keeper app. Monitor or put limits on any digital devices like mobile phones, tablets, laptops. Send their mail to a PO box or have a trusted neighbor collect and keep it for you to review.

You haven't mentioned whether your parents know this is coming or if they are resistant. Make sure you discuss with the agency and aids sent that your parents are not the ones to "fire" or send away the helpers.

Make sure you know what the laws are in their state for cameras and recording and to inform anyone you hire that they are there. Some states don't allow audio recording, some states limit where you can install them, etc.

Mostly, make sure (demand) that whoever is sent to care for them is either trained in dealing with people with cognitive/memory decline or has experience. The "training" that many agencies give people often *does not* include anything about dementia. They should know strategies to deal with "sundowning". If your parents are a fall risk, they will need to know this and will need to send someone with this higher level of training (and they have a higher hourly rate).

Don't hesitate to be "preemptive" about certain concerns, preferences, etc. As my very elderly Aunt's dementia progressed, she freely said the "n" word and used all sorts of profanity, and made hideous accusations. I knew that any aid of color or differing ethnicity would be subject to this abuse so I made sure I had this discussion in advance of being sent helpers. Also, because of her worsening hearing and comprehension I also requested aids whose English was very clear. After trying out 2 or 3 people, we finally hit the jackpot with a lovely woman from an agency who was with my Aunts for 6 years.

It will seem overwhelming at first and it will take time to get the right "fit" and rhythm. Just have tempered expectations: nothing stays the same for long. Your parents minds and bodies are in decline, so their care arrangement will probably need frequent adjusting and this is normal. Or maybe not -- everyone is different. Also, employee turnover can be high depending on where you live. Make sure you discuss the protocol if an aid calls in sick on the day they are supposed to work. This is one benefit of an agency, that they often can provide a sub at the last minute. I wish you all the best and peace in your heart!

I had a good experience w h a well known home health care place .
very professional

To hire an RN would be very expensive. Even an LPN. Usually its CNAs (Certified Nurses Aides) and HHA (Home health aides) that work in homes. They are similar in their duties but IMO a CNA is more hands on. It depends on what your parents needs are.

In my State CNA/HHAs cannot do medplanners or depense medications unless a medtech too. They cannot give shots.

strwbryblonde9, when my Dad needed caregivers at home, I called a well known caregiving Agency. Such an Agency is licensed, bonded, and insured. They also have workman's comp in case their employees should get hurt on the job, and they also deal with payroll.

The Agency sent out a Rep who interviewed Dad [and I], and I in turn interviewed her. She explained the contract. Plus if any of the caregivers were unable to make their scheduled duty, another caregiver would come in their place.

For a week the Agency would send over one caregiver, the next day a different person, same with the following day, etc. That way Dad could let me know which caregiver he felt the most comfortable with. The caregiver Dad picked was perfect. She had grown up on a farm like my Dad did, she had the same sense of humor, etc. It worked out great. Was she an RN? No, that would have been extremely expensive.

As for your parent's personal items, if your parents have a closet size safe [once called a strong-box] then put in items that are not used on a regular basis. It is not unusual for an elder to misplace something and blame the caregiver for taking it.

Let the Agency know you have a camera running, as not everyone is comfortable with that. I know I wouldn't like it for myself. My boss's wife had Alzheimer's and her long-term caregiver quit not long after the cameras were put in place.... my boss couldn't find a new caregiver that his wife would accept.

Hope you find someone that your parents really like, that's the key.

My family’s experience may differ from most in that we did not use an agency to hire my dad’s helper. We used a group, locally known in the area, of CNA’s who are mostly a bit older and burned out from their job experience in corporately owned settings. They banded together and have one lady who coordinates them. They each have a different rate, as well as differing hours and conditions they want to work with. I interviewed three of these ladies and struck gold on the third one I talked with. She had worked in nursing homes and grew frustrated because she liked to take her time in feeding residents at their pace and was told to hurry up. She had years of experience and excellent references. Her only question for me was if my dad “was mean” My dad firmly didn’t want anyone in his home, but agreed to meet her, and they worked out the terms of her working for him. She made his breakfast and lunch, prepped a dinner, took him on appointments and errands, was nearby as he showered, assisted with some steps of dressing, kept the house tidy, and did the laundry, which often involved changing the sheets. We quickly found out she did far more, she read the Bible to him, which he loved, they went to favorite places for lunch, which he loved, she really made a friend of a man that wanted nothing to do with her. We had prepped the home for her arrival by removing anything valuable, getting cash out, but in our case none of it was necessary. My sweet dad is gone now but this lady remains special to our family. One of my dad’s last requests to me was to “be good to her” I know our experience isn’t the story for everyone, I do hope you can find something similar. Often the elderly have a network where they know people who do this kind of work and it’s more reliable than agency workers, perhaps you’ll have success tapping into that.