Part 3B: Can I Stay At Home?
Hire Caregivers Privately (not via an Agency)
As the need for additional help becomes apparent to loved ones, outside caregivers are often considered. Perhaps there is someone completely trustworthy who lives on the block or is a member at your church who is a good fit. Perhaps you got a great reference about a specific individual. While these finds can be ideal - even perfect - notice the common thread. Each one is the result of someone personally knowing and vouching for the caregiver - the most powerful reference possible. Whether personally known by you or by someone you know and trust, that sort of recommendation is the gold standard and may well work great.
When you start considering strangers, though, everything changes. I have personally seen cases where caregivers were hired off Craigslist. By the time we became involved there was stated concern caregivers were drugging the senior to make them more cooperative. Our jaws dropped. Adult Protective Services were next to get involved.
Elder abuse is a real and growing problem and caregivers are often the culprits. Abuse includes physical, emotional, financial, sexual, psychological and neglect. Bringing in strangers with minimal or no vetting is a recipe for disaster. Even if you are fortunate enough to find one or more great caregivers, you may still have turnover problems that create a revolving door effect that creates more problems than it solves. Caregivers have their own lives, their own health and personal issues and, no matter how conscientious, cannot possibly be available at all times.
Care communities and in-home aide companies are required by law to perform criminal background checks on all their employees (including sex offender registry), have liability insurance and require continuing education of their employees. They handle payroll, benefits and do their best to find a replacement caregiver if your normal one can't make a shift or simply is taking some time off. When you hire privately, you become responsible for all these issues and more.
Many people have hired privately and found a great caregiver but for every success story with a happy ending, there are others where things went wrong - even tragically wrong. With the right person, this option can be a God-send but that right person is a diamond in the rough, so - BEWARE - and do your homework thoroughly!
Hire Caregivers Through An Agency
Hiring fully trained professional caregivers through an agency is the option most often considered for in-home care. Like any business, there are good agencies and bad agencies and everything in between. Make sure you do your due diligence in vetting agencies. Look at on-line reviews and consult local social media platforms like Facebook and Nextdoor. Consider all the reviews with a grain of salt. We know people are far more motivated to post a review when they're angry but that doesn't make the review invalid or the angry reviewer wrong - they may have valid reasons for their anger and they may not. Be discerning. Look for specific concerns and issues and see if the cumulative effect creates something of a consensus. Do your homework!
Of course, each agency is the sum total of its caregivers and staff. Good agencies are good because they hire and retain better caregivers. Even so, there remains the possibility you get a bad caregiver so you must be vigilant until trust is established. This is particularly true for seniors with significant cognitive decline who may not be able to speak up for themselves. Trust but verify.
When you hire a professional caregiver they will be trained, insured, bonded, licensed and compensated by a company that takes care of their taxes, insurance, benefits, etc. Due to exploding demand, staffing is a present and growing problem. Even if you are blessed with phenomenal caregivers, there will be times they cannot be there due to personal issues, vacations or mundane things like car trouble or being sick. At best, that means a last minute change in caregivers. At worst, it means no caregiver.
Then there is the cost, which adds up quickly. Three hours is typically the minimum and $22-$26/hour is the going rate in most areas. 8 hours a day at $25/hour equals $200/day. That is enough to pay for many LTCCs and is a really good start for many others. Oh, and the $6000 you're spending at home is in addition to all your other costs of home ownership or renting from groceries to utilities to home repairs & maintenance. The $6000 you spend at the LTCC gets you 24/7 care, all of your meals (bought, prepared, served and cleaned up), housekeeping, utilities, social activities, entertainment and more. Hmmm.
It should be noted that what we are talking about here is Home Care or Aides - NOT Home Healthcare. Aides provide assistance for things you cannot do alone but there are limits. Help with Activities of Daily Living (ADLs) like bathing, dressing, etc. can be handled by aides. Administering medication can not - but they can offer verbal reminders. Aides can also help with Instrumental Activities of Daily Living, or IADLs, like cleaning, laundry, meals, shopping, banking and pharmacy runs with or without the senior (as his/her capabilities and desire dictate).
Home Healthcare, on the other hand, is medical professionals that are sent into your home for specific medical tasks like changing a wound dressing. These professionals don’t help with ADLs or IADLs - they are there to do specific jobs and when they are finished, they leave.
There are also out-of-home resources like Senior Centers and Senior Day Care that can be quite beneficial to both the senior, who gets socialization, entertainment, etc., and the caregiver, who gets a break while knowing their loved one is in a safe place.
Next: Dealing with objections to moving to an LTCC.