Bringing a stranger into an elder's home is a big step and thought and consideration will go a long way in helping this big change be a success. First and foremost, the elder needs to be involved as much as possible. How would you like having someone else arrange to bring a stranger into your home?
Start by making a list of the areas in which the elder needs help, such as cleaning and meal preparation, personal care like bathing and toileting or medical attention for medications, therapy, skin care, etc. A different type of aide is needed for the different levels of care. Will they need to drive and if so will the aide need to have her own car?
Next, how much help is needed — 4 hours twice a week, every day all day, or day and night? If someone needs to be on hand for 24 hours, will they be able to sleep through the night or must someone be alert at all times?
This will determine whether you can have a live-in or if you will need shifts. A live-in is much less costly than shifts and helps to maintain a more stable situation.
Also critically important is the need to define a compatible personality that will interact well with your elder. Will the aide need to be able to keep control and be assertive, need to be tolerant of mood swings, need to play cards, or discuss current events? With the needs defined you are now ready to start your search.
There are some community resources available for home care which may meet your needs. You can call the Eldercare Locator at (800) 677-1116 to learn what public agencies are in your area and how to contact them.
However, most of these agencies are stretched to the breaking point and often will be unable to provide you with the level of care required, if they can provide any care at all.
Most areas have multiple private home health agencies available which you can find online, in the phone book and by asking for referrals. It is possible to save money by hiring someone directly, but if you have not had experience doing that, the choice can be fraught with obstacles such as medical screening, criminal background checks, payroll tax issues and more which you will have to handle yourself.
You definitely do not want to have someone come into the house without the medical and background checks being made. If you do not have that experience, I strongly recommend you use an agency.
Contact two or more different companies so that you will get more than one input about pricing, the amount of care needed, what type of aide, Home Health Aide (HHA), Certified Nursing Assistant (CNA), License Practical Nurse (LPN), etc. is required. Have them provide you a copy of their agency license, and referrals which you should call.
Revolving door
Determine whether the same person or persons will be providing the care. A revolving door of different aides is a prescription for problems.
If it is to be a live-in, will they really be there every day, or do they have obligations to a family and home? You may need two live-ins so they will they both be able to maintain a consistent schedule. If they will be driving get a copy of their driver's license and if they will be using the elder's car, make sure the insurance will cover them.
Interviewing aides from more than one agency will give a wider choice of candidates. The first person you hire, or even the second or third person may not be the right one. Don't get discouraged, the right match is out there. Do not settle for someone that does not meet all your expectations.
It is also critical that you provide adequate supervision during the start of the process. If you do not live nearby, you should get the help of a friend or relative. If there is no one, give serious consideration to getting a Geriatric Care Manager to help, at least in the beginning. Be sure to also ask your elder's opinion about the aide, but only when the aide is not present.
If you are not using a Platinum LifeLedger you will need to collect and make a copy available for the aide and the agency of all the many things they will need to know
Bringing help into the home is a big project and you will need to be prepared for these new, added responsibilities. Do the best you can - perfect is not going to happen.
---John Boden, a longtime geriatric care manager, is president of LifeLedger.com, a Web site for family caregivers.
