As our parents or other loved ones and family members grow older, they may start to need a level of care which is beyond what we can offer. This can lead to significant challenges and stress for all concerned. Engaging a professional at home health aide is a way to remove some of these stresses and make sure that your loved one gets the best care possible, but it can be difficult to know how to choose the best care agency for your needs. Below we list some of the aspects that must be considered when choosing home health care for your loved one. 

Skilled or non-skilled home health aides?

It’s important to know the difference between skilled and non-skilled homecare. Skilled home health aides provide specific medical care such as supervising medications, replacing dressings and so forth; non-skilled (a.k.a. custodial) care looks after everyday non-medical-specific issues such as bathing, preparing meals, cleaning, and offering companionship. 

Custodial care

Custodial care is not specifically medical but is frequently brought in on the recommendation of a physician. Custodial care involves home aides who address matters that are not directly medical but are related to the well-being of the individual. Frequently these matters are split into three categories, personal needs, household needs, and emotional needs. 

Personal needs include any daily activity with which the individual may require assistance, e.g., dressing, grooming, bathing, and making sure medication is taken on time. 

Household care refers to general household duties which the individual may not be able to address themselves any longer, such as cleaning, preparing meals, yardwork, collecting mail, and household administration. 

Emotional care involves more nebulous caregiving concepts related to the individual’s happiness in general. Research has shown that nearly 9 out of 10 caregivers provide their patients with emotional support. Home care providers can give emotional support to individuals simply by talking to them and sitting with them. 

Skilled care

Skilled care is provided by medical professionals with the requisite training or licensing. An individual may need skilled care if they require continuous medical treatment, intravenous injections, catheter changing, physical therapy, wound dressing, and help taking medication, amongst many others. As you would expect, hiring a caregiver of this type is more expensive than custodial care. 

Agencies vs Private Hire

If you need to engage skilled care, your options are either to go to a care agency or to hire an independent caregiver. Both courses have advantages and disadvantages. Which path you choose will depend on your loved one’s needs and the types of healthcare available in your area. 

Advantages of agency hires

Screening: agencies make extremely thorough checks on their employees, meaning that you can be highly confident that you have a suitably qualified and capable home health aide. Agencies carry out checks on employee references and background, ratify all their qualifications and confirm their citizenship, things that it is difficult to achieve as an individual 

Qualifications: agencies provide you with a substantial number of individuals from which to make your pick, and it is obviously in their best interest to provide the best possible staff. Some agencies help their employees to acquire further qualifications and guarantee that they will make good any damages arising from misconduct by any employee. 

Needs assessments: many agencies will have meetings with the individual requiring care and assess the services they need free of charge. 

Easy substitutions: agencies will always have another worker on hand to fulfil your needs if your primary caregiver moves on, is sick, or you feel they simply aren’t suited to your needs. It is also easy to find temporary home health aides from an agency, for example if you need cover for a couple of weeks so you can go on vacation. 

Disadvantages of agency hires

Price: agencies generally cost 20%-30% more than an independent caregiver per hour. 

Hourly minimums: many agencies have a minimum number of hours for which you must engage their services, typically three- or four-hour minimum shifts or twenty hours minimum total per week. This can be difficult if you are on a tight budget, particularly if the patient only needs a few hours care per week. 

Benefits of private hire

Cost: as above, private hire is often up to 30% cheaper per hour than an agency hire and with no minimum shift or weekly requirement you only pay for what you need. 

Customized care: in independent hire situations the customer is the employer, meaning that you can select exactly who you want as a caregiver and mandate exactly what services they should provide. 

Disadvantages of private hire

Time consuming: one of the things you pay an agency for is to take the recruitment process out of your hands; with private hires, it could take a considerable amount of time for you to find the right candidate. 

Additional responsibility: there are a considerable number of additional costs with private hires because you are their employer. You may have to pay for background checks, drug screening, etc., sort out their payroll, taxes, Social Security etc., and meet the cost of any injury or illness the caregiver incurs while working for you. 

No backup: if your chosen private hire caregiver falls ill or takes a vacation, either you have to take on the burden of care yourself or go through the time-consuming process of finding a suitable replacement. 

Finding the right home health care agency

While agencies are the simplest way of finding a home health aide, they vary in quality, the types of service they provide, and their regulations. One of the best ways of finding the right agency for you is to ask trusted members of your loved one’s medical providers who they would recommend. State/local health departments, social services, and aid agencies  should be able to provide you with a full listing of local agencies. Don’t neglect the expertise of your neighbors, friends, and family, many of whom will have experience of engaging healthcare staff from agencies. 

What to ask

Once you’ve got a short list of agencies, you should start interviewing them. When you visit, or they visit you, make sure you have prepared the questions you want to ask. Apart from any questions specific to the individual involved, the following questions should be helpful: 

• Can I have a written cost breakdown? 
• Is there any time you can’t provide caregivers (holidays, weekends, etc.)? 
• Can I have a breakdown of your services and any options that incur additional costs? 
• Do your caregivers have bonds through your agency (i.e., insurance against theft and losses)? 
• Does your agency have certification from Medicare/Medicaid? 
• How do you resolve any difficulties with clients? Will you supply a substitute home health aide if we don’t think the one offered is suitable? 
• Do you provide your caregivers with continuous training? 
• Can I see your standards for quality of care? 
• What are your screening processes for employees? 
• Does your agency have state licensing? Can you show me references or testimonials? 

Selecting your home health aide

Once you have selected your agency, or decided to go down the independent caregiver route, you need to choose your specific caregiver. Obviously, you want someone with expertise in all the tasks they will have to cover. However, you also want someone who will get on with your loved one and that they will be happy to have around. Some of the qualities you should look for are enthusiasm, experience, honesty, resourcefulness, attentiveness, dependability, education/training, a sense of humor, and compassion. A good caregiver should be dependable, patient, attentive, and resilient and devoted to supporting the person they have been employed to care for. 

When you interview a caregiver, these are some of the questions you might want to ask them: 

• What do you find enjoyable/satisfying about working around seniors? 
• What specialized training do you have? 
• What experience do you have of the specific needs of my loved one? 
• What do you find the greatest challenges of your work? 
• Tell me how you would cope if… (give examples of something that is likely to happen or has happened before with your loved one) 
• If all goes well, how long do you think your employment with us would last? 
• Tell me how you would deal with any problems that arise personally between you and my loved one? 
• Tell me what you have to offer in this position? 

Once you have found the right caregiver for you, make sure that you undertake a thorough investigation into their references and credentials. Agencies will do this, but you should doublecheck and triplecheck: sadly, there are many criminals who make a living masquerading as caring professionals with the intention of defrauding and stealing from those who employ them. It’s particularly useful to check references from previous employers and, if they are local, getting in touch with them and asking if you can talk about how satisfied they were with the caregiver’s services. 

Every caregiving agency is obliged to have full insurance, and any independent health caregiver should consider taking insurance out too. Visit this page for a full explanation of the types of insurance available and what it will cost.