Help With in-Home Care for Someone With Alzheimer’s

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

If your loved one lives at home, you may want to hire someone to help you care for them. There are two main types of in-home care services: home health care and general in-home care.

Home health care is for people who need a nurse or other health care professional. They might need after-hospital care, help with their medicines, or physical therapy. These services may be covered by Medicare, Medicaid, or private insurance, at least in part.

In-home care is for people who need help to do things like take a bath, dress, make their meals, and help keep them safe. They also might do household chores or shopping. In general, these services aren’t provided by nurses and aren’t covered by insurance.

In-home care can be provided by a certified nursing assistant (CNA), home health aide (HHA), or personal companion. Although they often do many of the same roles, their level of training and experience could be very different.

CNAs must have more education, so under the supervision of a nurse, they can often do things like give medicines or change a wound dressing. In some states, home health aides are also trained to do these kinds of tasks.

Finding the Right In-Home Caregiver

When you decide to hire an in-home aide, think about what you’d like them to do:

  • Do they need to help your loved one bathe, dress, eat, and use the toilet?
  • Will they give medicine and check their vital signs?
  • Are they responsible for household chores?
  • Will they drive your loved one where they need to go?
  • Do you want them to spend time with your loved one and be a companion to them?

Talk about these needs with anyone you interview for the position.

Also, think about what your loved one would like. For example, would they prefer a male or female, or do they have any language preferences?

Next, you’ll need to decide whether to use an agency or to hire an individual directly.

Going Through an Agency

Advantages

  • You’ll have a large number of caregivers to choose from. If one doesn’t work out, you can try a different one.
  • If your caregiver is sick or has an emergency, the agency will send a backup.
  • Agencies often take care of the caregiver’s taxes and liability insurance.
  • Agency caregivers are bonded and insured.
  • Agency caregivers are often trained in things like CPR and first aid.
  • Agencies often have a nurse to supervise the caregivers and check in on the client from time to time.
  • If you have an issue with your caregiver, the agency can help resolve it.

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Disadvantages

  • Agencies are often more expensive than if you hire someone privately.
  • You may have less of a say about who’s assigned to your family.

Questions to Ask

  • Is your agency licensed? (This is required in some states.)
  • Are your caregivers bonded and insured?
  • How do you do background checks? Do you check driving records?
  • What are the educational requirements of your caregivers?
  • Are your caregivers screened for contagious diseases?
  • Will you take care of all payroll paperwork?
  • What is the turnover rate of your caregivers?
  • Can we interview potential caregivers? Do we have input on who is assigned to our family?
  • Will we have the same caregiver for each visit?
  • What are the policies if our caregiver can’t make it? Will you provide a substitute? Is there an extra cost for that?
  • How do you supervise caregivers? Will a nurse make supervision home visits? How often?
  • What are the service agreement terms?
  • What if I have a complaint about a caregiver? How does the agency handle conflict?
  • Can I have some references for your agency and for the caregiver we’re assigned?

Individual Caregivers

If you hire an individual, it’s a good idea to do a background check before they start. If they’ll drive your loved one, check their driver’s record.

Advantages

  • You may be able to find someone who is recommended or who you know will be a good fit for your family.
  • You know who will come to your home each time.
  • It’s usually less expensive than an agency.

Disadvantages

  • You may be responsible for costs if the caregiver is injured on the job.
  • In most cases, you’ll be responsible for the caregiver’s taxes and benefits. It’s a good idea to check with an accountant to know your responsibilities.
  • If the caregiver is sick, on vacation, or has an emergency, there’s no one to replace them.
  • If problems or conflicts arise, you’ll have to deal with them directly.

Questions to Ask

  • What’s your experience? Have you ever cared for someone with dementia?
  • Why did you become a home caregiver?
  • What is your training? Do you know CPR and first aid?
  • Can you work with someone who’s anxious or agitated?
  • What times and days are you available? How many hours do you want to work?
  • What are your holiday or time-off needs?
  • What are your salary needs?
  • Can you drive my loved one on needed trips, like to doctor’s appointments or to get their hair done?
  • Do you have personal injury insurance?
  • Are you bonded?
  • Will you sign a care plan and a contract?
  • Is there anything I need to know for the background check?
  • May I have some references?

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Find the Right Match

Whether you work with an agency or directly with an individual, you’ll want to take certain steps to make sure they’re the right match. Talk with at least two references about their job performance. These should be families who’ve hired them.

Take the time to interview potential caregivers, and see how they interact with your loved one:

  • Do they seem patient?
  • Do they understand their needs?
  • Do they have experience with the care needed for someone with dementia?
  • Do they have a common background or common interests with your loved one?

See if the caregiver will agree to a trial run for a week or two before you sign an extended agreement.

Once they’re hired, have written expectations and duties from the start. Include things they shouldn’t do, like be late, smoke, bring children to work, or use their personal cell phone for non-emergencies. If you’ve hired through an agency, make sure you have input into the care plan. If you’ve hired an individual, make sure to sign a formal contract.

After They Start

Spend some time with the caregiver to train them. Give them notes about your loved one’s habits, likes, and dislikes. Let them know what calms your loved one. Set regular times for you to meet with them to discuss problems, concerns, and what has gone well. If they do a good job, tell them so.

If the Situation Doesn’t Work Out

Talk to the caregiver directly about the problem. Be calm and respectful. Come up with a plan to resolve the issue. If this doesn’t work, and you’ve hired through an agency, talk to their supervisor. If the issue doesn’t get better and it’s important, don’t be afraid to let them go.

If You Suspect Abuse, Neglect, or Stealing

While it’s not common, there are some caregivers who take advantage of families. They may mistreat or neglect their clients. If your loved one’s in immediate danger, call 911 or the police. If you see or suspect abuse or neglect, but they’re not in immediate danger, call Adult Protective Services in your area.

If you don’t have evidence, talk with your caregiver calmly about your concerns. There may be an explanation, so don’t accuse them. If you’ve hired through an agency, talk with them about it. Keep an eye on things, and don’t be afraid to trust your instincts, even if it means you have to find a new caregiver.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Melinda Ratini, DO, MS on August 10, 2018

Sources

SOURCES:

Alzheimer’s Association: “Living with Alzheimer’s for Caregivers: Tips for Middle-Stage Caregivers.”

Caring.com: “Hiring the Right In-home Caregiver or In-home Nurse.”

Eldercare Locator: “Home Health Services.”

Family Caregiver Alliance: “Hiring In-Home Help.”

HomeCare & Hospice: “How Do I Select the Right Home Care Provider?”

National Center on Elder Abuse: “Frequently Asked Questions.”

New York Times: “Home Health Care: Shouldn’t It Be Work Worth Doing?”

PBS News Hour: “How to Hire In-Home Help When Your Aging Parents Don’t Want to Move.”

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