"I should be able to do this," you think, as you try to fit your caregiving responsibilities into your everyday life. Or your loved who has an independent spirit is reluctant to allow someone else to step in, although you worry about them.
Hiring someone to help can be one of the most important decisions you make. So how can you make that choice easier?
What Is Home Care?
There are two basic types. In-home care services cover general daily activities and support, such as cooking, cleaning, helping your loved one dress, or just keeping them company. Home health care services, on the other hand, can offer a variety of medical services, from nursing duties to giving medication to physical therapy.
You'll usually have to come up with the money to pay for either, but there are two exceptions.
The first is when your loved one is in the hospital. If the doctor writes them a prescription for in-home help for after they leave, insurance may cover certain types of care. "I'm always trying to remind people to think about it while they're at the hospital," says John Schall, chief executive officer of the Caregiver Action Network (CAN). "Once you get home and realize, 'Oh gosh, we can't manage this,' Medicare is not going to cover it."
The second situation is long-term care insurance that provides some amount of money for in-home care as part of the plan.
When You Should Think About It
Consider your loved one's needs. Maybe your parent, who used to have someone to look in on them, now needs around-the-clock supervision. Or your spouse, who's recovering from an accident, can't bathe on their own or take care of their wound -- and you can't handle it either.
If it's difficult to leave them alone for any stretch of time, it's a good bet that you could use some help.
Take a hard look at the house. Are dishes and mail piling up? Are the bathrooms dirty? Does the lawn need mowing? Is the pile of laundry starting to scare you? When neither you nor your loved one can keep up with the day-to-day housework, it's probably time to bring in another set of hands.
Consider your needs, too. Your mental and physical health are just as important, but it's something that family caregivers often overlook. You shouldn't have to struggle to take a break or manage the situation yourself.
"Many times, people feel like, 'Well, I can do all this,'" says Amy Goyer, AARP's family and caregiving expert. "And then they don't recognize the signs of burnout. They don't realize how stressed they are. They're not taking care of themselves."
For AJ Saleem, 29, the turning point came when his mother injured herself trying to care for his father, who has supra-nuclear palsy. "My mother went to lift my father, and she herniated her disc," he says. "We always thought of the idea to hire in-home help but never made a solid step toward it."
He admits, "We were slowly losing our sanity and becoming bitter toward each other. After hiring in-home help, the atmosphere calmed down."
How to Choose a Provider
Figure out the type of help you want: Do you need someone who can clean the house and make some meals, or are you looking for wound care and IV management? Once you've pinpointed what you need day to day, you can start looking for someone who offers those services.
Using an agency to find providers has its advantages. They'll handle the vetting and training of employees, as well as their taxes, worker's compensation insurance, and other benefits. You'll also have the ability to find quick back-up care if your provider gets sick.
That said, you won't be able to choose the caregiver yourself, and some agencies send a rotating cast of employees. You'll also pay more than you would for an individual caregiver.
Before you hire an agency, request the fee schedule. There may be hourly rates, daily rates, and even 24-hour-care rates. Ask how they train their employees, and whether they do background checks. How do they handle complaints or issues of poor service?
"I like to ask how much they pay their workers," Goyer says. "Some of the services that pay workers poorly, I get workers who aren't very happy, who aren't well trained, who aren't as dedicated."
If you're hiring an individual, you'll want to do your own background check and get at least three references. Find out about their job history and the training that qualifies them to be a caregiver.
Be very clear about what you expect them to do. Write up a job description or make a checklist so there's no confusion.
It's a good idea to meet them first, one-on-one, and then to bring them to your loved one's home and see how they interact. "Pay attention to how professional they are," Goyer says. "That really speaks to a person who takes this seriously."
Don't Cut Corners
It can be unsettling to think about a stranger in your living space, or your loved one's. That's why it's important to do the legwork up front.
It's generally safe, but, "There's no question that there are some bad actors out there," Schall says. "That's still not common, but it is an issue to be concerned about."
Your best defense is to make sure that the agency you use takes care in its hiring -- and that it's bonded and insured. With an individual, do your due diligence and trust your gut.