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6 Questions to Ask Before Hiring an In-Home Caregiver

Northwestern MutualVoice Contributor •  October 21, 2014 | Home and Family

By Sonya Stinson

When you’re helping Mom or Dad choose hired caregivers—the people who will become a part of their household and an intimate part of their lives—the last thing you want to do is rush the decision.

Picking the right caregiver takes time, something most of us have precious little of—especially the so-called “sandwich generation,” working adults in their 40s and 50s who have both aging parents and dependent kids.

Yet, the right caregiver can help ease some of the pressure you feel to ensure your parent is well-taken care of. To get a head start on the decision-making process, here’s a list of questions to guide you in evaluating your options.

1. Is home care the best solution for your loved one? Before you start getting referrals and dialing up agencies, this is the first question that must be asked and answered, says Barbara McVicker, elder care expert, national speaker, author of, “Stuck in the Middle: Shared Stories and Tips on Caring for Mom and Dad,” and host of a PBS special on the same topic.

“Many times Mom or Dad will say, ‘I don’t want to leave my house,’” McVicker says. “But that isn’t always the best decision in terms of their health, their socialization or their safety.”

Some people fare better in a retirement community than aging in place. They may need more social interaction to thrive, or have medical conditions that require round-the-clock access to skilled nursing care. And when that’s the case, it may be wise to consider moving them while they are still cognitively able to adjust to a new living situation, she advises.

2. What type of assistance do you need? If your loved one and your family have determined that home care is the most desirable and workable option, it’s time to figure out what kind of help you want to hire.

Working with Home Health Aides, an article on the United Hospital Fund’s Next Step in Care website, includes a useful summary of the range of services available. Home health aides and personal care attendants provide assistance with activities such as bathing, walking, dressing, shopping and preparing meals. In addition, home health aides may perform health-related tasks such as checking blood pressure or changing a dry dressing.

When looking for an in-home aide, “You need to be very exact about your expectations of what the care is going to look like and the tasks that the caregiver will be doing,” McVicker says.

3. What kind of screening and training has the caregiver undergone? State laws vary on how home health aides and personal care attendants are defined, as well as the training and credentials required of each type of caregiver. At the very least, make sure the agency or individual caregiver you’re considering is licensed, bonded and insured, McVicker urges.

Another article on the Next Step in Care site suggests asking whether aides have received special training to handle your family member’s particular medical condition, such as dementia, paralysis or stroke. It also recommends inquiring about criminal background checks and drug testing of the agency’s employees.

Even the caregiver’s driving record should be investigated if that person will be transporting your loved one to the doctor’s office and grocery store, McVicker says.

4. What is the cost, and how will the bills be paid? “Be certain to understand the whole payment package,” McVicker advises. For example, does the agency tack on extra charges for billing, taxes and worker’s compensation or include them in a single fee for services? Some agencies will send you a bill that includes the hourly rate for services plus additional itemized charges for taxes and administrative costs. Other agencies will simply charge you an hourly amount that encompasses all costs.

Neither Medicare nor most supplemental plans will cover personal care. Medicaid programs run at the state level pay for a varying range of home-based personal care services.

You need to do a clear-eyed assessment of the total costs you’re about to incur and the resources you have on hand to pay for them.

5. What are the agency’s rules of operation? Some agencies require you to book a minimum of hours per week. Some provide services 24/7; others go off-the-clock in the early evening.

Find out the agency’s cancellation policy and what backup procedure it has in place if the caregiver doesn’t show. On a similar note, ask how many caregivers will be assigned to your loved one. McVicker believes two is the ideal number; more than that might create a confusing lack of continuity, but having only one aide available could lead to a gap in care, she said.

6. Does the care recipient like and approve of the caregiver? Unless the answer to this question is ‘yes,’ the arrangement is bound to fail, no matter how good your intentions. McVicker recounts the story of an audience member at one of her speeches who shared her experience in trying to find a helper for her aging father.

“She realized later that one of the reasons Dad was having a hard time adjusting was that he really would have appreciated having a male caregiver instead of a female,” McVicker says.

To the extent that they are able, Mom and Dad should have a say in choosing their own caregivers, just as you would want if you were in their place.

Asking the right questions—of the provider, your parent and yourself—is the first step toward finding the person best suited to help care for your aging loved one.

Additional Information from Northwestern Mutual:

Sonya Stinson is a writer for print and web publications, businesses and nonprofit organizations. She writes about higher education, careers, small business, retirement and personal finance.

This article originally appeared on Northwestern Mutual Voice on Forbes.com.

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