How to Choose Home Care for Elderly Parents

When the time comes that a love one needs help at home, the process of convincing them to accept help can be difficult. Most of us value our independence, and having someone come into one's home to assist with such intimate activities as bathing and dressing can be a problem.

As our population lives longer, and our aging parents have more impairments with aging, the need for professional care aides who can enable elders to stay in their homes increases. Most elders, if asked, would say that they prefer to stay at home, rather than move to a facility as they age. How do we keep them safe at home, when we must rely on others to provide help with activities of daily living?

Be aware of the risk of abuse.

Choosing a worker is taking a risk. Since elder abuse has been called "the crime of the century," it is important to be aware that with elders at home, it can be a crime of opportunity for the caregiver. Financial abuse affects millions of seniors, as most of us know. Preventing it must include a consciousness of protecting elders from those who enter the home freely and who work unsupervised for long hours.

The resistance of the aging person himself or herself is just part of the picture. Some won't let strangers inside their home. Getting past the resistance is usually the job of the family member, who may be the first to see the need. According to Erin Winter, co-owner of Hired Hands Homecare Inc., in Novato, California, "about 75% of the elders we serve don't think they need help when it is obvious to those around them that they do."

One must gently push ahead, presenting the idea that the help is needed for the peace of mind of the family member. It's the "humor me" approach. It seems to work for most, Ms. Winter reports. If the family member is able to persuade the elder to try it, and the worker is consistent, kindly and respectful of the elder, they actually may be relieved to have the help.

Weigh the costs versus the care.

Choosing a professional is a different challenge. Many people, worried about the ongoing expense of having help at home seek helpers through the newspaper or general internet advertising. Invariably, it is cheaper to go this route than to use a home care agency to find a worker. However, the family should consider the risk and added expense of background checks, drug testing and liability.

If the statistics on identity theft and financial elder abuse are not enough to convince the consumer to use an agency, consider the economic times. Desperate people, even those whom you think you know, can do desperate things. The temptation to take money, valuables, or misuse a credit card can be overwhelming for a worker whose spouse has lost a job, or who feels economic pressure. A licensed agency offers several layers of protection for the consumer.

First, the agency doing its job properly will do a thorough background check of every worker. This should include a national criminal records search. Next, the agency should be insured, bonded, and licensed. If a worker steals, at least there is a remedy.

Hiring an independent aide could pose extended liabilities. Homeowner's insurance may or may not cover a loss due to theft. The deductible may be too high to make it worth making a claim. Identity theft would likely not be covered by such a policy.

Do your research.

Finally, a quality agency providing home care professionals will screen for suitability for the job, perform drug testing, and will train and supervise its workers. It will also replace them if one leaves suddenly.

Hiring an independent individual may not offer the resources necessary to replace the worker as quickly as an agency can. Not all agencies are alike. Do your research on potential agencies. Longevity in the field is a good sign. With the increase in need, new agencies are springing up rapidly to meet it, making it harder for the consumer to check on past performance of the agency.

Doing your own background checking is essential if the agency only conducts a statewide check. Ask about the training and supervision of caregivers. Not all agencies provide this. Some use certified nursing assistants, and some do not. The extra cost of using established employer-model agencies is well worth the security they can provide to keep elders safe.

Those agencies which place independent contractors only are out of the picture to monitor quality or to supervise the workers, once they are placed and the placement fee is collected. It is certainly much simpler for the agency to keep only independent contractors as workers, but is more risky for the recipient of services. In many instances, reliance on an elder's ability to monitor care, especially when the elder has cognitive impairment, does not make sense.

What's the lesson?

Follow these tips, and enhance your chances of safely using a professional to help an aging loved one stay at home. 

  1. Accept an aging loved one's resistance to help at home, and keep respectfully urging when you see the them resisting. 
  2. Use an established, employer-model home care agency to find a qualified caregiver for an aging loved one. 
  3. Do your research on the agencies you are considering. A supervised worker is safer for an elder.
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