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He wants to live then die at his own home. Anyone using / recording w/cameras for video/ audio surveillance of activity? He has openly displayed family valuables in his home- and is vulnerable due to lack of awareness so just remove these things? Is there a comprehensive checklist for this type of home prep?
He’s 90-got moderate memory impairment, serious pain in back and knee that require freq sitting, needs meals, snacks, prep and to eat w/him, help staying organized with hearing aids, phone, checkbook, glasses, keys (he still drives!) remembering to take meds from prefilled planner, reminder for Nebulizer 4xs day, safety issues as he is on tractor and doing tasks inside/outside home and using power tools, can’t do heavier house keeping; to make him stop these activities would be a THE huge deal to him and he’d give up on life. His pain has started to effect his eagerness to do so much physical work but he lives to do work and still regularly has desire to try.
So back to ? agency vs private hire... only have access to 1 local reputable hire agency. I posted job on care.com and have Some applicants Interested but must pay to join in order to contact them plus do a lot of background checks and manage them myself. There is only a few $/ hour difference in cost-or possibly same cost. So based on that and our urgent need I will probably try agency first. But for the long term- anticipating quick uptick to a 7/24 hr situation -Any other WAYS to find locals with interest to interview? Living in Henderson Ky- Bordering Evansville Indiana- How to find the right person and determine the amount to pay an individual(s) privately? Every day is another challenging step to negotiate... just starting to learn to dance our way thru.

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Agree with most here on hiring an agency.
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I agree with all of the comments so far as to hiring an agency for all of the reasons....reliability, taxes, screening...can you imagine if you had to do this on your own during this COVID crisis? I would like to add one item.....I always thought I would keep my mother in her home until her death...I know that was her wishes. I hired a fabulous agency for 3 years who provided constant 24 hour live in care until last year when mom ended up in the hospital 3 times within a 4 month period and then a rehab nursing home who told me a week before she was going to be discharged that she was a 2 person assist and that I needed to prepare for that. I immediately sat down with the owner of the care giving agency and knew that moms next move was out of her home and to a "facility"....I never, ever thought I would send her to a facility but with her dementia, mobility issues and medical issues, but it became apparent. I looked at standard nursing homes, memory only facilities (that was a real education as she is a quiet woman, not a wanderer or verbally abusive and would have been labeled as an "easy" patient and not paid attention to) and a residential care home which doesnt take more than 8 residents at a time and the ratio is 3 patients to 1 caregiver, although there always seems to be more staff. I chose the Residential Home which is more beautiful than my home, I know all the staff, have emails and phone numbers for nurse and house manager. My concern and what I was warned if I put mom in a typical facility was the call that she would need additional care and that would be additional cost (we all know how this prolonged care giving costs are...they are $$$$)...what I was told by moms new home was that (1) this would be moms last stop, and (2) if and only if moms medical case changed and they needed additional staff just for mom they might call me to support that financially, but it would only be for a week until they would figure moms new care routine... What I didnt realize was that because this home has a schedule I receive every week (the company runs 9 homes) the interaction with the staff who are fabulous and the activities and moms other 7 "roommates" was what I didnt realize would really perk her up. In her home, she had gotten use to her wonderful caregiver and it was just mom and Flo and while Flo tried to get mom to do activities, she wouldnt. The socialization she gets at this wonderful place is what I didnt anticipate and I believe has given her a new boost of life. Mom turned 96 in March and while her dementia has progressed and she isnt very verbal she is happy and I can tell as I WHATSAPP chat her weekly and call her because the Residential Home is still in lockdown because of the virus. I look at the 3 nursing homes in MD that I looked at prior to deciding on this place, and their staff infection rates and all high and their resident rates are ridiculously high with infections and death....I probably would have lost mom during Covid because she is so quiet and mild mannered. With mom at this wonderful home, they have been proactive in all of their homes and thank goodness her home has been safe from the virus. I cant event imagine how I would have handled mom and the caregivers, even with an agency (just the maintenance of the house, groceries, etc) during Covid if she was still at home. I am thankful where mom is as I know she is safe.....the point being is that while you think keeping your loved ones at home is the best way to care for them, it may not be. I am blessed that I found a wonderful new home for mom!
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I recommend an agency - because they take care of (1) background checks, (2) references, (3) payroll taxes, and (4) liability insurance - for their employees.

If you do "private pay," you will be responsible for ALL of the above. Do you really want that responsibility?

BTW - in terms of pay, if you go through an agency, you can expect to pay at least $20 per hour in most locations. The aide is NOT getting all of that money. A chunk of it goes to the agency for their costs of doing business, such as the items I mentioned above.

Rotating caregivers is a constant problem with home health aides - be they from an agency or private pay. The best strategy to "minimize" this is to treat the aides well, such as giving them snacks/beverages when they are there, giving them a bonus on their birthday or at Christmas, etc. - and to establish a good "emotional relationship" with them while they are working for you.
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We have tried both ways with my Mom who only needs moderate help and no memory issues. The problem we had with the agency was the rotating caregivers. They do provide coverage but during the 3 months we used them, we had 3 different caregivers. We gave plenty of feedback about the type of person we were looking for and the first did not speak English, the second was allergic to her cat and the third was on her phone all day. The aides are to have a relationship to the agency but not the client. This is common among agencies. I complained but it was to no avail. We have had 3 private pay aides also but there are downsides to that too. My advice is to ask her doctor or nurse for recommendations. Most of them know the good people. Her nurse recommended the one we have now. She is wonderful. Be clear about expectations. I would also advise putting valuables away.
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Hello

IMO I would hire a caregiver from a reputable agency that’s insured and bonded, they get paid through the agency, you pay an invoice from the agency, no payroll tax or other accounting work for you to worry about.

People in Care.com are usually not insured. If they get hurt in your dad’s house/property that’s a liability issue for him..unless you chose a Caregiver from a company, it’s work for you to research background checks, driving record-if they will be driving your dad to appointments, references, Insurance/bond documents, etc.

Hourly pay depends on what’s involved to take care of your dad and what’s the going rate for your area? I know when I checked for my mom with Dementia in my city it was $30 an hour with a 20 hour a week minimum so that idea was out for me...but I also live in a major city.

Good luck stay safe!
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Thank you. She will not be excluded In discussions and in fact will benefit herself from the changes. She is not Physically or mentally healthy And is not capable of making good Or proper decisions This is care provided in his Exclusively owned home-she has her own home 30 miles away where she can retreat to at will yet our dad will continue to be cared for - in her presence or her absence.
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Caregiver, whoa! so your Dad actually is married!!!

This is a huge, HUGELY different situation than you & bro doing whatevers for a parent widow or widower living at old family home.

I’ve got to ask why oh why did you leave this not so little tidbit out of your inital post? She’s is his wife; laws prioritize spouse over kids, unless kids actually are “kids” like minors & actual dependents. Trying to sideline his wife, even if you have a DPOA, trying to cut her out of $, access or property, well she IS his wife; & she (& her kids looking out for moms behalf) can make you & your brother actions to do this quite, quite difficult.
As it should be..... your dad chose to marry her and share his home with her; she is his wife, whether she’s 20 years younger than him or 20 years younger than you.

so really what is the backstory here???
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Caregiver626 Jun 15, 2020
Dads very chronically sick wife ADMITS she is doing all she can to date but KNOWS And admits it is far from meeting his needs for meals, meds, eyes on for safety, etc. etc She States The stress of his situation and decline is causing her to be sicker. She does not have mental or emotional capacity to adapt to his changing personality and actually inflames his behavioral outbursts vs diffusing it. She did not marry a declining man who is quickly becoming a burden. This is how my father has ALWAYS acted when pressed- and it may not Ever change,And could get better or worse.
Dad has provided everything she needs to continue her life in her home city, beyond his life, but she has received over $1M in tangible assets and cash but believes he’s giving her Another 1M$ upon his death hence she returns to his home as a guest with suitcase since she left him 1 year ago and came back in this manner when the divorce attorney appt was set up a few days later. So everything in her city is all in her name too. Plus a load of cash in bank to pay her own bills but she knows $ is how my dad shows appreciation/ love in exchange. It’s never enough for her tho and he additionally pays for the next thing she can think of- phones, tires, whatever she asks for etc etc. She has all she could ever need except common sense to live within her means to make it last. She may love him but at this point I’m certain she also desperate for his demise & more $ ( so I’ve been noting, teaching her to no avail and filling her gap of Proper care with bandaids for almost 2 years) - so she stays in his house and occ takes him to hers- but he’s bored and uncomfortable there ( plus Exposed to others in this time of Covid) so bottom line is We want to make sure he is cared for and secure in the place he prefers to be while he’s capable of choosing.
His funds are in Trust and other structures For over 30 years, her name is on nothing with him except the marriage license, we know the beneficiaries, we know what’s in the Will, we know he has funds to have care in his home -where he says he wants to Live with quality and die peacefully - not from neglect or unmet needs. Personal attendant duties will benefit her Mentally and physically as well (when she’s there with him) as much as It will him and give her freedom to leave at her will yet we will know that he has attendant there at these times. She has never cooperated to tell us when she abruptly leaves him alone for days on end never sure if or when she’ll return. She has never advocated for his health care and couldn’t if she wanted to. I’ve had open discussion with her re the goal of provision for his needs at end of life per his wishes. I’ve counseled her on how to emotionally manage his deficits, I’ve stayed with dad for weeks at a time so she could be home at her doctors in her times of illness. To date she has not fully adapted or evolved with the pending Caregiving situation so I’ve told her it’s OK that she can’t, won’t, doesn’t - a reason is not important- but that my dad WILL be provided what he needs. I will be learning whether or to what extent she is going to be supportive about the changes and most importantly if she will speak positively to dad in support of this vs her past preaching to him that we - his children-are trying to take ALL control from him. We have tolerated a lot from her Attempts at division of our family and how she has used her position with dad for many many years -but I’m confident that with my being active Legal Heath Care Surrogate and brother active POA that a medical declaration would make this the sticking point- should it occur that we need to seek this sooner than later.
All dad has asked is that we be nice to her - add Tolerance- in the name of providing for his needs that she isn’t doing and having peace of mind that he’s already provided for her future in the manner he chose long ago. There is always more To say but is there Anything else Helpful to know?
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Caregiver, to come to your own best answer maybe ask yourself these questions:

- what is the impact on me (the caregiver) and my family as we attempt to honor his desire?
- how much stress and time sacrifice am I willing to make daily, on an increasingly intensifying level? (and let me gently point out that right now you cannot imagine how intense it can get because you've never done it).
- does he have enough money to fully fund his wishes? Emphasis on FULLY. Even private, in-home care can be very expensive and eventually exceed the cost of a facility.
- who is going to pay for/oversee the maintenance and repairs of his home? Are you also willing to do this in addition to his personal care?

Keep in mind that hiring a person privately may make you an employer (so you will need to check your state laws). As a small business owner, I know what the admin burden is around this. You may not click with the first hire, or they me a problem. Are you willing to spend the time and inconvenience of continually looking for the right person? Doing a background check every time? Checking references? And who will step in to sub for them when they call in sick on the morning they are supposed to work? Or when they go on vacation? If they rob him or abuse him, there is no recourse like with an agency.

Also keep in mind that there is currently a labor shortage right now. Fewer good candidates and increasing demand will drive up the price of their hourly wage.

Please understand that people spend their entire lives romanticizing aging and dying at home. Mostly it's lonely. In a facility they will get all the medical help they need and will have some social life. You will have peace of mind and your own life will remain intact. How far away from him do you live?

I do have a checklist to offer you. It is just my personal list that I created from my own experiences. Free to you as a pdf. Please PM me if you wish to have it. Many have been in your shoes, so they will also soon post many valuable thoughts and insights. I wish you all the best as you work through solutions!
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A hired caregiver definitely shouldn’t be helping with a checkbook, or ever even see it. If your dad can’t handle his finances independently, that task needs to be handled by his financial POA. With moderate dementia he shouldn’t be driving and must agree that only his caregiver drive his car, or the keys be hidden from him and only the caregiver have access to them. You’ll have to remove valuable items from the home or lock them up in an adequate safe prior to having a caregiver come in. Otherwise, my father's helper does many of the tasks you’ve mentioned. If you hire privately the rate of pay is negotiated between you and the caregiver. I found it best to be very upfront with a list of what was expected, the hours, and what my dad is like (for example, the helper wanted to know if dad was mean) We worked out pay and to all our surprise, it’s been a good experience for my dad, despite him being very resistant initially
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Caregiver626 Jun 14, 2020
Response W/ details Appreciated
Am glad to hear your private hire solution worked. Will proceed and hope for this same outcome. Great to hear It is possible. I’m legal healthcare rep and brother is POA - we are already performing these roles. But dad still has ‘say’ and we have not presented our evidence for declaring incompetency- but it’s on radar at July appt. there will likely be need for diagnostics to prove. We are in gray area til this and want his cooperation - I realize this might not occur. Complicating our situation is a spouse- 20 years younger who for many reasons-poor Personal health and with Lack of caring or mindful nature- incapable of meeting his needs when in his presence. Her own home / family is 30 miles away. She stays at his home extended periods [her pocketbook reasons unrelated to his care needs] and until recently leaves him unattended and after a year of asking continues not to inform us when she leaves or takes him with her but does nothing different and his needs go unmet. She admits to her inadequacy but will lose access to his $ if she is not in his presence. I anticipate she will and has been negatively impacting his acceptance of in home care providers even though I have assured her she will benefit from it as it will relieve her of burdens (including ones she has never Even thought of).
So 1 thing then the other- plan to openly discuss with dad for inhome Care to be started then Separately talk with the wife and determine her stance on the issue. Honest and Openly speak out concerns and expectations for her support.
Will have to proceed and see what happens - grey- black- red- Green-I expect all the colors and Must keep pushing forward in hopes for a harmonious rainbow.
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