Deciding Between Hiring a Private Caregiver and Hiring and Agency
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As a Geriatric Care Manager, I am often asked about whether to hire a private caregiver or go through an agency. The question is so prevalent that a colleague and I wrote a book about the subject titled, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home. Our story is personal and professional and takes us both on a journey of the pros and cons of hiring a private caregiver (without going through a home care agency). Now I’d like to take you through some of those pros and cons so you can make an informed decision about the type of care you'd like for yourself or a loved one.

What Are The Risks of Hiring a Private Caregiver and The Benefits of a Home Care Agency?

Senior thinking

Let’s take a closer look at what is involved in hiring a caregiver. Hiring private caregivers can be a full-time job and knowing the risks and responsibilities of hiring a caregiver will help protect you.

Background Checks

When hiring privately, you will need to do the checks yourself. It can be tempting to skip this step. Don’t. The situation below may seem unusual, but sadly it is not. This happens more than you would think.

Example: A family member who has a privately hired caregiver accuses the caregiver of theft. Upon further investigation you find out that this caregiver has a criminal history. But the damage is done. Valuable jewelry is missing and now you have to hire an attorney to prosecute.

How can an agency help? An agency will perform background checks and references on employees prior to hiring. Some agencies also require drug testing. This ensures you’re bringing a thoroughly vetted caregiver into your home.

Payroll Taxes, Minimum Wage, and Overtime

Paying a caregiver

How will your caregivers be paid? If you are handling payroll, then you will need to consider what taxes need to be withheld. This includes social security. You may decide to hire caregivers as independent contractors. This means that they have the responsibility to report income, but it is your responsibility to know what the minimum hourly wage is and overtime pay.

Bottom line: Know the current tax laws on hiring workers.

How can an agency help? Payroll, taxes, and overtime pay are handled by the agency. Agencies comply with state and federal regulations with regard to employment practices.

Liability Insurance

What do you do in the case of fraud, theft, abuse or exploitation? Talk to your insurance agent about additional protection in the event of illegal actions or accusations. There are real risks to seniors and/or their caregivers that can include the following types of abuse or neglect:

  1. Physical
  2. Sexual
  3. Emotional
  4. Medical
  5. Financial

Example: Your father with dementia is being cared for by a caregiver you have hired privately. The caregiver comes to you and accuses your father of making sexual advances towards her. She threatens to sue. You have no way to independently verify what happened.

Our example above speaks to the issue of caregiver misconduct. But what if the care provider makes accusations against the person they are caring for? What if they have an accident on the job and demand that you as the employer pay medical bills?

How can an agency help? Accusations of abuse, exploitation, or neglect are handled by the agency. Complaints can come from the client being served or the caregiver themselves. It can take some time and effort to sort out the truth but a good agency will take complaints seriously.

Example: Your mother who has dementia claims that the agency caregiver has stolen her credit card. The agency responds immediately by investigating the allegation. The caregiver was carefully vetted by the agency by undergoing criminal background checks and drug testing. The caregiver denies that she took the credit card. A few days later, the hired house cleaner finds the credit card in between the cushions of the couch.

Work Experience and Responsibilities

Resume and experience

Checking references is critical to making decisions about whether to hire a caregiver. Verifying experience of caregivers is also your responsibility. States each have their own rules about what a caregiver can and can’t do. For example, some states allow a caregiver to dispense medications while others do not. This is just one example of the myriad of tasks that can or can’t be performed according to state regulations.

How can an agency help? An agency will check caregiver references and verify the experience they say they have. An agency is also required to be compliant with state regulations regarding tasks a caregiver is allowed to do.

Scheduling and Care Plan Creation

Deciding

Many people underestimate the time and stress of managing privately hired caregivers. How do caregivers know what their responsibilities are? How do you give feedback to your caregiver? That call in the middle of the night from a caregiver who is calling in sick the next day comes to you. How do you replace a caregiver who is essential to the care of your spouse or family member? Are you or another family member prepared to cover that shift if there is no backup?

Consider these possible scenarios:

  1. A caregiver does not show up for a shift
  2. A caregiver quits without notice
  3. A caregiver requests a schedule change
  4. A caregiver complains about tasks

Example: Your mother requires help every day with getting up and dressed, going to the toilet and bathing. The caregiver that you have hired calls you when you are taking your kids to school on your way to work. She says she is ill and can’t make her shift. You are in a panic because you have no back up and you have to be at work.

How can an agency help? A home care company will do all scheduling and will replace a caregiver in the event of a missed shift. That middle of the night call will not come to you. It is the agency’s responsibility to replace caregivers and to make any necessary schedule changes. You can also let them know if you need to update your care plan or give feedback to your caregiver.

Example: You are just sitting down to dinner when you get a call from the home care agency saying that your father’s caregiver can’t make her shift. Since your father has multiple care needs including meal preparation and help getting to bed, you are understandably alarmed. The agency assures you that they have another care provider ready to go who has already reviewed your father’s care plan. She will be at your father’s in 15 minutes to get dinner started for him.

How Hiring Private Caregivers Benefits Aging Loved Ones

Caregiver with senior

Hiring private caregivers for an aging loved one can be the difference between aging at home and long-term institutionalized care. During a medical crisis, caregivers can be the stabilizing force that helps someone recover sufficiently to stay at home. Other benefits:

  1. Monitoring physical therapy exercises and encouraging movement. When people are home alone, it is often difficult to remember to move. A caregiver can give encouragement to someone to do their physical therapy exercises. This can decrease the likelihood of decline.
  2. Socialization and stimulation. Loneliness is now recognized as being a significant health threat. It leads to worse medical outcomes and increasing depression. Private duty aides can do a wide variety of activities with someone. There are great brain games for seniors, outings to cultural events, the senior center and just about anything else you can think of.
  3. Nutrition and hydration. Nutrition and hydration are very important determinants of overall health. Declining health leads to an inability to shop and cook. Hiring a caregiver to perform these tasks can take the pressure off of family members, and ensure proper, healthy nutrition.

Dehydration is a serious problem for older people. It can lead to emergency room visits and hospitalizations. A personal caregiver can give hydration reminders throughout the day to decrease the risk of dehydration.

  1. Medication reminders. Medication mismanagement is another potentially serious concern for older adults. Every state has different rules about what a caregiver can do with regard to medications. At the very least, a private caregiver can give medication reminders, which can be a huge help in keeping people on track.
  2. Help with activities of daily living. This includes help with bathing, dressing, transferring and getting to the bathroom. Assistance from a caregiver can help a family member stay home safely.
  3. Relief from family caregiving. Family caregiving is a noble and compassionate endeavor. But the reality is that there are consequences to caregiving. Most notably, loss of income, difficulty reentering the workforce, and stress. Hiring a caregiver from an agency can provide much needed relief from the daily stress and strain of family caregiving.

If you make the decision to hire a private caregiver, tread carefully and be fully prepared for what is involved. Plan ahead, if possible, for caregiving needs before a crisis occurs. Making decisions under duress can lead to poor judgment, so be flexible and willing to adapt as the journey continues!

About the Author(s)

Amanda Lambert is the owner and president of Lambert Care Management, LLC which provides care management for older and disabled adults. She is the co-author of, Aging with Care: Your Guide to Hiring and Managing Caregivers at Home (Rowman and Littlefield, 2018). She has worked for over 20 years in the senior-related industry including mental health, marketing and guardianship. She has a passion for topics related to health, wellness and resilience as we age.

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