Chapter 8

HOW DO I HIRE A HOME CARE EMPLOYEE?

You may want to explore the option of hiring a home care employee directly.

Hiring a Home Care Employee

Avenues for hiring home care aides include:

• Asking other caregivers for referrals.
• Going to senior or other employment services.
• Contacting agencies that assist displaced homemakers and others entering the job market.
• Advertising in the newspapers.

Screen home care employees carefully to ensure that they have the necessary qualifications, training, and /or temperament.

Interviewing Applicants

Your interview with a prospective home care employee should include a full discussion of the client's needs and limitations, a written copy of the job description, the home care worker's experience in caregiving, and his or her expectations.

Special Points to Consider:

• If the older person needs to be transferred from a wheelchair, make sure the aide knows how to do this safely.
• Do not try to hire someone on a 7-day-a-week basis. No employee can remain a good employee for long if they do not have time for their personal needs and interests. Additionally, aides who live in or sleep over cannot be expected to be on call 24-hours a day. If your older relative needs frequent help or supervision during the night, you should hire a second home care aide or have a family member fill in. If your older relative needs a considerable amount of help, live-in help may be available which can be less expensive than hourly or per day employees. However, keep in mind that you will be providing food and lodging, and that it may be more difficult to dismiss live-in aides, especially if they do not have alternative housing available. It also is important to ensure that the aide has their own living quarters, and that they have some free time during the day, sufficient time to sleep, and days off.

References

Have applicants fill out an employment form that includes:

• full name,
• address,
• phone number,
• date of birth,
• social security number,
• educational background,
• work history, and
• references.

Ask to see their licenses and certificates, if applicable, and personal identification including their social security card, driver's license, or photo ID.

Thoroughly check their references. Ask for the names, addresses, phone numbers, and dates of employment for previous employers, and be sure to contact them. If there are substantial time gaps in their employer references, this could indicate they have worked for people who were not satisfied with their performance. It is best to talk directly to former employers rather than accepting letters of recommendation. With the applicant's permission, conduct a criminal background check.

Job Expectations

When hiring a home care worker, it is important to list the job tasks and to ask applicants to check those they are willing to perform. You should also discuss:

• vacations,
• holidays/absences,
• lateness,
• benefits and wages, and
• the amount of notification time each of you should give if the employment is terminated.

If you work and are heavily dependent on the home care assistant, emphasize the importance of being informed as soon as possible if he/she is going to be late or absent so that you can make alternative arrangements. It is helpful to keep a list of home care agencies, other home care workers, neighbors, or family members who can provide respite care, if needed.

Be clear about:

• the employee's salary,
• when he or she will be paid
• reimbursement for money the aide may spend out of pocket.
  

Needed Information

When hiring a home care assistant, it is helpful to spend a day with him or her, so that you can go through the daily routine together. At the very least, you need to inform the home care worker, both verbally and in writing, about the older person's:

• likes and dislikes,
• special diets and restrictions,
• problems with mobility,
• illnesses and signs of an emergency,
• possible behavior problems and how best to deal with them,
• therapeutic exercises,
• medications, when they are taken, and how to reorder them,
• dentures, eye glasses, and any prosthesis.

Also provide information, verbally and in writing, about:

• how you can be contacted,
• contacts in case of an emergency,
• security precautions and keys,
• clothing,
• medical supplies-where they are kept and how they are used,
• food, cooking utensils, and serving items,
• washing and cleaning supplies and how they are used,
• light bulbs, flash lights and the location of the fuse box,
• the location and use of household appliances.

Transportation

If free or low-cost transportation is not available, try to hire someone who drives. This can save you substantial amounts of money in taxi or commercial van ride fares. If the home care employee is going to drive your family car, you must inform your insurance company and provide a copy of the aide's driver's license to your insurance agent. Your insurance company will check to see if the license has been revoked, suspended, or if the aide has an unsatisfactory driving history. If the home care assistant has a car, discuss use of their car on the job and insurance coverage.

Insurance and Payroll

Check with your insurance company about coverage for a home care employee, and contact the appropriate state and federal agencies concerning social security taxes, state and federal withholding taxes, unemployment insurance, and worker's compensation.

If you do not want to deal with these somewhat complicated salary withholdings, payroll preparation services can issue the employee's check with the necessary withholdings for a fee.

Some home care aides work as contractors. Even in these cases, you must report their earnings to the Internal Revenue Service (IRS). Before employing an aide on a contract basis, consult your financial advisor or tax preparer to make certain you are following the IRS rules that govern contract workers, because there can be a fine line between who is considered to be an employee versus a contractor.

Ensuring Security

Regardless of who cares for your elderly relative, protect your private papers and valuables by putting them in a locked file cabinet, safe deposit box, or safe.

• Make arrangements to have someone you trust pick up the mail, or have it sent to a post office box where you can pick it up.
• Check the phone bill for unauthorized calls, and, if necessary, have a block placed on 900 numbers, collect calls, and long-distance calls. You can always use a prepaid calling card for long distance calls.
• Protect checkbooks and credit cards. Never make them available to anyone you do not thoroughly trust.
• Review bank, credit card statements, and other bills at least once a month, and periodically request credit reports from a credit report company. Your bank can provide you with the names and addresses of these companies. If you do leave valuable possessions in the house, it is best to put locks on cabinets and closets and to have an inventory with photographs.

Protecting Against, Identifying, and Handling Abuse

Although abusive situations are not common, you must be alert to the possibility. They are one of the primary reasons why it is so important to carefully check the references of a prospective home care aide. You can help to prevent abuse situations by:

• Ensuring that the home care worker thoroughly understands what the position entails, your care receiver's medical problems and limitations, as well as behavior that could lead to stressful situations.
• Ensuring that the home care worker is not overburdened.
• Keeping the lines of communication fully open so you can address potential problems.
• Having a background check run. Your local Area Agency on Aging or Independent Living Center may be able to provide assistance in checking a variety of available registries.

Possible signs of abuse or neglect:

• Personality changes in your older relative or friend.
• Whimpering, crying, or refusing to talk.
• Unexplained or repeated bruises, fractures, burns, or pressure sores.
• Weight loss.
• An unkempt appearance.
• Poor personal hygiene.
• Dirty or disorganized living quarters.
• Confusion, excessive sleeping, or other signs of inappropriate sedation.

If you witness or are told by a reliable source about neglect, physical or emotional abuse, replace the home care worker as quickly as possible. Ensure that your relative is safe before confronting or dismissing the worker, especially if you are concerned about possible retaliation.

Once you have ensured your relative's safety, report the worker to Adult Protective Services at 1-800-922-5330.

Supervising a Home Care Worker

Once you have hired a home care worker, make sure the lines of communication are fully open and that both you and the worker have a clear understanding of the job responsibilities to the older person and to each other. Explain what you want done and how you would like it done. Keep in mind that the home care employee is there to care for the older person and not the rest of the family.

If the home care worker lives in, try to ensure that he or she has living quarters which provide you, the older person, and the assistant the maximum amount of privacy possible.

Once the home care aide is on the job, periodic meetings can be held to discuss any problems the home care assistant or the older person may have with the arrangement and to find ways to resolve them. It is important to be positive and open in your approach to resolving difficulties. In most cases they can be corrected. However, if, after repeated attempts, you find that major problems are not resolved satisfactorily, it may be best to terminate the relationship and seek another home care employee.