A Step-by-Step Guide to Hiring an In-Home Caregiver

Dr. Brindusa Vanta is a health care professional, researcher, and an experienced medical writer (2000+ articles published online and several medical ebooks). She received her MD degree from “Iuliu Hatieganu” University of Medicine, Romania, and her HD diploma from OCHM – Toronto, Canada.

As the baby boomer generation ages, most are expressing their desire to age in place and live independently. For many, the thought of leaving their home and the familiarity of their communities for residential care facilities is daunting. But they’re also worried about the risks to their safety, such as falling, that come with independent living, especially those with mobility or health issues.

If this sounds familiar, you may find that in-home care is the solution because it provides similar services to those delivered in residential care facilities. While it’s a great option, it’s important to choose the right caregiver because they will have almost total access to your home. They might see sensitive information and will certainly be in daily contact with your personal belongings. It’s therefore crucial you diligently research in-home care providers so you can be as sure as possible you’ve hired a reputable agency with trained and vetted caregivers.

This guide defines what in-home care involves and its benefits. It also compares in-home care to home health care, a similar but not identical option for seniors living independently. The guide takes you step-by-step through the process of hiring a caregiver. It covers tasks such as assessing your or your loved one’s needs, comparing competing agencies and interviewing candidates.

What Is In-Home Care?

In-home care is a type of supportive service provided to seniors and people with disabilities in their own homes. The aim is to help them maintain their independence and quality of life while receiving assistance with activities of daily living. About 88% of seniors between the ages of 50 and 80 years of age deem it extremely important to remain in the privacy of their own homes, and the latest figures show almost 5.3 million Americans receive home care services from Medicare-registered agencies. If you do even simple research, you’ll find the spectrum of home care services is wide, from basic companionship to specialized medical care. You’re likely to come across the following services:

• Assistance with ADLs such as bathing, dressing and personal grooming
• Meal planning and preparation
• Medication management and reminders
• Transportation for medical appointments and general errands
• Light housekeeping and laundry
• Companionship and socialization
• Help with mobility and transfers
• Skilled nursing, such as wound care and administering medications
• Early-stage Alzheimer’s or dementia care
• End-of-life care and hospice support

In-home care can be tailored to meet your needs, allowing you to receive the support you require to live safely and comfortably in your own home. There are other benefits as well, so let’s take a look at the most common.

What Are The Benefits of In-Home Care?

The numerous benefits of in-home care can apply to you and to your family. Some key advantages include:

• Personalized care: Care is tailored to your specific needs, ensuring you receive the exact level of support you require.
• Independence: An in-home caregiver will help you maintain your independence and quality of life by assisting with daily activities but won’t dominate every aspect of your life.
• Comfort: Staying in your own home may give you a sense of contentment and security arising from the familiarity of your surroundings.
• Cost-effectiveness: In-home care can be a cost-effective alternative to institutional care, such as nursing homes and assisted living facilities.
• Reduced stress: With caregivers regularly in your home, your loved ones will have more time to handle aspects of their lives and deal with things left undone because of their previous caregiving responsibilities.
• One-on-one attention: The personal nature of in-home care allows for one-on-one attention from a caregiver, who can ensure your needs are met and issues promptly addressed.
• Improved health outcomes: In-home care can lead to improved health outcomes, as you’re more likely to follow your care plan and receive the assistance you need to manage your health conditions.

What Are The Differences Between Home Care and Home Health Care?

Some people confuse in-home care and home health care, so the following table clarifies the differences and similarities between the two services.

In-Home Care

Home Health Care

Services

Assistance with daily activities (bathing, dressing, meal preparation, etc.), companionship, transportation, light housekeeping, medication management, etc.

Skilled nursing care (wound care, medication management, etc.), physical therapy, occupational therapy, speech therapy, etc.

Costs

Varies depending on the level of care needed, the location and the provider’s pricing policy. The monthly U.S. average in 2021 is $4,957.

Varies depending on the level of care needed, the location and the provider’s pricing policy. The monthly U.S. average in 2021 is $5,148.

Financial Assistance Programs

Medicaid waiver programs, VA benefits, long-term care insurance, private pay

Medicare, Medicaid, private insurance, VA benefits, private pay

Suitable For

Seniors who …

Need assistance with daily activities but don't require skilled medical care, want to remain in their own homes, and prefer a more personalized approach to care

Require skilled medical care (e.g., after surgery or dealing with a long-term issue, such as Parkinson’s disease), need assistance with rehabilitation or therapy, and have a doctor's order for home health care services

Step-by-Step Instructions to Hire an In-Home Careigver

Hiring an in-home caregiver typically involves making a series of important decisions. The following breaks these down into simple steps so you can be sure you’ve covered everything you should.

Step 1: Assess Care Needs

Consider your or your loved one’s medical treatments, but also create a schedule for the caregiver to follow to ensure medications are given and taken as prescribed. Determine which activities of daily living need support, such as bathing and dressing. If cognitive decline is becoming an issue, a specially trained caregiver experienced in aiding seniors experiencing memory disorders may be needed.

You should consider the amount of time per day or week the caregiver will be required. Consequently, you should have an idea of your budget upfront and if it covers the hours of care needed.

Step 2: Develop a Job Description

Developing a job description is a good way for you to pin down what type of caregiver you’re looking for. However, its primary purpose will almost certainly be as a tick-box exercise, so you can quickly filter out caregivers who can’t provide what you need. The job description should include the following:

• Job summary: Caregiver’s purpose and the senior’s care needs
• Responsibilities: Such as managing medications
• Qualifications: Such as previous experience
• Schedule: The hours and days of care needed
• Pay and benefits: The hourly rate and benefits, such as paid time off
• Additional requirements: Such as a valid CPR certification

Step 3: Source Candidates

Once you’ve fine-tuned the job description, it’s time to start looking for candidates. You should use at least three of the following suggestions so you can source the right person from a big enough field.

• Referrals: Ask friends, family and health care providers for recommendations of caregivers they have used or know personally.
• Home care agencies: Contact local home care agencies to see if they have caregivers available who meet your requirements.
• Community resources: Check with community organizations, such as senior centers, churches and volunteer groups, for caregiver recommendations or caregiver training programs.
• Social media: Use social media platforms, such as Facebook and LinkedIn, to post the job description and ask for referrals.

Step 4: Conduct Interviews

Once you’ve narrowed down your list of candidates or agencies, it’s time to conduct interviews.

• Prepare questions: Develop questions tailored to the person’s care needs and the job’s requirements.
• Conduct a phone interview: Start with phone interviews to save you time.
• Conduct in-person interviews: Invite the candidates who impress you the most to one-on-one in-person interviews. This will allow you to assess more than just their skills, enabling you to see if they’re a good fit for the senior.
• Ask behavioral questions: Ask questions that require candidates to describe specific situations they’ve previously encountered and how they handled them.
• Observe their interaction with the senior: If possible, bring the candidate and the senior together and observe how they behave with each other.
• Explain the job requirements: Be sure the candidate knows exactly what the senior’s care needs are and the job’s requirements. This may help avoid misunderstandings later.

Step 5: Conduct Background Checks

Before making a final hiring decision, you should conduct a background check on your preferred candidate. You must be sure they don’t have a criminal record and, if applicable, a good driving history. Follow these steps:

• Obtain written consent: You must get the candidate’s written consent for the background check.
• Hire a reputable company: It’s best to choose a company that specializes in conducting caregiver background checks.

If you’re planning on doing the checks yourself, follow these steps:

• Check criminal records: Use one of the many online databases that let you do a criminal background check for a fee.
• Check driving records: Request a copy of the candidate’s driving record from the relevant state’s Department of Motor Vehicles.
• Check references: Don’t assume the candidate’s references are genuine. Check them out.

Step 6: Hire the Caregiver

It’s time to make a hiring decision and offer the position to the best candidate. Once you’ve decided, follow these steps:

• Make the job offer: Be clear about the terms of employment, including the pay rate, hours and start date.
• Discuss expectations: Make sure the caregiver is clear about their responsibilities and that you’re confident of what they can deliver.
• Agree on a trial period: There’s no standard, but 1-2 weeks is usually enough for both parties to know if it will work out.
• Sign a contract: Once you’ve both agreed on the terms of employment, sign a contract that outlines the details of the job, including the pay rate, hours and responsibilities.
• Provide training: If training is required, ensure the caregiver receives it.

Step 7: Onboard the Caregiver

Onboarding the caregiver properly can ensure they’re fully prepared to provide high-quality care. Follow these steps:

• Introduce them: Introduce the caregiver to the person they will be caring for and any other relevant people, such as family and other caregivers.
• Review the care plan: Review the care plan with the caregiver to ensure they understand the senior’s care needs, medications and any other specific requirements.
• Provide training: If additional training is required, make sure the caregiver receives it. Don’t assume they’ll just pick things up.
• Establish communication: Keep continuously open and clear two-way communication channels with the caregiver.
• Set up a schedule: Create a schedule for the caregiver’s shifts and ensure they know their working hours and days.
• Provide support: Provide ongoing support and feedback to help the caregiver improve their skills.

Step 8: Manage Expectations

Finally, managing the caregiver’s expectations is crucial to establishing a stable and successful relationship. Here are some tips on how you can achieve this:

• Set clear boundaries: Ensure the caregiver is completely clear about their role and responsibilities. This is particularly important if you have to make changes that weren’t in the original contract.
• Establish regular check-ins: Stop in when you can to discuss any concerns, provide feedback and check their work is meeting your expectations.
• Encourage open communication: Build a rapport that allows open communication to flourish.
• Address problems promptly: Address and try to resolve problems quickly, before they become major issues.
• Provide positive feedback: It’s easy to focus on negatives, but it’s just as important to let the caregiver know you’re pleased with the work they do. It typically enhances working relationships.

By following these steps, you can improve your chances of finding the best caregiver for a loved one and develop a relationship that provides the care they need during their later years.