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01/21/2017 12:54 pm ET Updated Jan 13, 2018

How to Select a Home Care Aide for an Aging Loved One

A few months ago my real estate agent, Collette Fultz, called me because her parents needed someone to help them out at home. Her mother was recovering from a serious illness and her father, who had significant mobility problems, couldn't take care of her. Collette asked me for advice about how to find a home care aide. I wished I had an article about it to send her. But I didn't, so I decided to research and write this one.

Need for Home Care: The number of Americans requiring home care aides will only increase as the population ages. According to the Administration on Aging, the older population--persons 65 years and older--numbered 46.2 million in 2014. By 2060, with the aging of the Baby Boomers, there will be about 98 million older persons in the US.

Goal of Home Care: According to an article on the Alzheimer's Reading Room, the goal of home care is to help the care recipient remain as independent and safe as possible with services such as companionship, hygiene, light housekeeping, meal preparation, medication reminders, errands and transportation.

What Home Care Costs and Who Pays: Linda Nelson, LSCWS, CMC, Professional Care Manager at Kansas City's Creative Care Consultants says that "Home care is paid for privately and by some long-term care insurance policies. Medicare and Medicaid payment, when made at all, is extremely limited. Payment is also sometimes made through a Department of Veterans Affairs program called Aid and Assistance, which may cover up to $1,788 per month for veterans and up to $1,149 for surviving spouses of veterans." The cost of an in-home care aide typically runs between $15 and $26 per hour, although it is usually higher on the East Coast and West Coast.

Preliminary Decisions: Before deciding to hire a home care aide, you will need to make several decisions. These are as follows: Hiring an in-home care aide vs. having a family member provide needed care: There are many advantages of using a home care aide rather than a family member when looking at potential providers of care. According to Peter Ross, co-founder and president of Senior Helpers, a large national in-home care company, "Some of the most important reasons to hire an in-home aide are: it eases the burden on the family, sometimes no family member is available and/or willing to provide the care, being a caregiver can be too physically taxing--for example, if you have to lift your loved one. Finally, hiring an in-home aide can help family members avoid burn out."

Hiring an in- home care aide vs. placing your loved one in a care community: The first issue to consider is whether it's even feasible for a professional aide or a family member to provide for all the person's needs in the home. Some loved ones' needs are such that caring for them at home is not possible. If it is feasible, however, the most important reason to keep the person at home is that the vast majority of care recipients desperately want to stay at home. Another possible reason to keep your loved one at home is when there isn't a high-quality care community located in your area.

Hiring an aide through a home care agency vs. hiring an aide privately: Jean Youkers, BA, MBA, who has had 30 years of experience working in long-term care facilities in social work, admissions and marking says, "If you hire an aide directly yourself--usually with a recommendation from a friend or your loved one's physician--you may save money. However, hiring an in-company to provide the aide has advantages, too. It all depends on the circumstances." According to an article on the Elder Law Advantages website, the aide will be screened and trained, and the company will take care of requisite administrative duties, such as payroll, taxes and workers' compensation. Another important benefit is that the company can provide a backup aide if yours is not available on a given day.

How to Select an Aide

Interviewing Candidates: It's important to interview more than one home care aide candidate, regardless of whether you use an in-home company or hire someone privately. Be sure to let the person to receive the care participate in the interviews. It's important that they have good rapport with the aide. Some questions to ask are: Why did you decide to become a home care aide? How long have you been one? Do you have any special training? What do you like most about your job? Least? When would you be available to start work? Can you provide references?

If your loved one has Alzheimer's, Parkinson's, or other cognitive issues, you'll also want to ask if the company provides training in caring for people with those diseases. If you're interviewing a private prospective aide, ask if he or she has any relevant training and/or experience.

Check Potential Aides' References: The following are some questions you should ask aides' references: What was your overall experience with this person? How long did the person work for you? Was he or she dependable? What is the person's greatest strength? Weakness? Did you have any problems?

Questions to Ask In-home Care Companies: The Home Care Association of America (HCAOA) lists five questions to ask prospective in-home care companies. These are: How do you recruit your caregivers? How do you train and supervise them? Should a scheduling conflict occur, do you have back-up caregivers? Are your caregivers bonded and insured? What type of background checks and screening do you do?

The National Association for Home Care and Hospice (NAHC) and the Mayo Clinic also provide long lists of questions to ask agencies. Some of the more important ones are: Is your company licensed by the state? (Some states require licensing). How long have you been in business? How do you train your employees? Do you provide continuing education? What procedures do you have in place to handle emergencies? Is someone available 24 hours a day? What services can your aides provide? What can they not do? Do you provide training in the care of people with Alzheimer's and Parkinson's (if relevant to your situation)? Do you help arrange for additional services, such as Meals on Wheels? Can you provide letters of recommendation from satisfied patients, family members, and/or doctors?"

For More Information: For more guidance on selecting an in-home care aide, see a booklet entitled "Navigating Senior Home Care With Leeza Gibbons," developed by Senior Helpers. Ms. Gibbons, author of "Take Your Oxygen First," is a partner of Senior Helpers and uses their services for her elderly father. This detailed and helpful guide includes, among other topics: What to Watch For as Loved Ones Age, Eight Warning Signs Your Loved Ones Need Care, Taking Action to Take Care, What Options Exist for Care? And Assessing Your Loved One's Need for Care. You can request a copy of this free brochure on Senior Helpers' website

Marie Marley is the award-winning author of "Come Back Early Today: A Memoir of Love, Alzheimer's and Joy" and the co-author (with neurologist Daniel C. Potts, MD, FAAN) of "Finding Joy in Alzheimer's: New Hope for Caregivers." Her website, ComeBackEarlyToday.com, contains a wealth of information for Alzheimer's caregivers.