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Find the right at-home caregiver.

As we age, we become more susceptible to ailments and injuries that may affect our ability to care for ourselves. Many older adults in this situation relocate to a nursing home or assisted living facility, but if you want to retain more independence and continue to reside in your present home, an at-home caregiver can assist with activities of daily living and help with household chores such as shopping and housework.

According to the CDC, about 1.4 million Americans require the help of a paid caregiver each year. "When someone needs help at home, their loved ones are often lost about how to choose the right caregiver," says Sheila Barton, LCSW, a social worker in the Brookdale Department of Geriatrics and Adult Medicine at Mount Sinai School of Medicine. "The answer depends on the aide's personality, finances, the patient's care needs, and the ability of the family to become involved in care."

Barton says that personal recommendations are invaluable. "If a trusted friend has hired a home attendant for similar caregiving responsibilities, that recommendation is worth its weight in gold. You know automatically that the individual is reliable, trustworthy, and has done their job. You also know what the individual charges."

Barton also recommends obtaining two or more recommendations, going back in the person's work history. "When you are interviewing the individual, ask about their work with previous patients," says Barton. "Do they have experience with dementia patients? How would they handle a situation where a patient absolutely refused to bathe, or follow their instructions? What would they do in specific situations involving safety?"

Certification is sometimes important

Ask if the prospective caregiver has attended the 75-hour training required for home health-aide certification. This training teaches the aide how to care for a disabled patient (i.e., helping with dressing, bathing, feeding, toileting, etc.). If custodial care needs are minimal and you are hiring the individual for supervision and safety issues, then this training may not be necessary. Also, many individuals from foreign countries do not have this certification, but have significant hospital and medical experience. It's important to look at the person's resume and call their references.

Paying for your caregiver Because custodial care at home is a significant expense, many patients without long-term-care insurance cannot fund homecare indefinitely. "At that point, the patient and/or family member needs to talk to a social worker about the possibility of Medicaid funding for all or part of their home support services," Barton says. "For those with Medicaid, there is also something called 'consumer-directed home care,' where a patient can hire a private home attendant, have them register with a Med-icaid-funded consumer-directed homecare agency, and that agency will pay the worker the going Medicaid rate for hourly service."

If you are planning to use consumer-directed homecare services, keep in mind that the patient and/or family must be willing to supervise the home attendant and be available in emergencies,


* For patients with significant medical and custodial care needs, Barton recommends using a certified agency. Agencies tend to be more expensive, but their workers are supervised by a registered nurse (RN).

* Certified agencies have certified home health aides. Also, for the family member who cannot provide on-site supervision and direction, the agency can have their supervising RNs provide this supervision.

* Your local aging ombudsman or Agency for Aging can provide contact information for social workers in your locality.

* Tread carefully when it comes to website advertisments for homecare agencies and services. Your local Alzheimer's Association representative (call 1-800-272-3900) can refer you to social services and reputable homecare agencies in your area, as can the National Association of Professional Geriatric Care Managers (
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Title Annotation:INDEPENDENCE
Publication:Focus on Healthy Aging
Date:Dec 1, 2011
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