Today, one in four American families cares for an older relative, friend, or neighbor. An estimated 25-40% of women care for both their older relatives and their children. Half of all caregivers also work outside the home. It is no wonder then that caregivers often need help. Depending on your work, living, and family arrangements, there are a number of things you can do to make caregiving easier.

If you need additional information and assistance in caring for your older relative or friend, you can contact:

In addition, the AAA can direct you to senior center and adult day programs. These programs are particularly helpful to working caregivers who want a safe environment with planned activities for their older relative. To find your local AAA, go to www.eldercare.gov.

If you decide to hire a home care employee, you need to determine how much and what type of help your older relative needs. Following are descriptions of some of the types of home care personnel:

Sometimes, home care employees take on more than one of the roles described above.

Medicare may pay for home health care services through a certified home health care agency if a physician orders these services. Home health care agencies focus on the medical aspects of care and provide trained health care personnel, including nurses and physical therapists. For a patient to be eligible for services paid for under Medicare, she must need skilled nursing assistance or physical, speech, and/or occupational therapy. Home health care workers are a supplement to this care and usually help the older person for three hours a day, several days a week.

If your older family member or friend needs additional hours of care or requires custodial care, she may be eligible for services under Medicaid. The state where she resides determines if her income and assets qualify her for Medicaid covered services. Otherwise, you or your older relative must cover the cost of having a home care worker.

Home care agencies, which can be nonprofit or for-profit, recruit, train, and pay the worker. You pay the agency. Social Service agencies, in addition to home care services, may provide an assessment of the client’s needs by a nurse or social worker and help with the coordination of the care plan. If services are being covered under Medicare, your doctor, care manager, or discharge planner will probably make arrangements for a home health care agency.

If you select an agency, ask the following questions. Those questions marked with an asterisk (*) should also be asked if you are hiring the home care employee.

1. What type of employee screening is done?

2. Who supervises the employee? 

3. What types of general and specialized training have the employees received?4. Who do you call if the employee does not come? 

5. What are the fees, and what do they cover?* 

6. Is there a sliding fee scale? 

7. What are the minimum and maximum hours of service?

8. Are there limitations in terms of tasks performed or times of the day when services are furnished?* 

Unless your older friend or relative needs care for a limited number of hours each day, the rates charged by home care agencies for homemaker, home health aide services, and van services for transportation are often beyond the means of middle income families. If this is the case, you may want to explore the option of hiring a home care employee directly.

Avenues for hiring home care aides include:

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

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

Keep the following considerations in mind when hiring a home care employee:

Have applicants fill out an employment form that includes the following:

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 certain to contact them. If there are substantial time gaps in their employer references, it could indicate that 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, it is also possible to conduct a criminal background check.

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

If you work and are heavily dependent on the home care assistant, emphasize the importance of being informed as soon as possible if 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:

When hiring a home care assistant, 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:

Also provide information, verbally and in writing, about:

If free or low-cost transportation is not available, try to hire someone who drives since this saves 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 her car on the job and insurance coverage.

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 workman’s compensation.

If you do not want to deal with these somewhat complicated withholdings from the employee’s salary, 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. Before employing an aide on a contract basis, consult your financial advisor or tax preparer to make certain that you are following the IRS rules that govern contract workers since there can be a fine line between who is considered to be an employee versus a contractor.

Regardless of who cares for your elderly relative, it is necessary to protect important papers and secure valuable possessions.

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:

The following are possible signs of abuse or neglect:

If you suspect an abusive situation exists, don’t wait for it to be tragically confirmed. Find a way to check either by talking to the older person in a safe situation or by installing monitoring devices. If you witness or are told by a reliable source about neglect, physical abuse, or emotional abuse (emotional abuse includes threatening or overly controlling, possessive behavior and often involves isolating the older person from others), seek help and, if necessary, replace the home care aide as quickly as possible. If the situation appears serious, remove your care receiver from the premises and place him or her with another family member or in a facility that offers respite care. Always 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 aide to Adult Protective Services so they can take appropriate actions to prevent the aide from gaining employment with other vulnerable elders. If the abuse is of a serious nature including serious neglect, physical injury, sexual abuse, or the misuse of the funds of the older person, you should also contact the police.

Once you have hired a home care worker, make sure that 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, keeping 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 that 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. During this time, it may be necessary for your older relative to reside temporarily in a long-term care facility or for you to hire an aide through an agency. It is best to have reserve funds on hand should such an emergency arise.

While home care may not be less expensive than nursing home care or assisted living, it offers older people the opportunity to remain at home. What is more, it affords a degree of flexibility and choice for the at-risk elderly that few other living arrangements can provide.