We talked to Amanda Lambert and Leslie Eckford, authors of Aging with Care: Your Guide to Hiring and Managing Caregivers at Home, by email and phone about the essentials to get started in caring for an aging parent at home. Read the first part of the Q & A. The rest will follow next week in Part 3.
Question: What’s the most important lesson to remember as any of us start caring for an elderly parent?
Answer from Leslie Eckford: Starting out, I learned the lesson that finding a good home caregiving solution requires a respect for balance. Balancing the autonomy and rights of the older adult with the need for safety and security; finding balance in taking responsibility for the welfare of one’s elder family member while including that person in the decision-making. The huge demands of caregiving have to be balanced with the reality that one person cannot do it alone.
Q: If the goal is to keep the family member at home as long as possible, can you talk about the advantages of living in a NORC (a naturally occurring retirement community) where there are services and programs in one’s neighborhood? Socialization seems so important.
Answer from Amanda Lambert: The advantages of NORC are that the elder is able to stay in their community and keep long-term relationships that may have taken years to form; there is familiarity of the neighborhood and resources; affordability may also be a factor. In many cases remaining at home may be much more affordable and less disruptive than moving to another supportive community like assisted living. NORCS also have the psychological advantage of allowing someone to stay in their community while maintaining independence at the same time.
Q: Should a family member become a caregiver if there are no funds to hire a professional? And what are the boundaries if that is the course taken?
Answer from Leslie: Research by the AARP in 2015 found that 34.2 million American adults were unpaid caregivers for an adult family member age 50 years or older in the previous year. These are mostly women and a growing number are men. This decision may require that an adult child disrupt their own career, earnings and retirement fund to care for an elderly parent. It is a decision with huge consequences, but one that more and more families are forced to make. For the best outcomes, we suggest that families approach this in similar ways to hiring a non-family member to be the caregiver. Discuss the details in family meetings; be very specific about job duties and expectations; if possible, find some sort of financial reimbursement; plan for coverage if the family caregiver is sick or has a vacation; and create a work contract so that everyone understands and agrees on the fine points. We have an example of such a contract in our book.
Q: What are five characteristics to look for in a caregiver for an elderly person? What credentials are necessary?
Answer from Amanda: Families often approach the idea of private caregiving assuming that these care providers can do whatever is asked of them! Make certain you check state requirements for licensure requirements. If more medically necessary tasks are needed, then having a CNA would be advisable since there is some training involved. Characteristics to look for in a caregiver are: 1) Dependability. Someone who can be relied upon to consistently meet requirements, be on time and respond to changes; 2) Good communication skills. Whether it is through documentation/and or family and agency staff; 3) Awareness of what needs to be done from the perspective of the client’s needs and wants; 4) Professionalism. Characteristics such as respect and integrity are key; 5) Honesty is paramount.
Q: How much care and what type does someone potentially need? A registered nurse or specialist in geriatric care? A certified aid? How do you even make these determinations and how often to re-assess as health declines?
Answer from Amanda: If a person’s needs start to exceed what even home care can provide (or home health services have been discontinued due to insurance constraints) then a higher level of care may be needed. Some state requirements do not allow a certified aid to perform certain necessary medical tasks, and it may be necessary to consider home health or hiring a nurse privately. We talk in greater detail about these issues in our book.
Q: When is 24/7 care needed?
Answer from Amanda: When safety becomes an issue due to inability to function without assistance. Examples: the person needs help with toileting, bathing, eating, dressing, taking medications, transferring, walking. 24-hour care can be accomplished, but the costs can be significant and management of several caregivers can be challenging. It is also important to consider the level of stress that 24-hour care places on family member who are either managing that care or helping to provide it all by themselves.
Q: What’s the best source to hire from, an agency, a friend or relative’s caregiver who may be available?
Answer from Leslie: We learned through the process of writing our book, Aging with Care, that there is really no one right answer to this question. We have seen all sorts of successful combinations such as having a privately hired caregiver working some shifts with a family member staying overnight to having fill-in shifts by an agency. Families are very creative due to financial constraints and to shortages of qualified caregivers. The bottom line, however, is that an elderly person in the home who needs personal assistance is by definition vulnerable. There is no on-site supervisor. Care activities are private and thus bad behavior can be hidden. Therefore, a very thorough background check must be done that includes criminal and drug history and previous employment.
Q: How much should we expect to pay—and by the hour or day or week or month?
Answer from Amanda: Typically, the hourly cost goes down the longer the hours per visit. Cost also varies by state. The average per hour is approximately $20.00 per hour. Daily rates will be about $130.00. Some agencies have “sleep rates” which are lower per hour costs during an overnight stay. Cost also depends on whether you are going through an agency, an online company, or hiring privately through a referral.
Next week in Part 3 the authors address how to talk to elderly parents about bringing in help, what is fair to expect a caregiver to do, how to know if that caregiver is doing a good job, how to indemnify a caregiver who is not with an agency, when is the right time to consider assisted living or a long term extended care facility, and much more.