Should I Hire a Private Caregiver, Is it Worth the Risk?

When it comes to caring for aging parents or spouse, there are a lot of decisions to make. One of the biggest is whether to hire a private caregiver or go through an agency. Here are some things to consider when making your decision. Making the decision to hire a caregiver for an aging parent can be difficult. There are many factors to consider, such as cost, type of care needed, and whether or not you will be able to find a qualified caregiver. This blog post will explore the pros and cons of hiring a private caregiver versus an agency caregiver.

“My parents are getting older, and my sister and I want to be sure that if anything happens, they’re comfortable at home until the end.”

“What are the pros and cons of hiring a private caregiver vs hiring a caregiver from an agency?” “I work full-time and have a family I can’t do it all, where can I get some help?”

“I don’t live close to my parents but I need to know someone is looking out for them.”

Have you or someone you know said one or more of these statements?

Private caregiving has grown in popularity over the last few decades. Many family members live away from their parents. They may travel extensively for work. It’s also expensive to hire an agency caregiver and many private caregivers charge less than agencies do. But there are some downsides of private care, too. When you hire your own private caregiver, the number one thing you get is convenience. You don’t need to go through a background check or any other vetting process but this can be a double-edged sword. Many private caregivers have not been screened by a professional private caregiver agency. Bad private caregivers are everywhere and you’re taking a big risk if you don’t do your due diligence in checking that they’re certified, bonded, drug tested and trustworthy. You can expect to pay $15.00 to $25.00 per hour $300-$400 per week for full-time or for a private caregiver with an agency it may run $20.00 to $40.00 an hour depending on where you live. Live in care may run $120-$200 per day. I had a client with Alzheimer’s that was paying a little over $2000.00 per week to provide 24/7 care.

Another major downside to private caregiving could be the lack of continuity or it could be a benefit to help guarantee continuity. Families should anticipate having to switch private caregivers or build a pool of caregivers to choose from. A client of mine hired a private caregiver due to the cost being less expensive but it came with many challenges. They were not certified nursing assistants for one, did not have experience with caring for Alzheimer’s patients and one day the caregiver sent her daughter instead of her because she had something to do and the daughter had never been in the home before! The family felt trapped as they needed the care and was last minute so the daughter stayed and “winged it” so to speak. Not the best-case scenario. Make sure you have in writing how to handle these types of situations.

There are benefits to private caregivers such as stress relief for the family and more flexibility in scheduling. Another client of mine was cared for by private caregivers in his home until he passed away peacefully at age 93. He worked with one caregiver who helped him in all aspects of his life in the morning, allowing his mother-in-law a truly needed break. We do recommend if you do hire private caregivers and want continuity have at least 2 if not 3 caregivers the rotate to develop a rapport and get familiar with your loved one. If one of the caregivers get ill or go on vacation, the private caregiver agency will provide a replacement.

Often private caregivers may be someone who already knows your loved one. This is a big benefit especially if that person may have some form of dementia. Another benefit of hiring a private caregiver is that they can do the tasks you need them to perform. Some agencies do not allow their caregivers to drive your family member somewhere. Make sure if you use an agency, you ask if they can drive your loved one and whose vehicle has to be used. If they are taking your loved one to a doctor appointment and they get into an accident what is your liability?  Private caregivers can do what you instruct them to do and you have more leeway such as with medications both set-up and administration.

One drawback of private caregivers is that they often charge more, as the agency rates vary depending on location and company. Another downside to private caregiving is that it may be difficult for your loved one to get used to the private caregiver if he/she has been used to an agency you do not find yourself without a caregiver! With an agency it may be less or more expensive. What you will get with an agency is the headache of scheduling off your plate. If someone calls in sick, they are responsible for finding another caregiver to take their place. If private caregiving, you are responsible for hiring someone new, training them and ensuring they are familiar with your loved one. Hiring private caregivers is best if someone in the family wants to get involved with their loved one’s care or if you need extra help around the house. The agency also is responsible for training, background checks and drug testing, and often have a nurse connected to the case that provides supervision and oversees your case.

A private caregiver may provide a lower level of care, which means they take less responsibility over the day-to-day care of your loved one. For example, hiring private care means your family member will need to be present when medications are given, and medical decisions need to be made if the caregiver does not feel comfortable with this assigned task. Agency personal care workers or C.N.A.s (certified nursing assistants) cannot administer medications. This means that if your loved one cannot take their own medications this will be a challenge with an agency caregiver. They can remind but cannot administer. With a private caregiver you are taking on the responsibility of the choice to have them administer or even set up the medications based on their level of comfort.

The private agency takes more responsibilities in their hiring process. Agency employees are more thoroughly screened for things like criminal records and references. They also manage their pay and withholding taxes etc. If you hire a private caregiver, you may be liable to withhold Medicare and Social Security taxes. Rules may be different for hiring family members to care for your loved one.  There are some programs out there that work with you to pay family members to provide care. Check with your county’s Aging and Disability Resource Center to see if you may qualify for one of these programs. Make sure you check with your accountant or financial professional to check on what your liability may be in paying a private caregiver.

One of the biggest advantages to private care is that your loved one will receive whatever level of attention you want them to have meaning you can choose private caregivers who speak Spanish, French or any other language if needed. With an agency this isn’t usually the case. You can’t pick and choose your own caregiver but you do have a choice to ask for a different caregiver if the relationship doesn’t appear to be a good fit.

Be sure to check with your private caregiver or private agency that they conduct background checks and drug screenings. Many private agencies and private caregivers do not require these steps but it is usually a good idea to ensure your loved one’s safety and the workers’ protection. You should also ask if there is a trial period in which you can terminate employment

Another risk factor in hiring a private caregiver is your liability. If you hire a caregiver from an agency, they are covered under workman’s compensation. If you hire a private caregiver and it is wintertime a northern climate, they slip and fall and get hurt on the ice at your home what is your responsibility and liability if they get injured?

Staffing agencies help private caregivers find private jobs that are often times better paying and offer benefits. Most private care involves non-medical care, such as bathing, cooking or feeding, shopping etc. If you hire a private caregiver through an agency, it may be more expensive, but you get the advantage of having someone else doing some of the leg work.

Let’s assume you decide to hire a private caregiver. What steps do you need to take to ensure quality, dependability, and reduce your risk.

  1. You must be clear on the expectations.  As Board Certified Patient Advocates, we can help you determine what types of cares are needed. We help you put a “plan of care” in place. We help to set the expectations of what types of care are to be performed and how often. Will it involve medications? Will you need to train the private caregiver on managing these medications? Written instructions are a must. We also recommend a “communication log” for private caregivers. This can be as simple as a spiral notebook. They should have daily or as often as they are there, notes. You should get a feel for how your loved one did during the day. Did they eat if so, how much? How about having a bowel movement? Did they get a bath or shower? You understand what I am talking about.  Make sure you write down the things you would like them to document on a regular basis. Will they be taking your family member to doctor’s appointments? Whose vehicle will they use? What is the liability? Will they be preparing meals or doing light housekeeping?
  • What Equipment Will You Need in the Home for A Caregiver to Do their Job? How can you make the home safe for your hired caregiver to reduce the risk of injury to either your family member or spouse or your caregiver? You may ask your doctor if you could have a home health safety eval completed.  A therapist will come to the home and determine what equipment needs may be beneficial to promote safety. There are certain requirements to meet for Medicare to cover this service and here is where a Patient Advocate might come in handy to help you determine needs if you don’t qualify for a Medicare Home Health evaluation.  There are also some private pay therapy companies out there that you could hire to come in and do the safety evaluation.
  • Consider some form of contract. We have included a resource with a sample contract you can use and available in the resource section of this post. This should outline expectations, pay, time off etc.
  • Contact your Accountant to look at any payment documents and what information you need to get from your private caregiver. What records need to be kept and what documentation is required. What are the tax requirements?
  • How to Find a Caregiver:  You must be careful where you find a caregiver. There are many sites out there that you can get access to names of caregivers listed but be diligent in interviewing and you can do your own background check. Make sure you do an interview. We recommend having them come over and meet your loved one and see the interaction and how they begin to develop rapport with your family member or spouse. You are going to be trusting this person or people with a very special commodity, your loved one! Consider using a professional Patient Advocate to help you in the vetting process and choosing a private caregiver. Decide what qualities and qualifications you want your caregiver to have.  Do you want references? What skills or training have they had? Do they have any current and updated certifications? For example, in many states Certified Nursing Assistants need to have a certain number of continuing education credits to keep their certification current. Why are they doing private caregiving? These are some questions you may want to get answered in the interview and hiring process. There are programs out there such as Share the Care where volunteers are coordinated from church members, family, etc to help provide cares.  Your Patient Advocate can assist in helping set up this program if it might be a possible solution for some caregiving needs or you can work with Share the Care and implement on your own if you desire.

Some agencies work with private caregivers and take some of the responsibility away from you in finding someone that is a good fit. You can use a service such as this to help with background checks or get set up to do the process. “ShareAble for Hire” would be a type of service you can use to do the background checks. There are many others. Your attorney can assist with this as well. Remember you need permission from the applicant to perform a background check.

Every caregiver has their own set of strengths and weaknesses, so understanding who is the best for you will depend on your needs. An agency may have more caregiving staff to offer a wider range of skills, while private caregivers are often specialists in one area. There are also many benefits to hiring an Agency or Private Caregiver that can’t be obtained elsewhere-take advantage! Whether it’s tax benefits or guaranteeing the same person every day, there’s something unique about what these two types of caregiving services can provide.

The difference between a private caregiver and an agency caregiver is the level of care you receive. There are pros and cons to both options that should be considered before deciding which type of caregiving will work best for you. If you’re contemplating hiring someone outside of your family, there are many factors to consider when choosing what type of provider would work best for your needs; cost being one major factor. For example, it may seem like more money upfront but with some research into the benefits offered by different types of providers (private vs agency) this could turn out less expensive than anticipated!

We are board certified R.N. Patient Advocates with over 80 years of combined nursing experience. Our goal is to help you navigate the mucky waters of our health care system and provide you with resources and solutions to care for your aging parent or spouse. We have shared some of the benefits of hiring a Patient Advocate. There are local patient advocates all across the country and in many other countries as well. We can help you with just one piece of a health care challenge or we can set up the whole plan. That is the beauty of hiring an advocate, we can do as little or as much as you need us to do!  We are providing a directory of services that you can be confident that we have vetted our listing businesses and companies. We make sure that you are getting the quality we would recommend. We want you to feel confident in your choices. Know that we are doing our best to provide the resources you need.

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Thank you for taking time out of your busy schedule to visit our website. You are taking an important step in assuring quality care for your loved one.

Pam and Linda

Your Nurse Advocates

Resources:  (includes an example of an independent caregiver contract)

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