If you are seeking homecare for an aging parent and have never done it before, here is what you need to know.

First, you need to know what you need before you can make intelligent choices regarding the services you will be seeking. The basic questions you may want to have the answers to would be; “Why do you need homecare?”, “How many hours of service do you need in a day/week?”  “What involvement, if any, will the family have in caring for the individual?”  “What are the special circumstances that are particular to your situation that needs to be conveyed to the agency/caregiver.”  And perhaps the question that is on everyone’s mind… “What is the budget and how long can services be sustained on that budget?”

Once you have a good idea of what you need, you can start your search with some type of guideline. For instance, maybe your mother needs help around the house 3 days a week for 4 hours per day. You have a soft budget of $1000 a month, give or take. Knowing your sustainable budget is important as the need for homecare generally increases as the person ages. This is a fairly common scenario where many families enter into the field of homecare.

Where do you start your search? If you are like most people, your first stop will be to do some internet research. You may google “home care” or “care giver “ in your particular area to get a list of agencies. With a good amount of research and calling around, you will find there is a wide range of agency services.  An alternative to going through an agency is to independently hire a caregiver from classified ads or online from a website like craig’s list. Or you can use a  registry service which can assist with your search for a caregiver. We will discuss the primary advantages and disadvantages of these three methods of seeking homecare.

Direct Hire Caregivers

While direct hiring is probably the least expensive alternative in terms of money, choosing to hire caregivers directly will require the most time, effort and tolerance for risk.

Properly screening acaregiverand following up with references should take as little as a couple of  days to as much as a week. This is the bare minimum that you would need in order to do your “homework” before hiring someone to care for your parent. Many people are more comfortable having several caregivers to interview before they choose who would be the best fit for their situation. Screening multiple caregivers, in person, would almost certainly take the full week to complete. If the initial caregiver is not a good fit or quits after being on the job a few weeks, you would need to start from the beginning. There are also tax reporting obligatons that must be followed to stay clear of IRS trouble. The primary advantage of hiring a caregiver privately is that of cost. The primary disadvantage is the risk and being completely responsible for issues that arise with caregivers. There is no professional support should something go awry.

Full service homecare agency

On the other side of the spectrum is a full service home care agency. Full service agencies are the employers for the caregivers that they offer to clients. A good agency will have a strict screening policy and run various criminal background and employment eligibility checks on their employees to reduce their own exposure. These caregivers are usually bonded by the agencies. Bonding can offer an advantage if you are worried about the risk of damages occurring during care or caregiver theft. Bonding and worker's compensation insurance adds significantly to the costs of care which is why full service agencies charge a premium for their service. When considering how important bonding and insurance would be to you, keep in mind that homeowner’s insurance can cover many of the same damages that bonding and insurance would cover.  You should consult your insurance provider to find out the extent of your coverage under your home owner’s policy. Full service agencies will take care of caregiver tax reporting, and might also be able to perform services like billing insurance, which may be useful if you have insurance that pays for homecare, but like bonding, also raises the cost of service.

One of the primary benefits of using a full service agency is speed.  A well established agency should be able to send a representative to meet with you on the same day that you call. Some of the better agencies can have a prescreened caregiver delivered to your door on the same day for an interview.  The turn-around time for a full service agency is its strong point. If you are in a hurry and can afford to have all of the amenities, full service agencies are a good choice. The primary disadvantage of the full service agency is that all the features, i.e. insurance billing, bonding, 24 hr support lines, etc are usually built into the cost of services whether you use them or not.

Registry Caregiver Agency

Last but not least there is a “hybrid” known as a registry agency. If you are concerned about the risks of direct hiring, but aren’t willing to pay for features such as bonding or insurance billing, the registry agency may be a good fit for you.

Registry agencies offer a kind of middle ground between direct hiring, and full service agencies. The caregivers working with registry agencies are not employees of the agency, and instead are independent contractors. Registry agencies perform many of the same professional services as that of full service agencies, such as screening, interviewing and performing background checks on caregivers. Registry agencies may not offer the more expensive features that put full service agencies out of the price range of many people.

A good registry agency would have a quality assurance procedure to follow up with the clients to ensure that they are happy with the services on an ongoing basis. A great  registry agency  is able to facilitate a strong relationship between the client and the caregivers that they refer, ensuring that both are happy with the arrangement.  Working with registry agencies, just like with a full service agency, you can have a resource to call when unexpected situations arise.  The primary benefit of the registry agency model is that you get a professionally screened and checked caregiver without having to pay full professional agency prices. Some registry agencies can also provide payroll services to relieve you of the tax reporting burden to the IRS.  The primary disadvantage of registry agencies is that they generally do not offer bonding and insurance for the caregivers that they refer.

The risks

On the issue of bonding and insurance, the incidence of occurances of theft and damage  is generally very low for professionally screened and checked career caregivers. The vast majority of caregivers are honest people who understand that commiting an offense like stealing from a client can have devastating consequences on their future livelhood.

One insight that most people do not realize is that caregivers can be employed by multiple agencies at the same time. Generally speaking, agencies do not retain their caregivers when they don’t have work available. No agency  can afford to keep caregivers on the payroll when there are no clients to place them with. Therefore caregivers tend to “float” from agency to agency to private hire, wherever the work is available. It is common for a caregiver to work part time at two separate agencies, or even work as a private hire for  one client and through an agency for another.  Like the ocean tides, the high quality caregivers ebb and flow from the agencies as clients do. You can find top quality caregivers through private hire, registry agencies, as well as full service agencies. Understanding this dynamic will help you to evaluate agencies and not fall for the “we have all the best caregivers” pitch.  A good indicator of a quality caregiver is when they can reference multiple well known agencies that they have worked for. Each agency has their own screening process, and if a caregiver has passed the screening for several top agencies, you can feel a bit more at ease about their qualifications.

So now you have an idea of what is available in homecare. Pricing may differ in various parts of the country. In the San Francisco Bay Area, the prices generally range from $12 to $17 an hour for private hire caregivers,  $17-$22 an hour for registry agencies, and $22 - $35 an hour for full service agencies.

To find out which method of hiring would work best for you, you must also consider some intangible factors.

1)      The level of responsiveness.

2)      The quality of communication.

3)      What your feelings are regarding the overseeing and managing of caregivers.

You will just have to trust your gut when it comes to the intangibles. Like everything else, homecare requires a learning curve. Hopefully this article has reduced the time on your learning curve!