How to Find and Hire a Caregiver for Seniors

What Are the Types of Caregivers?

Those needing specialized care, palliative, or end-of-life care often do well having full-time caregivers. Others need part-time caregivers. These caregivers’ skill sets, credentials, and fees vary. There are three primary types of caregiver roles: companions/homemakers, home care aides/assistants, and medical caregivers (such as CNAs and registered nurses). Each has the skills and authority to perform specific duties in the caregiving process.

Companion Caregivers and Homemakers

As nonmedical caregivers, the role of companions and homemakers is limited concerning medical or hands-on client assistance. They play a very valuable role for seniors and their families. For example, when families need more assistance or a respite from their caregiving duties, companions provide support, companionship, and comfort to seniors. These individuals can also perform housekeeping duties, prepare meals, and transport clients to outings and appointments. Consider looking for a companion with a Certification for Homemakers from the National Association for Home Care and Hospice or a comparable organization.

>> Related Reading: Family Caregiver Annual Report

Home Health Care Aides

These professionals can perform the same duties as companion caregivers and more. Certified home health care aides can also render hands-on care and help seniors with their activities of daily living such as bathing, dressing, and grooming. They can check vital signs including blood pressure, respiration rates, and pulse. Like companions, aides usually can’t administer or dispense medications, but can prompt clients to take them. Look for candidates with a Certification for Home Care Aides from the National Association for Home Care and Hospice or a similar organization.

Requirements to be a home health aide vary. Some aides have certificates from community colleges and vocational schools. Some home health aides must be licensed, depending on the state. Based on federal law, home health aides must get at least 75 hours of training through a state program that includes 16 or more hours of hands-on training and 12 hours of continuing education every 12 months.2

Medical Caregivers

Medical caregivers are typically certified medical assistants (CMAs), certified/registered nursing assistants (CNAs/RNAs), or registered nurses (RNs). Most families and seniors can have their needs met by CMAs or CNAs, but RNs are often called in for specialized care needs for patients with cancer, advanced dementia, or patients who have experienced a stroke.

Medical caregivers can perform basic duties in addition to providing comprehensive medical care both in the home and in a facility setting. Additional services they can provide include:

• Monitoring vital signs and recording health patterns and behaviors
• Keeping in close contact with other health care providers and the family
• Administering medications and giving intravenous injections
• Pre-filling medication boxes
• Taking care of wound care and applying topical ointments
• Performing treatments such as enemas, douches, enteral feeding, catheterization, etc.

Now that you know more about the types of assistance, let’s explore the best ways to find the right caregiver.

What Are Your Caregiving Needs?

Before you reach out to agencies or individuals about caregiving, determine your loved one’s needs. Consider the logistics of the care you want and the duration of the care that will be needed. Those looking for short-term or part-time caregivers to give regular caregivers a break, for instance, should consider looking for respite care.

Respite care can be given at home on set days or within a facility for longer overnight care. Many seniors prefer to stay at home for comfort and convenience. If they do remain at home, families can consider long-term in-home caregivers who can be employed part-time, full-time, or can reside within the home.

Placement Agencies vs. Private Hires

Next, you’ll need to determine whether you want to use a service or agency to find the ideal caregiver. Some people prefer to perform research themselves or place an ad to secure a private hire. Both ways of finding a caregiver have advantages and disadvantages.

Using an In-Home Caregiver Placement Agency

Although hiring from agencies may be expensive and you may not know the caregivers beforehand, agencies take care of almost all the bureaucratic work for you regarding employing these caregivers. It’s also reassuring to know they’ve done various background checks.

Get referrals from friends and/or check the Better Business Bureau and find reviews before choosing an agency. The primary appeal of using a caregiver service or agency is that these providers typically:

• Screen each applicant carefully and check references
• Provide or confirm training and credentials
• Perform background checks on candidates
• Handle essential paperwork such as contracts and legal matters
• Handle payroll and taxes
• Take care of legal aspects of hiring a caregiver
• Provide backup caregivers if regular staff is unavailable

Finding a Private Hire Caregiver

If you don’t want to hire personal caregivers from a home care agency, getting a referral is usually the best way to find care. When looking for a caregiver, most people ask family, friends and colleagues. If you do find someone based on word-of-mouth — for example, if your sister recommends someone she works with and likes a lot — you’ll likely feel the recommendation is trustworthy.

You’ll also be able to personally talk with and interview the candidates rather than just meet individuals the agency has sent you. Another big benefit of hiring someone yourself? Because no fees are required, hiring private caregivers is cost-efficient for both the caregiver and the employer.

If personal connections don’t work out, you might need to post your search for a caregiver in newspaper ads or online on community sites like NextDoor.com. Also, you can try searching through online job sites and forums such as Craigslist and Indeed.

A big drawback to finding a caregiver on your own? You’ll need to handle the many tasks mentioned in the list above to ensure that you hire the right caregiver and comply with local ordinances. Regardless of your preferred method of finding a caregiver, read on for more advice about choosing one.

What to Look For in a Senior Caregiver

Here are a few things that seniors and families should consider if they’re hiring a caregiver on their own, whether the caregiver is needed full-time or part-time and whether they’ll live in the home or work in a facility:

• Credentials, licensing, and experience: Be sure to find a caregiver who has the right credentials and experience to be able to provide for your loved one’s needs, particularly if they require assistance with medications or daily activities. Note that some states require certification or credentials for people to hold certain caregiver roles, so make sure to confirm and obtain licensures.
• Personality is essential: Someone can have all the credentials and the best experience and simply not have a personality that meshes with the client or their family members. Assuming there are no red flags, go with your gut instincts after running a thorough background check through a national database. Also, be sure to ask final candidates some questions to determine if there’s common ground between them and the client.
• References: Do more than ask for references — call the references and listen for any complaints or any hesitancy in commenting that can be indicative that there were issues. Also, confirm the candidate’s length of employment, especially if you’re looking for a reliable person to hold a long-term position.

What Should You Include in a Contract?

If you use an agency or service, they usually take care of contractual matters. But if you’re hiring someone yourself, be sure to consider including the following details within a contractual agreement with new hires to avoid potential problems down the line. Within the contract outline, be sure to list:

• Expected job duties, scheduled hours, home privileges, and meal access
• Compensation, whether it’s hourly or salary
• Information on performance reviews, raises, and bonuses
• Rate and frequency of days off and vacation guidelines
• Transportation details. For example, will the caregiver use their car, your vehicle, or public transportation for client outings and running client-related errands?
• Confidentiality expectations concerning sharing personal information regarding work in the home

How to Pay for Senior Caregiver Services

Depending on your situation, there are several possible ways to offset the cost of caregiver services. These include long-term care insurance policies, traditional insurance, self-payment, and state and federal programs such as Medicare and Medicaid.

If you’re planning to use a service or agency, they’ll likely have financial advisers or social workers who can advise you about your options. Those opting for private hires will have special considerations, as you’ll have to pay your caregiver out-of-pocket and then seek reimbursement from the coverage provider if you or your loved one is eligible for reimbursement.

One of the most common questions people have is, “Do Medicare and Medicare Advantage plans cover the payments for caregivers?” As a general guideline, if it’s related to medical needs, they are more likely to pay.

Here are a few more resources that may be helpful:

• To compare costs and types of caregiving services in your area, check out our long-term care cost calculator
• To get an idea about respite care costs, see our respite care cost guide
• To discover other ways to pay for caregiving services, see our guide to finance for seniors. It offers financial planning resources to ensure your money takes care of you

Extra Tips for Finding a Senior Caregiver

Finding an in-home caregiver can be challenging. If you’re hiring someone on your own, here are some extra pointers to help you locate the best quality caregivers so you can have peace of mind.

Make a List of What You Need and Want

We suggest you sit down and create a detailed list of what you’re looking for in a caregiver. You can also jot down your expectations. For example, do you expect only nonsmokers to live in your home? Can the caregiver take your loved one for a spontaneous outing in the middle of the day or do you only want the caregiver to drive to doctor appointments? If the job requires the caregiver to be in the home three days a week, for example, be sure your job post reflects that you’re looking for a part-time caregiver who can reliably spend those three entire days with your relative.

Be Sure You’re Both on the Same Page

Make sure you’re clear about:

• Duties the caregiver should perform and the frequency. For example, you might need caregivers to do some light housekeeping every day they’re on the premises and help the patient bathe every other day.
• Types of specialized care. If your loved one has incontinence, renal urological disorder, or dementia, caregivers with special skills will be required.
• Living situation. Consider whether they’ll be in-home or live-out.
• Language. Do you want to hire someone who speaks certain languages?
• Gender. Would your loved one be more comfortable around a male or female caregiver?
• Qualities you’re looking for in a caregiver. Since a personal caregiver might spend a lot of time in your home, they should have the characteristics of someone you can trust. List the qualities that will make you and your loved ones feel safe and comfortable. These qualities will likely include patience, perseverance, kindness, and a sense of humor.
• Share your loved one’s irritations so that the caregiver can be prepared. Does your dad watch the news on TV three times a day? Does your loved one get easily frustrated with messiness and disorder? Knowing pet peeves in advance can alert the caregiver and help ensure a smooth relationship.

Screen Candidates and Conduct Interviews

The typical way of finding private caregivers involves looking for contacts, contacting them, scheduling interviews, and personally talking to the caregivers. It might take weeks or months to find the right caregiver; that’s why some people prefer having home care agencies screen candidates on their behalf.

Here are some helpful talking points and questions you might ask potential caregivers applying for the job:

• How long have you worked as a caregiver?
• Can you tell me about your work experience?
• Please tell me more about your specialized training.
• What can you say about your previous jobs, including likes and dislikes?
• After looking at the expected duties and the patient’s special care needs, can you handle everything on the list, including the patient’s irritations?
• Can you think of possible activities appropriate for the patient?
• If the patient becomes combative and irritable, how do you deal with the situation?
• Based on your experience, what makes you happy while at work?

While conducting the interview, inform interviewees of the details about the job. Here are some matters you might not think about that would be wise to include:

• Family and friend visits. Share information about the people who visit your loved one, like the neighbor who brings casseroles on Tuesdays or your dad’s sister who drops in often. This way, caregivers won't be surprised when they make a social call.
• Caregiver policies. Is your in-home caregiver allowed to have visitors or not? If so, how often? Do you want to create rules about cell phone usage while working?
• Salary and benefits. Are payments going to be made weekly, bimonthly, or monthly? Discuss a payment system that both parties agree to.
• Other compensation. Are caregivers compensated during vacations and do they earn holiday pay?
• Petty cash. You might need to leave money for household expenses that may arise. Or you might prefer to reimburse the caregiver and ask them for receipts as proof of payment.

How Can You Prepare for a Caregiver?

Once you decide on a caregiver, be sure to give them a cheat sheet that includes details about the care recipient, special care needs, the home, and emergency protocols. Here are some instructions and details that need to be on your list:

Details about the loved one receiving care

• Behavioral issues and ways to address them
• Preferences, including likes and dislikes
• Characteristics
• Diet and eating restrictions
• Mobility problems
• Medical conditions and illnesses
• Exercises and schedule of therapies
• Medication list and intake schedule
• Signs of when they need to be rushed to the hospital

Home details that the caregiver needs

• Room information for in-home caregivers
• Keys to accessible areas of the house
• Medical supplies
• Location of food, appliances, and cooking tools
• Room where the cleaning and washing supplies are
• Cabinet or room for extra clothes or linen
• Knowledge about location of flashlights, fuse boxes, candles, light bulbs, and emergency kits
• Security precautions and emergency exits

Contacts and information in case of emergencies

• List of names and phone numbers of guardians, adult children, and the one in charge of the care recipient
• List of names and phone numbers of doctors, clinics, and hospitals
• List of contacts for house-related matters like the handyman and plumber

Caregiving is a very stressful job whether it’s paid or unpaid. If you welcome a caregiver into your home, be sure to treat them with the respect and kindness they deserve, and you can be sure they’ll treat their care recipient the same way.