Finding Good In-Home Care for an Ill or Aging Parent:
Some Practical Tips

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

In an earlier blog titled "Stretching to Cover" (April, 2011) we talked about strategies for coping with caregiver stress--finding ways to manage the upset that follows those inevitable glitches and setbacks that occur when caring for an ill or aging parent. In this blog we explore one way of preventing caregiver stress before it occurs: hiring a professional caregiver.

There are many different types of home care services, and they vary according to the care-receiver's needs. The more complex the problem, the more highly trained the caregiver must be, and the higher the cost. The average cost per visit for a home care nurse today is more than $120; the average cost per visit for a home health aide is more than $60.

To be covered by Medicare, a service must be ordered by the patient's physician, who declares the service medically necessary. A wide range of in-home services can fall into this category, including:

  • Skilled nursing care
  • Speech, physical, and occupational therapy
  • Dietary and nutritional consultations
  • Some educational services (for example, diabetes self-care)
  • Rental or purchase of medical equipment (such as a wheelchair or blood-glucose monitor)

How can you fund services not covered by Medicare? For many people the best option may be a long-term care insurance policy. Unlike Medicare, most long-term care policies cover some custodial or non-skilled services (such as light housekeeping and transportation). Eligibility criteria differ from policy to policy, and you should check with your insurer for details before you contract for services.

Who May Provide In-Home Care?

In-home care is typically provided by certified home health care agencies, and certified independent in-home caregivers (also known as independent providers). A certified home health care agency is a corporation that provides a range of in-home services. To become certified, the agency must meet stringent federal and state standards in a variety of areas. Certified agencies must make their customer satisfaction data available to anyone who requests it, so don't be shy about asking for this information: Reputable agencies are usually happy to share it with you (it's a big red flag if they hesitate).

Not all good caregivers choose to work for agencies, however; many prefer to offer their services privately. Independent providers can usually be located through Medicare, insurance companies, via the web, or in the Yellow Pages (look under Home Health Services and Nurses). Like home health care agencies, independent providers are required to meet certain criteria in order to be licensed. They must have adequate training, and appropriate experience. They must also have malpractice insurance, adhere to the ethical standards of their profession, and fulfill continuing education requirements to stay up to date on the latest findings and treatments.

How to Evaluate an Agency or Provider

Once you find an agency, or independent provider, how do you assess the quality of their services? First, meet with them personally. There's nothing like a face-to-face interaction to help you judge a potential caregiver. Second, review their credentials. Everything should be in order here--no exceptions, no excuses. Third, ask others about the provider's performance. Past clients are a great source of input. Finally, trust your instincts. If something feels wrong, it probably is.

Questions are important, but not all information can be obtained by asking. To evaluate a potential caregiver, you'll need to judge a few things for yourself. Any good caregiver--whether they're an independent provider or employed by an agency--should have five qualities:

  • A professional appearance - Although most caregivers don't look like television nurses, a sloppy or unkempt appearance isn't acceptable. A professional caregiver should be clean and well-groomed, and dressed appropriately for the job.
  • Good observational skills - A caregiver must be sensitive to changes in the patient's condition--especially those the patient can't describe directly. Having the caregiver interact with the care receiver can be helpful in this regard.
  • Good communication skills - A caregiver must be able to communicate clearly with folks who have perceptual problems (so don't be surprised if they speak slowly, loudly, and very directly).
  • Quiet self-confidence - Self-confidence is essential in a caregiver. After all, part of the caregiver's job is to provide reassurance to you and your loved one. A good caregiver helps both patient and family member feel that everything is in good hands.
  • An open mind - Caregivers and care receivers are often quite different--in age, gender, and perhaps religious or ethnic background. Care receivers often vent their frustration on those around them, blurting out insults when depressed or upset. An experienced caregiver expects this, and won't take it personally.
  • A sense of humor - Professional caregivers know to expect the unexpected. Food gets spilled. Bedclothes get soiled. An even temperament and a dose of good humor are essential in a caregiver whose work is sometimes unpleasant.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here's the link: