How to find a professional caregiver
You know that saying, “It takes a village”? Well, caregiving takes a village! In fact, according to the AARP, more than 2.3 million workers in the United States provide in-home personal and health care for older adults and people with disabilities.
There are numerous types of caregivers and services, including family caregivers, adult day services, custodial care services and medical care services. Additionally, home care workers include personal care aids (PCAs), home health aids (HHAs), licensed nursing assistants (LNAs) and certified nursing assistants (CNAs), licensed practical nurses (LPNs), and registered nurses (RNs).
The type of care that you or a loved one need determines the skills required from an in-home care worker. It is important to note that the cost of care will vary based on the services needed. For example, if a loved one needs help with mobility and chores around the house, a personal care aide or home health aid may be a better fit in terms of both service and cost needs compared to a registered nurse.
If you or a loved one wishes to age in place and requires additional in-home support, this article will provide tips on how to identify the right level of care, and how to hire a caregiver.
Assess the type of care needed. Paid in-home caregivers provide a range of services. It is common to need a combination of the services noted below, or to gradually need additional assistance overtime.
Services are generally categorized as:
Personal/Custodial care: Bathing, eating, dressing, toileting, grooming
Household care: Cooking, cleaning, laundry, shopping, transportation
Emotional care: Companionship, meaningful activities, conversation
Health care: Medication management, physician’s appointments, physical therapy
Identify the different types of care workers based on what services are needed. These workers are generally categorized as non-medical and medical care workers.
Professional Caregivers provide non-medical in-home care.
Personal care aids (PCAs) can provide non-medical services such as personal/custodial, household, and emotional care. They are not licensed and training requirements vary by state. Since personal care aids provide non-medical care, their services are typically not covered by private health insurance, Medicare or Medicaid. These services would be considered out-of-pocket expenses. According to the U.S. Bureau of Labor Statistics, the median pay as of 2019 (the most recent data available) is $25,280 per year or $12.15 per hour. However, this amount varies based on the market, geography and if you hire them independently. If you go through a third party agency, the overall cost will likely increase.
Home Health Aids (HHAs) can provide non-medical services such as personal/custodial, household, and emotional care. They can also monitor the care recipient's condition, check vital signs such as blood pressure and assist with activities of daily living. Under Federal law, Home Health Aids must obtain 75 hours of training and 16 hours of on-the-job training. They are also required to meet state specific certification and training. According to the U.S. Bureau of Labor Statistics, the median pay as of 2019 (the most recent data available) is $25,280 per year or $12.15 per hour.
Licensed nursing assistants (LNAs) and certified nursing assistants (CNAs) can provide non-medical services such as personal/custodial, household, and emotional care. According to the website Seniors Matter, they also provide some medical services such as monitoring changes in the care recipient, taking vital signs, setting up medical equipment, changing dressings, cleaning catheters, monitoring infections, conducting range-of-motion exercises, offering walking assistance, and administering some treatments. It is important to note that a registered nurse (RN) or nurse practitioner directs and oversees the medical-related tasks that are performed by the assistants. Under Federal law, they must obtain 75 hours of training. They are also required to meet state specific certification and training. According to the U.S. Bureau of Labor Statistics, the median pay as of 2019 (the most recent data available) is $29,660 per year or $14.26 per hour.
Medical in-home care workers provide home healthcare services.
Licensed practical nurses (LPNs) do not provide non-medical care services. LPNs provide direct medical care that non-medical in-home care workers cannot provide. Licensed practical nurses (LPNs) must meet federal standards for health and safety and are licensed by states. The type of medical care they can provide includes administering IV drugs, tube feedings and shots; changing wound dressings; and providing diabetes care. In fact, there are licensed practical nurses that are trained in specialties such as occupational therapy, physical therapy and speech therapy. Since licensed practical nurses provide medical care, Medicare covers home health skilled nursing care that is part-time or intermittent, doctor-prescribed and arranged by a Medicare-certified home health agency. According to the U.S. Bureau of Labor Statistics, the median pay as of 2019 (the most recent data available) is $47,480 per year or $22.83 per hour.
Registered nurses do not provide non-medical care services. According to the definition provided by this AARP article on caregiving, they “provide direct medical care, administer medications, educate and advise family members, operate medical monitoring equipment, and assist doctors in medical procedures. They are required to have a nursing diploma or an associate's degree in nursing; to have passed the National Council Licensure Examination, administered by the National Council of State Boards of Nursing; and have met all other licensing requirements mandated by their state's nursing board. Their services may be covered by Medicare home health skilled nursing. According to the U.S. Bureau of Labor Statistics, the median pay as of 2019 (the most recent data available) is $73,300 per year or $35.24 per hour.”
Understand how to search for and hire a paid in-home caregiver.
This step may feel overwhelming at first and may take time to complete, but we hope these tips will help you navigate this process.
First, determine if you want to use a third party such as an agency or registry to search and hire a paid in-home caregiver—or, if you wish to be more autonomous, search for caregivers independently or through referrals.
Agency: The agency either contracts or employs the caregivers. You would work with them to identify a caregiver that would be the best fit. The agency does all of the administrative legwork like paperwork, prescreening workers, ensuring they have relevant experience, liability protection, providing backup care in the event your caregiver wasn’t available that day, upgrading care level to someone with more training as you or your loved one’s needs evolve, and more. If you are interested in researching agencies, we encourage you to contact your Area Agency on Aging and ask for recommendations. Use the federal government's Eldercare Locator to find your local agency, or call 800-677-1116. Once you have identified a few agencies, AARP has a helpful checklist that you can walk through with the agency to ensure they are a good fit.
Registry: A registry connects families with independent home health workers. This is basically a matching service. These firms may charge a one-time fee for a successful match, but otherwise the financial and professional relationship is between you and the caregiver. You will be responsible for all of the administrative duties, liabilities, and caregiver complaints. While registries may be less expensive than agencies, there are pros and cons to both methods. Examples of registries include care.com and carelinx.com.
Here are some additional resources to reference during this journey:
Aging Life Care Association provides help in locating a professional care manager: www.aginglifecare.org
Elder Financial Protection Network works to prevent financial abuse of elders and dependent adults: www.elderfinancialprotection.org
Family Caregiver Alliance (FCA) seeks to improve the quality of life for caregivers through education, services, research, and advocacy: www.caregiver.org