Fillable Printable Hiring Formal Caregivers for In-Home Services - Michigan
Fillable Printable Hiring Formal Caregivers for In-Home Services - Michigan
Hiring Formal Caregivers for In-Home Services - Michigan
HIRING PAID CAREGIVERS
FOR
IN-HOME SERVICES
Michigan Office of Services to the Aging
Community Services Division
February 2004
TABLE OF CONTENTS
Page
Introduction and Purpose of Guide.......................................................................... 1
Making the Decision as a Family............................................................................. 2
Who’s Going to Pay and How? ............................................................................... 3
What Will Home Care Cost? ................................................................................... 5
Recruiting Paid Caregivers...................................................................................... 6
Where to Look......................................................................................................... 6
Screening Potential Paid Caregivers....................................................................... 8
Interviewing/Sample Questions to Ask.................................................................... 8
References ........................................................................................................... 10
Criminal Background, Driving an d Medical Record Checks .................................... 10
Employing a Paid Caregiver.................................................................................... 11
Contract/Written Agreement.................................................................................... 11
Caregiver Checklist................................................................................................. 12
Training for Tasks to be Performed......................................................................... 12
Supervision ........................................................................................................... 13
Payment ........................................................................................................... 13
Taxes and Other Legal Responsibilities.................................................................. 13
Ensuring a Safe Environment.................................................................................. 15
Emergency Contact Information/Procedures........................................................... 16
Abuse and Neglect.................................................................................................. 16
Conclusion ........................................................................................................... 17
Appendix A. The Top Ten Tips in Selecting the Right Home Care Agency
Appendix B. Application for Employment
Appendix C. Employment Contract
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H
IRING
P
AID
C
AREGIVERS
F
OR
I
N-HOME
S
ERVICES
INTRODUCTION AND PURPOSE OF GUIDE
Staying independent as long as possible is a goal for most adults. As individuals
age, remaining at home becomes more difficult, and assistance with certain activities is
often needed. Most of the assistance provided is given informally, meaning that unpaid
family members, friends or neighbors provide the majority of care. While informal
caregiving is a rewarding experience, it can oftentimes be physically, emotionally, and
financially challenging.
Many resources exist to support the work of families and friends caring for an
older adult. One available option is to hire an outside individual to supplement some of
the caregiving duties. These individuals are typically referred to as formal caregivers or
in-home care workers. Formal caregivers are paid individuals who provide hands-on
assistance to dependent adults, can work either full-time or part-time, and can be hired
privately or through an agency.
The purpose of this guide is to help you navigate the process of hiring a paid
caregiver. Whether you plan to hire someone yourself or use an agency, this guide will
provide you with information to find an appropriate caregiver, and tools to ensure that
the relationship is successful.
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MAKING THE DECISION AS A FAMILY
Relationships involve expectations and misunderstandings about those expectations
can cause dissatisfaction with the home care experience. For the situation to remain as
clear and conflict-free as possible, you must understand the expectations of everyone
involved. Cooperation and communication between you, your loved one and other
family members can help the process go more smoothly.
Home care is more successful when both the caregiver and care recipient are
comfortable with it. For some, learning to accept help from others is a complicated,
emotional issue and to do so is a milestone for both the caregiver and the care
recipient.
Some caregivers may struggle with accepting that they can’t “do it all”. Try instead to
focus on the fact that home care is an addition that allows your loved one to remain at
home and gives you the opportunity for some respite or time to focus on other things
that may also need your attention.
Care recipients may voice some reluctance to allowing “someone else” in the home. It
may be helpful in these situations to help them view home care as “something to try for
a period of time” as opposed to “something they’ll need for the rest of their life”. You
can evaluate the pro’s and con’s of home care after an agreed upon period of time.
A number of options are available for finding in-home help. While this is good news, it
can also be overwhelming. A good first step is to sit down together as a family and
assess the needs of the individual needing care. Individuals may need assistance in
just one or several of the following areas:
• Household
Meal preparation, house cleaning, laundry, shopping, and transportation
• Personal Care
Bathing, eating, dressing, toilet assistance and getting around the home
• Health Management
Medications, injections, IV therapy, wound care, diabetes treatment, speech,
occupational and physical therapy
Consider how much assistance is needed. Does the individual need minimal, significant
or total assistance? Be as detailed as possible about the type and amount of
assistance needed. Once you identify what type of assistance is needed, you can start
determining what type(s) of caregiver you are looking for. There ar e many types of paid
caregivers. Listed below are the basic categories:
y Housekeepers or Chore Workers perform basic household tasks and light
cleaning. Chore workers often do heavier types of cleaning such as washing
windows and other heavy cleaning.
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• Homemakers provide meal preparation, household management, personal care,
and medication reminders.
• Home Health Aides, Certified Nurse Assistants (CNA), or Nurses Aides often
referred to as Home Health Care Workers, provide personal care, help with bathing,
transfers, walking, exercise, household services that are essential to health care,
and assistance with medications. Some aides have received special training and
are qualified to provide more complex services under the supervision of a nursing
professional.
• Registered Nurses (RN), Licensed Practical Nurses (LPN) and Therapists often
referred to as Skilled Nursing Care, perform duties that could not be performed
safely by nonprofessional personnel. These individuals assist with varied medical
care, such as giving IV injections, tube feeding, dressing wounds, and physical,
occupational or speech therapy.
WHO’S GOING TO PAY AND HOW?
Hiring an outside individual or agency is not necessarily a costly option. Depending on
the situation of the older adult receiving care, in-home services may be covered through
their health insurance.
Medicare
Medicare covers Home Health Care services, which include skilled nursing care and
certain other services for the treatment of illness or inj ury, if the individual receiving care
meets the following four
conditions:
1. The individual’s doctor decides that in-home health care is needed and
2. The individual must need either part-time or intermittent skilled nursing care,
physical therapy or speech language pathology services and
3. The individual must be homebound, which defined by Medicare is a person who
is normally unable to leave home, or leaves home infrequently, for short times or
for the purpose of getting medical care and
4. The agency providing home healt h care is Medicare approved.
What Medicare Covers
If these four conditions are met, Medicare will cover Skilled Nursing Care on a part-time
or intermittent basis. Medicare will also cover physical therapy, speech language
pathology services, occupational therapy, medical social services, certain medical
supplies (not medications or prescriptions) and medical equipment as long as the
individual is eligible and the doctor prescribes the services. Medicare will also cover
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Home Health Aide Services (personal care) on a part-time or intermittent basis only if
the individual receiving care is also receiving skilled nursing care or another type of
therapy listed above. The Home Health Agency directly bills Medicare. Medicare pays
the full-approved cost of all covered home health visits.
What Medicare Does Not Cover
Medicare does not cover 24-hour/day in-home care, prescription medicines, home
delivered meals, homemaker services, and personal care given by a home health aide
unless skilled care services are also being provided.
Medicaid
If the person receiving the care has limited income and assets, he or she may be able to
receive homemaker, personal care, and other services through Medicaid if they meet
Medicaid eligibility requirements. In Michigan, Medicaid’s Home Help Services (HHS)
assists functionally limited individuals with activities of daily living (ADLs), and
instrumental activities of daily living (IADLs). Through the Home Help Services
Program, individuals have the ability to hire (and fire) their own paid caregivers, which
may be family members, friends or neighbors. The paid caregiver is paid by the Family
Independence Agency for providing care to the older adult. Contact Michigan’s Family
Independence Agency to learn more about this program and Medicaid eligibility at (517)
373-2035.
In addition, the MI Choice Home and Community-Based Service Waiver for the Elderly
and Disabled is another resource for services. Through MI Choice, income eligible
persons with a need for a nursing home level of care may receive services that allow
them to remain in their own home. Contact the Michigan Department of Community
Health at 517-241-7263 or at
www.mdch.michigan.gov for more information.
Out-of-Pocket and Medigap/Private Insurance
If the services needed do not fall under the coverage of Medicare and the individual
receiving care does not qualify for Medicaid, personal care and home services must be
paid out-of-pocket. Some Medigap plans do cover in-home health services. Check with
the care recipient’s health insurer to determine what services are covered by their plan.
Additional Insurance Questions
If you have questions about Medicare, Medicaid or Medigap coverage for in-home
services, call the Michigan Medicare/Medicaid Assistance Program (MMAP), a free
health-benefits counseling service for Medicare and Medicaid beneficiaries, their
families and caregivers. Trained MMAP counselors will answer your questions
regarding eligibility, enrollment, coverage, claims and appeals. Contact them at 1-800-
803-7174 or www.MyMMAP.org.
Public Programs
Some unskilled services may be provided for free or on a sliding scale through the
Older Americans Act. These vary by city, but can include programs such as meals-on-
5
wheels, homemaker assistance, transportation, adult day care, companionship and
respite services. Voluntary organizations such as the local Volunteer Center, Retired
and Senior Volunteer Program or Senior Companion Program may also provide
volunteer services that assist the homebound. Check with your local Area Agency on
Aging, faith-based organization and senior community resources to learn more about
these options in your community.
WHAT WILL HOME CARE COST?
Costs vary depending on where you live and what type of caregiver you need. Prices
are generally higher in larger cities and lower in smaller towns. Similarly, agencies in a
single city or town will charge different prices for the same type of services. The more
skills and training required from a paid caregiver, the higher their hourly rate. It is
recommended to check with friends who have hired caregivers and agencies in your
area to get a sense of what the going rates are. When calling agencies, be sure to
inquire about their out-of-pocket/private-pay rates (opposed to Medicare/Medicaid
rates).
As of this writing, federal law requires that you pay a home caregiver a least $5.15/hr,
which is the current minimum wage. You are also required to pay Social Security
benefits as part of the caregiver’s salary (discussed later in this publication). Using the
minimum wage as a starting point, factor in the cost of living in your area, and what
agencies charge for comparable services, to determine how much you should pay. You
want to offer enough salary to recruit and retain reliable help.
In hiring a paid caregiver, you can choose to go through an agency or self-hire. There
are advantages and disadvantages to both options, as discussed below.
Self-
Hiring
a
Caregiver
Advantages
•Self-hiring a caregiver is likely to
be a less expensive option if
Medicare, Medicaid or Medigap
will not cover the services.
•You have personal selection of the
caregiver.
•There is greater flexibility in the
caregiver’s work schedule and in
the caregiver’s responsibilities.
Disadvantages
•The time, cost and effort to
advertise, interview, check
references and select the
caregiver.
•The caregiver has no supervision
or training from an agency.
•There is no coverage for caregiver
absenteeism.
•You may have to pay for insurance
coverage.
•As the employer, you will be
responsible for payroll, including
deductions and taxes.
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Hiring a
Caregiver
Through
An
Agency
Advantages
•All of the hiring/firing is done by
the agency.
•Caregivers are supervised and
screened.
•There is typically 24-hour/7 day
back up for caregivers.
•Agencies pay insurance coverage
(in some cases).
•The agency serves as employer
and handles payroll and tax
issues.
Disadvantages
•This option is usually more
expensive than self-hiring a
caregiver.
•You have less choice in selection
of the caregiver.
•Individual caregivers may
alternate.
RECRUITING PAID CAREGIVERS
After you have determined what kind of in-home help you are looking for, the next step
in this process is recruiting potential paid caregivers. Knowing exactly what you are
looking for in a caregiver is helpful when sorting through all of the individuals and
agencies providing caregiving services. It is recommended that you write a detailed
job description, including the specific services you expect from the paid caregiver.
Consider the following issues as well:
• What type and what level of healthcare training is needed?
• Any language skills or other special skills needed.
• Experience working with memory impairments or other disabilities.
• Ability to lift the care recipient and/or operate any special equipment.
• Is a valid driver’s license and/or personal care needed?
Consider if the individual receiving care will be more comfortable with a home care
worker who shares their cultural background and/or language, or if they have a
preference between male and female caregivers, particularly if the hired caregiver will
e assisting with personal care activities. b
WHERE TO LOOK
Whether you intend to self-hire or go through an agency, a good first place to start is
with your local Area Agency on Aging (AAA). Area agencies on aging can provide
you with information about in-home and community services available in your area.
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They will have information on home care agencies and volunteer groups that provide
help, and may maintain a registry of home care workers from which you can recruit
directly. To find the AAA in your area, check your local telephone directory or contact
Michigan Office of Services to the Aging at 517-373-8230 or via the Internet at
www.miseniors.net
.
Finding an Agency
If you have decided to use an agency, some good resources for finding reputable
agencies in your area are listed below. Contact the Better Business Bureau to see if
any complaints have been filed against the agencies that you are considering.
Referrals for Agencies:
y Doctors, social workers and discharge planners
y Recommendations from family and friends
y Your local Area Agency on Aging
y Telephone Directory, under Home Care or Home Healthcare
y Internet, Homecare Online, www.nahc.org
; Extended Care Info Network,
www.extendedcare.com
.
y Medicare Approved Agencies: If Medicare will be covering the services, be sure to
look for agencies that say they are Medicare approved. You can search for Medicar e
approved agencies on www.medicare.gov
. Beginning in late fall 2003, you will be
able to view quality measures of Home Health Agencies in Michigan on this website.
If you belong to a Medicare managed care plan, your choice of Home Health
Agencies will be limited to those agencies working with the managed care plan. Call
your managed care plan if you have questions about their home care rules.
Once you acquire the names of several agencies, you will want to learn more about
their services and reputations. A list of the “Top Ten Tips in Selecting the Right Home
Care Agency”, developed by the Michigan Home Health Association to determine which
agency is best for you or your loved one has been included as Appendix A.
Self-Hiring Independent Caregivers
The idea in recruiting a paid caregiver is to target individuals who are suited, either by
experience or life circumstances, to help older adults. Some promising labor pools
include students, young adults, women with young children, mature women and
retirees. Here are resources for finding qualified help:
Referrals for Independent Caregivers:
• Referrals from family and friends
• Area Agencies on Aging
• Independent living centers, senior centers, religious congregations, or national
health organizations (i.e., Alzheimer’s Association)
• Local college career offices, especially those with nursing or social work programs
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• Michigan Works!: As an employer you can post your job listing, or you can search
the resumes posted by job seekers on the Michigan Works! website. Visit
www.michworks.org
for more information.
• Attendant Registries: Most communities have attendant registries that can be a
good resource for finding in-home help because they typically provide some initial
screening of applicants. These are generally listed under Nurses and Nurse
Registries in the phone book. While some registries are free, fees for using a
registry service may vary greatly. It is a good idea to shop around.
• Want Ads: If none of the other referral methods prove effective, you can try
advertising in the “Help Wanted” sections of your local paper. Your ad should
include hours needed, a brief description of duties, telephone number and time to
call, but do not list your address. In the ad, you can also mention preferences
such as non-smoker, male/female and wage offer.
SCREENING POTENTIAL PAI D CAREGIVERS
Before scheduling face-to-face interviews with any potential applicants, do some initial
telephone screening to ensure the person is appropriate for the position. Over the
phone, describe the job in detail, stating specific expectations, as well as information
about hours and wages. It is appropriate at this time to ask the applicant about relevant
past employment experiences and if they have reliable transportation.
If you are satisfied with what you have heard from the applicant, schedule an interview.
Request that the applicant bring two or three professional references, a valid driver’s
license and/or proof of identity (social security card, picture ID, etc.). If applicable, ask
them to bring their licenses and training certificates as well.
It is not necessary to schedule an interview if the phone screening did not go well.
Thank the individual, take their phone number and inform them that you are doing other
interviews and will get back to them. Do not give your name and address to those
you do not intend to interview.
INTERVIEWING/SAMPLE QUESTIONS TO ASK
Have the applicant complete an application, and review it with them, making sure
everything is complete and legible. A sample job application form can be found in this
booklet (Attachment B). Feel free to reproduce this document for your purposes.
During the interview, give the applicant a list of your needs or a copy of the detailed job
description to read. Being as detailed as possible, discuss with the applicant the
services you expect to be performed, noting anything he or she is not willing or trained
to do. Try to be as informative as possible about the position to avoid any future
surprises. Be clear about your expectations, the salary and time commitment.
9
Look for someone who has experience with the type of tasks they will be performing in
your situation, particularly if the care recipient has special needs, such as memory
impairment or physical disabilities. Try to assess as much as you can about the
applicant by what they are telling you and how they appear during the interview. Did
they arrive on time? Do they present themselves well? Do they appear to have reliable
transportation? Do they seem patient? Compassionate? Flexible? Trustworthy?
It may be wise to see how the applicant interacts with the individual they will be caring
for. Do their personalities match? How do they get along? Could they work together?
Is there some mutual respect? Similarly, since you may be spending a lot of time
interacting with the paid caregiver, make sure that this is somebody with whom you can
get along with as well.
It is recommended to have someone with you during the interview. Their company will
help you feel more comfortable, and they may also be able to give you another
impression of the applicant after the interview. Before the interview, make a list of
questions that are important to you. Try to ask the same questions to all the applicants.
This will help you compare them later. After the interview, write down your impressions
and discuss them with others who sat through the interview. If you had concerns or
questioned something the applicant said, write it down and check it out.
Possible Interview Questions:
• Why are you in this line of work?
• What kind of special training, if any, have you had?
• What types of work do you enjoy? Do not enjoy?
• Do you have any physical or emotional problems that would hinder you in this job?
• Have you ever been convicted of a crime? What? Where? When?
• Do you mind being around someone who smokes or drinks?
• Will it bother you to work around a cluttered house?
• Would you be willing to transport the care recipient to doctor’s appointments or other
outings?
• Is there anything on my “list of needs” that you can’t or won’t do?
• How long do you plan to stay on the job? Will you provide at least two weeks notice
before resigning?
• Would you ever have any occasion to bring someone with you?
• Are there any problems with the days or hours that I need you to work?
• Can you work on weekends and/or holidays?
• What are your salary requirements? Is it negotiable?
• Would you agree to a trial period for training and getting acquainted?
• Are you familiar with special diets (i.e., diabetic, low sodium, low cholesterol) ?
• Do you have reliable transportation?
Interview Questions for Special Needs:
• What is your training and experience in the area of memory loss?
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