Whether you need full-time care, part-time care, or occasional respite care, choosing someone to look after your elderly loved one is a stressful process. You’re looking for a senior caregiver who can manage the details of the job — like cooking, cleaning, keeping medications organized. But caregiving is so much more than a list of household and helping tasks. It’s also an interpersonal role that demands compassion, patience, and excellent communication skills.
Locating that special person can feel like a daunting task. It might help to know there are more than 800,000 households in the U.S. that rely on the services of a professional, in-home caregiver. If they can find a qualified individual, you can too. The search begins with defining the right level of care for your senior.
What do caregivers do: Levels of care
Reach out to a home care agency or a prospective caregiver and you’ll be asked almost immediately about your desired level of care. The two primary options are companion care and home health care.
1. Companion care
Companion care involves supervision, social interaction, transportation to appointments, and light housekeeping duties. Companions might do the grocery shopping, prepare meals, and take your senior to the hair salon, but they will not provide help with dressing, grooming, or toileting. For that reason, companion care is only an option when your senior is mobile, continent, and reasonably communicative.
Companions may also be called home care aides.
2. Home health care
Home health care is provided by a home health aide, sometimes called a home health nurse. Home health nurses provide companion-level services but are additionally equipped to help seniors with activities of daily living (ADLs), such as grooming, dressing, eating, and going to the bathroom. Home health aides can also:
- Transition the senior from a bed to a wheelchair or from wheelchair to a chair
- Manage the senior’s medication schedule and remind the senior when to take medications
- Monitor the senior’s general physical and mental condition
- Check the senior’s vital signs
If you aren’t sure which level of care your senior needs, ask your senior’s physician for a recommendation.
Live-in care vs. 24-hour care
You probably have a sense of the schedule you’d like your at home caregiver to follow. If you plan on sharing caregiving duties, for example, an hourly, part-time home care aide or home health nurse is an economical choice. But if your senior wants to stay in his or her home, rather than yours, you may need around-the-clock home care. In that case, you have two options: live-in care or 24-hour care.
What is live-in care? A live-in caregiver works in 24-hour shifts, sleeping at night in the senior’s home. Note that the caregiver doesn’t typically move in with the senior or stay with the senior seven days a week — he or she would keep a permanent residence elsewhere. If care is needed daily, two caregivers might switch off every four days to provide full-time coverage. Live-in assistance is a good choice when you’d like someone in the house at all times, but the senior is able to sleep comfortably at night.
Twenty-four-hour care is a slightly different arrangement and is appropriate when the senior needs care during the night. A 24-hour care plan would involve two to three caregivers who each work 12- or eight-hour shifts. The caregiver on the night shift would remain awake and alert at night. This approach is more expensive than live in assistance but does ensure that the senior is under a watchful eye at all times.
A note on caretaker vs. caregiver
The words caretaker and caregiver are sometimes used interchangeably, particularly in British English. In American English, these two terms have slightly different meanings. A caregiver is a person who looks after another person. Caretaker is a more general term, referring to someone who looks after anything — it could be another person or an inanimate object, such as a home. In the context of searching for someone to support and assist your senior, caregiver is the more correct term.
Where to find a home caregiver
You can find a home caregiver by working with a home care agency or by asking friends and family for referrals. An agency may ultimately cost more but has better protections in place for you. The agency will vet candidates thoroughly, calling references, verifying work history and credentials, and performing background checks. Agencies also manage payroll taxes and documentation such as 1099s, so you don’t have to.
If you want to work with an agency, interview several and always check their references and reviews. Evaluate their customer service approach as you interact with them. Your agency will be indirectly managing your caregiver, and you need to feel comfortable you’ll get answers when you need them.
Qualities to assess in senior caregivers
Interviewing is a critical phase in your search, as it’s your chance to evaluate how closely applicants’ professional and interpersonal skills align with your senior’s situation. Plan on interviewing several applicants. That way, you can evaluate them individually and relative to one another.
Here are six lines of questioning that can help you uncover the right applicant.
1. Personality and interests
A great caregiver can manage situations assertively and take directions gracefully. That’s not an easy balance for anyone — but it’s particularly challenging when the relationship involves a senior who’s losing his or her independence. Ultimately, the right caregiver is someone who can earn the respect of your senior. That’s the only way the caregiver-senior relationship can develop and thrive.
It’s also important to stay focused on the role companionship plays in caregiving. The perfect caregiver must have some common ground with the senior. For example, your senior might be a die-hard sports fan. In that case, the right companion would have an interest in sports or at least be capable of holding a conversation about sports.
Try these starter questions to get a sense of the applicant’s personality and interests.
- Why did you decide to become a caregiver?
- What are the most challenging aspects of being a caregiver?
- What is most rewarding to you about caregiving?
- How would your last client or boss describe you?
- What are your top three personal values?
- Tell me about a time you had to deal with a difficult situation or personality and how you managed it.
- If the senior under your care refused medications, how would you handle it?
- What are your interests outside of work?
- What’s the top item on your bucket list?
Your ideal caregiver will be experienced in the type of care your senior needs. Consider the senior who’s a wheelchair-bound vegetarian, for example. That places two special requirements on the caregiver. He or she must be strong enough to transition the senior in and out of the wheelchair safely, and also must be comfortable preparing vegetarian meals.
These questions can help you assess the applicant’s caregiving skills:
- Have you ever cared for someone who is wheelchair-bound/has memory loss/is incontinent (or any descriptor that’s applicable to your senior)? If yes, what was most challenging about that assignment?
- Describe the skills needed to be an effective senior caregiver.
- Tell me about any certifications you hold.
- How do you approach continuing education or develop new skills?
- Are there any professional skills you don’t have currently that you’d like to acquire?
- The senior falls out of his wheelchair, gets angry, and won’t let you help him. What do you do?
It’s not enough to ask for references. You have to call those references, too. Consider it a red flag if the applicant is reluctant to provide references or asks you not to contact them. This is a critical part of the hiring process, as it’s your only opportunity to get feedback from previous employers. Here are the questions to ask:
- Did this individual work for you? When?
- What were his or her responsibilities?
- What was your general experience with this individual?
- Would you hire this individual again in the future?
If you are hiring through an agency, ask the agency to outline the individual’s work history and any feedback gathered from their own reference checks.
4. Attention to detail
Attention to detail is critical, particularly if the senior is taking multiple medications. You need to know your home aid provider can follow care instructions without deviation or oversight. Questions like these can help you evaluate the caregiver’s precision with respect to implementing a care plan:
- How will you keep track of the senior’s medications?
- How will you monitor and document the senior’s physical and mental condition over time?
- Do you use any tools to stay on top of doctor and other appointments?
- When is it acceptable for you to deviate from the care plan?
Elderly care in the home should be structured according to the senior’s needs, but there are situations that demand flexibility from your caregiver. For example, a daytime caregiver will need to stay late if you are delayed leaving work. Or, a live-in caregiver might need to miss a few hours of sleep if your senior needs extra help at night. As well, the senior’s condition and care plan may change over time, and the caregiver has to adjust accordingly.
Get comfortable with the applicant’s willingness to be flexible by asking these questions:
- Do you have another job that would be impacted if you had to stay late?
- Do you mind if family members or friends drop by in the middle of the day? (And, how would you determine that the individual actually is a family member before letting him or her inside?)
- Would you be willing to stay over a long weekend if we needed extra help?
- If the senior says he’s too tired to do his daily stretching exercises, how would you handle that?
6. Driving and transportation skills
If transportation will be one of your caregiver’s duties, remember to verify the caregiver has a valid driver’s license and car insurance. In addition, you should ask:
- Are you comfortable driving the senior’s car to run errands, or will you drive your own?
- What is your process for helping seniors get in and out of the car?
- Do you have a clean driving record? Describe the last time you were pulled over for a traffic violation.
Finding the right fit
The right caregiver has the required skills plus a personality that’s compatible with your senior. The surest way to find that person is to interview several applicants, using a broad range of questions to get a complete view of each. Then, ask yourself which applicant makes you feel most confident that your senior will be safe and happy while you are away. Often, there will be one clear standout — and that’s your perfect caregiver.