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How do I find and hire a good private home healthcare worker?

Entrusting the care of your loved one to a stranger is a very hard decision to make. Coupled with sensational news stories, it’s hard to know what to believe.

Licensed home care agencies carefully screen prospective employees (companions, nurses' aides, et al) during the hiring process. Candidates must pass basic skills testing, background checks, reference checks and possibly a drug test. Once hired, caregivers must successfully complete regular training sessions to keep their skills up to date, learn about cultural traditions, comply with any appropriate regulations, etc. Additionally, all homecare workers should be closely supervised.

There are pros and cons to hiring privately. Agencies have all the systems in place to manage and train caregivers. If there is a problem, there is a process to getting it resolved. However, an experienced and very qualified caregiver may opt to become an independent contractor and seek his or her own clients. Sometimes families will refer a caregiver with whom they've had direct experience.  That's always a good way to initially learn of someone.  If you do choose to hire an independent contactor, be prepared to take on all the responsibilities of being an employer. Consult an attorney with regard to labor practices, such as workers’ comp, liability and federal tax issues. While you might be enamored with the person’s skills and demeanor in the beginning, it’s important not to make an emotional decision and enter into a relationship without a formal agreement.

If you ultimately decide to hire privately, spend the time, energy and money to check references and do a background check. While most people enter the caregiving profession with a genuine desire to help people, there are those few people who seek to exploit what can be an emotionally charged situation.

Private home healthcare workers are individuals hired directly by you or your family. They may be found a number of ways including through a friend or by using a classified ad or a similar "help wanted" posting. These caregivers typically provide companionship and help with activities of daily living (ADLs) such as housecleaning and meal preparation.

If you plan to hire and pay an unlicensed personal care attendant for home healthcare services on your own, you do not need a doctor's order. However, licensed nursing services that are provided by a RN or LPN do require a doctor's order.

If you do decide to find your own home healthcare worker, be aware that you will be required to take responsibility for certain things. Carefully consider these responsibilities including:
  • The need to withhold taxes as an employer for the worker.
  • The need to have a written contract (including a job description) with the home healthcare worker, particularly if he or she is going to live in your home. If the caregiver is going to live with you, it must be clear in the contract that their right to stay in your home continues only as long as that person works for you.
  • The need to be certain that the home healthcare worker is covered by personal liability or worker's compensation insurance so that you are covered in case there is a liability claim such as an injury in your home.
  • The need to do background check to make certain that the healthcare worker you hire has no record of criminal activity or abuse. Some states have registries (many are available online) for personal care attendants and home health aides that make it easier for you to do the background check.
  • The need to have a back-up plan for care in case the worker becomes ill or unavailable at short notice.
Interview potential health care workers in your home where there is an opportunity for the caregiver to become acquainted with you and any family members. The interview and selection process should be a time for an open and honest discussion between the patient, family, and the healthcare provider. Ask the caregiver how he or she would respond in specific situations and request that they provide examples from past experience that show how they solve problems.

Make it clear to the home healthcare provider that you will not tolerate abuse, neglect, chronic tardiness, absenteeism or failure to perform assigned duties.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.