Questions to Ask When Hiring a Caregiver for Elderly Parents

Often times when your parents start to age, the children take on the majority of the caregiving duties. Your parents have raised you and took care of you all your life, and now you may feel like it’s your turn to do the same. However, sometimes the extent of care required can interfere with your career, family life, or other things. When the care is affecting your life negatively, this can be described as caregiver burden. Caregiver burden is defined by Zarit, Todd, and Zarit (1986) as “the extent to which care- givers perceive their emotional or physical health, social life, and financial status as suffering as a result of caring for their relative” (p. 261).

While you want the best for your parent, there is no shame in delegating some or all care to a trained caregiver. Finding a caregiver that works well with your parent and makes both of you feel comfortable is important. Here are some things to consider when making this decision.

Agencies vs. Independent Hiring

When hiring a caregiver, you can either choose to hire one from a home care agency or by independent hire. There are advantages and disadvantages to each however studies have found that the overall performance of the caregivers was similar.

The main reason you may choose to hire from an agency is that the agency will take care of the managerial tasks whereas you would have to deal with this on your own for independent hires. These tasks include payroll, background and criminal checks, liability insurance, and proper licensing. You will pay more for a caregiver from an agency because of all the behind the scenes management you may not be aware of, however it will be more time consuming doing these tasks on your own for independent caregivers. Agencies also typically supervise their staff through home visits to assess the relationship or check with the caregiver directly when they come into the agency for any reason. This is another thing you would be responsible for if you hire independently. While supervision is not always necessary, it does give you a good piece of mind knowing your parent, or other care receiver, is in good hands. Other reasons you may prefer to go with an agency over independent caregivers is that agencies will replace the caregiver should they retire, quit, or stop working for any other reason. Agencies often have caregivers with different levels of experience available, although the cost will go up with the more experience. Additionally, agencies will have already trained their staff so additional training from you should not be required. This may be something an independent hire could need assistance with at first depending on their level of experience. However, if you are looking for a caregiver to assist with transportation, whether it be to appointments or to go grocery shopping, agencies often do not allow this. This is because there is a higher liability when the caregiver drives the care receiver around. This is an example of when independent hiring may be preferred.

When hiring through an agency, it may be smart to do your own research on them, past what is shown on the website. It may be a good idea to call the agency with questions, cross referencing information on their website to ensure you are getting full, correct information. Agencies may also give families a false sense of security because of their background checks and screening. While it is helpful to have the screening done for you, you cannot be sure of the quality of the agencies screening process.

What to Look for in a Caregiver?

The first step in looking for a caregiver is to determine what you would require of them. Do they need to prepare meals for the patient? Does the patient need assistance with bathing and personal hygiene? Or do you simply need someone as a companion and to assist with medications? The level of care required will differ by person, so you will have to determine what is best for you and your parent.

Some general qualities you should look for in a caregiver no matter what you need them for are dependability; so you can ensure they show up on time and stick around should problems arise, compassion; so they can empathize with and understand the care receive, trustworthiness; as they have access to many of the care receiver’s personal things including finances sometimes, and patience. You should look for a caregiver with prior medical experience. The more experience the better, although the price will increase with more experience. This is so that they can properly understand and ensure that the patients’ medications are used correctly and are able to promote adherence to even complex medication regimens. Caregivers should also be able to follow physicians’ directions properly. In the case that the patient needs assistance lifting things or moving themselves from place to place, you should ensure that the caregiver has the physical ability to do so. Some other things you may want to consider should they be needed is can the caregiver schedule medical appointments and accompany the elderly to them? Do they have adequate knowledge of nutrition if you would like assistance with the patient’s nutrition? Are they able to assist with managing finances for the elderly patient? Are they able to assist with laundry, household cleaning, and garbage removal? Additionally, if the patient has dementia, they may be more difficult to deal with so the caregiver will need to be more patient and tolerable to problematic behaviours. Experience with other dementia patients in this case is especially helpful. And while the majority of caregivers are women, any gender is capable of quality care.

You also should be aware of the patient-caregiver relationship. Ideally you should be looking for a close relationship developed through mutual respect. You should want the caregiver to provide a friendly, informal, supportive atmosphere. Positive communication between the patient and caregiver is also essential as communication is an important piece to any relationship.

What Questions to Ask?

When hiring a caregiver, it is a good idea to briefly interview them. Ensure to ask them what their experience in health care or other related care is. You may want to perform a criminal background check on them as you want to be sure you are leaving your parent in the hands of someone safe and competent. Elder abuse is a big issue if the wrong caregiver is hired. They may harm or threaten harm to the patient physically, mentally, or psychologically. However, if their background check comes up clean and the caregiver has previous experience you should not have any reason to worry. Some people may want the caregiver to go through a psychological screening to ensure they are of fit mind, especially when dealing with more difficult patients. Drug screening and health literacy tests may also be wanted. You may also want to ask what languages the caregiver speaks as you want to ensure the medications and their instructions are communicated properly. Most medications in Canada are given in English, so if English is not the first language of the caregiver, you may want to ensure they are fluent. Also, if your parent speaks another language at home, for example if your parent’s first language is French, you may want to consider a caregiver who speaks fluent or at least a good amount of French. You also should communicate to the caregiver what tasks you are looking to be done (i.e. personal hygiene, preparing meals, or lifting) to ensure they are able to and comfortable completing them. You should also ask if the caregiver has been CPR certified or has other relevant certifications.

When hiring from an agency, you may want to ask questions regarding how they operate. For example, you may want to ask what their hiring requirements are and what the recruitment process is. You may also have questions regarding their screening process. This is so that you can ensure the screening processes are up to your personal standards. You should also ask how the agency assesses what the caregiver is capable of doing. Also ask questions about the agency’s supervision processes, how frequently they occur, and if they occur in person or over the phone. Should a caregiver become sick or need a day off, what is the agency’s policy on substitute caregivers, or replacement caregivers should the main caregiver stop working.

How to Avoid Bad Caregivers?

While most of the caregivers out there are experienced, good workers, there are cases where you may be dissatisfied with their care. Most of the time it will be hard to tell from the beginning whether a certain caregiver is unfit. You can typically avoid hiring a bad caregiver by asking the questions and following the screening mentioned earlier. You should also be sure to communicate with your parent about their care and how their feeling and check up on them once in a while. Some things that may be a cause for concern is inadequate health literacy rates or limited English proficiency. Both of these factors can lead to miscommunication of information and possibly to dosing errors of medications. Ensure that your caregiver never gives unprescribed medications, or mixes medications that were not intended to mix. You should also be aware of any personality conflicts between the caregiver and patient. Do they seem uncomfortable around each other? Does your parent complain about them? Are tasks getting done? Some cases the caregiver just may not be the right fit, and another one may work better. You should also monitor that the relationship does not get too close, as there is risk of the caregiver taking advantage of the patient emotionally or even financially.

How to Improve Patient-Caregiver Relationship?

A study was conducted at the University of Florida examining the relationship between patients and caregivers and spoke with each of them regarding how this relationship could be improved. The main feedback was to improve communication. The caregiver should use the patient as a source of information (given they are competent). It also showed to be helpful for the patients to keep a list or journal of questions, side effects, and pain so that it can be communicated effectively to both the caregiver and doctor. One patient said that filling out papers on pain gave them a “psychological grip” and showed that their pain was being recognized. It also may be a good idea for caregivers to keep track of medication schedules and dosages, so that they can work with the doctor to fix any issues. The caregiver should also listen to the patient’s needs, how they feel and how the wish to be treated. The caregiver should show caring behaviours by providing emotional support, being lighthearted and encouraging independence, while limiting inhibiting behaviours. Some patients reported feeling that their caregiver was talking to them in a patronizing way, making decisions for them, being insensitive to their feelings and concerns, as well as hiding some information. These patients found it more helpful that the caregiver not show these behaviours. The caregiver should also aim to educate the patient regarding their care, being able to answer any questions the patient should have, and simplifying seemingly complicated medical terms.

Tips on How to Find Caregivers.

Knowing where to look to find a good quality caregiver may be difficult for those who have never had this experience before. Try talking to friends going through similar situations with their parents or elderly people already receiving care for recommendations in your area. Here is a list of keywords you should try searching, made by talking to geriatricians, geriatric based social workers, and other hospital staff:

  • Private duty attendant
  • Caregiver
  • Caregiver services
  • Companions
  • Homemakers
  • Direct care workers
  • Personal care attendants
  • Non-nursing home health worker

 

Citations.

Faison, K. J., Faria, S. H., & Frank, D. (1999). Caregivers of chronically ill elderly: perceived burden. Journal of Community Health Nursing, 16(4), 243-253.

Schoenmakers, B., Buntinx, F., & Delepeleire, J. (2010). Factors determining the impact of care-giving on caregivers of elderly patients with dementia. A systematic literature review. Maturitas, 66(2), 191-200.

Lindquist, L.A., Cameron, K.A., Messerges‐Bernstein, J., Friesema, E., Zickuhr, L., Baker, D.W. and Wolf, M. (2012), Hiring and Screening Practices of Agencies Supplying Paid Caregivers to Older Adults. J Am Geriatr Soc, 60: 1253-1259.

Kimberlin, C., Brushwood, D., Allen, W., Radson, E., & Wilson, D. (2004). Cancer patient and caregiver experiences: communication and pain management issue.

McGilton, K. S., & Boscart, V. M. (2007). Close care provider–resident relationships in long‐term care environments. Journal of clinical nursing, 16(11), 2149-2157.

Breeding, B. (2019, May 6). Which is Better: An Independent Caregiver or Home Care Agency?. In My Life Site. Retrieved from https://www.mylifesite.net/blog/post/independent-caregiver-home-care-agency/.

Jillian Crosmas is a 3rd year B Sc student at the University of Ottawa majoring in biochemistry with a focus on microbiology and immunology. She has worked in the pharmaceutical industry as well. She is on track to graduate with honors. As a post-graduate she wants to continue her studies in emergency medicine or genetic research.

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