10 Tips to Manage In Home Caregivers

Having tips and a process for hiring and managing in-home caregivers is beneficial when seeking in-home care support for elderly parents or yourself. It is essential to know that companion in-home caregivers are not always trained or experienced, so some of this work falls on the hiring family caregiver or direction from the person who needs care.

Due to the transitory nature of in-home care, caregivers who are trained or have extensive experience often move on to advance their careers. As a result, turnover can be high in these positions. Additionally, the cost of in-home care can be a concern.

Many in-home caregivers have a strong desire to help older adults. Many learn by doing. Understanding the background of the in-home care industry offers tools and tips to manage in-home caregivers.

Tips to Hire and Manage In-Home Caregivers

Many aging adults can benefit from the assistance of caregiver companions and personal care aides. An in-home caregiver comes to the home to help with activities of daily living, often referred to as ADLs and other daily tasks.

• Activities of daily living include assistance with bathing, continence, eating, dressing, toileting, and transferring.
• In-home caregivers also provide support with light housekeeping, meal preparation, laundry, running errands, physical activity, and socializing.

This type of support is essential because family members and friends may not always have time for these activities if they are assisting with medical or financial matters.

Objections to Hiring an In-home Caregiver

In-home care agencies employ caregivers who come into the home. Other agencies, known as registries, do not employ but offer access to a list of potential caregivers in return for a finder or referral fee.

The transition to accepting help in the home can be frustrating when the older adult or family caregiver incorrectly assumes that in-home caregivers are trained, trustworthy, and do not need supervision. The person hiring the in-home care agency or an independent caregiver as an independent contractor is responsible for oversight and management.

The primary hurdle to establishing a routine with in-home caregivers is usually the older adult’s resistance to having strangers come into the home or pay for care. Adult children often hear parents say, “I don’t need any help.”

Boundary Setting for Caregivers and Families

Aging parents’ care refusals can make adult children feel stuck in a caregiving role until the children set a boundary. The boundary is that in-home care is a necessity and not an option. Even after this, in-home caregivers may arrive and be sent home.

Maintaining appropriate boundaries offers a learning opportunity.

• In-home caregivers require repetitive training to maintain professional boundaries.
• The in-home caregiver frequently misconstrues the caregiving relationship as a family relationship.
• Family caregivers and the person needing care cause boundary issues by treating in-home caregivers like family members.
• In-home caregivers are hired workers, not family members.

When families learn the benefits of boundary setting, successful relationships can be established with in-home caregivers. If this does not occur, the potential for abuse occurs.

In-home caregivers have been known to bring their children to work, make or accept personal calls on cellphones during work shifts, and eat food belonging to the client as if they were family members.

• These entitled activities and thinking result in conflicts of interest, safety, and potential abuse.
• Although in-home caregivers have good intentions, their focus must be limited to roles and responsibilities.
• The caregiver relationship must be professional and not extend to a family member’s emotional or support role.

Considerations Before Hiring

Identifying specific needs is the first step before hiring and managing in-home caregivers. Why is a caregiver needed? What skills are necessary?

• Companionship and socialization
• Support with daily living tasks, meal preparation, errands, or transportation
• Safety and supervision for a person with memory loss

Create a list of specific tasks and relate these to the time necessary to complete them. If a family caregiver is currently providing these tasks, timing them can help determine how much of a caregiver’s time is needed daily or weekly.

Write or type the list of tasks and time frames to discuss with an in-home care agency. For other tasks like meal preparation, offering a list of suggested menus can be beneficial in determining whether a caregiver has cooking skills. If errands or driving are required, hiring a caregiver with a valid driver’s license, car insurance, a clean and well-maintained car, and a good driving record is essential.

This information can be used to create a daily checklist for the caregiver to ensure that requested tasks are completed. The caregiver can also be requested to provide additional documentation about observations or other specifics. More importantly, this information can identify the timing of future or additional care needs.

1) Interview the In-Home Agency Owner or Supervisor

After a list of requirements is developed, identify agencies, visit their websites, and call to inquire about services and rates. If the agency is a good fit, take these next steps.

• Interview the owner or caregiver supervisor of the in-home care agency.
• Request educational backgrounds, copies of resumes, certifications, and the qualifications of management staff.
• Ask how long the company has been in business and whether it is privately owned or part of a national franchise.
• Request a copy of the company’s liability and workers’ compensation insurance.
• Most companies must register with the State Department of Health or the Division of Regulatory Agencies. Inquire where you can view the company’s profile, which may include complaints filed against the agency.
• Request permission to speak to the company’s clients to understand the type of services provided and client satisfaction. Due to personal privacy regulations, companies will have to ask permission from family members to give out their information.
• Ask for a list of professional boundaries for interactions with caregivers.
• Confirm who will be the primary point of contact.
• Ask about the process and time frame to identify a caregiver who might be a good match based on the situation’s needs.

2) Ask for Background Information About the In Home Caregiver Selected for You

Regarding caregivers, ask if all in-home caregivers are background checked and if you can receive a copy of the background check. Further, ask these questions:

• Does the agency run national and local criminal background checks?
• Do they check driving records that can indicate irresponsible behavior or substance abuse?
• Do they request a copy of an employee’s car insurance?
• Do they run a credit check?

Issues with any or all of these may potentially expose you or a family member to safety, abuse, or neglect. It’s a good idea to ask the agency to confirm in writing that the caregiver has a clear background check.

Because of staffing shortages, agencies have become more lenient in accepting caregivers with poor driving records or minor criminal citations. Additionally, some agencies use state websites for background checks that are not nearly as thorough or up-to-date as those run through organizations specializing primarily in these services.

• Be specific with the care agency about other qualifications and disqualifications, such as being a non-smoker.
• Ask about dementia training, bathing, cooking, and other desired skills.
• Agency management can make the best match when they receive a specific description of the characteristics and skills of a suitable caregiver.

You can request to interview several caregivers and select the one you feel will be the best fit. Hiring and learning to manage in-home caregivers is a two-way relationship.

3) Ask About In Home Caregiver Turnover

Staffing turnover averages 50% at in-home care companies. This means that the in-home caregiver assigned may leave employment after several weeks. Turnover can be frustrating for families as they learn to manage in-home caregivers and for the person who needs care who experiences frequent caregiver changes.

Ask what actions management staff takes when a new caregiver has to be identified and introduced to the situation. Does the agency take responsibility for training the replacement caregiver? Does the responsibility of training fall on the client or family caregivers?

Identify a system for frequent two-way communication with an office supervisor to be notified of missed shifts or other scheduling changes. In addition, any concerns about caregiver performance should be immediately reported so that these can be addressed.

4) How Is Time Kept and Billed?

In-home care companies committed to a higher level of quality care use automated time and attendance systems. In these systems, the caregiver “calls in” from the client’s home and “calls out” when leaving. This serves as a time clock to ensure billing occurs only when the caregiver is in the home providing services.

Care agencies receiving payments from state Medicaid must participate in an electronic visit verification (EVV) program to avoid billing fraud. This requirement applies to personal care services (PCS) and home health services (HHCS). More information about this can be found in Section 12006(a) of the 21st Century Cures Act.

Automated systems alert the agency if the caregiver does not call in at the scheduled time, which means that a visit may be missed or a caregiver is late to work. If a paper system is used, request a copy of timekeeping to be included with the invoice to verify the accuracy of the reported schedule. Reviewing this paperwork and other daily care notes is critical to managing in-home caregivers to ensure that schedules are met and the care desired is provided.

5) Participating in Honest and Ethical Behavior

Older adult clients unintentionally initiate boundary issues that cross the employer-employee relationships. These boundary issues can result in the in-home caregiver losing his or her job. Do not be the client whose actions result in the caregiver being fired for dishonesty or unethical behavior.

An example of one situation is where the client tells the in-home caregiver to leave early and signs paperwork to falsify the timesheet so that the caregiver is paid for the entire time. This request results in dishonest actions by the caregiver, who knowingly falsifies paperwork at the client’s request and is terminated.

Why Maintaining Professional Boundaries With In-Home Caregivers is Important

6) Ask About the No Call – No Show Policy

No-call – no-shows can be a frequent occurrence in the in-home care industry. Caregivers call off work at the last minute or do not call to report an absence at all.

The risk is that older adults who may not be safe alone or need assistance like meals are left without support. Clients with mobility issues who depend on transfer assistance to safely rise from bed in the morning or go to bed at night are at greater safety risk if the in-home caregiver does not make the scheduled shift.

Older adults with advanced dementia, who should not be left alone, may be unable to call the agency to make the report about a no-show caregiver.

• How does the agency confirm that caregivers show up for shifts?
• How does that agency ensure that coverage will occur if there is a no call – no show?
• How is the family member or person needing care notified about a shift or caregiver change?

7) Set Up a System for Frequent and Ongoing Two-Way Communication

Establish a relationship with the owner and the supervisor of the in-home care agency to support open communication about concerns and ways to identify solutions and alternatives. Never hesitate to call with issues.  Ask how often the supervisory staff will contact you to request feedback. Ask about the frequency of supervisory visits to the home to ensure customer satisfaction.

If you are dissatisfied with the assigned caregiver, contact the agency to request a replacement. Not all matches are made in heaven. By being clear with care expectations and understanding what the agency can provide, a trusting relationship with the care agency can be achieved.

8) Create a Daily Check Sheet

When the older adult receiving care cannot direct the in-home caregiver, make a daily checklist for the caregiver to avoid unproductive time. Then, request the caregiver document the projects completed on the checklist or those uncompleted and explain why in a notebook.

This system of checks and balances ensures that you are not paying for an in-home caregiver who does not complete the requested responsibilities. It can also identify areas where an aging parent is refusing assistance that is beneficial for their care and well-being.

9) Confirm Medication Reminding Rules

In-home caregivers are not permitted, by most state laws, to take medications from prescription bottles and provide the medications to a client. If you or a loved one cannot complete this task, ask a family member or friend to set out medications in a reminder box.

If this is not possible, a nurse may be hired to confirm medications prescribed by a physician, pick up medications at the pharmacy, and place the medications into medication reminder containers.

In-home caregivers are permitted to remind the older adult to take medications. However, in many states, in-home caregivers are not allowed to assist with eye drops, ear drops, over-the-counter supplements, or wound care. To avoid surprises, discuss needs specific to prescription medications and related topics with the agency owner before initiating services.

10) Maintain a Professional Relationship

No matter how close you or a loved one become with the hired caregiver, remember that the caregiver is not your family. By creating and maintaining a professional relationship, you ensure that the care requested is the care provided.

Understand the professional boundaries, conduct, and rules of the in-home care agency so that you are aware of permitted and not permitted activities and do not create complications for the caregiver.

Caregivers who lack boundary skills can inappropriately share personal information in general conversations with clients. Many agency training programs direct caregivers not to provide personal information to clients. This includes personal cellphone numbers, family information, and distress about financial matters or work situations.

Additionally, personal information, such as financial struggles or disagreements with spouses, can be discussed with clients. Concerns about children and other matters expressed to a client by an in-home caregiver add burden and worry to the situation.

The goal of hiring an In-home caregiver is to lessen worry and burden, not add burden or worry to the care situation.

Another area where boundaries are often crossed is in the “giving of items.” Giving caregivers household items that are not needed is not permitted.

Gifts, tips, or money should never be given unless during the holidays and with the agency’s prior approval. By crossing the gift boundary, clients are “training” the caregiver that accepting items is okay. Accepting gifts from a client can be cause for termination.

Managing In-home Caregivers Takes Effort

By following these ten tips to manage in-home caregivers, you might feel you are personally training the agency and caregiver. You are!

Each individual and situation is different. Most in-home caregivers are average people without extensive training or experience who have good hearts.

You are paying for a service. You should receive the quality of care your loved one needs and that you expect.

Interested in Learning More About Managing Care Providers for Elderly Parents? Check out Pamela’s Online Program.

© 2018, 2024 Pamela D. Wilson, All Rights Reserved.

This article was updated on 8/21/2024.