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After her mother died in 2009, Maryland resident Kim Salmon knew that she’d need to hire local help to care for her then-81-year-old father, who lived across the country in San Francisco and was adamant about remaining in his own home.
But finding the right help proved tough. Salmon’s dad, who needed assistance with everything from cooking to getting dressed, fired the first few people that Salmon hired to care for him.
For months, Salmon flew back and forth across the country to interview new aides, trying to find the right match. She also had to stay in constant communication with his entire medical team. “In bad months, it was like 20 to 40 hours of dealing with doctors and agencies,” she says.
Finally, they found Brenda, a home health aide who stuck with Salmon’s dad for eight years, until shortly before he passed away.
If you haven’t been in Salmon’s situation already, odds are you will be someday. More than 70% of adults 80 and older require help with mobility, household activities, or self-care.
About two-thirds of the time, that care falls to family members, according to AARP. But it’s not always possible or practical to shoulder the load on your own.
Finding a person or team whose skills and personality fit your needs and your budget—as well as those of your parent—can be tricky. The following guide can help you get started.
Assess your family’s needs
All too often, the need for in-home care becomes apparent after a medical emergency. Other times, the need presents itself subtly. You may realize your parent isn’t take medication, is becoming less socially active, or seems overwhelmed by basic chores.
“If you suddenly start seeing piles of mail or stacks of laundry, that could indicate an issue,” says Vicki Demirozu, national director of personal care and support/private duty at Interim HealthCare.
If your parent only needs help with household chores but not hands-on care, you can hire a homemaker or companion. For help with things like bathing and dressing, however, you’ll need to hire a certified home health aide.
Dispensing medication or monitoring vital signs requires the services of a registered nurse.
If you’re not sure exactly what type of assistance your parent needs, for about $250, a geriatric care manager (find one at aginglifecare.org) can do an assessment. For an additional hourly fee ($50 to $200), they can also check in regularly to make sure nothing has changed.
“A geriatric care manager can serve as your eyes and ears if you live far from your parent, or you cannot visit as often as you like,” says Joy Loverde, author of Who Will Take Care of Me When I’m Old. Expect to pay $50 to $200 an hour for a geriatric care manager’s services.
Get help with the hiring process
More than 60% of home care employees work for agencies, according to the Paraprofessional Healthcare Institute. You can find agencies in your area via Medicare’s Home Health Compare tool.
You’ll pay about 30% more for a caregiver hired through an agency, says Jody Gastfried, vice president of senior care for Care.com. But the agency will handle administrative work for you, such as background checks of the candidates and payroll and taxes.
If you want to hire independently, you can still get some help with the process. Call the director of nursing at a local assisted living community or senior center and ask for recommendations of privately paid caregivers who’ve worked with families they know, says Loverde.
Also check with your HR department: some large employers have resources to connect you with either individual caregivers or agencies.
Regardless, be sure to specify that you want someone with the right training and credentials for your parent’s needs, and experience working with clients who have a similar diagnosis.
If possible, arrange for a trial period, so both you and your parent can get a feel for whether the relationship is going to work. After all, if it’s not a good personality match, the quality of his or her medical skills will be moot.
In all cases, be sure to check multiple references.
If the job requires the employee to move in with your parent, discuss housing issues up front, such as which spaces are shared and which are private, and what hours they’ll be on duty. “The more clear the arrangement and expectations, the better the chances are for success,” Gastfried says.
Investigate resources to help with the bills
The majority of people pay for in-home help out of pocket, and it isn’t cheap. The median monthly cost for 44 hours per week of homemaker services is $4,000, while home health aides cost about $4,200, according to Genworth.
You could also end up paying far more than that if your parent lives in an expensive part of the country, or if she needs more than 44 hours per week of care.
In general, Medicare only pays for doctor-ordered skilled nursing care. Starting in 2019, however, some Medicare Advantage plans will offer coverage for home health aides. And if your parent is a veteran, he may have access to help via the Veterans Administration.
For those with limited financial means, Medicaid will pay for both medical and non-medical in-home treatment on a part-time basis. You can see which benefits you qualify for and find local resources at eldercare.gov.
