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Yes, This is an excerpt from “Caregiving 101: A Practical Guide to Caring for a Loved One “ It will explain a bit about how to find and hire good in home help.Chapter 2.Calling in the ProsDespite all the best efforts of you and your team of caregiver heroes, there may be a time to call professional caregivers into your home. There is no shame in this. You and your team are not giving up. These folks have walked this road before. They are usually quite experienced, skilled, and knowledgeable. They can be a tremendously helpful part of the team. Professional help can fill gaps in difficult times so other caregivers can rest and rejuvenate. They can perform tasks that may be beyond the comfort level of your team. They can help lead, teach, and often defuse potential growing conflicts that are common. Asking for experienced paid help means you care more for your loved one than for your own pride, so don’t be afraid to reach out for help.We had set parameters for when we would call on paid caregivers. This helped put everyone, even Karen, at ease. It allowed us to step back from our caregiver roles for a time and be just friends, family, lovers again.Finding Good Professional Caregiver HelpSo how does one find these elusive nightingales of mercy? The first and maybe the best resource are the people in your caregiving team: your friends, neighbors, and the people all around you. Chances are, they know someone who knows someone who has been very effective in a caregiving situation.Many professional caregivers are well connected. If they can’t take the case, they may know someone who can. This is how we found the best caregivers for my mom.If you are connected with hospice, a comfort care nurse, a social worker, or a caseworker, they may be able to help you find the right professional caregivers. They may know individuals for hire as independent contractors, or they may work with an agency that places paid caregivers.Also, if you live near a school with a nursing program, the admissions people there may know of aspiring students who need work experience. Students are usually bright and enthusiastic, but they do often lack experience.A home-care agency is a company that employs and often trains and oversees caregivers in various aspects of health care, including professional home caregivers. They usually have set hours and shifts, though this may be negotiable. They charge you a fee and may work with third-party payers like your state’s Medicaid program or your private disability insurance. You can find an agency yourself online using keywords such as “home care.”Self-directed care falls somewhere between hiring a caregiver yourself and using an agency. In this model, the agency can help introduce you to the caregiver, help train them, and help you with managing the financial resources available for paid caregiving. One agency I talked to, Consumer Direct Care http://consumerdirectcare. com/, actually helps you with payroll and taxes and sometimes acts as a bridge between your Medicaid coverage and the paid caregiver. Even with all this assistance, this model is less expensive than going through a traditional agency, and the savings canresult in higher pay for the paid caregiver. Higher pay usually attracts better caregivers.Some states have allowances written into their Medicaid program for the self-directed care model as well as many other wonderful services. To find out about programs and resources in your state, search for your state Medicaid officewww.Medicaid.gov or just type “Medicaid” and the name of your state into your search engine. You may also be able to search out such agencies yourself with the keywords “self-directed care,” “self-determined care,” or “person-centered care.”…Selecting the Right ProfessionalSo many questions revolve around bringing someone into your home:• Will they be able to be there at the right times?• Do they have the skills and abilities your loved one needs?• Do they possess the temperament and personality that work with your loved one and your team?• Most importantly, do they connect and care well for your loved one and just “feel right” to you and your loved one?Trust your gut and the feedback from your care network, and invite your loved one to participate in the selection if they are able.If your loved one needs more medically related skills from a paid caregiver, such as wound dressing, care for lines like IVs or catheters, more advanced bowel or bladder care, or more advanced help with mobility, look a bit more closely at the letters behind the caregivers’ names. Below is a short list of what some common abbreviations mean in relation to training and expertise. Requirements and specific skills-and-practices acts—laws that say what each type of caregiver can and cannot do—vary somewhat state by state.Companion. This is more of a job title than a professional designation. This person may or may not have any formal training yet they can be critically important in helping someone who cannot be left alone safely. They might help with meals, light housekeeping, laundry and transportation. They cannot help with medication and probably cannot help with any more advanced nursing care. You also may see the general home care designations of direct support professional (DSP), and caregiver.People working under these designations may or may not have experience or training.Certified nursing assistant (CNA). This is probably the most common professional designation in caregivers both for in the home and in facilities such as hospitals and nursing homes. In most states, they can perform basic medical-related tasks such as changing a dressing and caring for lines (like catheters or IVs) under the supervision of a nurse or doctor. In some states, this designation is written NAC or NA-C. To earn the certificate, they must complete 75 hours of coursework and hands- on skills work, as well as take a written and skills test. NA-R means they have taken the coursework and registered but have not yet received their certificate.Certified medication aid (CMA). This person works under the supervision of a nurse or doctor and can administer most medications but not by central lines or chemotherapy depending on the state.Personal care attendant (PCA). This means the person has completed 16 hours of coursework (about three days) plus specific orientation to that case.Attendant care worker (ACW). This designation began in Arizona as a base level of training required for that state’s Medicaid reimbursement. It is now gaining favor as a benchmark for other states. It requires that people sit for an examination that includes a written test and a practical skills test. Generally the coursework to be ready for the test takes about 40 to 60 hours of focused learning.Home health aide (HHA). These people are usually capable to do many of the same basic tasks as CNA’s but their focus is more on care in the home. The formal education requirements vary state by state. However, all states do require training for someone to be certified as an HHA, with the minimum at the time of this writing being 75 training hours.…Going Through the Selection ProcessOnce you know the kind of professional help you want, make a list of candidates. I like to create a folder for each one or at least a page of paper with their name, contact information, their work experience, and any notes. On this paper you can write reminders for the questions you might want to ask during the interview. Here is a link to a fairly generic but nicely comprehensive list of possible interview questions from Find Child Care, Senior Care, Pet Care and Housekeeping http://www.care.com/senior-care-senior-caregiver-interview-tips-p1145-q7744646. When you are interviewing, write down the answers in a way that makes sense to you. Also record your overall impression of the person. I like one to five stars and a quick note as to why. Then you’re ready to contact them.Phone call. Chances are, when you call you will leave a message and ask them to call back. If they don’t call back, cross them off your list. Don’t give out your address until you are ready to set up an in-person interview. Try for at least five candidates to interview.Telephone interview. You can ask many basic questions quickly in a phone interview. Describe the days and hours you will need and the level of specific needs your loved one has, such as minimal assist with bathing, dressing, toileting, help with mobility, etc. You may ask about the person’s availability, transportation (do they have a reliable car?), allergies, whether they smoke, etc. You can ask about their work history, especially their last few jobs and why they left. You can ask what types of clients they like most and least. If they still seem like a good fit, you are ready for an in-person, in-home interview.In-home interview. For the best chance to see the person interact with your loved one and gain a good sense of your loved one’s reaction, do an in-person interview in your home. Your loved one is really the person making the choice. It’s their care. Introduce the candidate to your loved one. Does the interaction feel right? Is the person respectful, interacting well, fitting in with your family? Take your time, don’t rush. Be open. Listen. Be prepared with your care plan, the Carebook, and your interview sheet. Explain fully your needs and expectations. You may review their availability, training, prior work history, how their last job ended, and anything else that wasn’t answered well on the phone.Because I know what I’m looking for, I like to give the person an opportunity to work a little in the interview process. Can they help with whatever is needed at the time? Is there a skill you know is needed, like a maximum assist transfer? Can the candidate do it with you? Ask what their questions are. Listen, and be honest in your answers. Ask for at least three references, two of which should be professional references from people they have worked with. You may also consider a background check. Each state has its own and you may find the form by typing “background check form” and the name of your state into your search engine. Lastly, talk about salary and any benefits. You will need their social security number if you are going to hire them legally.Cultural considerations. You may notice that many agency caregivers are immigrants. This is not necessarily a problem. In some of the Muslim cultures of Africa, the Philippines, and Southeast Asia, caring for people in need is more honored than in our culture. If you are considering hiring an immigrant, can you and your loved one put aside any prejudices that may exist? Questions that are most important are more about the ability to understand each other’s communication and whether your loved one is able to connect with them comfortably.References. Yes, actually call the people the candidate says will give a good review. If it’s a professional reference, ask about the specifics of what the person did there. If the candidate stated what they were paid, you may confirm it. Confirm why they left the position. Watch for words like “difficult,” “challenged,” or other negative words. Don’t be afraid to ask whether you should hire the person. Many human resource policies will not allow a reference to tell you more than the dates of employment, but ask any questions you want, to get what you need. I like to ask things like “Would you hire them again?” or “Hypothetically, is a person like her great with nonverbal patients?” to try to get at the information you need.For a good video about hiring an in-home caregiver, check this YouTube from Washington State’s Department of Social and Health Serviceshttps://www.youtube.com/watch?v=L3skIWEmpas&feature=youtu.be.Managing Hired HelpOnce you have hired your new helper, be there to help familiarize them with care and routines. This will make everyone more comfortable and give you a chance to watch them work with your loved one. Again, are they respectful? Do the two interact well together? You can also get a better view of their skills. Once they are up and running, you will want to stop by unannounced. It’s just another way to check up on their good work.Don’t be afraid to let a paid caregiver go if the fit isn’t good. You’re paying them, you’re the boss; think of it as moving the employee on to a better-fitting job. Everyone benefits from a good match, and nobody benefits from a poor match.…Salary and BenefitsWage information varies region by region and over time, so I won’t give specifics here. You can look up expected salaries for your area by searching “salary” and the professional designation, for example, “salary CNA Seattle” or “salary homecaregiver.” Salaries are considered for 2000 hours per year, so you may calculate an hourly rate by dividing the salary by 2000.…Payroll and TaxesIf you are hiring from an agency, the caregiver is an employee of the agency so you do not need to worry about the payroll. If you hire a caregiver directly, they are your employee or a contractor. The simplest way to handle this is to file and provide them with an IRS form 1099 for independent contractors at the end of the year (or the end of their work for you, if that happens first). Keep track of your payments by tracking the checks in your bank account and/or get a receipt book.…Paying for In-home CaregiversWhen my mom was sick, her neighbor told us to get a pocketful of $100 bills and just go out and find good caregivers. This is in fact what many people do for shorter-term in-home care.Under Finding Good Professional Caregiver Help earlier in this chapter, we discussed Medicaid. Maybe that agency can help; they can be tremendously helpful with many resources for those who qualify. Many states have opted in to a waiver system that allows Medicaid to provide in-home support for people. To learn if your loved one qualifies and find out more about how Medicaid can help, see Chapter 8, Medicare, Medicaid, and Private Insurance. You also can look up your state’s website with the keywords “Medicaid” and the name of your state. One of the most clearly written and informative sites I’ve seen is Home - Long-Term Care Information http://longtermcare.gov/ medicare-medicaid-more/Medicaid/.Medicare and most private health insurance policies do not provide for home health aides or caregivers. They will provide for “skilled” in-home care. This means skilled medical services such as physical therapy, occupational therapy, speech therapy, and skills that require a nurse or nurse’s aid under the supervision of a nurse if the person is homebound. They will do this for a limited time following a recent hospital stay for the illness or injury being treated and require medical necessity and physician’s orders.Medicare supplements do not pay for in-home caregivers. They also tend to follow the Medicare guidelines listed above and are mostly focused on helping pay the amounts Medicare does not cover.The Department of Veterans Affairs (VA) provides caregiver help to veterans registered at a VA for health care. They can provide support to caregivers as well as other professional home health services. Programs include home-based primary care, home health aides, respite for family caregivers and a variety of other caregiver services. The website www.caregiver.va.gov/ is an excellent website for family caregivers to find support and services. There is also an established VA’s Caregiver Support Line 1-855-260-3274 toll-free to ask about caregiver support services. Each VA has a Caregiver Coordinator who can help caregivers find out about how to qualify for additional benefits.The Aid and Attendant program may give increased allowances to qualifying veterans to help with long term care and respite care (see below). If you don’t already have a VA caseworker, contact your VA health care team for your specific case. If your loved one is not already registered at a VA, find your local VA office by typing “Veterans Affairs” and your city into your search engine or go to www.va.gov.Various Veterans Service Organizations can you navigate the VA system and help with getting VA benefits. The Veterans of Foreign Wars (VFW), Paralyzed Veterans of America (PVA), Disabled American Veterans (DAV), and other Veteran Service Organizations may also help you navigate the system.Private disability insurance does not directly pay for in-home caregivers, but Social Security Disability (SSDI) might through Medicaid. If your loved one is already enrolled in SSI, check with their caseworker or your local Social Security office.Private long-term care insurance or combination life insurance and long-term care insurance usually does pay for home health aides and companion services.This is private insurance you buy when you’re healthy. There are many rules to follow. Read your policy carefully and ask a trusted advisor to help you decide when to start using the insurance, because most policies limit the total time you can use them. Be aware that once your insurance company gives the OK for a service, you may need to pay out of pocket for an “elimination period,” and once you start using the insurance for anything, it may start the clock ticking on a payment window that closes according to the time stated for your policy.Some life insurance policies may allow for your loved one to tap into their life insurance benefit in the form of an accelerated death benefit (ADB). Your loved one may be able to use this if they are terminally ill or have a life-threatening diagnosis, needs long-term care services for an extended amount of time, and/or is confined to a nursing home and incapable of performing activities of daily living (ADLs) independently. Typically this amount is capped at 1 percent of the death benefit per month for home care, 2 percent for nursing home care, and 50 percent total. You may want to consider that taking a lump sum of money in a person’s name may create a situation where their assets exceed the amount allowed by Medicaid or Supplemental Social Security and may jeopardize those benefits.Chapter 8, Medicaid, Medicare, and Private Insurance, has more about all this, including links to help you find a good lawyer.Making sure it “Feels Right”I leave you with this story about hiring Karin, a most wonderful caregiver who helped us when my mom was sick.Karin is a registered nurse (RN) and has a company called 24/7 staffing. She identifies herself as a terrible businesswoman.24/7 is a tax ID and a loose network of caregivers of different backgrounds and educational and credential levels, from RNs, respiratory therapists (RTs), and CNAs to folks with no credentials who are low-cost and there to be companions.Karin doesn’t take a fee or percentage from the other people in her 24/7 network. She gets her work entirely by word of mouth; the work comes to her. Usually friends of friends, family, or other people who have gone through caregiving situations say “I know someone …” If she cannot or will not take the case, she often can turn to one of her contacts in 24/7 who she feels will be a good fit. Likewise they may turn to her.The most important thing to Karin when deciding to take a case is the “fit.” It’s a feeling that she should be there with this person, with this family, in this home, helping them through this journey. The moment she met my mom, Karin knew she should help us. They reached out to each other, shook hands, and Mom smiled and then took Karin’s hand in both her hands. Their hands were warm together. She was meant to be there.* * * * *Often our most complex and important decisions are not made on what we think of as a rational basis. They are far too complex for the little wedge of neurons on the front of our brains for that. We make decisions about who to let into our homes, lives, and caring hearts because it feels right. There is so much more to it than all these forms and questions can outline. Of course we did the interview, checked the references, did all the steps listed above, and they all checked out ok. Those are important to avoid a nasty situation and help provide structure, but this is how Karin decides to take a case: if it is a good fit. This is also how we decided too. It felt right.