How to Hire a Caregiver for Your Senior: Your Complete Guide to Finding, Employing, And Retaining in-Home Help

Glossary

Introduction

The Rise in In-home Senior Care

It’s not news: Americans are living longer and, therefore, need help to remain in their communities and homes and, for as long as possible, out of facility-based nursing homes. To stay in their homes, seniors mainly access help from family caregivers. In fact, there are an estimated 40 million Americans now caring for an elderly parent, relative or friend, and that number is rapidly growing. However, family care usually isn’t enough to meet the competing demands of seniors, other family members, and careers. The question many families now face is: How can we give our parents the care they need, but also take care of our own children, our own health, and be successful at our jobs and juggle our other responsibilities? This is even more difficult if the senior does not live close by. The solution for many families is in-home care. Depending on the senior’s needs, in-home care does not necessarily include professional, skilled health care. In fact, today’s household senior care is often not focused on health but on what is needed to enable the senior to continue to live in his or her home as long as possible, also known as aging in place. This could mean hiring a housekeeper who performs cleaning and laundry work or a companion who helps the senior throughout the day, perhaps driving the senior to appointments and the grocery store, preparing meals, etc.

Whatever the need, family caregivers cannot do it alone. About half of all middle-aged American adults comprise the sandwich generation; whereby they care for at least one ailing elderly parent (aged 65 or older) while simultaneously raising a young child or supporting a grown child financially (The Sandwich Generation: Rising Financial Burdens for Middle-Aged Americans, Pew Research Center, Washington, D.C., Jan. 30, 2013). Americans caring for aging parents are often overwhelmed: they provide unpaid, informal senior care to an aging parent and then must cope with the resulting strain on their own health, families, finances, career, and emotions. Stretched to their limits trying to manage it all, more and more often, families and individuals hire in-home senior care. These families often do not want or need a licensed home help company or team of community services because usually it is less expensive to hire a caregiver directly; and, as the caregiver’s employer, they have greater control over the caregiver’s duties and are better able to customize the care their senior receives.

According to the Population Reference Bureau 2016 report, Aging in the United States, the number of Americans aged 65 and older is projected to more than double from 46 million today to more than 98 million by 2060, and the 65-and-older group’s share of the total population will rise from 15 percent to nearly 24 percent. With baby boomers aging and needing greater assistance at home as they age, the trend of hiring in-home senior care—informal and formal, unpaid and paid—is growing. Many American households are now employing senior care in the home: caregivers, companions, housekeepers, nurses, therapists, gardeners, drivers, personal assistants, respite care workers, etc. to help balance their work and home lives. (See Chapter 1 for the diverse types of senior care.)

Not surprisingly, the U.S. Department of Labor (DOL)’s Bureau of Labor Statistics (BLS) projects that the home health and personal care industry will see a 38 percent increase in employment from 2014 to 2024. Also, according to the Paraprofessional Healthcare Institute (PHI)’s 2015 report, Workforce Data and Analysis, home care is projected to add more than one million jobs between 2012 and 2022, making it the highest-growth occupation in the United States.

Household Employment as a Profession

For whatever reason, in the United States, household employees such as caregivers— especially ones not employed by an agency—have often been viewed as temporary workers, a position taken by workers who are deciding on other aspects of their life (such as those who are deciding whether to pursue higher education, what profession they really want to do, or where geographically they want to reside). This is changing rapidly and, during the last two decades, the household employment industry progressed in establishing a more professional structure around the very informal and often customized situation that is household employment. Household employment’s growth—particularly in senior care—throughout the United States helped to authenticate the household professional as a qualified, well-trained, career-minded specialist, while varying economic times, rapid technological progress, and changing fiscal realities created several industry trends, such as online hiring and fluctuating pay and employment benefits. However, the American attitude toward in-home care remains the same, and many families still see the employment of help within the home as an informal relationship.

During difficult economic times, caregivers and other household help employed by individuals may experience a decrease (or at least a fluctuation) in their annual salaries. Because household workers are dependent on individuals and not companies for their wages, domestic workers then experience the same hard fiscal realities their employers face. For example, if your firm is downsizing and you must take on a lower paying job, then the caregiver you employ for your elderly relative may need to accept a lower annual salary. If your company is foregoing another year of salary increases, then your elderly parent’s housekeeper may need to deal with another year at the same salary and forfeit a cost of living increase. Yet, caregivers for seniors across the United States report that they are offered some benefits, such as paid time off—unheard of just a decade ago—and this book will look at caregiver benefits in detail in chapter 9. The federal government and some state legislation is changing how household employers treat in-home care and are ensuring that they follow labor, tax, and insurance law. The government is working to professionalize the industry for household employees—thereby improving in-home working conditions for the estimated 2.5 million domestic workers in the United States.

In 2010, New York State became the first state to enact a Domestic Workers’ Bill of Rights law that offers labor protections, such as overtime pay and paid time off, to household employees who do not work for an agency, regardless of their immigration status. The law also provides protection against discrimination and sexual harassment. This led to Domestic Workers’ Bill of Rights laws in other states: Hawaii, California, Massachusetts, Oregon, Connecticut, and Illinois.

Many states are developing new laws to improve the rights of domestic workers, and much more is being publicized in the media about how families need to abide by legal and official practices when employing help. By reading this book, you are already one of the many wanting to improve your knowledge and find out best practices to successfully hire household help, establish a well-defined and well-compensated job, learn the legal considerations to adhere to, and understand how best to build a mutually respectful relationship.

The Risk of Employing Illegally

Despite seven states with Domestic Workers’ Bill of Rights (at the time of writing) that enact safeguards for household workers, the media still reports scandals involving political and other well-known figures who willingly disregard labor and tax law protections for their household help. They not only risk jeopardizing their personal finances, estates, reputation, and professional careers, but face fines and even potential jail time. It is not new, but it is still surprising that people—even those well versed in the law—continue to evade their responsibilities when employing and paying their household help.

The average U.S. household employer is not immune either. Many first-time household employers worry about keeping abreast of the legal requirements and mandates issued by federal, state, and local governments. This can be a time-consuming and frustrating aspect of being a household employer. However, if you decide not to follow U.S. laws and regulations, it could greatly cost you both monetarily and in the lifestyle your family and you presently enjoy. Legislatures and courts throughout America are no longer turning a blind eye and instead are aggressively enforcing laws and regulations pertaining to household employment.

Good human resources, as you will read in this handbook, can be quite involved. Yet, thousands do it properly and are committed to it. GTM Payroll Services (www.gtm.com/household) is at the forefront of improving the household employment industry with household HR counseling, insurance, and payroll and tax services. Education is vital for the household employment industry. While great advancements have been made, misconceptions, misunderstandings, and blatant tax evasion remain.

Making the Decision to Hire In-home Senior Care

To achieve an effective and practical balance between your career and your family—making your private and professional lives enjoyable, fulfilling, and manageable—you decided to hire an in-home caregiver for your parent or elderly relative and, therefore, to have your senior or yourself become a household employer. From the start, as a new household employer or manager, you must see household employment as a legitimate profession. The caregiver your family employs is entering a home, and the private life within, to tend to your elderly relative’s needs. It is his or her career that just happens to be based in the home. As his or her employer, it is your business—one recognized by the federal, state, and local governments—to treat household employment as the real profession it is, and abide by all legal, labor, wage, insurance, and tax requirements as a household employer.

Your Guide to Success

Most of you will not have human resources experience such as recruiting, interviewing, negotiating agreements, and implementing personnel policies; or have knowledge of taxes, payroll, insurance, liability, and employment law. The good news is that these skills can be learned and this book aims to help you meet this challenge.

Offered throughout this handbook is information to help you professionally manage your caregiver, just as you would professionally manage and treat employees at your place of business. It covers everything you need to know about hiring and retaining good in-home senior care: easy-to-access guidelines, real-life experiences, practices, procedures, handy samples of forms and letters, and up-to-date information on laws and regulations. You will learn how to advertise a job, how to interview candidates, how to form a work agreement and negotiate job terms, how to make sure your caregiver is safe in his or her job, how to make sure your senior remains safe and healthy with a caregiver, how to set wages and hours, pay taxes, file records, and keep abreast of relevant household employment laws. This book is your resource. Use it throughout your household employment experience—whether you are reading it through for the first time or referencing specific sections as issues arise. With it, you are well on your way to becoming a successful household employer.

This handbook is designed to help you prepare and maintain successful employer-employee relationships. It details many lessons learned by household employers throughout the United States. In a sense, you will learn from those who have been doing this for the last 30 years and who have mastered—sometimes the hard way—the best ways to handle issues like hiring, firing, writing work agreements, and managing wages, payroll, taxes, and insurances.

Once you realize that household employment is employment, a little bit of business experience and personal intuition will help guide you. You most likely are, or have been, employed somewhere and, therefore, know some of the requirements, guidelines, and laws that you need to follow and implement.

Employing household help to care for your elderly loved one takes careful thought and preparation—preparation that will help you when unexpected challenges arise, or even avoid those challenges altogether. Investing the time and effort from the start and treating your caregiver (or other household employee) as the professional she or he is, will not only help you begin a successful working relationship and avoid conflicts between the caregiver and the senior they are caring for, but will also enable a comfortable work-life balance for everyone concerned.

Note: Much of the information in this book is kept up to date on GTM’s website at www.gtm.com/household.

Disclaimer

The author hopes that you find the information provided herein helpful. However, the information should not be misinterpreted as a replacement for competent legal or accounting advice. Accordingly, use of this information is at your own risk. In particular, while the information herein is believed to be accurate, the applicable laws and regulations are complex and change from state to state. Therefore, the author cannot be held responsible for any errors or omissions in the text, or for any misunderstandings on the part of the reader. We strongly recommend that you consult an experienced employment law attorney or accountant to address any questions or issues that you may have. Furthermore, any references to outside sources provided herein do not indicate an endorsement of the services or products provided by those sources.

Preface

Ihave been working for more than 30 years in the household employment industry. All those years of experience working with thousands of household employers throughout the United States is provided in this handbook to prepare you for employing a caregiver in the home. The most important thing is to simply remember that your caregiver is working for you. He or she is doing so to earn a living. It is your employee’s livelihood — your caregiver’s way of living and providing for self and family.

I first became involved in household employment soon after my grandfather became ill. My mother, Joyce, a registered nurse, and I began a home health care and hospital staffing agency. As I am one of 13 children, family has been, and always will be, extremely important to me. It was no surprise that, as a college student, I joined my mother to operate a family business together.

While running the agency, I met many people who juggled caring for their own families, working long hours at their careers, and attending to the needs of their ailing parents, much as many families face today with the increase in demand for senior care. Truly, these people were sandwiched between generations, with each demanding extensive care, time, and energy. Thus began GTM Payroll Services—which started as a household work placement agency; then extended to payroll, tax, and insurance services; and finally evolved to the household employment human resources service it is today. GTM is known throughout the United States as the leader in the industry, having built an impeccable reputation and impressive client satisfaction rating. One of the goals I maintain for my company is that it continually responds to clients’ needs through innovation, new services, and excellent assistance to make the lives of household employers and their employees easier.

Hiring home help can be an incredibly time-consuming and difficult process. You can hire caregivers on your own, contract on your own with a placement agency, or outsource it all by having a licensed home care agency that employs the caregiver for you. Usually the benefit of hiring by yourself is that it is much less expensive. Hiring with an agency, however, is often less time-consuming as the agency screens the employees and has a readily available pool of candidates to choose from. Whichever way you choose to hire a caregiver, the job of employing someone to care for your senior does not stop with the hire. Many people do not take the time necessary to be a proactive employer/manager. Without a well-designed ground plan, your caregiver, your family, and you, may be unprepared for the day-to-day issues that arise. Therefore, to hire a senior care employee properly, professionally, and legally requires some guidance.

As proponents of household employment, my wife, Diane, and I have hired many caregivers as household employees in our own home (first a nanny, then a household manager and a tutor). We prepared for our household employees in many ways, but we have learned much, much more over the years. It really comes down to using common sense and good judgment to handle daily problems or issues. We can do this because we established a comprehensive work arrangement and built a relationship that enables mutual trust and open communication. Diane and I communicate continuously and openly with our household help—not only to set initial standards and boundaries, but also to maintain and build on the employer-employee relationship. By hiring a caregiver to help care for your elderly loved one, you add a new member to your senior’s care team, and all of you need to be on the same page. This is only possible with open communication.

We were not always so proficient in working with our help. In fact, like many families, we employed several household employees before—or while—refining our household management skills. It is all part of the learning process, helped by being alert to the employment situation and relationships, as well as the family’s needs. I like to think that many of the lessons we learned as household employers, and also from our clients at GTM, influenced the advice and support offered throughout this book. I have tried to streamline the complicated process of hiring your own in-home senior care help—from interview questions, creating a work agreement, determining wages and hours, to managing payroll, insurance, and taxes. You will also learn about how to make your home safer, and how to protect your elderly loved one from potential problems (such as elder abuse and neglect, financial scams, trips and falls, and more).

I hope this book becomes a comprehensive go-to resource for your family, as well as America’s sandwich generation, caring for aging parents, grandparents, family members, friends, or loved ones by providing in-home, affordable, and reliable senior care.

—Guy Maddalone

Choices in Senior Care

According to the U.S. Administration on Aging (AOA), in 2015, 14.1 percent of the U.S. population was aged 65 or older, or one in every seven Americans. By 2020, 54 million people in the U.S. will be over the age of 65; by 2040, that number will top 82 million. People reaching age 65 today have an average life expectancy of 85.8 years (male) to 87.8 years (female), according to the Society of Actuaries MP-2016; which will result in a staggering number of seniors over the age of 80 in the next 20 years, many of whom will need some kind of care. Already, senior care is critical in our lives and so it will continue.

Senior care is essential to our expanding elderly population. Some senior care is short-term, following an accident or injury that generally resolves itself. Most, however, is long-term care which involves a variety of services which help meet both the medical and non-medical needs of seniors with chronic illness, disability, or advanced age who have difficulty caring for themselves. Long-term care can be assistance with activities of daily living (ADLs) like dressing, bathing, meal preparation, and using the bathroom, or medical care that requires the expertise of skilled practitioners to address chronic conditions. According to the U.S. Department of Health and Human Services’ National Clearinghouse for Long-term Care Information from 2016, at least 70 percent of people over the age of 65 will require some long-term care services at some point in their lives, and, the AOA noted, people turning age 65 today could need up to three years of long-term care services, with almost two years of that care provided at home. According to the Family Care Giving Alliance’s National Center on Caring, by 2050, the number of individuals using paid long-term care services in any setting (e.g., at home, residential care such as assisted living, or skilled nursing facilities) will likely include 27 million people—double the number of individuals that actually used services at the turn of this century (13 million)—reflecting the population growth of older people in need of care.

According to the Family Caregiver Alliance/National Center on Caregiving, in 2015:

●65.7 million informal and family caregivers provided care to someone who is ill, disabled, or aged in the United States

of that, 43.5 million caregivers provided care for someone age 50 plus and 14.9 million cared for someone who had Alzheimer’s or other dementia

●the vast majority—80 percent—of elderly people receiving assistance, including many with several functional limitations, live in private homes in the community, not in institutions

●elderly people with limitations in three or more activities of daily living (ADLs) who live in the community received an average of nine hours of assistance per day (counting both formal and informal sources of care), and people aged 85 or older with that degree of impairment typically received about 11 hours of assistance per day

Senior care relates to a wide range of care but commonly refers to extended services for seniors who need help with ADLs. Senior care can be provided in a senior’s home, as well as the home of a family member (such as a son or daughter), in the community, or in various facilities like adult day care centers, fixed communities, assisted living facilities, and skilled nursing homes.

The National Aging in Place Council (NAIPC) reports that more than 90 percent of older adults prefer to age in place—that is, to stay in their homes as long as possible. (See Aging in Place later in this chapter.) Senior care provided in the home can include a wide range of medical and nonmedical services, such as: respite care; household financial planning and management; companionship; geriatric assessment, evaluation and care management; medical home health care; nonmedical home care; live-in home care; home safety; hospice services; meal preparation and delivery; personal care (e.g., bathing, grooming, toileting); rehabilitation services (e.g., physical and occupational therapy); transportation; physician visits; and, even transition services, such as home sale, relocation, downsizing, or asset liquidation.

In-home senior care is usually provided in three ways.

1.By a home health care agency that employs the worker to work in the family’s home, and sees to payroll, taxes, and human resources. (The agency employs the senior care provider in the home and maintains control of the worker’s job duties.)

2.By a referral or placement agency that finds and recruits the senior care worker on behalf of the family, charging a fee to do so, but then withdraws direct responsibility and transfers control for the employment over to the family. This type of agency may provide advice, support, and replacement services, if needed. (See chapter 3.)

3.By hiring independently, whereby the family or friend finds, hires, and employs the senior care worker according to all federal, state, and local requirements as a household employer, on behalf of the senior needing care (sometimes the senior is also the one employing the caregiver directly).

Hiring through a home health care agency places all the responsibility of employing the senior care worker on that agency. Hiring through a referral or placement agency means some of the hiring requirements are fulfilled by the agency and the employment practices and procedures (and payment and tax obligations) are handled by the family that needs the senior care. Hiring independently and by using a referral or placement agency is where this handbook truly helps, as those going it alone need to understand all the obligations involved as a household employer—from hiring to firing, and everything in between.

For many families and individuals faced with caring for an elderly parent, sibling, spouse, relative, or friend, the choices in senior care can be overwhelming. Some choose to be the caregiver themselves, putting a tremendous toll on balancing work and life commitments around attending to a senior’s needs. (See Informal and Formal In-home Senior Care, later in this chapter.) Others decide to hire an agency to take care of some of the duties, hiring workers to care for their senior at home. Particularly with home health care agencies, this is usually the case with very specific medical care that requires caregivers to be trained and licensed to perform medical treatment and to know what they are doing. (Licensed home health care offers nursing services on an intermittent, short-term basis. The senior usually has a specific medical need that requires the expertise of a RN, physical therapist, or other medical professional.)

It is becoming more and more common—especially when nonmedical senior care is required—to hire independently. Families and those responsible for caring for seniors are choosing to hire and employ in-home senior care for a variety of reasons. Firstly, they have more control over the employment arrangement and are truly in the driver’s seat: they can choose how the care is managed and performed. Secondly, hiring on your own is typically more cost-effective, particularly if the senior needs less specialized care or only needs help for certain hours or days a week. Hiring a caregiver directly allows families to save money by taking on the management and supervision of the worker themselves. Thirdly, with senior care, there is a lot of red tape involved in hiring through a home health care agency. Hiring independently avoids this for the large part, as long as the employer still adheres to necessary hiring and employment laws. It tends to be the easier way to go if the senior only needs nonmedical support and care to help with his or her comfort, safety and well-being. This type of care is generally not the same as nursing care or special medical services and is more to do with providing assistance that will help a senior continue to live in his or her home (or at a relative’s home) for as long as possible.

Assessing the Senior’s Care Needs

It is critical that prospective household employers begin with a clear definition of what they want in a caregiver. First, understand what your objectives are in bringing an employee into the home to look after your senior’s needs, particularly if you are not using an agency and hiring care by yourself.

For many families, it may be just one adult child who is in charge of the parent’s care if the senior is unable to do this. However, it often involves a family consultation with all the senior’s family members and a cooperative effort to communicate and agree on what kind of care the parent requires. It is best if all siblings can meet, or at least talk on the telephone or video chat, for a family meeting. Some of the questions raised could include the following.

●How much and what kind of care does mom/dad need?

●How is each one of us able to help physically or contribute financially?

●Is there anything in the community that can help us? (The Eldercare Locator at www.eldercare.gov is a public service of the U.S. Administration on Aging and helps connect you to services in your community for older adults and their families.)

●Do we want to hire a caregiver?

●If so, what specific care duties will that caregiver need to do?

●Which days and how many hours do we need a hired caregiver for?

●Can the family cover back-up help?

●Who will be in charge of the hire and employment of the caregiver (including recruiting, background checking, payroll and taxes, insurance, and supervision of work)?

●Do we want to use an agency to help? What type of agency do we need? Do we need an employment agency or a placement agency?

●Who will be the liaison with health care providers?

It is best to remember that family meetings can become difficult at the best of times, and that when discussing emotional and financial issues such as senior care, it may be beneficial if you can arrange for a more impartial person to be present to help navigate the emotional terrain of this kind of meeting. A social worker or religious official, or just a calmer, more objective family friend may be invaluable help to finding solutions for any familial tensions surrounding the senior’s care. The family may benefit from consulting a senior care coordinator or geriatric care manager who can assess the senior’s care situation and needs and offer guidance and decision-making assistance for the senior and his or her family. The care manager can offer help on medical, personal, socio-interactive, financial, estate planning, and environmental issues affecting senior care. The care manager’s job is to weave together all the aspects of the senior’s life and needs to formulate a plan of care for the senior’s remaining years. This often includes some kind of hired home care.

Household Employers of Senior Care

It is not easy to define a household employer or household employee, because the terms are used in so many different ways—almost as many ways as there are household help professions. The U.S. Internal Revenue Service (IRS) defines a household employer as any person who employs caregivers, nannies, housekeepers, maids, gardeners, and others who work in and around an individual’s private residence. Therefore, those that independently hire a caregiver in the home, or via a referral or placement agency, are deemed household employers of that worker.

Traditionally, household employment was the province of the wealthy. This is no longer the case. As the number of U.S. household employers grows, especially for senior care, the spectrum of household employers is increasingly varied. However, the following are some important, general characteristics of the most common household types that choose and use senior care.

●The wealthy . This group often has little difficulty providing a good household workplace for employees because, most often, the wealthy families have grown up with household help around them, or become accustomed to it as their wealth accumulated. Wealthy families are often in tune with this being a work relationship and often have few problems with an employee being in their home environment. This group may be more concerned with, and put more emphasis on, confidentiality than other groups. A variety of household employees may be on staff for wealthy homes so the senior care provider will often work alongside other domestic workers such as nannies, housekeepers, household managers, cooks, personal assistants, gardeners, and so on.

●The sandwich-generation family . This household is already common in the United States. With elderly parents living longer and families choosing to care for them at home, as well as having a family of their own, the breadwinners (single parents or couples) are tasked with managing the care of all their dependents around their careers. With so many different pressures on them, this family can save a lot of time and hassle by understanding the correct way to look after an in-home caregiver from the start. With more and more available senior care and child care options for the home environment, this family may hire a caregiver and/or a nanny to achieve a successful work-life balance that benefits everyone in the family. The caregiver may be working in the same home as the nanny, or may be employed in the elderly parent’s home.

●The mature family . With adult children living or working independently or at college, mature families now care for one or more elderly parents while maintaining their professional lives and supporting their older children. Arranging senior care services is often difficult, and emotionally and financially draining. Many families allow seniors to age in place either in the senior’s home or in the family home, maintaining their beloved senior’s stability and independence.

●The individual caring