In-home care for the elderly -- a pro's advice

Frank Newton
August 8, 2006 8:10 AM
Do you have a loved one who needs in-home care? Do you know what to do? Whom to call?

Most families are unprepared for this eventuality. Quality of care is important, of course. But how can you be certain the caregiver is adequately trained and responsible? Do you know the laws for hiring an in-home worker?

And whether we like to admit it or not, cost is a factor. Hiring an independent caregiver unquestionably costs less than using a home care agency (roughly one-third to one-half less per hour). But are the cost savings worth it?

To shed some light, I found a professional who could provide me with some straight answers: Toni Liquornik, who has a master's in social work. She has been in the home care industry for a quarter century and is now a care manager for LivHOME. Experience has taught her that the relationship between a family and an independent home care worker usually starts out simply enough, with set hours and specific tasks. But the situation can rapidly get complicated.

A fundamental source of trouble is how a client's health problems can affect so many facets of their life. "These assignments can quickly become overwhelming," says Toni, "because the caregiver comes in thinking they're just handling a few basic needs. But one small problem can affect the client's social life, eating, transportation, finances and more. So the caregiver may get sucked into doing more than they planned -- and maybe more than they've been trained to do."

If caregivers can handle these extra burdens, their assignment may work smoothly. But if they make a mistake or if they refuse to take on extra work, the family may get upset and fire them -- or even not pay them.

So the situation is risky for both sides. The family may always have doubts about the caregiver's competence. And when hiring privately, the family opens itself to legal and financial risks that a credible agency will usually assume (such as workers' compensation, bonding and national background checks).

In turn, the caregiver may be abused, with too much work piled on, inadequate rest breaks and insufficient pay. Sometimes caregivers are zapped with fines from the IRS because the family didn't file taxes or other payroll deductions.

"We forget that caregivers have rights too," says Toni. "But as independent workers, they're all alone. There's no one to help them when there are problems -- and problems always arise."

Because in-home care is fraught with risks for both the family and worker, Toni is a firm believer in the value of home care agencies. "An agency like LivHOME," she says, "helps the client and also advocates for the caregiver. The agency does a professional assessment of the client's needs and then defines the caregiver's work assignment."

Perhaps more important, Toni says, an agency eases the inherent tension between the family and the worker. "The caregiver feels freer to be friendly with the client," she says, "because they're not always on guard. And the family doesn't have to reprimand the worker. If they see a problem, they simply call me and I take care of it."

"Families may think it's better to hire an independent for less," Toni says. "But it can be worth it in terms of quality of care and helping the family avoid headaches."