Should You Become the Caregiver or Hire One?
If anyone would know what to expect in becoming the primary caregiver for their elderly parents, it would be Barry J. Jacobs. For seven years, the clinical psychologist, family therapist, and healthcare consultant assumed the role for his stepfather with Alzheimer's disease and mother with vascular dementia. Yet there were some points even Jacobs, a Philadelphia-based columnist for the AARP website and coauthor of The AARP Caregiver Answer Book, did not anticipate.
“What surprised me was how fragmented our medical and support systems are,” Jacobs recalled. “My stepfather’s and mother's physicians did not communicate well with one another and had no communication at all with the home care agencies or personal care aides we hired. I found myself in the role of care coordinator, sharing information from one provider to another and trying to help them coordinate their treatments. It was time-consuming and frustrating.”
Questions to Ask Before Choosing Family Caregiving or Professional Home Care
For those considering whether to hire a provider or to become the primary caregiver of an elderly loved one themselves, Jacobs suggests asking questions such as:
- Am I willing to defer to my older adult's preference to have me provide care, or am I prepared to overrule them and decide to hire a personal care aide?
- If I plan to hire a personal care aide, do I have a specific home care agency or aide in mind? If not, then do I have a set of criteria for hiring the right support?
- Do I have the time to interview potential agencies/aides and then manage the care they provide?
- Does our family have the money - generally $35/hour - to pay for an aide's services? Alternatively, do I have the available time to provide the care myself?
- Have I considered how providing the care myself might change my relationship with the older adult positively and negatively? Have I thought about what other family members might think about me if I provide the care, especially if I am receiving money for it? Would they be supportive? Critical?
Can Family Members Get Paid to Care for Elderly Parents?
Jacobs points out that family caregivers may be paid to provide care if their older adult qualifies for Medicaid. Arch National Respite Network, which promotes the development of quality respite and crisis care programs in the United States, is frequently asked about whether payment is available for family caregivers. Their website provides many valuable resources, including a page dedicated to the question: How Do I Get Paid To Be A Family Caregiver?
Signs It May Be Time to Hire a Professional Caregiver
Donna Benton, PhD, a Research Associate Professor of Gerontology, finds the decision-making process usually begins around complicated health changes that have more physical demands than the family member is capable of handling. There may also be behavioral issues that the family member can no longer manage such as anger, hallucinations and wandering away. Another decision-point is financial, where savings are depleted and now, the family member is eligible for Medicaid.
Dr. Benton says cultural considerations are often an additional determining factor. Whether it is language, race, rural culture or faith, the availability of caregivers with a shared background can be an important consideration.
Many families considering hiring professional caregivers are looking for people who are “adding value beyond the exhausted family caregiver who sees this person day-in and day out”--someone who not only has the caring and compassion they possess but “can improve the quality of life at home” with other skills like cooking, singing, playing cards.
Training and Support for Family Caregivers
College departments of gerontology like the USC Leonard Davis School of Gerontology, where Dr. Benton teaches, often offer courses which teach family members who want to be caregivers how to better understand behaviors, talk to those in the healthcare field, and, since half will continue working outside the home as well, manage their own stress and prevent burnout. Some classes will help families recognize when an individual can safely be left alone at home. Maybe they could initially rely on phone calls and monitors but as cognitive abilities change, would they know what to do if there was an emergency?
Of course, for most families the real question is what is in the best interest of their loved one. “There are counties where they do help pay for professionals and family members are still the foundation for the care,” Dr. Benton says. “The families that [provide] the highest level of care are those that still have somebody coming and visiting and being involved, so I think it’s not going to be an either/or. It’s always going to be a combination.”
Resources for Finding and Hiring Caregivers
RewardingWork.org provides a resource for families choosing to hire directly. In addition to supporting families in CT and MA self-directing their supports, Rewarding Work makes low-cost subscriptions available to anyone needing to hire. Learn more at RewardingWork.org/employer/how-it-works-employers