A rule of thumb about home care agencies is that they charge from a third to a half more than they pay the caregivers. For example if an agency charges $17/hour for a Certified Nurse’s Aide (CNA), they probably pay the Aide approximately $11/hour. And if you need someone to live-in with your parent –an ideal arrangement for an Alzheimer’s patient- you might pay the agency $180 per 24-hour day at a time when they would be paying the Aide $110/day or thereabouts.

Naturally, you could hire an Aide directly and avoid the mark-up. But then you would be foregoing all the benefits of an agency. These are as follows:

  • A good agency recruits and screens Aides on a continuous basis. They would have a vast roster of caregivers, so that if one doesn’t work out, they can send another. And the caregivers they send must meet your needs: for example, they must be certified, with some Alzheimer’s experience, completely vetted for background and temperament, with a car, living close by, etc. This becomes critical when your main caregiver needs time off, for the agency would be ready with a fill-in who, again, meets your needs.
  • The agency would have a supervising RN who would provide nursing guidance to the Aide. The nurse can usually be reached promptly for advice on anything that crops up. She would be the one to provide advice on whether the Aide can deal with the new complaint, or whether you need to take your parent to the doctor.
  • The agency would have “Care Coordinators” who dispatch the Aides to assignments with their respective patients. The Coordinators would know the Aides intimately and would act as day-to-day supervisors. They are your main contact with the agency, acting also as “first responders”, available to you and the caregivers on a 24/7 basis.
  • Finally, the agency handles all caregiver-related payments, taxes, and benefits, usually on a weekly basis. They then turn around and bill you usually on a monthly basis. This is perfect if you are living separately from your parent. You won’t have to rush every Friday to settle with the regular as well as the fill-in Aides.

Whether you hire directly or through an agency really depends on a couple of factors. The first has to do with the difficulty of caring for your parent. Get an agency if your parent has reached a stage where he or she can become non-compliant and combative. Or get a neighbor or Aide independently if your parent is docile and just needs a loving hand. The second factor has to do with filling-in for your primary Aide. Hire an agency if you need a fill-in Aide every weekend. Or get someone independently if you live with your parent and will cover for the main Aide when she goes on a break.

I am frequently asked about how to select a home care agency. There are so many agencies around these days that the process has become real easy. Here are my views:

  1. Screen two or three agencies by visiting them in person. Ask for a brochure and sit by the receptionist, eying the operation. Get a measure of how busy they are from the ringing of the phone, their culture, size, how they deal with their caregivers over the phone, and whatever other tell-tale signs the visits produce. Throughout each visit, you are in reality assessing whether you are going to be comfortable dealing with this outfit on a daily basis.
  2. Settle on an agency that is fairly busy. That would be your sign that they would have a large enough roster of Aides to meet your needs. Get a very busy agency, and they might end up scraping from the bottom of the barrel for you. Get one that is not busy, and their best Aides may have transferred to other busy agencies.
  3. Weekend fill-in Aides are the Achilles’ heel of many agencies. An agency might produce a primary caregiver that you really like and that your parent takes well to. But when it comes to the weekend fill-in staff, they may stumble badly and start sending unqualified or unresponsive Aides. Get a good answer about that before finalizing with anyone.
  4. A thorough screening for your parent’s Aide: Most States require criminal background checks for all Aides, as well as regular validations and updating of certification requirements. In addition, at some agencies, an Admin Assistant makes the calls to obtain the references, while at others that task falls on to the Care Coordinators. Look thoroughly at the notes made by the caller and make your own reference checks if you have any doubts as to the voracity of what the agency has done. Check for yourself to see if prior employers would hire your Aide again.
  5. Find out how an agency reacts to emergencies: Your parent probably has Aides in shifts on a 24/7 basis. The agency has to maintain continuous coverage, and when someone doesn’t show up, in the parlance of home care that’s an emergency. An agency has recourse to stand-by Aides, but that breaks down at times, and that’s when you need to ask the agency what they would do next. What you want to hear is that they would send someone from the office until a more appropriate caregiver could be dispatched.

Nothing is more bothersome than having to change caregivers every couple of weeks. So do yourself a favor and avoid a turnover by catering to your caregiver’s needs. Caring for your parent is tough enough, so treat your Aides compassionately, give them plenty of privacy and rest periods, and always have some snacks, beverages, and vegetables and meats to cook with. Don’t let a great Aide abandon ship simply because her basic needs are neglected.

About Mike Takieddine, the author:

Mine has been a privileged life, first for having traveled all over as son of a diplomatic family, then for having had the opportunity to study at Oxford, and finally for a gratifying and diverse career in business, in geriatric home care, and in writing. I look forward to using this wonderful medium to discuss some of the exciting aspects of life that I had experience in.