This information is not intended to be a recommendation for an individual in-home worker or agency. This information should be used as a guide to help you determine whether it is best for you to get help with the assistance of a Case Manager, get a worker to help you at home through an agency, or hire your own home worker yourself. Please review our legal notice.

Although there are many wonderful in-home workers, you need to be careful about bringing outside help into your home or that of your loved one. This guide can help you make that decision, but it is not a substitute for using good common sense and taking precautions.

You can find an in-home worker from a variety of sources including the following:

1. Assistance from a Case Manager to help you find private pay help or, if you qualify, free and low-cost help.
2. Getting a worker through an agency
3. Hiring your own in-home worker
4. Some final thoughts to help you have a gratifying experience.

Assistance from a Case Manager

If you choose to have a Case Manager assist you, consider the following information.

A Case Manager helps you to “navigate” through the maze of free or low-cost programs for which you may qualify. The Case Manager makes an assessment of your situation by listening to you describe your needs and observing you in your home. The Case Manager can help you determine which services might help you and how to make your home safe.

The services of a Case Manager are available free for adults aged 60 and older from Case Coordination Units in Illinois or for a fee through private companies. The Case Manager will provide you with information about various free, low-cost, and private pay services available where you live for which you qualify.

If you choose to work with a Case Manager, make an appointment for an assessment in your home by using one of the telephone numbers listed at the bottom of this page. You will need to have certain information available during the interview, such as your social security number, income information, health records, etc. in order for the Case Manager to make a thorough assessment of your needs.

The assessment process includes questions regarding your health, income and age, and the amount of help you get from family and friends. This information is used to develop an individual Care Plan and determine which free, low-cost, and/or private pay services are right for you. Charges, if any, will be explained before you agree to sign up for the services you need.

Examples of services which Case Managers might suggest include the following:

1. Senior center activities, such as congregate meals, recreation, and health screening.
2. Adult Day Services or homemaker services which are designed for seniors who need daily attention and monitoring.
3. Private in-home care.
4. Transportation to community resources.
5. Home delivered meals for homebound seniors.
6. Home safety suggestions, such as lighting in poorly lit areas, suggestions to prevent falls, etc.
7. Home modifications, such as wheelchair ramps and bathroom grab bars.
8. Assisted living facilities when living in your home is no longer an option.

For an assessment from a Case Coordination Unit in Southern Illinois use this link. Elsewhere in Illinois, call the Illinois Department on Aging Senior HelpLine at 1.800.252.8966. If you live outside of Illinois, call the Eldercare Locator at 1.800.677.1116. Private pay Case Manager services may be available in your community by looking in the telephone book Yellow Pages usually under “Case Management Services” or “Social Service Organizations.”

Getting a Worker Through an Agency

Consider the following if you choose to get a worker through an agency.

The advantages of arranging services through an agency rather than hiring a worker yourself may include:

1. Backup workers will be made available when your scheduled worker is unavailable.
2. Social security, workmen’s compensation and unemployment insurance for the worker is paid by the agency.
3. The agency will supervise the worker.
4. Additional services can be provided when needed.
5. Most agencies also provide their workers with training or continuing education.
6. Most agencies will give you information about their services over the telephone and some will mail information to you. Generally is it best to compare the services, prices and policies that agencies offer.

Once you have chosen an agency, an appointment will be made for an assessment. The assessment is an interview with you to determine the services you need and to write a Service Agreement. Clarify if there is a charge for this initial assessment. If you are hospitalized or in a nursing home, have the assessment at that location, if possible, in order in order to arrange for services to begin the day you return home, if this is what you choose.

Other factors to consider:

1. Get written information about the agency’s services including their charges, types of services and qualifications of workers who work in the home.
2. Be sure to purchase only the amount and type of service needed.
3. Ask about billing procedures, such as does the agency bill weekly, bi-monthly or monthly? Before you services begin, clarify whether another source will be paying for the service. Put the payment agreement in writing (regardless of the payment source) and retain a copy.
4. Ask whether services are offered during evening hours, overnight, weekends and on holidays. Are the charges higher at these times than during weekdays?
5. Ask if the agency does criminal background checks on workers?
6. What are the training requirements of workers?
7. What type of orientation to assigned tasks do workers receive? Does the supervisor make a home visit prior to giving instructions to the worker. Are instructions made verbally or are they written?
8. How many workers will be assigned to help you. Agencies may schedule more than one worker.
9. How often will the supervisor visit or call you and the worker?
10. Does the agency measure the worker’s performances in terms of respectful and courteous behavior?
11. If you need daily help (which will likely involve two or more workers) what arrangements are made to ensure communication and continuity of services? Some agencies require workers to communicate significant information in a notebook kept in the client’s home.
12. Tell the agency your needs and preferences regarding the days and hours of service and smoking (many agencies prohibit workers from smoking in clients’ homes). Inform them about your pets if you have then, and whether you need help with the pet’s care.
13. Make sure who pays for/provides the worker’s meals.
14. Whom do you call when you have billing or worker problems? Or, when a worker does not arrive?
15. How much notice does the agency give if they are unable to find a worker for your hours? Most agencies should have something called a backup plan for they are not able to provide services. Be sure to clarify the backup plan.
16. How much notice does the agency want from you if you have to cancel service? Can your service be rescheduled?
17. How much notice does the agency give when they decide to discontinue services to you?
18. Are there other policies that may impact you, such as their policy if you decide to hire their worker directly?
19. Is the agency insured and are their workers bonded? If a worker breaks a valuable, how would you be compensated?

If, after having the initial assessment, you decide you do not want the agency’s services, you can cancel all arrangements. You may also discontinue services at any time after they have begun, although the Service Agreement may list the procedures you must follow.

An Agency’s Service Agreement:

You should receive a copy of an agreement which containing the following:

1. A description of the services to be provided and their frequency.
2. The name of the person or categories of persons who are to provide services.
3. The schedule or frequency of sessions (visits or phone contact) of supervision or monitoring required, if any.
4. The fees for services.
5. The procedure for canceling the service.
6. A plan for contingency action that includes:
   • the action to be taken by the agency and you or other responsible person, if scheduled services cannot be provided,
   • the method for you or other responsible person to contact an agency representative whenever staff are providing services,
   • who to contact in case of an emergency or a significant adverse change in your condition,
   • the method the agency will use to contact the other responsible person, if any,
   • your wishes for emergency medical services which are consistent with your advanced directives for health care.

You may be asked to sign vouchers that document the employee’s visit or hours work and the tasks completed. Before signing you should review them for accuracy. Keep a copy for your records; you may want to verify your bill.

Hiring Your Own In-Home Worker

If you choose to hire a worker yourself, consider the following information.

The advantages of hiring your own in-home worker directly are:

1. The cost may be less than by hiring through an agency, and
2. The consistency of having one person helping you.

The disadvantages may be:

1. When the worker is unable to assist you, there is no one to provide backup assistance (unless prior arrangements are made),
2. You are the supervisor and no one else is there to assist you,
3. You may be responsible for paying all applicable taxes, and
4. You are inviting a stranger into your home to help you.

The lack of formal supervisory oversight is an important consideration for consumers who have cognitive impairment, especially if there are no family or other responsible persons who can help you supervise the worker on a daily basis.

Generally, when you hire your own in-home worker, whether it is a homemaker, registered nurse, therapist or paraprofessional, you hire the worker as your employee and you may be responsible for paying all applicable taxes. Contact the IRS or a public accountant knowledgeable in tax law for more information.

Step 1: Getting started –

First, you may want to talk to family, friends, and/or church members about obtaining reliable and trustworthy help.

If you need to, you can advertise for an in-home worker in the "Help Wanted" classified section of a local newspaper or post "Help Wanted" posters at a senior center, community center, church, or synagogue. Some community newsletters also feature advertisements from individuals seeking employment as a household helper. A sample advertisement could read something like this:

“Female helper needed part-time for personal care and housekeeping. Flexible hours. Call (insert your telephone number) after 6:00 pm.”

or like this –

“Home helper needed for chores. Must have drivers license and automobile. Non-smoker with time available in mid-morning to mid-afternoon on weekdays. Call (insert your telephone number). Early morning is best.”

Be careful! Do not divulge too much of your person information which might attract unscrupulous individuals.

Step 2: Screen candidates –

Although you should interview anyone you are considering hiring, you don’t have to meet with everyone who responds to your advertisement. Before you set up an interview, make sure to ask a few pre-screening questions so that the person understands the basic duties and schedule and you get an idea about the prospective worker’s prior experience or training. In addition, be ready to provide basic information such as:

1. How many hours of work (total per week or per month) are needed,
2. What days and times of day are needed,
3. Specific job duties (include driving, if appropriate),
4. Salary and benefits, frequency of pay, and
5. Other specifics (e.g., non-smoker only, must be able to cook, etc.)

Step 3: Interview candidates –

Interviewing is the pivotal part of your hiring process. This is where you ask more detailed questions and begin to evaluate which candidate is best suited to do the job. Some questions you should ask include:

1. Where have you worked before?
2. Do you have experience working with an elderly or disabled person?
3. What do you know about _______________ (ask about a specific illness or condition)?
4. How do you feel about working for an elderly or disabled person?
5. Tell me a little about yourself, your interests and hobbies.
6. Do you have any health or physical problems which might hinder you on the job? (ask about lifting, bending, ability to drive or push a wheelchair).
7. What other obligations do you have (e.g., school, part-time job) that will affect your schedule?
8. Do you have your own car and car insurance?
9. Would you be able to transfer someone from a wheelchair into a car?
10. Are you comfortable cooking for someone else?
11. How do you feel about cooking and eating food that someone else wants?
12. How do you handle someone who is upset, angry or fearful?
13. If appropriate, ask: Do you have experience being around someone with memory problems?
14. How do you handle someone who is confused?
15. What made you choose this kind of work?
16. Is there anything that makes you uncomfortable or angry?
17. How do you feel about smoking, drinking or using drugs?
18. Is there anything in the job description that you would not do?
19. What time commitment are you willing to make?
20. When could you begin work?
21. Do you have any questions about the job duties, schedule, or salary?
22. Is there anything else you would like to add?
23. Please give me two work-related references and one personal reference. (make sure I have your phone number and the best time to reach you)

Step 4: Evaluate the interview –

After interviewing a candidate, take a little time to note down your impressions or concerns. Try to do this immediately so the person is still fresh in your mind.

Use the following questions to guide you in choosing:

1. Did the person arrive on time?
2. Did I have a good feeling about the person/pleasant rapport?
3. Did we agree on the job duties and schedule?
4. Did the person provide the requested references?
5. Did I tell the person when I would notify her?
6. Was there anything about the person that made me uncomfortable?

Step 5: Check references –

Once you have narrowed your choices, be sure to do some background checking on the candidates. Use the following questions to check with prior employers:

1. This is a reference for (name of job applicant):
2. Provided by Date:
3. Relationship to applicant:
4. Phone number:
5. Ask at least the following questions:
6. How long have you known the applicant?
7. What was her position?
8. Please tell me about the responsibilities on the job?
9. What is your impression of her as a worker?
10. Is the person reliable?
11. Punctual?
12. Did the person show initiative or wait to be told what to do?
13. Does the person listen well?
14. Follow instructions?
15. Is the person trustworthy?
16. Does the person show good common sense?
17. Were there any problems on the job?
18. Were you aware of any problems with drugs or alcohol?
19. Would you recommend this person?

Step 6: Sign an agreement of understanding –

Before hiring someone to work in your home, you should write down what is expected of the worker and how you will deal with situations which may come up, such as ...

Service Agreement

1. Your name:
2. Worker’s name:
3. Date of Hire:
4. Salary (per hour, week, month):
5. Fringe Benefits:
6. Terms of Payment (e.g., weekly, monthly):
7. Hours of Employment from ______ to ______ on ________________ days (work hours can be negotiable):
8. Worker’s Social Security number:
9. Worker’s Duties (fill in chart below):

List examples of non-acceptable behavior and/or reasons for termination:

Your Signature and Date:

Worker’s Signature and Date:

Some Final Thoughts

Have realistic expectations.

The in-home worker may not perform tasks exactly as you would perform them so your flexibility is important. Inform each worker how you prefer tasks done but allow for some differences. Allow flexibility in their arrival time when they must travel to your home, exact arrival times are not always possible.

Resolve schedule conflicts in advance.

When your personal schedule conflicts with your in-home worker’s schedule, inform the worker and/or agency as soon as possible to either arrange an alternative date or cancel service on that date. Workers and agencies appreciate your courtesy of informing them of scheduling conflicts. If your services are through an agency, call the agency directly instead of telling your worker. If you become hospitalized, arrange for someone to call your worker or agency, if possible.

Handling service changes and concerns.

Most agencies arrange for a supervisor to be responsible for the implementation and monitoring of the service agreement and troubleshooting when conflicts occur between the consumer and agency. Contact your worker’s supervisor directly regarding any changes you wish to make in your services agreement or any concerns you have about the services. Communicating your concerns to workers rather than the worker’s supervisor may cause misinterpretation of a concern or may delay its resolution.

Discontinuing services.

If possible, give advance notice if you decide you no longer want the service. An appeal process may be available for terminated services when you use an agency or government supported programs and services.

Emergencies.

Agency workers are instructed to call the office or “911” if they observe you having a medical emergency. If Hospice services are involved, workers are given specific instructions on how to handle medical emergencies. If you employ your own in-home worker, be sure to decide how you want specific types of emergencies handled.

Broken items.

Most agencies have insurance that covers the repair or replacement of items broken by their workers, but inquire ahead of time. Should an incident occur, inform the agency as soon as possible. If a worker you hire directly breaks an item, you will need to work out the issue together or make an agreement about this issue in your Service Agreement.

Suspected theft by your in-home worker.

Sometimes people believe that their money or items are missing. Sometimes this may be a result of rearranging or forgetting where they were placed. It is important to look thoroughly for your belongings before taking further action.

However, if you think your worker you has taken anything of value ...

1. If the worker is hired through an agency, call the agency to report your allegations. Agencies usually will investigate and attempt to resolve complaints.
2. If you hired the worker yourself, you must decide how to handle the situation. You may want to talk directly with her/him before taking further action. If you are sure of theft, call the police as soon as you discover the items missing. Just as you would call the police if someone broke into your home to steal, you should do the same if you suspect theft by your worker.

Keep your money and other valuables such as credit cards, telephone calling cards, cash machine cards, check blanks, income checks and valuable jewelry in a locked area or other secure location.

Be aware of the activities of your worker. Most people would agree that the majority of workers do not steal. But, a very few dishonest workers can present the most problems.

Hiring an in-home worker yourself requires patience and trust; and your instincts will be important. Beyond that, your time spent screening applicants and checking their references beforehand will greatly improve your chances of finding someone whose qualifications meet your caregiving needs.

###

Return to Family Caregiving