Finding a good home health care aide to take care of an elderly loved one is a challenge more people are facing today.
Whether you are a spouse or partner to someone who needs in-home help or a sibling of adult child of the same, you want your loved one to receive the best care possible.
Yet the home health care industry itself is not necessarily well-positioned to facilitate your desired outcome. The in-home caregiver industry itself is not optimized to accommodate the growing need for its services, let alone to support the workers bearing the brunt of the daily caregiving responsibilities.
Without understanding the challenges the industry itself is facing, you will find it far more difficult to connect with a caregiver who can offer the level of skilled, compassionate, steady assistance your loved one needs.
This article presents an objective overview of the home health care industry and outlines the steps you must take if you want to find a good home health care aide for your relative.
Why Is It Hard to Find a Good Home Health Aide?
According to U.S. News & World Report, the average annual salary for home health care aides is around $23,000, with a range of between $20,000 and $26,000.
Job site Glassdoor states that the average hourly pay for in-home care aides is currently around $12, with a range of between $10 and $15.
What this highlights is that, while the demand for home health aides is forecast to grow by up to 70 percent in the coming years, the pay rate to date continues to hover right around what you might expect to pay to hire an unskilled and transient seasonal fast food worker.
In addition, unlike most fast food workers today, as of yet not all states mandate that home health aides are eligible for overtime, benefits, sick leave or vacation time. Finally, in many states home health aides, or HHAs, are not required to have any special training or even to show proof of a high school diploma or GED certificate.
What does this all add up to? It adds up to overworked, underpaid, often untrained or under-trained, perpetually exhausted and stressed-out home aides – and these are the people you are expecting to care for your loved one with grace, poise, empathy and grace.
So what can you do to ensure your loved one is matched with a skilled, compassionate, conscientious caregiver who will go above and beyond to ensure their comfort and calm?
The first step is to figure out exactly what type and level of care your loved one needs.
First, Identify What Type of Assistance You Are Seeking
The very first step, before you even tackle the issue of pay rate, background checks, skills and qualifications or bedside manner, is to identify the type of assistance your loved one needs.
There are three main categories of home health aides: non-medical personal care, home health care and private nursing care. Each one is different in structure and purpose.
Non-medical personal care
At its most basic, non-medical home care aides help with activities related to daily living that are non-medical in nature. Examples include bathing, dressing, household and housekeeping tasks, meal planning and preparation, driving, picking up prescriptions, support for light exercise such as walks, pet care.
In nearly all cases, personal care aides receive no special education, training or certification.
Home health care
Home health care aides can provide all of the above services and in addition can dose and administer medication, monitor vital signs, assist with tasks such as lifting the individual, physical therapy exercise support and similar light health/medical duties.
In most cases, home health care aides do receive special education and training and are licensed and certified.
Private nursing care
Private nursing care is beyond the scope of this article. Private nurses can provide all the same types of services that nursing professionals would in medical settings such as clinics and hospitals. Different levels of skilled nursing are available, including licensed and registered nurses.
These professionals must be able to meet federal and state mandated guidelines for health and safety and obtain state licensure prior to finding work.
You can read these general outlines to identify the one that most closely matches the type of care your loved one currently requires. Once you have identified the appropriate level of care, it is on to the next step!
Next, Create a “Job Description” For Your Ideal HHA Candidate
Once you have identified the general type of care your loved one requires (personal/non-medical, home health assistance, private nursing), the next step is to identify the specific tasks that need to be done.
This process, in essence, will help you develop a job description that can lead you to your ideal home health aide candidate.
Without knowing exactly what your loved one needs, it will not be possible to interview and hire a candidate who is ready, willing and able to provide for each of these needs in full.
Start by making a list of all the things you do for your loved one that they cannot do for themselves. If at all possible, talk with your loved one to discover any other types of assistance that they want and need and add those items to the list.
Once you feel your list is largely complete, it’s on to the next step!
Decide Whether to Hire Independently Or Through An Agency
You have two basic options for finding the right home health care aide to care for your loved one. The first option is to hire an aide on your own. The second option is to work with an agency.
There are pros and cons for each option and it is important to understand what those are and how they can influence your care experience and bottom line.
Hiring a freelance independent home health care aide
Hiring a freelance independent home health care aide (an aide that does not work through an agency) can potentially cut your care bill by as much as half. However, it can also potentially increase your workload by as much as half.
When you hire an independent home health care aide, you will be relying on family, friends, personal networks and private want ads to generate leads to qualified candidates.
You will be responsible for conducting your own research, which may include civil and criminal background checks, employment verification, credit scores, reference checks, et al.
You will interview each candidate using a list of questions you develop and the job description you created (see previous section here).
You will be in charge of training, supervision, performance reviews, record keeping, accounting and payroll.
If your aide cannot make a shift, you will be responsible for filling in or finding someone who is qualified to fill in. If your aide resigns, you will be responsible for finding a new qualified candidate by repeating the steps (as listed here).
You will set the hourly rate or salary and decide whether to offer benefits such as overtime or paid sick/vacation.
Working with a home health care agency
Working with a home health care agency to locate and hire a qualified home health care aide can potentially cut your personal workload (as just described here) in half. It can also potentially double your care expenses.
This is because agencies will always charge you more than what the care worker will make.
For example, if an agency charges you $25 per hour, the home health aide that tends to your loved one will make $10 to $15 of that. The rest goes to the agency for overhead and administrative expenses.
The benefit to you is that the agency will handle recruiting qualified candidates, conducting the first round of interviews, doing relevant background checks, providing any training and supervision and meeting emergency replacement staff needs if your aide is ill or cannot make a shift for some other reason.
If the aide resigns, the agency will work with you to find a replacement. The agency will also handle all the behind-the-scenes administrative tasks, including payroll, bookkeeping and accounting.
Which route should you take? Again, there is no one-size-fits-all answer. If you have zero extra time, you may need to work with an agency just for expediency’s sake.
However, in general, hiring your own independent freelance home health care aide can give you more flexibility to offer a higher hourly wage or salary, which in turn can help you attract a more motivated, skilled and successful candidate.
Found a Great Home Health Care Aide? How to Keep Them Coming Back
There is one critical mistake that too many families make after hiring a great home health care aide for their loved one. That mistake is simply a failure to appreciate the aide who is tending to their loved one!
It might seem this mistake is so simple it should never even happen. But here again, families are often stretched to the max when a home health care aide enters the picture.
They may have been handling all the caregiver responsibilities and are burned out, frustrated and stressed – and only too happy to hand off all those extra to-do list items to their loved one’s new home health care aide.
Unfortunately, this can quickly become a recipe for disaster. The home health care aide is new to the family and new to caring for your loved one and are experiencing stress of their own trying to get up and running in their new role.
No matter how much you are paying, it will rarely ever be enough to truly reflect the little special extras that a home health care aide worth keeping will offer to your loved one.
Sending a little appreciation towards your home health care aide is often enough to at least alleviate the stress of starting a new role and a new relationship with your loved one. Considerate touches like bonuses and thank you gifts are another way to ensure your wonderful new HHA stays with you over the long-term.