One of the greatest fears of older adults is the loss in independence. That loss is felt acutely when it translates into the need for institutional living. Even the most luxurious congregant living facility isn\’t the same as your own home. “Aging in place” is the chief desire of our aging parents, but for some, it just may not be possible without assistance. It is not uncommon for an ailing, frail adult to be cared for by their aging frail spouse, who will soon become ailing as well from the stress and demands of caregiving. Frail seniors who will be facing old age alone may have a poor outcome if living independently.

It is an especially frightening prospect for those of us who have an aging parent in a different city. Imagine having a parent who doesn\’t always hear the phone when it rings. How many alarm bells go off in your head when the phone rings off the hook? Are they taking a nap, or lying unconscious on the bathroom floor? Do they have groceries? Did they remember to take their blood pressure medication? When was the last time they took a shower?

Professional help in the home can take many forms, but custodial care (assistance with bathing, dressing, meal preparation, errands, companionship, light housekeeping, etc.) is the type of care most frequently needed by the aging population. This type of care is not covered by Medicare or senior HMO. Long term care insurance is the only third party payer designed for this need and different policies have different allowances.

When arranging for care, realize that care might not have to start out all day, everyday. Examine what the actual current level of need truly is. Which of the tasks necessary for safe and healthy home living are no longer able to done independently? It might just be assistance with meals, trips to the doctor\’s office, or the occasional outing for exercise and mental stimulation. On the other end of the spectrum, however, it might be that an individual is so frail they are no longer able to safely bathe and dress themselves. Perhaps knowing that someone is awake in the house at night for assistance with trips to the bathroom offers a sense of security. Care can be provided in a shift-work, live-out arrangement from 4 to 24 hours per day, or live-in. Costs vary according to the level of care (e.g., simple companionship vs. providing personal care). These needs can change over time and caregiving can be flexibly arranged to match the need.

Another consideration is whether to use an agency or hire privately. There are obvious advantages to dealing with an agency. The staff are pre-screened for you. Additionally, if an agency caregiver is ill or on vacation, another caregiver can easily be substituted. An agency handles the payroll taxes and workers\’ compensation coverage for its employees. Inquire if the agency utilizes employees, or are their caregivers “Form 1099” independent contractors. Be aware that for the latter, the client will be responsible for the payroll taxes and must be certain that their home owner\’s insurance will cover workers who may get injured while in their employ. This will also be true if the caregiver is hired privately.

Another advantage to working with an agency is they will help the client adjust during the initial phase of having a caregiver in the home. To some fiercely independent seniors, having a caregiver is seen as an affront and they will work very hard to sabotage the relationship. They will find fault with everyone. (“You sent me someone with blue eyes! I can\’t be cared for by someone with blue eyes!” Yes, it\’s happened.) That can mean a revolving door of caregivers until they become accustomed to having someone in their home. Ultimately, regardless of the route taken to hire a help in the home, to quote a popular commercial, “Finding the right caregiver – priceless.”

Sherry Netherland