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Long-Term Care: Hiring Home Care Workers

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After formal home care services end, or even before, many people turn to hiring home care workers themselves and paying them privately. The benefits include being in charge of the care, deciding how and when certain tasks are performed, and, in theory at least, having continuity of workers.

People usually do better when they have the same aide or team over time. Some Medicaid programs permit qualified enrollees to hire and fire their own workers, with fiscal oversight.

Workers paid privately may charge less than an agency, but in some areas there is not much difference. The worker, of course, gets to keep more of the pay. A downside of hiring privately may be the lack of backup. If the regular worker is not available, you have to find a substitute on your own. You also have to juggle additional responsibilities for financial management and supervision.

You can hire someone to manage the payroll and Social Security, but this adds to the cost. Yet this investment can make the difference between your family member's willingness to accept the help (not a foregone conclusion!) and your comfort with the quality of care being provided.

Starting January 1, 2015, if you hire home care workers directly, you will have to follow the new Department of Labor rules implementing the Fair Labor Standards Act. Most home care workers will have to be paid minimum wage and overtime.

In interviewing potential aides, describe the aspects of care that are particularly important to you and ask how well the person can meet those needs. If you need night or weekend help, ask if the person will be available for those times.

You should get several recent references. Ask previous employers about the person's work habits, attitude, and reliability. Check with the state Department of Health’s registry to see if any past complaints of abuse or neglect have been filed against the worker.

You may want to have a trial period before hiring a worker. Sometimes what looks like a good match turns out not to be one, and you'll be better off acknowledging that early on. Establishing a set of house rules that respect both your family member's privacy and your own as well as the home care worker's needs will help create a good working relationship.

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