The Ins and Outs of Hiring Private Care

In the past few months, Family Caregivers of BC received numerous calls from individuals asking about how to hire private care, through an agency or an independent care provider. Most cases we come across involve care for the elderly. Hiring private care is sometimes an option in other cases involving other disease specific illnesses or conditions. The three most common forms of hiring private care are through a home care agency, hiring a private home care provider, and employing a live-in caregiver.

This article is most relevant for hiring private care for a senior. We’ll be tackling hiring a private live-in caregiver in a subsequent piece.

Mrs. Robson is a 92-year-old widow with Alzheimer’s disease. In her younger years, she was a schoolteacher and raised three children. She and her husband married at 20 years old and enjoyed a 60-year marriage. She was an avid hiker, gardener, and enjoyed reading. She loves her home, which overlooks a nearby park, and she has lived in the same neighbourhood for the past 40 years.

Although very independent, Mrs. Robson needs some care and supervision; she can no longer make meals, isn’t consistently taking her medications, is unable to drive and is unsteady to shower by herself. Some of her children’s concerns include Mom getting lost on one of her walks or having a fall in her home.

Before her diagnosis, Mrs. Robson and her children discussed her future and she expressed her desire to stay in her home for as long as possible. Although Mrs. Robson was assessed by a health authority case manager and she was eligible to receive home support services publicly, her current income and her need for consistency in who provides care and support are the main reasons her family want to explore private care.

For consideration: it is very important for families to engage with the public health system. Don’t bypass this step. Circumstances, care needs, and caregiver abilities can change quickly. Health authorities have specific and specialized programs and services to support seniors to remain independent and in the community. For example, Mrs. Robson had an in-home assessment done by a case manager through Home and Community Care as well as she was seen by a geriatric team through a program called Seniors Outreach Response Team. Mrs. Robson is very social and only one of her children lives nearby. Part of her care plan includes going to an Adult Day Program once a week.

There are several important decisions seniors and their families face when more help is needed to allow an aging loved one to stay in their home. Hiring a private caregiver to provide home support services and other household management tasks are often at the forefront. There are different options for hiring private care depending on the needs of the person being care and we’ll cover each option below.

Assess Private Care Needs

Before jumping in with two feet, it’s important to ask, “What assistance is needed and how much?”  Consider personal care, household tasks, transportation, meal preparation, medication management, companionship and cultural compatibility.

In Mrs. Robson’s case, the family decides that their Mom needs a care provider every afternoon, Monday to Friday, for two hours to help with meal preparation, housekeeping/laundry, transportation to appointments and some companionship. The family will rotate and assist in the evenings and weekends.

Which route to go?

Using a local home health care agency is often a first choice for families and seniors. A well run reputable private home care agency will run criminal record checks, screen and train employees, and require them to abide by a strict code of conduct. Talking to friends and colleagues who’ve used private care agencies is a good place to start. The other option of hiring a private caregiver through the newspaper or online is a riskier and often requires more up front time on the behalf of the family.  One Canadian online database of for hire caregivers is www.caregiverjobs.ca.

Regardless of which option you choose, there are some key due diligence activities to consider with using private care providers.

Research, Research, Research

Some families or seniors are fortunate enough to receive a direct referral from a trusted source.  Even so, it is still important to ask key questions about an agency or individual’s care services:

• How many years has the agency/individual been serving in the community?
• What are the services and costs, and do they have the information in print? Be sure to ask if  if travel time is included in the service and if so, how much time is allocated for travel time.
• What is the minimum amount of service?
• If you live in a more rural area, ask about travel time and/or mileage costs for staff’s travel.
• Is the agency accredited? This means that their quality of care has been surveyed and approved by an outside accrediting organization.
• Double check insurance coverage – general liability and WorkSafe BC, especially for independent private caregivers
• Can you get a service agreement which outlines the services to be provided and the cost, in writing?
• How does the agency/individual handle billing?
• Will the agency/individual provide a reference?
• Are the agency’s caregivers available 24 hours per day, seven days a week?
• Does the agency have a nursing supervisor on call and available 24 hours per day? For individual private caregivers, ask about backup plans
• What are the qualifications of the staff? How are they trained?
• Does the agency/individual do a in-home assessment and what’s included? Is this free of charge?
• How does the agency/individual ensure client confidentiality?
• Does the agency require criminal record background checks and communicable disease screens for its employees?
• What is the process for resolving issues that may arise between the client/family and home health-care staff?
• What happens if the care provider fails to make a scheduled visit?
• What is the cancellation policy?
• Will the same care provider visit regularly?

Service Contract

Once you know what you need, write down a job description. It doesn’t need to be fancy (but it can be!) and it helps to lay the foundation for a service contract between you and your in-home provider.

It’s best to be as specific as possible and list expectations, duties, and responsibilities. Typical duties include personal care (bath/shower assist, getting dressed), companionship, housekeeping, meal preparation, grocery shopping and other errands, transportation to appointments, etc).

When dealing with an agency, they should provide a contract detailing the terms of the servicer relationship.  When hiring an individual care provider, it’s ideal to hire them as an “independent contractor”.  An independent contractor deals directly with Canada Revenue Agency (CRA) to pay their own income tax, etc.

It is still vital to have a service contract with an individual private caregiver with a detailed section outlining the rate of pay, number of hours and termination of contract, etc.  Some independent care providers may have a sample contract to use as a template.

If the private caregiver wants to be hired as a legal employee, the employer (the person paying for the services) are required to follow all the necessary rules on having an employee on payroll. This includes submitting payroll records, paying employee deductions (EI and CPP) to CRA, covering holidays and abiding the regulations on overtime and statutory holidays. This can be a very laborious and time consuming process.

Insurance Coverage

If an individual is providing care, the following areas of coverage are important to understand.

WorkSafe BC: You may need to provide WorkSafe coverage to a private caregiver providing ongoing services in your home or the care recipient’s home. Start here.

Home Insurance: Inquire with home insurance agent to make sure that adequate coverage is in place to protect from theft, injuries not covered by WCB, or damage to the home or contents caused by the caregiver providing care.

Vehicle and Passenger Insurance: Call ICBC to find out what insurance is required:

• If caregiver is using their own vehicle
• If caregiver is using care recipient’s vehicle

Interviewing

Ask the right questions. Interviewing potential applicants and doing reference checks is key. Standard questions can give you insight into a person’s skills and their reasons for working with seniors. It’s also helpful to give hypothetical scenarios and how a care provider would handle the situation.

Here are some areas and questions for consideration:

• Are they comfortable with the duties required for the position?
• If care recipient has pets, are they comfortable with pets?
• Any medical conditions that would prevent them for completing tasks as listed in the position description?
• Are they able to add hours, alter times if needed?
• Experiences with caring for a senior? A person with cognitive impairment?
• How do they feel about people who are older and/or have disabilities?
• Why are you interested in this position?
• Have you handled an emergency before? If so, what happened and what did you do?
• What type of supervision do you respond to best?
• What do you think will be the most difficult part of the job?
• We all make mistakes. Give an example of a time when you made a mistake?  How did you handle it?
• What do you hope to realize / gain from this position?
• Describe a situation were you had a serious difference of opinion with another co-worker or supervisor. How did you handle it and what was the final outcome?
• Describe a time when you were asked to do something that was against the rules. How did or would you handle it?
• Under what circumstances would you say it is acceptable to break a confidence of a client?
• Why do you feel you are the right person for this position? What do you think you would
• How important is “balance” in your life? What would you say your current level of satisfaction with balance is?
• How would you respond if the person you were caring for wase verbally and physically aggressive towards you?
• A client refuses to comply with care for example won’t take a bath or take medications. How would you deal with this?

Getting permission and checking references are next steps. Acquire copies of documentation such as education certificates, first aid training, etc.

Sound daunting? Have a friend or family help you or have a professional assist you in setting up the paperwork and assist with hiring the right person.

Everyone’s caregiving situation is a bit different, but hopefully this will be useful for you as a starting-off point. If you have any questions, you can always contact us.

You can find this article here on the Family Caregivers of BC blog.