Professional or Private? Which Type of Care is Best For You?

By Rick Lauber

The time has come. Gladys slipped and nearly fell while taking a bath. Her husband, Pierre, has been diagnosed with Parkinson’s disease and is also becoming rather forgetful. Until now, Gladys, Pierre and their little dog, Hondo, have been able to live in the family home but, of late, there have been a few too many “incidents.” They and their family are no longer sure they can manage on their own.

Gladys and Pierre could use some help around the house to increase both their comfort and their personal safety. It’s no secret that extra help would also take a load off both the family’s mind and theirs if they’re open to the idea. The big question: Where can you find someone honest and reliable to help out? A neighbour has a friend who she claims were very good as a nanny/housekeeper for her three kids, but she needs to live in. Your brother-in-law recommends using a professional nursing agency. With so many options, how can you decide what kind of help is needed?

Essentially, there are two types of help—perhaps best described as privately arranged care and care provided by a professional or homecare agency. Each route has its benefits and drawbacks, as well as different costs, that you’ll need to explore and navigate. It’s a serious decision so before making any rash—and perhaps regrettable—moves, carry on reading for some pros and cons to bear in mind.

Considerations when hiring an agency:

  1. Location, location, location. Professional homecare companies can be found across the country. Therefore, it shouldn’t be difficult to find a suitable provider nearby. In some rural areas, there may be a regional coordinator who will work with you, and sometimes there is a charge for mileage or transportation time. You can find local agencies by Googling homecare companies in your area. You’re likely to get numerous listings and likely some paid ads at the top of the page. Browse each firm’s website to get a sense of how it operates, and then call around to compare services and pricing. Make a list of what you think you need before you call. In addition, decide whether you’ll be asking for live-in or live-out care and part- or full-time assistance, the level of personal or nursing care required and what housekeeping duties you would like completed.
  2. Recruiting. A homecare company will advertise for, interview, screen, and train its employees—thus saving you a great deal of time, reference checking, asking for visa/citizenship papers and so on. An experienced agency staffer will work to match potential caregivers with your loved one’s needs, where possible giving consideration to the assignment, language skills required, cultural considerations, and the client’s interests, personality type and so on. In many cases, a personal support worker or nurse will start work without you or your parents meeting them beforehand—but, if you’ve been clear about your parents’ needs, that person will usually be a good fit.
  3. References. To be on the safe side, it is worth checking the company’s references with other families who use their services currently or have used them in the recent past. The agency will handle candidates’ reference checks, including verifying professional credentials and performing a criminal record check in most cases. You can ask for proof of the results if you wish.
  4. Scheduling and payroll. The agency will handle administrative duties such as organizing shifts, overtime and time off. It will also manage payroll and necessary source deductions, such as taxes, pension contributions, and employment insurance.
  5. Plan B. When you have an agency-supplied caregiver, a substitute worker can usually be supplied if your “regular” person is ill, needs time off or, heaven forbid, quits without proper notice.
  6. Reliability. Regulations and standards are met, ongoing training is provided and staff is supervised when a professional homecare company is on the job. There should be written
    job descriptions, an individual care plan for your loved one and a reporting structure that keeps both agency management and a designated family member in the loop. (This is important, as healthcare situations can change day-to-day or even hour-to-hour with some elders.)
  7. Cost of care. The costs will vary depending on the level of care and the number of hours your loved one requires. Specialized care from a qualified RN or palliative nurse will be more expensive, and sometimes there is a premium for overnight care or a minimum number of hours the company will accept. For instance: If you only require a worker for just one hour each day, you might end up being asked to pay for three hours as a minimum. Remember, however, you are getting a lot of extra services, advice and monitoring built into a higher hourly rate.
  8. Flexibility. There is no guarantee that the company will provide the same worker for each visit, and consistency of care can be hard to achieve. Depending on your loved one’s comfort level with the change, seeing a different worker at the door each time can prove difficult. Not only will each new person have a different routine and way of doing things, but it can also confusing or even frightening for seniors to have a constant stream of strangers in their home.  Agency-provided caregivers work with several seniors over the course of a day and—particularly if there is poor weather or bad traffic—can fall behind schedule and become rushed or worn out, or might simply not have been briefed well enough if they are filling in for someone else. Be prepared to speak up, check in and provide an additional briefing if needed.
  9. Quality of care. Agency guidelines and supervision make for good care management most of the time. Day-to-day or hour-by-hour visit records are kept. Each assigned caregiver and their supervisor will be brought up to speed on their client’s current state of health, personal care, medications, food preferences, routines, quirks and habits, and preferred activities. Client files are dynamic and constantly updated, often using the latest technology, with changes communicated between team members and the family.

Considerations for hiring private care:

  1. Your choice. You can write your own job description, advertise, screen resumes, interview, follow-up on a candidate’s references and hire whomever you feel would be the best fit for your loved one’s situation. When you personally meet with potential candidates ahead of time, you can chat with them, get a better feel for each applicant, introduce them to your loved one, show them the home and dog, and then decide who to hire. Be prepared to spend a good deal of time on this process and expect some disappointments, with people not showing up for interviews, changing their minds, pushing for a higher salary or not always telling the truth. But there are some gems out there so, if this is your preferred route, be patient and diligent.
  2. Scheduling flexibility. With a private caregiver, you may find that they are more available with respect to when and where they are needed. They might be willing to work a few extra evenings or trade time off to accommodate your schedule. On the other hand, some caregivers may work for a couple of families at a time to piece together full-time work or extra hours, which can reduce their flexibility.
  3. Assuming more responsibility. Private caregivers may be more willing to accept duties such as cooking, laundry, cleaning, grocery shopping, driving to appointments and taking your loved one on outings. Agency workers might be bound by their contract to do only certain tasks and be unwilling or unable to take on other duties, however necessary.
  4. Stability. With the right fit, a private caregiver may be more likely to remain working with the family for the long-term, whether they live in or out. In my family’s case, we hired a private caregiver for Dad when his Alzheimer’s progressed. Our choice, Jannett, was truly a great find! She got to know Dad and us very well and had time to focus on his changing needs as time went by. We all loved her and, thankfully, she worked with Dad until he passed away. Jannett even attended his funeral, and we were sad to lose her as part of our lives.
  5. Oversight. You will become the private caregiver’s direct employer and, as such, will be responsible for their job description, direction and management, reviews, disciplinary discussions, payroll and so on. Consider hiring your caregiver as an “independent contractor”—as such, they will deal directly with the Canada Revenue Agency to report their earnings and pay their
    own income tax. As your private caregiver’s employer and manager, you (or another family member) will become “plan B” if the caregiver calls in sick or fails to report for duty one day. This might mean you have to become available for caregiving duties on short notice, whether or not it is convenient.
  6. Missing a company’s “perks”. Unlike a company-provided care worker, your private caregiver might miss the increased security, benefits and comradery of fellow staff that they would find within a business. In addition, they might always be on the lookout for alternate employment with better pay.
  7. Planning ahead. Requirements can change, and it might become necessary to ask the private caregiver if they would consider moving into your loved one’s home to provide live-in care. While a private caregiver will have gathered ample information to help with such a transition, full-time, live-in help can drive up care costs dramatically. Ultimately, whether you choose professional or private care for your loved one, consider their healthcare needs first. Ask for second opinions from trusted family members and try not to let your emotions lead.

Rick Lauber is a published book author and freelance writer. He has written two books, Caregiver’s Guide for Canadians and The Successful Caregiver’s Guide (Self-Counsel Press). Visit ricklauber.com.

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