Advice When Choosing Among Home Health Care Options

Thanks to our population’s aging demographics, in nearly every social situation in which I am involved, people talk with me about the care of their parents. As they contemplate hiring private help to assist, I’m often struck by their lack of knowledge regarding the private homecare industry and the potential risks involved.

Some tell me they are considering a particular agency based on a newspaper ad they saw. Others consider using a person who used to clean their parent’s home, or who a neighbor suggested. Whatever the particulars, it’s clear they don’t know very much about what they are getting into. That makes sense. Most of us have, at most, just two parents and home health care is therefore a new experience for all involved.

So I ask if they’ve ever hired assistance to care for their children. Nearly everyone answers by going into tremendous detail about the research and vetting process they went through when making such arrangements and how closely they supervised the care.

I ask them to view their next steps for their parents with the same sense of importance. This is how they will make the best decisions moving forward.

Private homecare – What is it?

Private homecare services are generally provided by home health aidescertified nursing assistants or personal care aides to individuals in their home, with the intention of helping them live independently and safely. Assistance is provided with activities of daily living (ADLs), defined as the things we normally do when we get up in the morning to get ready to go out of the house. This includes things like getting out of bed, going to the toilet, bathing, dressing, grooming and eating. We also have to keep our environment clean and, hopefully, interact socially with others.

Some people need a few hours a day of assistance, others require 24/7 help. Defining the specific needs of your loved one is where you must start.

Note as well that although this assistance may seem simple to you, the skill level of the individual providing this care is critical to the well-being of your loved one. Let me assure you, moving a 240 lb. man from a bed to a chair, or caring for a 90 lb. woman whose skin is so fragile that the slightest touch causes a bruise or tear, requires knowledge and skill to perform activities safely and effectively.

Options for hiring

When hiring in-home caregivers, many things must be considered. The three that stand out for me as most important are competency, cost and risk.

  1. Competency. When guiding families to set up these services, my first inclination is to ask them to consider a reputable agency that performs many of the employment functions for you. An agency will hire individuals who are credentialed as home health aides or certified nursing assistants; perform background checks; provide appropriate insurance (including liability and worker’s compensation); train their caregivers to the specific needs of the client; regularly provide management and support; manage the schedule, ensuring that your loved one is never left without a caregiver on site; and handle all payroll functions including withholding of appropriate taxes.

    Can you manage this yourself by hiring an aide directly? Absolutely, and many families do. Just keep in mind that with no agency in the mix, all of these employment functions fall to you.

    Remember as well that even with an agency involved, you must still manage the relationship with the agency; outline your specific expectations; request to interview the caregivers; help in the hiring process; develop and enhance relationships with the individual caregivers; continuously check in and, overall, hold everyone accountable.

  1. Cost. Homecare services are quite costly, averaging $25.00/hour or about $300.00/day for a live-in caregiver for whom you provide room and board. Often, it is this cost that causes a family to consider care outside of the formal framework of an agency.

    Again, I admit to having worked with many caregivers in this capacity who are phenomenal at what they do. But, as described in the next point, there is more risk when you take this on your own shoulders entirely.

  1. Risk. If you decide not to use an agency, plan on taking the initiative to perform many of the necessary functions. Check multiple references; ask to see (not just hear about – actually see) credentials; hire a payroll company to manage payroll and taxes; and purchase appropriate insurances. You’ll also need to plan on being even more involved in providing training, oversight and hands-on management.


Families have their reasons for why they may lean in one direction or another and I’m open to both avenues. Most caregivers I encounter are great, but I have been involved in difficult circumstances – in both scenarios – where caregivers were not competent, breached trust and/or were just not the right person. In all cases, trade-offs must be made and risks must be mitigated.

Whatever you decide, understand that when you hire an individual to perform a service in your home, you become an employer and with that comes certain responsibilities, the most important of which is the management of relationships.

And so please take these matters very seriously. This will ensure that your loved one is competently cared for, safe and happy. And you too may have the great pleasure of working with some truly incredible people.