Start the process while Mom is in the hospital. We tend to become consumed by the medical issues and trying to follow the test results that the doctors give us. We take the position that it is too early to think about what Mom’s needs will be when she comes home. These days, however, we do not have that luxury. Inability to walk, for example, is not a criterion for being able to stay in the hospital. If your instincts tell you that any amount of homecare is going to be needed after the hospital, then you can start interviewing personnel immediately. You can then test out your candidate in the safe environs of the hospital to see if you have a good match.

(2)   Trust your instincts. If in the interview process you are not 100% comfortable with the person, then you are probably right. There are fabulous home care workers out there. There is no need to settle for mediocrity.

(3)   Use a geriatric care manager. If you are just too overwhelmed to deal with this process, consider hiring a geriatric care manager. He or she can assess what the care needs are by doing an in-person assessment in the hospital and of the home/apartment, and then can interview homecare candidates for you. In some situations, such as with persons with Alzheimer’s Disease or other mental health disorders, a care manager can personally introduce the aide and help with the initial transition and problems that arise at the outset.

(4)   Be clear about your expectations. Try to keep the relationship professional. It is okay to become fond of the homecare worker, but limits have to be set. Just because someone does a good job doesn’t mean they make the rules. Be clear from the outset about the pay rate (including specifying what you consider the holidays to be). Be clear about the job responsibilities. Be clear from the outset that you want the worker to feel free to voice any complaints to you, and that you have the same right to voice any concerns that you have. Be clear that the common goal is to provide quality care for your parents.

(5)   Help to prevent burnout. You know your parents better than anyone. Homecare workers often are eager to help, but they don’t know enough about your parents’ history. You can help fill in the gaps, and provide useful tips on how they can spend their time together. In this way it doesn’t become a dull and dreary job where they just do their chores and then put on headphones the rest of the time.

AND

(1)   Don’t hire help solely based on cost. For example, hospitals give out lists of agencies to hire help from, and they tend to highlight the cheapest ones. You may get lucky, but the risk of getting someone of poor quality is great. Whatever you do, you or someone you trust must interview the person before they are introduced to your parents.

(2)   Don’t relinquish control to the homecare worker. Many times families get infatuated with one homecare worker, and entrust too many important duties to her. They let her make the schedule and bring in other workers to cover for her. This is too risky. At the very least someone should interview these people as well.

(3)   Don’t have the homecare worker handle important communications with doctors, lawyers, accountants, etc. These days, with cell phones, there is no reason that family members cannot be kept in the loop where important decisions are being made. The best homecare workers are able to identify what is important and what is not, so that they’re not calling you too often.

(4)   Don’t share financial information with homecare workers. There simply is no reason to do this, even if they are trustworthy. Do not give them access to any accounts that have significant amounts of money in them. Require that they give you receipts for money spent when you have dispensed money with them. This is standard practice and should not be met with any resistance whatsoever.

(5)   Don’t let the homecare worker hold you hostage. Keep the lines of communication open, and don’t lose perspective. They are working for you, not vice versa. Don’t be afraid to make a change if you feel there is friction. The best homecare workers are able to be honest without being defensive. When you see that they have gone beyond the call of duty during a crisis, reward them. But then there has to be a return to normalcy. Bonuses do not become part of the norm, and sometimes that has to be clarified.