Ways to Vet a Caregiver or Caregiving Agency
Here's where to start and what questions to consider
Recently, The Wall Street Journal published the results of its investigation into the practices of Care.com, the country’s largest matching site for caregivers, babysitters and nannies. What it found raises serious questions for anyone who needs to hire help to care for a loved one.
Care.com claims to have overhauled many questionable procedures and policies since The Wall Street Journal article in March, but the findings should make all of us think carefully about how we evaluate the qualifications of people we employ to do the vital, difficult and sometimes emotionally fraught tasks associated with caregiving.
"An agency should be doing background checks through the various law enforcement databases as well as checking references."
As with everything else, hiring a caregiver comes with its own set of caveats. But you can find reliable care if you do your homework, proceed as you would with any other major decision, ask the right questions and learn how to evaluate the answers.
To Vet Caregivers, Start with Your State Government
Amy Goyer, a family and caregiving expert for AARP and the author of the book Juggling Life, Work, and Caregiving, has plenty of professional and personal experience in this area.
When looking for a reliable home care agency, she advises, check with your state’s monitoring and licensing departments first. The government groups that monitor and license home care agencies vary from state to state, but a call to your state’s department of aging or department of health should point you in the right direction.
In addition, says Goyer, Medicare’s Home Health Compare lists Medicare-certified agencies, which may be useful even if you’re not using Medicare to pay.
Unfortunately, the quality of Medicare’s patient care ratings are of limited use, since they only indicate that a particular agency performed better, the same or not as well as other agencies in “selected measures.” This is borne out by the low patient survey marks given even to the agencies with Medicare’s highest ratings. But it’s a place to start.
Questions for a Caregiver Agency
Geriatric care-manager Forest Gong, a licensed clinical social worker with a private practice in Los Angeles, has been working with older adults and their families since 1993. He recommends asking a prospective caregiver agency about its hiring practices and vetting process.
“An agency should be doing criminal background checks through the various law enforcement databases as well as checking references,” Gong says. If an agency is reluctant to share that information, he adds, “it’s a red flag.”
Gong suggests asking to see a copy of an agency’s license and proof and date of bonding. Once you have that information, you can verify it through your state’s monitoring agency and check to see if the agency had any renewal problems.
One advantage of going through an agency, says Gong, is that it handles things like benefits, withholding taxes and unemployment insurance for the caregiver.
Hiring a Caregiver on Your Own
You can skip an agency and hire a home caregiver on your own. If you do, Goyer suggests reaching out to friends, houses of worship and neighborhood groups for recommendations. Social workers at a local senior center may also prove to be a good resource.
But going it alone means you’ll have to approach things as if you were your own caregiving agency. That means paying for thorough criminal background checks, getting and checking references, interviewing applicants and spending time with them to make sure you find someone who is a good fit for your loved one.
Don’t know how to do a background check or what kind you need? “Ask local law enforcement to point you in the right direction,” Goyer says.
Whether you’re hiring on your own or through an agency, “you have to be clear about what you expect from the caregiver in terms of services, hours, time off and accountability,” Goyer adds.
And, Goyer emphasizes, your job is far from over even once the caregiver is in place. Popping in unannounced every now and then is very important. Is food being made? Is the living space clean? “There is no substitute for a hands-on family member,” Goyer says. And if your loved one is capable of evaluating the situation themselves, ask for that person's input.
Questions for a Prospective Caregiver
Regardless of how you hire a caregiver, you’ll want to take note of the person's professional demeanor and whether you can be given a resumé. Ask about on-the-job experience, why the person became a caregiver and credentials.
A caregiver doesn’t require any certification or special training, but a certified nursing assistant must complete specific courses that include classroom and clinical work. Then, the person must pass a state licensing exam.
Goyer notes a number of things to observe when introducing a caregiver to your loved one: Does the caregiver treat your loved one with respect or condescension? Does the person seem impatient, disorganized or insensitive?
If you think you have a loved one who may need home care, “don’t wait until it becomes an emergency,” says Dr. Megan Rau, an instructor in the Division of Geriatric Medicine and Palliative Care at New York University’s Langone Health. She says you’ll have a much better experience with an inherently difficult situation if you give yourself and your loved one time to plan ahead.