Like many of our friends' parents, our mom, who was our dad's primary caregiver, was resistant to having in-home care.  There were many reasons - she felt that Dad was her responsibility, she was concerned about the cost, and she didn't want a stranger in the house.  We’ve also heard other friends talk about their parent’s fear of relinquishing control of their surroundings, and losing their independence.
 

There are two ways to secure in-home care – through a licensed agency or  through the “gray market,” a term which simply refers to in-home care without using an agency.  The gray market has become popular because it’s less expensive.

But cost is obviously not the only factor to consider.  Marki Flannery of Partners in Care, part of the Visiting Nurse Service of New York, gives this list of things to consider when hiring in-home care:

In-Home Care Agency:
Our family chose care through a licensed agency.  We used our parents' Yellow Pages and looked under “Home Health Agencies.”  If you’re looking online, you can google: “home health agencies” with your parent’s zip code.

There are basically four types of caregiver:  a skilled nurse (handles taking and monitoring vital signs, wound care, dispensing medications); a home health aide (bathroom assistance, bathing, eating); a home care helper (housekeeping); and a companion (transportation to appointments, meal preparation, visiting, light housekeeping).  If you’re going with an agency for help, you may want to choose one that provides all four categories just to give yourself more alternatives in case your situation changes.  Be mindful that pricing varies depending on the caregiver’s level of experience and the time of day that caregiver is needed.  For example, a skilled nurse is more expensive than a home care helper, and overnight help is more expensive than daytime help.  Here are some factors you’ll need to consider:

We were surprised to find so many volunteer organizations that were able to provide assistance.  We checked with a local church and found they had a large outreach program (we also recommend contacting the local city or town hall).  They provided such assistance as delivering meals, fixing things around the house, running errands like picking up groceries or medications, chauffeuring to appointments, as well as friendly visits to the home, nursing home or hospital.  The local church also had volunteers who were willing to give respite care, which provides a break for your other caregiving parent.

Once we narrowed down the prospective agencies, we invited each one to send a representative to our parents' home for an interview.  The  agencies were happy to comply and each sent a nurse to talk with our family and help us evaluate our situation.  Here are some things to consider and questions for the agency:

Either my sister Karen or I tried to be there when our parents were trying out a new aide.  We wanted to describe our expectations for the job, to show them where things were located in the house, to explain how our mom liked things done and, most importantly, to establish a relationship with them.  It was vital that we made them see that, though our mom might be stressed and our dad might be very sick, these two people were someone’s parents.  We wanted to humanize a situation that might otherwise be just another business arrangement.

We had an Occupational Therapist from our dad’s rehab center come to our parents' home to recommend specific changes to the house.  He suggested most of the items listed below, but he also checked doorways to see that our dad’s wheelchair could fit through it, checked to see if the wheelchair could get in and out of the house, recommended that we rent a hospital bed with a trapeze bar, which would help Dad pull himself up in bed.  Having the Occupational Therapist make personalized recommendations gave us more confidence in our ability to care for our dad at home. 

“Consider hiring a sitter from an in-home care service if the staff at the hospital or nursing home seems overwhelmed.  Hire someone to sit with your loved one for a shift, preferably the first shift after surgery.  Or ask the DON (Director of Nursing) when the staff will need the most help.  I am always worried when older people come out of anesthesia in the middle of the night and have no clue where they are.  Having a sitter there will solve that problem.”  Jen, Home Health Nurse, The Villages, FL