Staying Home

The term “home care” encompasses everything from occasional companionship to 24/7 medical attention, but no matter what form it takes, the goal is the same: to maximize an older person’s quality of life, and perhaps even extend it, without forcing him to leave his home. Home care can also be cheaper than institutional care—as much as 25 percent less if the person is not in need of full-time medical attention. That’s the good news. The bad news is that home care is difficult to manage: There are hiring hassles to maneuver, delicate relationships to manage, and forms and filings galore.

There are essentially two options when the time comes to hire a home-care provider: using a home-care agency or hiring someone on your own. Cutting out the middleman means you’ll save money—the usual agency rate for an aide is $20 per hour, compared with the $16 that’s more typical of a private deal—but as an employer, you’ll be on the hook for everything from finding qualified aides to managing problems to paying taxes by yourself.

If you decide to hire your own aide, experts advise using caution if you search the classifieds (“Situations Wanted: Elderly Companion” in the Irish Echo is the traditional marketplace, and is the modern version). Rip-offs and elder abuse aren’t uncommon, and if you do your own hiring, your screening ability will likely be limited and you’ll have little recourse if something goes wrong. A better alternative is to ask for recommendations from doctors, tax attorneys, friends, and neighbors. No matter how you find a candidate, be sure to ask about, and check for, state certification and legal work status, in addition to professional training. It’s also wise to hire a private investigator to run a criminal-background check. When you interview the candidate, find out how the aide would handle emergency scenarios. Check references. Once you identify someone you think you like, invite him to your home for, say, a half-day trial run (offer to pay, of course) to see if the chemistry is there. If you don’t want to do your own payroll and tax accounting, services like ADP (877-623-7729) and Paychex (800-322-7292) can do it for you (fees for a single employee run about $750 a year). Home-care agencies are government-certified and can therefore automatically accept Medicaid, but you’ll have to get Medicaid-certified through the Consumer Directed Personal Assistance Program if you or your loved one plan to pay for your home care via the welfare program.

If you decide to hire your own aide but don’t want to do the searching yourself, consider a home-care registry. Unlike an agency, which is a full-service staffing business, registries act like a home-aide headhunter. They make their money by charging you, the employer, a fee strictly for finding an aide: Typically, it works out to be equal to one month of your aide’s pay. In return, they check certification credentials and professional licenses, criminal records, and credit histories. Top-notch registries like Town & Country Companion Agency (212-921-5588) will list only home-care workers with several years of experience and solid references. Because agencies tend to pay poorly (close to or at minimum wage), the more experienced and entrepreneurial home-care workers—as well as the ones with specialized nursing and language skills—tend to gravitate toward the registries, since once they’re hired, they can make more money. A registry will typically send you several candidates to select from.

If you do decide to use an agency, again, ask for recommendations, then follow up with quantitative research through the Home Health Compare pages at medicare. gov: There you’ll find search engines and spreadsheets that compare agencies in many categories. You’ll be able to determine, for example, that the elders cared for by Montefiore Medical Center Home Health Care have lower rates of pain than at any other rated agency in the Bronx, or that Village Care’s patient-mobility rates are 9 percent better than those of any other rated service in Manhattan. Which agency is right for you or your loved one depends on the person’s needs. But basically, you want an agency that’s a well-established not-for-profit or affiliated with a hospital or church. The Visiting Nurse Service (888-867-1225) is the dominant agency in the city, and it has service agreements with several hospitals. Other well-regarded agencies include fegs (212-427-3949) and Selfhelp (212-971-7600). There are also agencies that cater to specific communities. The Metropolitan Council on Jewish Poverty (212-453-9500) can arrange for aides who prepare kosher meals, the Chinese-American Planning Council (212-941-0920) can provide bilingual R.N.’s, and Family Home Care Services (718-832-0550) has a close affiliation with Catholic Charities. Agencies typically have case managers whom you can talk to about what you’re looking for in an aide—the better agencies will let you meet some of their staff and make a selection. In the interview, ask the same questions you’d ask if you were hiring someone on your own. And don’t be afraid to ask to meet more candidates if you’re not satisfied. “I’m surprised sometimes by what families think they have to settle for,” says Steven Schwartzman, of Eldercare NY.

If all this seems overwhelming, there is another option: geriatric-care management. Like a wedding planner, a care manager will orchestrate the entire process of finding and organizing care for an elder (they can do anything from providing an hour of advice or interviewing prospective aides to accompanying a senior on doctor’s appointments and making sure insurance forms are filled out properly). It’s expensive, about $150 an hour, but might be worth it. It’s mostly a word-of-mouth business, but there is a national professional organization, and its Website ( is a good place to start if you don’t have a referral. All of the managers on the index have either a degree in nursing, psychology, or social work or at least three years’ experience in gerontology-related services. Choose someone close to where you or your loved one lives and ask about their caseload—fifteen to twenty clients is about all one manager can reasonably handle. Finally, look for someone who never turns off their cell phone. “I sleep with mine,” says Irene Zelterman, a Brooklyn-based geriatric-care manager.

“I am half-deaf and my children hired an aide who comes five days a week. I hate it. She eats half a big box of cereal and talks on the phone all day to her boyfriend. Our temperaments are opposite. When we go out walking she holds me at all times, which I hate, of course. We argue over idiotic things.”
Margo Bachman, 93, at home, Upper East Side

Whether you hire a full-service care manager or find every last attendant, aide, and nurse yourself, it’s critical to foster a healthy relationship between caregiver and client. If you’re hiring someone for a parent, try to be around in the first few weeks that the attendant is in the home to help facilitate the bond, and establish a relationship with the aide yourself by calling regularly and asking for updates or by dropping in occasionally. Avoid potential problems before they begin by removing any valuables from the house; dementia and forgetfulness on the part of a senior often lead to suspicion. (If you believe a caregiver is stealing or, worse, abusing or neglecting your parent, contact the Department for the Aging’s elder-abuse program at 212-442-3103.) Whether you or a parent is receiving care, keep the house stocked with food, perhaps some of the aide’s favorites. Feeding an aide isn’t required, but eating meals together can forge bonds. If the aide is live-in, ensure she has a private room or at least some personal space. Work a regular paid vacation into her schedule. (Visiting Nurse Service has a “respite service,” short-term replacement caregivers for just this kind of thing.) Don’t ask an aide to do laundry or housework that’s not related to the senior whom she is hired to care for, and consider using a cleaning service, if necessary, to keep the house tidy. And, as with everyone, a little basic respect goes a long way. “They’re health-care professionals, not your servants or slaves,” says Joe Campanella of the Home Care Council of New York City. “You want to treat them like human beings.”

Staying Home