Ann McGrath | Health Coach

Ann's Caregiving Tips!

NOTE:  These are my experiences with caregivers over the last 3+ years.  These are my recommendations only.

I have been taking care of my elderly mom full-time since 2020.  She was diagnosed with dementia in 2017, and had two bad falls in 2019.  She has needed 24/7 caregivers since 2019.  Based on my experience with caregiving companies and caregivers individually, I am writing this blog to help anyone who will need caregiving for themselves or a friend or family member.  I will update this as I learn more!

First, the negative: 

I am in Northern Virginia, so will tell you which companies to avoid completely in this area.  Do not use:

Some of these companies are embroiled in legal issues, and I will list some of the problems I've had over the years, which are not specific to any one company, but occur across the board.  They include:

Read EVERY word of the agreement that you sign with any company, and feel free to change the agreement!  I now change every agreement I sign.  They will include "non-compete" clauses that could cost you $10k, $20k or $30k if you hire a caregiver privately.  Have an attorney look over the agreement, if you have ANY questions.  Check the Better Business Bureau for the company's rating, and get a copy of their business license.  Many of these companies don't have a BBB rating, so get a Yelp review, or get a referral.  Don't hire a company without checking them out!

Speaking of hiring privately, I've done that also.  The downside of that is that you need to keep timesheets, and file 1099 forms with your taxes.  Have a good CPA if you go that route!  The upside is that it may cost less.

What does it cost?  That varies a little, but in this area, it will cost at least $32 an hour, and time and half for overtime (over 40) and holidays, which is $48 an hour.  If you have long term care insurance, it may cover a small amount daily, so use it!  Even if your LTC covers $100 a day, that helps.  NOTE:  If you only want a caregiver for a few hours a day, it will cost more by the hour, at least $35, because caregivers want regular hours.  They prefer to work 8 hours a shift (or more), 3 or more days a week.  The only way I was able to get $32 an hour is because we have caregivers for more than 200 hours per week.  If you use live-in caregivers, it will cost less, but you will get less.

Live-in or hourly caregivers?  That depends on what your needs are.  Live-in caregivers typically get paid less, and they burn out faster than hourly caregivers.  They will need a break once a month or so, so you may have someone you don't know in your house for one weekend a month.  We tried several live-in caregivers, but found that once my stepfather and mother needed more care, we also needed 24/7 care, and hourly people were required.  We had one live-in that lasted 9 months, but had NO experience with dementia, and when mom would sundown, the caregiver would hide upstairs!  My stepfather fell several times while she was there, and ended up needed stitches because the caregiver was not around.  I'm not a fan of live-in caregivers, unless you need minimum care.

And on the topic of cost:  CHECK EVERY LINE ITEM ON EVERY INVOICE.  I have a spreadsheet that I use to check the invoices, and it has saved me a lot of money.  Thankfully someone tipped me off that one of the companies listed above was overcharging, so I have no idea how much money I lost before I started checking the invoices.

PUT CAMERAS IN THE HOME!  This is absolutely required, and I wish I had done it MUCH sooner.  Put them in every room where your loved one will be, including the bathroom.  We have had jewelry stolen by caregivers and repairmen!  We lost custom jewelry my grandmother had made a century ago, which is irreplaceable and was not appraised.  Put everything valuable in a safe, preferably NOT in the property.  If the safe has to be on the property, make sure it is attached to the wall or floor, and that the caregivers don't know where it is.

Put a smart lock on the door!  I use Sifely.  It comes with a physical key, in case the smart lock fails, and I have copies of all physical keys in a lockbox attached to the side of the house.  There are several advantages to a smart lock:

Next, the positive:

Once you find good caregivers, you will be able to relax.  It took me a VERY long time to find four qualified, compassionate people to take care of my mom!  We now have someone working 830am-bedtime, a second day person who works noon-830pm, and an overnight person who works 830pm-830am.  Why two people during the day?  Two reasons:  1-it takes two people to lift mom, and it's easier cleaning her with two people, and 2-someone needs to have their eyes on her AT ALL TIMES.  She had her last fall because she decided she could get up and walk, forgetting that she couldn't.  She fell, broke her hip and hasn't walked since.  That last fall was the beginning of the end of her life.  Consider carefully how much help you need when choosing how many people you need.  The second day person we use doesn't have to be as good as the primary caregiver, or speak English as well.  They are just the "helper" for the primary caregiver.

This is not a racist statement, but:  Latin caregivers do a better job.  We have had caregivers who are American (never again), as well as many African countries.  I now use a company that hires almost exclusively Latin people, and I am thrilled with all of them.  There are exceptions!  Hire people with plenty of experience in your loved one's condition.  Personally, I only look for people over 30, who are familiar with dementia, sundowning, terminal irritability, and can cook meals.  Many caregivers from other countries were nurses in their countries, but don't speak English well enough to be nurses in the US.  They have excellent training and experience, so ask about their experience.

INTERVIEW EACH CAREGIVER FIRST.  I now have a lead caregiver who does this for me, and I trust her implicitly!  She also trains new people, and manages the schedule.  She is a gem, and I hope you find someone just like her!

Certifications don't matter!  Almost all our caregivers have CNA certifications, but some are awesome, some are just terrible.  We had more than one who had never experienced sundowning, so when mom started yelling, so did the caregiver!  Totally unacceptable.  Ask for references, because many of these people will tell you they have experience to get the job, but they do not.  Talk to someone who used the caregiver before, preferably with a similar condition to your loved one.

And a personal note:  Whenever anyone says to me, repeatedly, "I have XX years of experience" ... move on!  Really good people do NOT brag about how long they have been working.  People who have to reassure themselves about their "experience" are insecure, and usually do a terrible job.  (This is generally true for every profession!)

Summary of things that I do, and suggest to you, if you must have caregivers in the house, and especially if you do not live with your loved one:

-updated January 2023

Ann McGrath - Health Coach (retired)

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