Using Home Care Companies vrs. Indp. Contractors/Employees

Camille25

My sister and I live in different states, half-way across the country from my 82 y/o mom in the early-mid stages of Alzheimer's (3.5 years into the diagnosis). Mom lives independently with no help other than a great support group of friends. Mom enjoys good health other than the ALZ, is physically active. This week, for safety reasons, we asked her to stop driving. 

We want to bring in a companion for 1-2 days a week for a total of about 4-10 hours (for now) to help Mom with transportation, accompany her to appointments, and help her at home with things that crop up during the week as well as meal planning/prep. We need someone to be our eyes, ears and hands.

Please share your thoughts and experience on using Home Care companies (who are employers) vrs. Care.com or independent contractors/employees, especially as it might pertain to a situation where the LO and family reside several hundreds of miles apart.

I can see strengths and weaknesses in each type of employment structure.

Thank you for your thoughts.

Vitruvius

Not to scare you but make sure you vet any independent individual very thoroughly.

 https://www.today.com/news/news/prevent-financial-elder-abuse-home-caregiver-rcna5689

Old89

I am doing both.  I have one independent and a home care company.   An independent done properly requires a bit of work to set up proper payroll and worker's compensation to project your mom's assets if the person was hurt.  Care.com makes that all pretty easy and it has worked well for me.  And advantage of direct hire is that you avoid the overhead of the care company and may be able to save money on the hourly rate or pay the person a higher rate than they would make with a care company. 

The advantages of a care company are that they have better resources and more experience vetting and training people.  Perhaps the biggest is that all people have things come up and are unexpectedly absent.  With a care company they are used to getting substitutes on short notice, so if your mother had a Dr. appt and the helper was unable to come, the care company would be able to fill that gap for her and you. 

With the distance issue, I might opt for the care company so they are responsible for seeing your mother is well served. 

I am working with Home Instead and find they have a good system and the people have been fine for exactly what you are talking about.  But beware that almost all of these companies operate on local franchise so I don't know how uniform the quality is from office to office.

harshedbuzz

Camille-

I would not be counting on a network of friends to be your safety net/eyes and ears from halfway across the country. At the very least, you need a professional geriatric care manager to be your eyes and ears on the ground. That person can cobble together a team to provide care and manage emergencies when staff don't show up.

Friends are a nice extra in the life of a PWD, but they are not part of the care community in most instances. As a PWD progresses in the disease friends, and even family, withdraw. Sometimes it is a matter of the PWD losing their social filters and becoming unkind or squirm-worthy to include on public outings causing people to disinclude them. Sometimes, it's just that the memory issues and repetition can be tiresome or painful to witness which can lead to a friend withdrawing. And it's hard to know as PWD are such poor reporters and aren't well oriented to time.

When I moved my parents near me from their homes in MD and FL, dad carried on bitterly about losing his golf buddies, days at the pool and dinners with their social group. Fact was, his behavior had led them to become outcasts in MD years prior and while in FL mom was active and busy, dad hadn't done any of those things in 5 years according to his neighbors.

You didn't ask, but in your shoes I would make a plan to move mom closer to the child who has time to keep an eye on her care and who lives in a community with a lot of resources. If she's not wealthy, I would compare Medicaid policies for LTC in each of the states where you live; some state Medicaid will pay for MCFs while others only cover a semi-private room in a SNF.

In terms of comparing private pay vs agency help. It's hard to say as so much depends on the individual caregiver- a commodity that is becoming rarer as the pandemic goes on. Agencies typically handle the vetting and payroll and can more easily back-fill a slot if the regular caregiver is sick or flakes assuming your mom calls and lets them know she had a "no-show". They're more expensive and they can still be issues. The first caregiver the agency sent us swiped a bunch of my mom's jewelry and accidently left behind some other client's checkbook with 3 signed blank checks in it. 

My neighbors had a live-in caregiving couple for her mom with Alzheimer's. He was a CFO (so doing payroll was no biggie for him) and had been through the private caregiver routine with his late wife. It worked pretty well for him because they were local to provide days off and deal with emergencies and mom was an "easy" PWD.

HB

mommyandme (m&m)

When my mom lived in a different state than both my brother and I, we used both an agency and care.com.  Also when my mom declined to 24/7 supervision we included cameras which are invaluable.  

A home care service takes responsibility for many of the legalities.  Payroll is a big one but you pay more for the service than you would for an independent contractor that you hire yourself.  Of course you have to do the vetting with an IC but you have to do that anyway, with the service.  Often there is turnover regardless.  The service may also have a minimum daily hour requirement. 

I talk with our service caregivers thru text which a I told the service I would require so that I can discuss schedule and needs that come up, in real time.  I can’t stand having to call the service number for every little thing. 

Care.com was a great choice for us because we needed a CNA, so I advertised for that.  There’s no saying what experience the service employee has when they show up.  

We’ve had fails and successes with both.  Less expensive with your own IC but that comes with payroll/taxes and interviewing etc.  Less headache in those areas with a service but more expensive.  You never really know until you get someone in if it’s a good fit.  

Try a few, hopefully the one or two you start out with will be fabulous.  

Abzu

Right now I am in the process of hiring an aid for my mother for a few extra hours since medicaid will nor increase her hours. Privately is proving too be far more of a headache. Granted some services like care take care of the background check and even payment, but I have found it is far easier and less stressful to go through an agency.