Appropriate cost for Home Health Aide

TheCatWantsOut

The quote I received for a home care assistant seems quite high compared to what research led me to expect, but I understand internet research may be misleading. I was quoted $650 per week, for three days per week, six hours per day. State is New Jersey. Does this roughly agree with others experience?

harshedbuzz

I'm in PA minutes from NJ.

That works out to about $36/hr which is about what I would expect. If you're in near the beach, Princeton or New York, I would consider that a about as good as you might get. Dad's agency HHAs were about $32/hour 5 years ago-- pre-COVID when there was less of a shortage of folks providing care professionally.

FWIW, agencies take a big bite out of that hourly fee in exchange for hiring, vetting, maintaining schedules, providing coverage for no-shows (when they can), insurance and payroll. If you are willing and able to do this, you may be able to get a cheaper hourly rate via HHAs found on Care.com or through word-of-mouth. At the time we hired agency help, local independent HHAs were asking $15-$20/hour. I don't know that you'd find someone much cheaper than $20-28/hour using that formula.

HB

CanyonGal

In fall of 2019, we paid a private cna for $15 an hour, until we lost her due to a family crisis within her family. Mom was in assisted living about a month later and Covid and lockdowns prevent hiring another caregiver. In 2021, we had hired a part time caregiver for doctor appointments, and to take mom shopping or to visit friends at $20-21 per hour. She only lasted 3 months, as she wasn't one to deal with dementia clients . Agencies were wanting close to $25 and a guaranteed 20 hours. With today's inflation, I would guess higher wages. She lives in a small town in FL.

Quilting brings calm

We paid $17 an hour in 2019 in Alabama for a night/time person. I do not think that agency provided dementia specific caregivers, nor do I think they were even the type that did more than just show up and make sure the person wasn’t alone. My sister arranged for them- we needed someone immediately. In addition, by night 3 we’d given up. The first person didn’t want to stay up herself as she worked elsewhere that day. My parents didn’t let the second person in the next night ( my parents’ problem, not hers) and the third person didn’t show up the third night.

You get what you pay for. It is a rough job and the people themselves end up making the same money saying ‘do you want fries with that’.

Unfortunately you are between a rock and a hard place.

TheCatWantsOut

Thanks for the responses. It sounds like the quote is not that far out of line, but it is at the high end so I should expect a reliable, competent individual. That may be the right solution; since I am handling this remotely I can't really directly manage no-shows or poor quality-of-care.

harshedbuzz

https://alzconnected.org/discussion/comment/169238#Comment_169238

You can wish for reliable, capable and competent, but I wouldn't expect it. Especially initially. Especially from a distance.

If you aren't going to move mom into AL/MC at this time, I wonder if you would benefit from hiring a Geriatric Care Manager to handle this for you. These are usually well-connected MSWs who coordinate care for families who can't because of distance or time.

IME, the agency will send you what they have available.

The best folks they have likely have a full roster of clients and aren't taking on new people unless someone has recently died. The best folks want close to full-time typically and the 15 hours may not appeal to them, or it might conflict with long-standing clients' schedules.

Because of the above, you may get a newbie who either isn't well trained around dementia or someone who isn't popular with clients in general. We had 3 who didn't work out. The first wanted to boss me around and was more focused on housekeeping. The second seems to have swiped a few pieces of mom's jewelry under the guise of making the bed. She also left another client's checkbook, with signed blank checks, in mom's kitchen cabinet. WTF? Number 3 was a recent immigrant from Eritrea who seemed to have no idea what she was supposed to do and whose accent was so heavy neither of my parents could understand her. Number 4 was lovely. She looked a bit like my mom did as a young woman and they both adored her. A little Facebook search revealed that she was very into weed which is no big deal to me but might be off-putting to others. She was very helpful around resources in the area, and I weighed her opinion heavily when selecting a MCF. She even dropped in to see dad a couple of times once he went to MC.

My dear friend who had her mom at home hired HHAs from a different franchise of the same agency we used. She lucked out initially with a older lady who spoke German as her mom had. This allowed my friend to work and have a weekly date with her husband who was living in another city and traveling 2 weeks every month. Mom and the HHA would start dinner together, bake, do puzzles, sing, take walks on the community nature trail. It was great, but the HHA went back to Europe for 4 months to care for her own mom and when she returned, she asked the agency for a new assignment as my friend's mom had progressed to a point where she was too hard to engage. The HHA's sweet-spot was early to middle stages and then she moved on. My friend was devastated.

TheCatWantsOut

Good Lord. The whole reason for hiring help is because I cannot be there. If someone needs to constantly watch over the Home Care help, then what's the point? Since I can't believe any feedback my mother provides about her caregiver I kind of need to trust that services are being provided. If that is a bad assumption then maybe home care isn't a great option.

elhijo

Hello TheCatWantsOut,

Out here in Florida I pay a better-regarded agency 25/hr but they want 6 hours per visit. That comes out to $150/day. Even at that rate, it adds up quick to $750/week for Monday-Friday 6-hours care. Others may find that rate cheap but keep in mind that it's still high as it's $7,800 for each day of the week of care, per year ($150 * 52 weeks). Multiply the $7800 by 5 for the 5 days in a work-week, and you'll see what I mean. Even at that price though the rate is not the highest where I live. One agency wanted something like $32 hr and didn't sound very convincing. Needless to say, I didn't call them back. But like others have said, you get what you pay for. For my part, I only use an aide when I need one. Mom never got accustomed to strangers and after I quit using Home Health Aides on a regular basis, her sundowning became non-existent and her anxiety got down to zero. No head meds needed. Even one she got along with, still caused her great agitation for when the aide would leave, mom she would remember someone had been in the house for days on end, causing me agitation in turn. I can take care of her as I work from home by God's grace. But it is still a lot of work. I've found ways to make it work over the years though.

Since you are a remote caretaker, finding help will be hard but it doesn't have to be impossible. One thing to look into is purchasing spy cams and put them in your mom's home the next time you visit. Or maybe a close relative near your mom or a friend can do it for you. There are some on Amazon that work over the internet so you can check in, and see what the aide is doing. Another thing is that with Alzheimer's, HHA's aren't really suited for the job. You need someone with more education and training which is what you can get with a CNA, Certified Nursing Assistant. I say can because not all CNA's have experience with Alzheimer's, some do, some don't. Some work in dementia facilities and they pick up an extra bit of money by also doing caretaker work for an agency on the side. So they have a bit more training. But, like everything else "caretaker", the pay won't be that much great for being a CNA and your CNA will generally move on. Question is, how soon? After a couple of days, months, years etc. You just don't know. You'll also have to pay a little more for a CNA, but like all things, you get what you pay for.

And part of the reason the cost went up for this type of service was that, with the Covid pandemic, a lot of the women that did these type of jobs left the workforce or decided to move on to better paying/less stressful jobs. Also the agencies that employ these women tend to exploit them, in some cases, taking in as much as 50% of the rate for themselves. Not all agencies do this but my impression is that for this particular industry, the industry tends more to do it more than not do it. So flat-out ask the agency how much they pay their HHA or CNA per hour. If they won't give you a figure, or a dollar range, say thank you and call another one.

Another thing to watch out for is one you get your CNA (hopefully a CNA) is that if they start having too many personal problems where they start being really late to their shifts, or don't show up at all, that's a sign they're looking for something else or just have too much baggage going on in their lives to continue with the job. It's a sad reality when this happens but it does happen as you've read from other members who have posted on here. The low pay plus the stress of taking care of someone that you're maybe not really trained to take care of (Alzheimer's is different) takes a toll on someone. Even if you find a good CNA, she may decide that working at a facility and doing this on the side is too much. So my advice is to be on the lookout for 'problematic behaviors' and cut the cord -early. I speak from experience on this.

And I agree with others in seeking out a geriatric case manager to assist you. Maybe your local "Alliance for Aging" office can help. I think every major city has one and if you Google "Alliance for Aging" you should be able to find one where your mom lives or one in the closest vicinity. They generally know the "lay of the land" so-to-speak and can give you information about what services are available in your mom's area, might have information on what the going rates are for HHAs/CNAs, etc., things local to your mom basically.

Like all things dementia, take their advice with a grain of salt. Dementia is a very specific disease and not all counselors/case managers/etc. are trained on it or have experience with it, let alone Alzheimer's.

I wish you and your mom the very best of luck!

Warm regards from the Sunshine State