FREQUENTLY ASKED QUESTIONS ABOUT
MANAGING CARE HELPERS

Being a family caregiver is not about doing it all yourself. It is about making sure your relative's needs are met. In this role, there may come a time when you and your relative decide to start using help beyond what family and friends can provide. This decision must be made with your relative when possible, based on informed choices among available home care options, good judgement and fitting a service to your family care situation. The next step, after hiring a paid caregiver or arranging for volunteer help, is to prepare yourself and your relative to share their home and supervise the daily care being provided. The following information will help guide you in the successful management of home care helpers.

What should my relative and I expect to gain from having paid or volunteer help come into the home? You should start with having realistic expectations of what the service can and cannot offer. Homemakers don't give baths and usually home health aides don't clean. You may have to train the care helpers to perform tasks the way you or your relative likes to have them done. Be aware that the same helper may not be available all the time depending on schedules, time-off and illness. Benefits to your relative may include companionship; different approaches to care leading to favorable results in health, functioning and behavior; and overall improved happiness and wellbeing. Benefits to you as the caregiver may include: respite/personal time; reduced stress; transportation for your relative to medical appointments and recreational activities; learning new caregiving skills; peace of mind; and a better relationship with your loved one.

What type of information should I gather that would help the caregiver understand my relative's needs, likes and dislikes? Begin by creating a Personal Profile of your relative. Write down information in the following areas:

• Names – the name your relative prefers to be called, names of family members, where they live and how they contribute to your relative’s care.
• Health - medical conditions, treatments, medications, allergies, status of vision/hearing/speech and aids used, and the location of advance directives, if applicable.
• Eating/Drinking Preferences - dietary restrictions, if any.
• Daily Routines - waking, sleeping, meal/snack times, exercise times and type of activities, best time of day, most difficult time of day.
• Getting Around - right/left handed, assistive devices used (canes, walkers, wheelchair), assistance needed both inside and outside of home, transportation used to medical/professional appointments.
• Assistance/Supervision Needed with Daily Activities - eating, dressing, grooming, bathing, etc.
• Activities/Hobbies – description of activity as well as time of day performed.
• Emergency Contacts - names and telephone numbers of: family members and friends, treating physicians, pharmacy(s) used, health insurance information, emergency medical department preference and poison control.

Make a copy of this information for all helpers involved in your relative's care. Care helpers must

know what to expect.

What questions should I ask to make sure the care helper understands what my relative and I need? What you are looking for in home care is trustworthiness, reliability, dependability, skills, goodnatured care and patience. You and your relative will need to observe and evaluate the helper. Consider asking yourself the following questions:

• Is the care helper compassionate, professional, calm and proud of their work?
• Is the care helper trained in first aid and other appropriate care techniques?
• If your relative has a Prehospital Medical Care Directive (orange card and page), does the care helper understand the terms of the directive and is willing to abide by them?
• What can the care helper do to help us now?
• Is the person willing to abide by household rules? (Smoking restrictions, TV or telephone use)
• What will happen if the helper has an emergency, is sick and/or unable to arrive at their scheduled time? Are there prearranged times when the care helper will not be available? Have they planned for problems with transportation, childcare, etc?
• What arrangements need to be made about vacation and holiday coverage and wages? How far in advance should they inform you about taking time off? How much time off and how often?
• Is the helper willing to do things the way your relative wants them done?
• Is the helper willing to be flexible and do extra tasks if the need arises?
• Are there cultural sensitivities or language abilities that should be addressed? Make a list and discuss with the care helper what you expect them to do, how often and how you want tasks/activities to be performed. For instance, how many meals will be prepared each day, the time they will be served and the menu that will be followed. Or, consider identifying and discussing the specific cleaning duties to be completed, how often and what cleaning supplies might be used. Keep in mind the helper has been trained in basic health, home management and personal skills and may have valuable insight about your relative's care. Once you have agreed upon the specifics of the care to be provided, use this list to write a contract, so that both you and the care helper have a copy of what was agreed upon. Make sure you include what the helper should expect to happen if the terms of the contract are not met.

Many families choose to hire a care helper privately rather than through an agency. Be aware that as an employer you are required to complete certain payroll and tax documents including tax withholdings, FICA and other related taxes such as unemployment compensation. The care helper will also need to complete an I-9 form for immigration purposes. For a fee, independent accountants or local accounting firms will assist you and make sure you have completed all the required documents to protect you as the employer and the care helper as the employee.

My relative has memory problems. Even though we discussed and agreed upon obtaining outside the family help, my relative has probably forgotten and might be resistant to accepting help. How do I introduce the care helper to my relative? Most importantly, you should arrange to be present when a new care helper arrives at your relative’s home. This provides an opportunity to observe and evaluate the situation. Have they received training in caring for persons with memory problems? Is the helper pleasant, professional, and sociable? Is your relative fearful, uneasy or in need of reassurance? Are they able to strike-up a conversation? Many times a new person or activity is scary and threatening for persons with memory disorders. Care helpers should be informed about your relative's memory problem and their possible resistance to help prior to arriving at the home. Take advantage of this time to discuss possible approaches to be used for introducing your relative to the care helper so that they both may feel comfortable and at ease. For instance, introduce new home care workers as people who are there to help around the house, not to specifically assist the person who has memory problems. Also, you may want to provide information about your relative’s likes and dislikes that may help the home care helper "breakthe-ice" and promote social conversation.

How should my relative and I communicate with the care helper to get what we want done but not make the person defensive or negative? If you are unhappy with the care helper’s performance, behavior or question their knowledge and/or skills, speak to the person immediately. It is very important that you learn some tips for communicating effectively, including:

• Make sure your message is clearly stated, such as: "When you do this, here's how it makes me feel."
• Don't use an accusing tone. Use phrases such as: "How do you think we can correct or change whatever is wrong?" "I would feel better if we tried it this way." "It makes me uncomfortable/upset/tense when you ----"
• Try to put the care helper at ease. Encourage the person to feel free to talk. Create an environment that supports good communication.
• Show the care helper that you are listening. Look and act interested in what they have to say.
• Don't jump to conclusions. Avoid making assumptions about what the care helper is going to say.
• Ask questions. Questions you ask should serve to guide the conversation.
• Be patient and flexible.

What are some of the warning signs that may suggest potential problems of exploitation, abuse or neglect? Some warning signs of potential problems include:

• Does the care helper prevent family or friends from visiting your relative? Is the care helper isolating your loved one from prying eyes?
• Does the care helper do all the talking? Do they make decisions for your relative?
• Has the care helper invited their friends or family into the home or used your relative’s car without permission?
• Has your relative’s personality changed since the care helper has been
  hired? Does your loved one appear afraid?
  
• Are there checks missing or made out to cash or to the care helper for
  more than the agreed amount? (Look for missing checks in the back of
  the checkbook or with the unused checkbooks.)
  

If you suspect your relative is being abused, neglected, and/or financially
exploited by a care helper report your concerns to the care helper’s
employer. If you privately employ the care helper report the matter to
Arizona Adult Protective Services (Central Intake Phone Number: 1-877
767-2385). However, if there is a clear indication of abuse, neglect and/or
exploitation fire the care helper and immediately report the crime to
Arizona Adult Protective Services (see above phone number) or the Pima
County Elder Abuse Police Hotline (Ph: 790-7262), and the agency
employing the care helper, if applicable.

CAREGIVER TIPS FOR MANAGING HOME CARE HELPERS

• Remove from the home, or lock up, all valuables (jewelry, artwork, cameras, etc.) as well as any cash, checkbooks and bank statements.
• Secure all mail. The care helper should not have access to important mail, such as: pension,
  social security and reimbursement checks or credit card solicitations. Credit card solicitations
  can be easily used by anyone to open an account in your relative's name. You may consider
  obtaining a post office box to make sure all mailed items are secure.
  
• Set-up a petty cash fund if the care helper will be shopping for your relative. Require the care helper to return receipts and any change from all purchases so that you can calculate the amount of petty cash remaining. NEVER GIVE A CARE HELPER A CREDIT CARD OR BLANK CHECK TO USE FOR SHOPPING.
• If the care helper will be driving your relative to medical appointments and other destinations consider doing the following, check your relative’s insurance policy related to their coverage as a passenger in another person’s vehicle. Make a copy of the care helper's current driver’s license. You will need this information if there is an accident involving your relative's or care helper’s car. Also, your insurance agent can use the license to check the care worker's driving record.
• Record on a calendar all scheduled or prearranged visits that will be made to your relative's home by friends, maintenance workers, gardeners and other local vendors. You may decide to initiate a rule that requires the care helper to contact you if there is a question about allowing strangers entry into your relative's home.
• Care helpers should not be allowed to accept gifts from your relative (with perhaps the
  exception of food items). This protects both your relative and the care helper if there is a
  question about the nature or circumstances surrounding the gift giving.
  
• If possible, make "spot checks" of your relative's home on the days that care helpers are
  scheduled to work. This will provide the opportunity to observe what is happening and
  whether or not it is appropriate.
  
• Don't forget about attending to the needs of your relative's pets. Outline the specific duties the care helper will be responsible for including daily routines and grooming.
• "Set boundaries" on the kinds of information (personal or business) that is appropriate to share and that which should not be shared with or by care helpers with other persons.
• Set rules about television viewing. The selection of television programs should be for the
  enjoyment of your relative not the care helper.
  
• Write down instructions or prepare a script describing how the care helper should answer,
  record messages and respond to telephone calls.
  
• Do not allow the care helper to begin a new exercise activity or program without first checking with your relative's physician.

Additional considerations include:

• Will care helpers be allowed to have their own relatives and friends visit?
• To what extent should care helpers be involved in socializing or participating in activities with your relative and his/her friends? Your relative may want private time with friends.
• If you hire a care helper who smokes cigarettes, it may be necessary to set limits on the amount of time taken to smoke, and the designated areas (inside and outside) where smoking will be allowed.

Prepared for Pima Council on Aging by the Arizona Center on Aging, the University of Arizona®