Most American’s will eventually face some very difficult choices concerning how to best care for their aging parents. Many families are already struggling to cope with the stress of such decisions. Many families are already caring for their elderly parents, all the while raising their own children who are still living at home. And many still are stretched to the limit of their physical, emotional, and personal resources, which eventually force families to make the difficult decision of retaining an in-home care provider for their elderly loved ones. Below are a few suggestions that may assist you in evaluating the needs of you and your loved ones and, at the same time, help you make decisions those that will hopefully give everyone some peace of mind.

First, consider whether you want to hire a caregiver from a state agency or private agency. Typically, a state agency receives funds from the state, while a private agency is independently owned and operated and receives its funding from private pay clients (i.e., you and/or your loved one). There are advantages and disadvantages to each. A caregiver from a government agency is subject to hiring practices that are standardized. Accountability and administrative procedures are taken care of at the agency. On the other hand, private pay companies are often staffed by a small group of workers who are paid a salary of by the hour. They have their own accountability standards, as with any sole proprietorship. The option you choose may depend upon your financial situation. Private pay service is usually much more expensive.

Second, consider the needs of both the potential caregiver and the person for whom care will be provided. Generally, caregivers provide four categories of services: (1) Health Care Services; (2) Emotional Care; (3) Independently Living; and (4) Personal Care Services. Health care services typically include managing medical appointments, medications, physical therapy, etc. Emotional care services typically consist of providing social activities, hobbies, a creative outlet, or simply companionship. Independently living services typically include the caregiver running errands, fulfilling transportation needs, shopping, cooking, cleaning and performing other household chores. And, finally, personal care services typically includes bathing, dressing, toileting, etc. If possible, both you and your loved one should actively participate in the hiring process (if your elderly loved one is capable). Your loved one may have strong preferences about the type of person he or she wants to hire. For example, your parent may prefer one gender over the other, cultural similarities, age, etc. Get as much information as you can about all proposed care providers. If you are going through an agency or a private pay company, make sure that they run background checks on their care workers. The goal is to gate as much available information as possible about the person who will have full access to your loved ones and their home and often their finances. Be as thorough as you would be for child care.

Check In Regularly. Check in at different times and on different days (so that the care provider doesn’t know when you will be stopping by). If the care providers requests that you call first, this may be a huge red flag. And when you stop by, look around. Is everything in order? Is your loved one dressed, bathed, and in a comfortable position? Have they taken their medications? Are the premises reasonably clean and sanitary? By checking in on your loved ones, you are letting the care providers know they are being supervised. While you may really like the gregarious, attractive care giver who is caring for your elderly mother, you may not know who or what is being brought into the house during your absence.

Recognize the Signs of Neglect and/or Abuse. Remember that elder neglect is a form of elder abuse, and since the elderly are much more vulnerable, such neglect/abuse can result in permanent injury or even death. Isolation from family and friends is one of the first signs of abuse. Again, if you are not allowed unfettered access to your loved one, or you believe excuses are being made for your loved one’s absence or lack of availability via phone or in person, be sure to look closely at the situation. And, always been on the look out for signs of neglect.

Re-evaluate your Care Provider Regularly. As health requirements and personal preferences change, so must the services provided. It is not uncommon for a loved one to require greater levels of care as they age. So, make sure that your care giver can provide the increased care (or that he/she has the additional health care resources available to properly care for the elderly person).

And last, but not least, make sure that you express your appreciation to your care provider. You are hiring a care provider because you either cannot or will not take up this immense task. Theirs is a noble profession, one that requires compassion and infinite patience. Be certain that you acknowledge their efforts and show your appreciation for a job well done.