It's never an easy decision to make the choice of getting additional help for a loved one. When do you know it's time and what is the best way to choose someone to provide care for your family member? If you are part of the "Sandwich Generation," you are navigating raising your children while helping to care for your elderly parents. It can be overwhelming and frustrating. According to a 2013 Pew research report, ( pewsocialtrends.org/2013/01/30/the-sandwich-generation) "Nearly half (47 percent) of adults in their 40s and 50s have a parent age 65 or older and are either raising a young child or financially supporting a grown child (age 18 or older)."

KNOWING IT'S TIME

Oftentimes, we start noticing small declines in our family members. Forgetting to take the garbage out one week is not alarming.

Leaving the stove on all day is. It is important to see if your loved one is becoming more and more isolated. If they used to be social and outgoing, but now never want to leave the house, it’s time to figure out why. You may notice a change in their physical abilities. They may struggle with balance or walking. They could have a cognitive decline such as not remembering to eat meals, taking medications or repeating the same story over and over. Their ability to drive could be in jeopardy. It’s probably a good time to start interviewing companies that could provide some assistance. I always tell families, the time to make this important decision is not when you are in the middle of a crisis and you limit your options.

WHAT TO ASK 

Our elderly population is a very vulnerable group. They need extra help and are usually trusting. It is the perfect opportunity for devious people to take advantage of them. When choosing a caregiver, Craigslist is probably not the best option. You want to make sure that the people you invite in your home have an extensive background check. You want to make sure they are licensed, bonded and insured. What happens if a caregiver is injured in your home? You do not want to be held liable. What happens if someone takes advantage of your loved one? Who is responsible for that? What are the qualifications of the people you are hiring? Do they have training, experience and support? What is the policy if your regular caregiver calls off - do they have enough staff to replace him/her? What if your loved one doesn't like the caregiver?

A CLEARER PICTURE: Think about what you need and to communicate those expectations. Is the caregiver going to be acting as a companion and taking your loved ones to the movies and lunch, or are they going to be there to provide more hands-on care such as bathing and dressing? It may be a combination of both.

STARTING CARE

I always recommend to families that they interview a few agencies. There are many companies out there and you have options. Make sure you have a list of questions prepared to ask the agency. Check out their reviews on Google or ask if you can speak to a past client who used their services. Continuity of care and having the same caregiver is crucial to success. Understand that agencies want continuity as much as a family does. It makes it easier on everyone involved. The best way to ensure continuity is to have a regular schedule. The first few weeks of the relationship may be a little rocky while your loved one settles in and gets used to the idea of a caregiver. It may take a few tries for the agency to find the "perfect" fit. While one person may want a caregiver who is chatty and more of a companion, another person could want someone to be out of sight and only do tasks around the house. Larger agencies have all kinds of people working for them, and they can find the perfect match. Be patient. Communicate what is working and what isn't. Make a plan together involving your loved one so that everyone can be set up for success. 

If your loved one is not in a crisis, I suggest starting off slow. Hire a caregiver for a few hours a day, a few days a week. Your loved one will get used to the additional help without overwhelming them. I always suggest to families to think about what they are needing and be sure to communicate those expectations. Is the caregiver going to be acting as a companion and taking your loved ones to the movies and lunch, or are they going to be there to provide more hands-on care such as bathing and dressing? It may be a combination of both. Agencies will come in and meet with your loved one and establish a "Plan of Care." This will act as a guide for the caregivers to follow when they are with your loved one. If they are able, it is important that the person receiving the care is an active participant in creating the plan. They already feel as if they are losing their independence, making these decisions without their input is not a good idea. A good "Plan of Care" is adapted and updated with the needs of your loved one. People get better or worse or change their minds about what they want and need. The first few weeks are trial and error and a learning experience for everyone.

GETTING YOUR LOVED ONE ON BOARD

While it may seem that hiring a caregiver is taking away someone's independence, it's actually the opposite. Sometimes, the extra help allows a person to remain in their home and be independent much longer than someone who is not receiving care. For families who live far away from their loved ones, it is peace of mind that someone has eyes on their loved one and can notice a decline or any other issues. Never hire a company that makes you sign a long-term contract. Your loved one may be resistant to this after a few weeks and the last thing you want is to be stuck with a long-term contract. Let your loved one feel in control and communicate with them. My most resistant clients are the ones who end up loving the additional help the most. Aging can be very isolating. Having someone there to motivate you, engage with you and provide extra support goes a long way.

INTERVIEWING AN AGENCY 

• • Do you provide insurance for accidents if they occur in the home?
• • Does an RN conduct an initial assessment before starting each engagement and to follow up with supervisory visits to ensure the plan of care is being carried out to your satisfaction?
• • Are your caregivers trained and competency tested?
• • Are all employees drug tested, background checked, licensed, bonded and insured?
• • Do you take care of paying the employees, including taxes and withholding?
• • Will you send another worker of equal skill and experience levels if my caregiver has an emergency?
• • Can I interview the employee(s) before I commit to using your agency?
• • Does your agency have a Guaranteed Compatibility® system in place if there is a conflict of personalities between me or my loved one and the caregiver?
• • Can you accommodate any length of visit request, even as short as 1 hour per day?
• • What are your rates?
• • Can I get someone who has been trained in a particular condition?

Remember to be patient and understanding with your loved one. While this is all new to you, the agency that you hire does this all day, every day. No one dreams of the day they will need a caregiver. It is a reminder that we are not as fit and healthy as we once were. However, if done properly, it is a breath of fresh air and greatly enhances the quality of life for the person needing care. •

ABOUT THE AUTHOR: Becky Sennes Torrez is the Owner of BrightStar Care in Las Vegas, Nevada. Becky is a former teacher and stay-at-home-mom who decided to open a home health care agency seven years ago. She has grown the business from two team members to over 180 employees. Becky has been married to Marc for 21 years. Her son Connor is a sophomore at Arizona State university and daughter Sophie is a senior in high school.