Home Care

Caring for a PALS can be emotionally and physically draining. The energy of the caregiver is not endless, time is limited, and caregivers have needs and require nurturing, too. That is why it is necessary to have realistic expectations and accept limits. Sometimes the escalating needs of an impaired loved one deplete the caregiver's personal resources. 

Respite care offers relief for family and friends so they can take a break — a respite — from the demands of providing constant care. Time away provides a chance for the caregiver to rest and re-fuel in order to relieve the exhaustion and energy loss which can interfere with a caregiver's ability to provide good care. This time away may involve the hiring of additional help so that the caregiver can have time to replenish his or her own inner resources without worrying about a loved one's care. One type of respite care includes home care services which can be provided a few hours a week or over a weekend.

Hiring In-Home Help

A number of options are available for finding help at home. It is possible to hire a helper from a home health agency, which can be found listed in the yellow pages of local telephone directories. An agency would do the screening and hiring of an in-home helper for you.  Many people, however, find it is more affordable to hire an in-home helper privately.

Financing Respite

Take a hard look at your financial resources and determine how much you can afford and are willing to spend on attendants. Contact your insurance company about your home health benefit for custodial care. Most insurance companies do not cover custodial, or non-skilled, care. Money for attendant care will probably come out of pocket.

ALS Association Respite Care Grant Program

The Jim “Catfish” Hunter Chapter of the ALS Association offers limited financial care giving assistance for persons with ALS. In order to be eligible to receive respite assistance, an individual must:

• have a financial need
• have a definitive diagnosis of ALS
• live within the service area of The Jim “Catfish” Chapter of The ALS Association

Hiring In-Home Help

Writing a Job Description

An important first step in hiring in-home help is to determine what help is needed and to prepare a list of duties you would like carried out. Typical duties for an in-home helper include:

• Personal Care: Bathing, dressing, hair and nail care, feeding
• Nursing Duties: Help with medication, turning, lifting or transferring, caring for skin
• Meal Preparation: For whom? Is a special diet required?
• Light housekeeping and home maintenance tasks which pertain to the PALS
• Recreational activities with PALS, reading out loud, playing cards

This job description should be designed as a work contract which can be signed by the in- home helper and the PALS or caregiver. A good work contract should include the following:

• Name of employer and "household employee"
• Wages and benefits (e.g., mileage, meals, etc.)
• Payment of social security and income tax
• When and how payment will be made
• Hours of work
• Employee's Social Security number
• Duties to be performed
• Unacceptable behavior (e.g., smoking, abusive language, etc.)
• Termination (how much notice, reasons for termination without notice, etc.)
• Dated signatures of employee and employer

Looking for Help

The next step is to find the appropriate person to fit the job description.  One of the best ways of finding a helper is to get a personal recommendation from a trusted relative or friend. Churches, synagogues, senior centers, Independent Living Centers and local college career centers, especially those which have nursing or social work programs, are good places to advertise for in-home help.

Most communities have attendant registries which are an excellent resource for finding in-home help because they typically provide some initial screening of applicants. While some are free, fees for using a registry can vary greatly. It is a good idea to shop around and obtain the best service for the lowest fee.

Interviewing the Applicant

It is not necessary to personally interview every person who applies for the job. Some screening over the telephone is appropriate. In screening applicants over the telephone, caregivers should describe the job in detail and state specific expectations listed in the work contract as well as information about the hours and wages. It is also important to ask about the applicant's past experience and whether she/he has references. Then if the applicant sounds acceptable, an interview should be scheduled.

You must always consider your personal safety.

Always have another individual close by when you conduct interviews. You may wish to consider interviewing in a location other than your home.

The following are some suggested questions for the interview:

• Where have you worked before?
• What were your duties?
• How do you feel about caring for a disabled person?
• Have you had experience cooking for other people?
• Do you have a car? Would you be able to transfer someone from a wheelchair into a car or onto a bed?
• Is there anything in the job description that you are uncomfortable doing?
• What time commitment are you willing to make to stay on the job?
• Can you give me one personal and two work related references?
• How do you feel about assisting the patient with personal hygiene?

Consider the person most qualified for the job and with whom you feel most comfortable. Always check the references of at least two final applicants. Don't wait too long to make the offer, as good applicants may find another job. If the offer is accepted, then set a date to sign the contract and begin work.

Legal Issues

There are several legal considerations. First, household employers should verify that their household insurance (renter's or homeowner's) covers household employees in case of an accident. It is also imperative that the employer be fully informed of the legal responsibility of making contributions for federal and state unemployment taxes, deducting Social Security payments and paying workers' compensation premiums.

For more information, contact your local Caregiver Resource Center, call 800.445.8106 or visit Family Caregiver Alliance’s web site at www.caregiver.org. 

Keeping Attendants

Often the trick to a happier experience is keeping good attendants once you have located them. Short-term patience pays long-term dividends. If you can avoid being irritable when an attendant is learning, you are more likely to establish a mutually beneficial, lasting relationship. It is important not to take out frustrations caused by other aspects of your life on your attendants. While you should be tolerant with your attendants when they make mistakes or run into emergencies, you should firmly and directly correct any deficiencies in their performance early on. It is very important for you to be involved in their training, and to be sure that proper training techniques are used. 

Excerpted with permission from Family Caregiver Alliance Clearinghouse Factsheet: "Hiring In-Home Help".

Excerpted from RSC NewsNet published by the Ohio Rehabilitation Services Commission.