As in many situations, for in-home CareGivers cost is but one factor the family must consider in deciding between Private Hire and Agency staff. We believe the issue is hidden costs and value added. The bottom line is that managing CareGivers is not your business. How do you want to spend your time: Managing the CareGivers or being with your loved one? Quality time may be overused terminology, but we know that quality time is the not time you spend dealing with personnel issues.

The primary advantages of hiring a CareGiver privately are said to be consistency in staffing and direct cost-reduction.

Having the same person day-in and day-out is comforting to the family and often brings more continuity of care. As a single caregiver becomes familiar with the person, the family and their routines, a level of trust may develop that allows family members freedom from the burden of daily oversight. We believe that a CareGiving Agency can achieve this goal through its relationship with its CareGiving staff often with as much success with a private-pay CareGiver (especially if there is family involvement).

Employing a Private-Pay CareGiver staff is not always less expensive, and we believe there are several hidden costs, which can outweigh any perceived benefits of any direct-cost reductions. These hidden costs can include:

1. Overdependency: Perhaps the greatest disadvantage of privately hiring CareGivers is that the family becomes totally dependent on one person. If a CareGiver becomes ill or has an emergency that interferes with working, families have no options but fill in themselves or go to an agency.

2. Personnel management: The personal connection that generally evolves between the employee and the family can make it difficult for family members to address problems that need attention for fear of embarrassing or alienating the caregiver. As with any staffing situation, people issues can predominate and overshadow the substantive work to be done.

Common personnel issues that many experience with the CareGiver workforce include:

* Criminal behavior and background

* Theft

* Physical abuse

* Caregiver availability/Scheduling is often a big issue

* Accountability for quality of care

* Lack of quality of care (through negligence or ignorance)

* IRS employment issues (including record keeping)

* Accountability for attendance/tardiness

* In a word, a symbiotic relationship often occurs and most often this does not end with a happy result

3. Liability and reimbursement issues: a private CareGiver seems to offer a significant cost savings, however if IRS employment requirements as well as personal risk and liability are taken into account, the gap between privately hired care closes considerably.

As noted above we believe that good agency homecare providers work on risk management issues and attempts to mediate these problems. A good agency should run criminal and background checks to assure the CareGiver coming into the home is not a threat and is who he or she claims to be. In many instances you should check and confirm if the Agency has direct experience with specific CareGivers and know what they can do and their experience level. Should there be a problem with a caregiver (from theft, tardiness, not delivering quality care) the Agency, not you, deal with the CareGiver employee and the issue.

A good CareGiver Agency should provide the following services for families:

* Background checks - protecting vulnerable loved ones

* Training - gives a family confidence about the caregiver's basic knowledge and basic care skills, including CPR, transfer skills, implementing a daily plan of care, and instruction in managing unwanted behavior, etc.

* Insurance - protects families which could otherwise be vulnerable for being sued if something happened to the caregiver while in their home

* IRS compliance - pays worker's taxes, social security, etc.

* Availability - Agency guarantees and schedules caregivers

* Employment management - intervenes in the event of misunderstandings or unacceptable situations between the family and caregiver

* Provision of liability coverage for property damage or theft

* Quality monitoring - Agency generally provides a care manager to oversee the plan of care and monitor the quality of the care provided by the caregivers

Summary

Finding the right situation for a loved one who needs assistance is a daunting task. With time, patience and persistence, one will learn what elements are most important in creating a CareGiver model that best suits your loved one's needs.

The family knows best its own resources of time, patience and energy. The family knows its own stress points. Often it is time, or money, or both, and the family needs to assess thoughtfully the tradeoffs of hiring an Agency CareGiver to maximize the peace of mind and extra time available to everyone.

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