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Nursing Home Toolkit

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Hiring In-Home Help

Most caregivers of persons with cognitive disorders reach a point when they need help at home. Tell-tale signs include recognizing that the impaired person requires constant supervision and/or assistance with everyday activities of daily living. Caregivers also find that certain housekeeping routines and regular errands are accomplished with great difficulty or are left undone. It may become apparent that in order to take care of any business outside the home, a substitute care provider is needed.

Exploring Home-Care Options

A number of options are available to caregivers for finding help at home. It is possible to hire a helper from a home health agency (listed in the yellow pages of local telephone directories). Many caregivers, however, find it is more affordable to hire an in-home helper privately. With some foresight and careful planning, it is possible for the caregiver to locate the right person for the job.

For caregivers in California, the local Caregiver Resource Center is available to assist in determining what kind of help would be most useful and what types of resources are available in each community.

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 the caregiver would like carried out. This job description should be designed as a work contract which can be signed by both the caregiver and the in-home helper.

Typical duties for an in-home helper include companionship and supervision of the impaired person and direct assistance with personal care such as bathing, dressing and feeding. The in-home helper may also do light housekeeping and home maintenance tasks which pertain directly to the care of the impaired person or which the caregiver can no longer manage without assistance.

A good work contract should include the following:

Name of employer and "household employee"
Wages and benefits (e.g., mileage, meals, etc.)
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 at Home

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. When calling an attendant registry, it is important to inquire about their particular screening process and/or training requirements as well as about any fees charged. While some are free, fees for using a registry can vary greatly. There are also non-profit community agencies that maintain lists of individuals available to perform all kinds of household tasks, from cleaning and laundry to repairs and gardening. It is a good idea to shop around and obtain the best service for the lowest fee.

If all of the above sources fail to produce an in-home helper, the caregiver may choose to advertise in the "Help Wanted" classified section of a community college or local newspaper or newsletter. The advertisement, at the minimum, should include hours, a brief description of duties, telephone number and best time to call.

Interviewing the Applicant

The caregiver does not have 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. At this time it is also important to ask about the applicant's past experience and whether he/she has references. Then if the applicant sounds acceptable, an interview should be scheduled.

In preparation for the interview, the caregiver should have a list of questions pertinent to the job description and a sample work contract ready for the applicant to read. 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 an elderly/disabled person? Or a person with memory problems?
Have you had experience cooking for other people?
How do you handle people who are angry, stubborn, fearful?
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 two work related and one personal reference?

Immediately after the interview, it is important for the caregiver to write down first impressions, and if possible, discuss these with another family member or friend. 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, the caregiver and the in-home helper should set a date to sign the contract and begin work. Both employer and employee should keep a copy of the contract.

Investigating Legal Issues

As an employer of a "household employee," 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 paying taxes for household employees.

As of this writing (1996), if the caregiver pays more than $1,000 to a household employee in a calendar year, he/she is required to withhold Social Security taxes of 7.65 percent and file them with the Internal Revenue Service annually. The employee is required to pay an additional 7.65 percent. Employers may report the worker's wages and tax liabilities on their annual 1040 form. For information on paying federal taxes for household employees, call (800) TAX-FORM and ask for Publication 926 which explains specifically about household employees. The employer will need a W-2 form to file at the end of the year and a copy of the form should also go to the employee. A W-3 form is also required if an employer has more than one household employee and is filing more than one W-2 form.

If the caregiver pays more than $750 to the household employee in one quarter (three months), he/she is required to register with the California Employment Department by calling (415) 929-5700 and obtaining a DE1 form. Employers must also file quarterly state withholding tax and are required to pay unemployment taxes for the household employee. If more than $999.99 is paid to the employee in one quarter, the employer must also pay disability taxes for the employee. If wages paid total $20,000 or less annually, the employee may elect to file an annual contribution return instead of filing quarterly.

There is one other requirement which every employer should know. Each employee is required to fill out an Employment Eligibility Verification form I-9 and a record of this should be kept on file. The penalties for not paying taxes on household employees include paying the back taxes, plus interest and penalty fines. FCA advises both household employers and employees to be informed and comply with state and federal tax laws. There are often local services available to seniors who need assistance in filing tax statements for household employees. The Caregiver Resource Center or Senior Information and Referral in your community would be able to identify these organizations.

Making Your Home Care Situation Work

The relationships between the caregiver, the impaired person who requires assistance and the in-home helper are very important. Consequently, it is imperative that the caregiver take the time to go carefully through the selection process. In California, the Caregiver Resource Centers are available to assist caregivers in locating community resources and finding the in-home helper that fits each individual's needs. Lists of interview questions, employer's and employee's rights and responsibilities, and more detailed information on types of assistance available to caregivers can be obtained from the Caregiver Resource Center in each community. For more information, call (800) 445-8106 (California only) or (415) 434-3388.