IntroductionWAKING UP TO A NIGHTMAREWhat would you do if you realized that the caregiver that you hired to take care of your elderly parents in their house turned out to be stealing from them and exploiting them? Leslie shares her horror story of realizing that the hired caregiver that she knew, liked and trusted turned out to be robbing her family blind. She describes her professional background as a geriatric nurse and Licensed Clinical Social Worker and her dedication to supporting her parents to age in their own home. She assumed that even though she lives far away from her elderly parents, she would know enough to make the right choices. But all of this was not enough to protect her family from being taken advantage of. When she discussed her family''s plight with her friend, Amanda Lambert, also a geriatric professional as well as a certified geriatric care manager, they realized that though they agreed on many approaches to home care for the elderly, they diverged when considering hiring privately or through a care agency. Thus, the idea for this book was born: to share our professional and personal experience to assist others to make educated choices about hiring employees to be elder caregivers for their family.Chapter 1FINDING MORE THAN ONE WAY HOME: TWO APPROACHES TO HIRING CAREGIVERS While Amanda and Leslie agree about the value of aging at home and promoting safety and quality of life for all elders, they have some different approaches on how to hire the right caregivers for home care. Even after the criminal caregiver fiasco, Leslie still prefers hiring privately. Amanda has a different perspective related to her experiences as a geriatric care manager. Amanda describes her duties in this professional role, its definition and how she helps elders and their families navigate the challenges of staying in place to age. The tremendous growth of people who are over 65 and the increase in life expectancy is creating an Aging Tsunami. As more Americans grow older, more can expect to eventually need some assistance with daily care such as preparing meals, dressing and bathing and mobility. Where will they get that care? In recent history, older adults have been encouraged to move into assisted living or other retirement communities. However, in poll after poll of older Americans, they clearly express their desire to stay at home. Staying at home is one thing, but being on the receiving end of personal care is another. Invasion of privacy, and loss of control are considered in the context of real life experiences of elders. Two different ways to hire a caregiver (private hire or through a care agency) are presented with the Pros and Cons of each. Families are encouraged to consider the needs of elders and their choice of hiring the best caregiver on a continuum. Needs for assistance can change as one''s health does, thus impacting the type of caregiver that will be best. Leslie describes the advantages of privately hiring a caregiver (more control over who is chosen, less turnover and more consistency of care, reducing cost of third party) and disadvantages (such as the need to vet individuals for criminal backgrounds, time required for hiring process and management). Amanda offers a contrasting perspective for hiring with a care agency: the upside includes less hassle for the family, the agency will take care of any sick calls and other unavoidable problems, and it saves time. She acknowledges the downsides such as an increased hourly rate for the consumer and higher rate of staff turnover which can be upsetting and disruptive for seniors. Each chapter ends with Take Away Points that emphasize the most important concepts for the family to consider as they embark on increasing home support.(See Sample Chapter)Chapter 2GETTING STARTED: HOW MUCH HOME CARE DO YOU NEED?Knowing if or when to begin considering care in the home can be complicated. Typically an event, or trigger, can be the precipitating factor for family members or even the elder themselves to realize that help is needed. The cost is potentially staggering. Is it the right decision for you or your family member?Learn some basic terms and vocabulary about home care as it differs from care in a setting like a nursing home. Doctors may refer to home care in ways that may be confusing and lead you to believe that all home care is covered by some insurances when it is not. Refer to a useful sidebar to demystify the differences between Medicare and Medicaid. This chart will answer your burning question: which home care expenses do they really cover? Use our Needs Scale to determine the type of home care that will assure your successful stay at home. A Home Care Needs Scale will assist families and elder persons to assess what care can be done by a family or friend versus a professional caregiver. The best planning will figure out which activities, such as medication management or bathing, are most important to this individual. Emphasis is on flexibility. For example, it could be an advantage in areas such as how and when to schedule caregivers. The Home Care Needs Scale will help you determine if staying at home is a realistic option for you. Instructive stories based on real elders'' experiences are incorporated throughout to learn how others initiated care in their home. Having ""the talk"" with older family members will help everyone to reach agreement about possible circumstances that trigger the need for care. Talking openly with one''s family about whether or not staying at home with care is a viable option is a source of dread for many. With all the parent-child dynamics in play, strategies for segueing into to and staying on topic are critical. How to deal with elderly family who are resistant to having any care at all. How to incorporate the Advance Directive as a tool to ensure that a person''s wishes are honored. Recognizing what each side can be flexible about can further the process.This is an expensive proposition. Individuals and families need to deal with the real costs of home care. Talking about money between generations can be perceived as an intrusion on one''s privacy. Full access to varied factors (savings, equity, net worth, overall health and prognosis) are necessary to create a budget for the cost of home care. An unique plan of care for each person is needed. While a certain amount of help for part of the day can be manageable and less expensive than moving to assisted living, the price soars with round the clock care. What to do if private caregiving is something you and your family simply cannot afford. We discuss options for care when finances are tight. Throughout, real life stories of how different families have come to terms with the costs of staying at home are shared. Chapter 3FINDING THE RIGHT HIRED CAREGIVER FOR YOU AND YOUR FAMILYMost elders and families have only a vague familiarity with the world of caregiving. In order to hire a caregiver, it helps to start with the basics: who they are, what their training is and where to find them. There are a variety of definitions for certifications. Contributing to the challenge in making a good choice of caregiver is the complicated lexicon for home care workers. Caregivers can be CNAs, PCAs, medication techs and more. The type of care that is needed may dictate the certification that is most appropriate. There are significant differences in the typical training caregivers receive in the United States. Skills level, oversight of caregivers in the home, and background checks vary widely from agency to agency and state to state. Knowing the typical training that caregivers in the US receive for levels of certification will help in decision making. There are more choices than ever before in looking for caregivers with pros and cons of each path. Recently, there has been an increase in the number of online companies that match the caregiver to the consumer such as Care.Com and Carelinx.com. Thousands of agencies across the country are vying for the business of providing caregivers. Some families decide to go it alone and rely on other family members or people recommended from the community. Each of these options has potential and each has its dangers and complications. Interviews with the online services such as the CEO of Care.com provide insights about the changing terrain for private hiring and how the process is becoming more accessible and streamlined.Caregiver interviews tell the story from the trenches. Caregiver interviews provide insight into their unique and personal perspectives on working at agencies versus working privately. Caregivers share their frustrations as well as their passion for doing this kind of work. Chapter 4BUILDING THE BEST CARE PARTNERSHIPThe hope of every family seeking a caregiver is to find ""the one"" that is a good fit. It is a huge responsibility to be the family manager who must have the time, the skills and motivation to be the supervisor of an ongoing, at-home care program. A skills list clarifies what individuals need to manage caregivers in the home setting whether hiring privately or through an agency. Delegating and contracting out when possible become essential tools. It sounds obvious, but the plan will not succeed without the family elder being on board. Tips are outlined to engage the elder family member in the search and to deal openly with their desire and understanding of their need for caregiving. Negotiate a list of the characteristics of the caregiver that you want to hire and reach agreement on key expectations.How to assess resistance and objections from the family about a caregiver. Sometimes, it is simple complaining but other times it is more significant. Having strategies for a successful fit for the elder and the caregiver includes effective communication between you, your parent and the caregiver. Clear, direct and honest communication with a caregiver will help avoid problems down the road. Have you really explain