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STATISTICS from the Centers for Disease Control and Prevention show that nearly 6 million Americans over age 65 require the help of a regular caregiver — either from a  family member or neighbor, such as helping with shopping and household chores, on an informal basis, or from a paid caregiver, an alternative more formal option, for those seniors who suffer from medical issues affecting their ability to care for themselves and who need more help with activities of daily living, says the November 2012 issue of the Mount Sinai School of Medicine’s Focus On Healthy Aging.

As we age, self-care may become increasingly difficult because we become more susceptible to ailments and injuries.

“Often older adults in this situation relocate to a nursing home or assisted living facility,” says Mount Sinai social worker Sheila Barton, LCSW, “but many older adults fear nursing home placement and would rather ‘age in place’ in their own home, where they can maintain autonomy and keep routines and friendships.”

For older adults who are keen to age in place, an at-home caregiver can be a good middleground, but finding the right caregiver can be daunting — a recent study (Journal of the American Geriatric Society, July 13) revealed that many agencies are not as vigilant as they should be when it comes to checking their employees’ background and references.

The health letter offers these practical tips, if you choose to go through an agency to hire an in-home caregiver — ask these questions before hiring a caregiver:

• Will your insurance cover the costs? - Check if the agency accepts your insurance plan.

• How do you recruit caregivers? - What are your hiring requirements? Do the candidates undergo a thorough criminal background check (preferably federal)? — this is vital for finding out if a potential caregiver has been convicted of elder abuse or other crimes in a different state.

• What types of screenings are performed on caregivers before you hire them? - In a recent study, researchers posed as consumers and surveyed 180 agencies around the country about their hiring methods, screening measures and supervision. Only one-third did drug testing - “Seniors frequently take multiple medications, including narcotics,” Barton explains. “Without a proper background check, you may hire a caregiver who is a drug user and who may use or steal your meds to sell in order to support their own drug habits.”

• Are your caregivers certified in CPR or do they have any health-related training? - Few agencies adequately assessed caregiver skills, and many assessed these using client feedback - “However, an older adult with dementia may not be able to identify and report what a caregiver is doing wrong,” Barton observes, “and if relatives are too busy to supervise, the alarm may not be raised.”

• Are the caregivers insured and bonded through the agency?

• Does the agency evaluate the quality of home care on a regular basis? How does the supervision occur — e.g., over the phone, through progress reports, or in person at the home of the older adult? Only 30 percent of the agencies surveyed sent supervisors out to check on the caregivers at least once a month.

• Is a substitute caregiver provided if the regular caregiver cannot provide the contracted services or calls in sick?

• “Ask about their work with previous patients,” says Barton - “Do they have experience with dementia patients? How would they handle a situation where a   patient refused to follow their instructions? What would they do in specific situations involving safety? If at all possible, Barton highly recommends hiring on the basis of personal recommendation. “If a trusted friend has hired a home attendant for similar caregiving responsibilities and is happy with the caregiver’s performance, you know automatically that the individual is reliable, trustworthy, and has done their job,” concludes Barton.