Safe Help In Your Home

Step Three: Hiring Safe and Appropriate Staff

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I provide in-home help
I work for an agency that places workers in clients' homes
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From completing the checklists, you have decided what you want help with --household chores, errands, transportation to doctor, assistance with activities of daily living, medication -- and approximately how much time the helper should need for each task. So, you know the skills the helper needs, the interpersonal style that will work and how many hours a week of employment you are offering. Great! This is an excellent start.

How can you find capable and honest people whose quirks won’t drive you nuts? How much will they be paid? For how many hours at a stretch? How many stretches per week or month? Will these people be employees of yours/your parents? Of an agency? Or independent contractors? Do you know how the IRS determines these things and what paperwork and record keeping are required? Have you thought about worker’s comp and withholding? Suppose the applicants don’t speak much English?

Overwhelming, especially after such a good start? Does this sound like as much effort as doing the work yourself? It doesn’t have to be…you are on the home stretch of hiring.

This section guides you through the hiring process. We help you think about what you need to do to
• find candidates either through an agency or privately, and agree on hours, salary, and how workers will be paid;
• interview candidates to choose a compatible match,
• screen candidates to reduce the risk of abuse and neglect, and
• hire and keep things running smoothly after the honeymoon ends.
Finding Candidates

There are two common ways to find help. You can hire workers through an agency or you can hire privately using referrals from friends, neighbors, physicians, local groups or advertisements. Do you know the pros and cons of each option?

Agency hires

What are the pros and cons?

If you hire through an agency, the helper is the employee of that agency. It will find candidates, select a helper, pay that person, withhold taxes, provide W-2 forms to the helper, and bill you at its hourly rate. Although you will not have to recruit, screen, or haggle over wages, you will have limited choice in whom the agency sends — but somebody will show up, including substitutes when your worker is ill or on vacation. Clients may ask about the agency’s hiring and screening policies but are expected to rely on the agency’s selection.

If you have a problem with the worker, you can call the agency and a supervisor will talk to the worker for you. This is a strong argument in favor of agency hires, as long as you are willing to report dissatisfaction while problems are small and easily fixed.

You will probably be charged between $20.00 and $30.00 per hour and will have to agree to a minimum number of hours per visit, usually four. The worker receives about half of the agreed-on fee. If the worker is dissatisfied with the fee schedule or benefits, that dissatisfaction is with the agency, not with you. Most agencies have policies prohibiting clients from supplementing salaries or giving gifts to their helpers. This is to protect clients from pressure by rather poorly paid helpers. If a helper suggests ways for you to skirt this policy and bestow tokens or riches, the agency should be told immediately. This could lead to financial abuse. Will you tell the agency promptly if this happens?

Types of agencies:

If you decide to find candidates through an agency, what sort of agency is useful? The answer depends on the results of the checklists you filled out. If you want simple housekeeping, you can work with a housekeeping agency. If you need personal assistance as well, use agencies that specialize in in-home helpers and non-medical personal care providers. If you need assistance with health problems, you’ll need to look into more skilled home health aides.

The first option, housekeeping agencies, provides people who clean homes. But even this apparently simple option should be influenced by the results of the checklists.
Some house cleaners sent by housekeeping agencies bring their own cleaning supplies. That’s a help if it saves you a shopping trip, especially one that involves hauling heavy containers. But it’s a problem if you want specific cleaning products used and not others.

House cleaners from agencies probably are on a fairly tight schedule, will come in, clean, and move on to the next house and may work in pairs or teams. This is great if you want the house cleaned quickly because it reduces the time somebody is in your home. But it can be a problem if you don’t like people in the house because it increases the number of people there at one time. And with a team cleaning, several rooms may be in upheaval at the same time.

Agency house cleaners may also chat with each other, and not necessarily in English. This can be a problem if you don’t want the noise involved with several people cleaning and talking. If you want to work along with or supervise the helpers, you may hit trouble both because of the helpers’ time constraints and also because they may not speak much English. And, if you want sociability as well, you may want to avoid this option. These workers get paid for cleaning, not talking, and need to move quickly and get on to their next job.
The second option, agencies that provide personal assistance and light housekeeping, offers more services and more sociability. Even if you don’t need much assistance beyond light housekeeping at this point, choosing an in-home health aide agency may make sense. As your needs increase, you won’t have to start fresh with a new agency. These agencies provide employees who can offer broader services including transportation, sociability, assistance with activities of daily living, and other support. In essence, you make a list of things you’d like help with, how many hours a day/week you’d like assistance, and the agency does its best to match your request with their available staff. The agency bills an agreed hourly rate based on the level of difficulty of the services provided. It has policies about weekend, holiday, and overtime charges.

To get the best match through an agency that provides help beyond housekeeping, you should give the intake worker at the agency copies of the checklists you’ve just filled out. And you should review these checklists right away with any helper who shows up at the house to avoid the well meaning 19-year-old who unintentionally drives you crazy by gabbing all day long about a fruitless search for a soul mate.

Private Hires

How to get started:

If you decide to hire privately, the challenge is how to recruit good candidates. If you want household help only, check with neighbors, friends, or relatives. Take a look at the ads in the local paper, but this approach makes the interviewing and screening part of the hiring process even more important.

If you want some personal assistance as well, start at the local senior center, ask your physicians, and the discharge planner at the local hospital and nursing/rehabilitation center, and day treatment programs. These places probably have registries of workers. Also check the eldercare locator, or 1-800-677-1116. Keep in mind that registries are lists of people willing to do this sort of work, nothing more. You will have to interview and screen candidates yourself.

What are the pros and cons?

The good news is that you are apt to get somebody with more experience. People usually start working for an agency and then become independent contractors when they are experienced and well networked. They will usually quote an hourly rate that is higher than what they’d be paid working for an agency but lower than the rate the client would be charged by the agency.

The downside is that you are now the employer and need to pay an independent contractor an agreed-on hourly rate and provide a 1099 form or have a salaried employee, withhold taxes and provide a W-2 form. You’ll also have to negotiate benefits, health insurance, paid holiday and sick leave for an employee. When this helper wants a raise, you will be asked. Can you really say no and still feel safe and relaxed in the care of this person whose raise you’ve just denied? It will be up to you to come up with alternatives for holidays and vacations and when the helper is sick.

Choosing between an agency and a private hire

See what’s available in your area before deciding whether to hire through an agency or privately. If there are a couple of good agencies with strong recommendations from people you trust, you can probably save yourself a lot of hassle starting with them. If your network of trusted friends, relatives, clergy, physicians, and senior center staff recommends an individual, start there. Because these jobs are stressful and have high turnover and burnout rate, go with available excellence where you can find it. Hire for today’s needs, not trouble you foresee down the road. People well suited to one set of needs and circumstances may not do as well in others.

Look for a good fit now. If you need to change arrangements next year, remember how quickly personnel change in these jobs and start with a fresh list of suggestions. Today’s Florence Nightingale may be tomorrow’s Nurse Ratchett.


Interviewing is a critical part of the hiring process and can elicit all kinds of information unavailable through references. Whether you hire through an agency or privately, the interview should include two steps: a preliminary phone interview and a face-to-face interview. The preliminary phone contact serves as an initial screen and is intended to gather basic information that helps you decide whether to take the time to do a face-to-face interview. The phone interview reduces the number of candidates suitable for a face-to-face interview, allowing time to talk to people who might be a good fit. For this reason, both the phone and face-to-face interviews are important. Do not skip either step.

The Preliminary Phone Contact

Agency hire

Agencies interview both prospective employees and prospective clients. Clients can – and should – ask about the agency’s process, but in reality have little say or involvement in the process. If you opt to hire from an agency, your preliminary phone call will let the agency’s intake worker find out the sort of assistance you wish. Many agencies use this phone call as a first step and follow it with a visit by an intake worker to your home to meet you and do the needs assessment. Smaller or more short-staffed agencies may forgo the intake home visit and gather the information over the phone. This needs assessment helps them understand how well you perform the activities of daily living, what level of assistance you need, and what other services might be helpful.

After collecting this information, the agency will match your needs with a helper on its staff and send the helper to meet you. You will have the right to veto this helper and ask to meet somebody else. You can’t do this endlessly, though, and must keep in mind that choosing from two or at most three people is all an agency can realistically offer. Either way, most people they send will have the basic skills you need, but a few may also annoy you unintentionally. For this reason, the conversation with the intake worker is extremely important. The clearer the agency is about what you need and what sort of person you can comfortably spend time with, the greater the chance that those two or three candidates will be suitable.

As a result, the more specific you can be about personality characteristics and behaviors that will please or annoy you (“I’m an introvert; I would like somebody quiet, not a chatty extrovert who will want to draw me out” or “I am looking forward to company as well as assistance with household chores, so please select somebody personable, and if possible with interests in _______________”) the better your odds are. Be very specific about things that will nix the match, e.g., you have pets and smoke and the worker the agency has in mind is allergic to animal dander and smoke. You should tell the intake worker that you have created a list of preferences and would like to provide it for the agency to use when selecting a helper for you.

Private Hire

You will be introducing yourself to the prospective helper with this first phone call. You will need to have the detailed lists of tasks and personality traits handy. During this phone interview it is helpful to:
• say how you got the helper’s name and ask what services the candidate offers;
• be clear and specific about how many hours and which hours are required (15 hours a week, 2:00-5:00 each weekday afternoon, for example);
• what duties the job requires;
• ask the candidate’s salary requirements and hourly rate; and
• ask about job experience, qualifications, credentials, and three references, two professional and one personal. Call the promising candidates’ references right away (for questions to ask, go to Getting the information: What to ask.

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Getting The Information Font Size 18

If the candidate has problems with any of the requirements or does not seem suitable during the conversation, say thanks and end the conversation. These candidates have not made the cut. With promising candidates, ask if they can come for a face-to-face interview. If they hesitate at an interview, thank them and end the conversation. If they are willing to come for an interview, schedule a date and time.

Before giving your address, tell the candidates you wish to meet to bring three documents to the interview: a chronological resume, a DMV clearance, and a credit check. Tell them you will also require, and will pay for, fingerprinting. This conversation alone will screen out candidates who can’t follow directions, aren’t organized enough to get everything together, or who know that the fingerprinting will nix their chance of employment. Giving this information up front will spare you and interviewing unsuitable people. It also stops the process before you give your address to people with criminal pasts.

Give driving directions, instructions about parking, and any other information the candidate needs to get to the interview. Keep an eye out to see if these instructions are followed and how prompt the candidate is. Anybody can get lost going someplace for the first time, but candidates should also want to make a good impression. Lateness should be a red flag, a large one if promptness matters to you or if being unattended without warning would create danger or upset.

The Face-to-Face Interview

Interviews can be stressful, both for the interviewer and the interviewee. To minimize the stress, consider having a friend or relative join you for the interviews. Go over the checklists with that person and discuss how he/she should participate in the conversation ahead of time.

These third parties can be helpful especially as a second set of eyes and ears and a second opinion about issues relating to honesty, safety, and judgment. Their presence also indicates to the candidates that you have a support system, thus subtly discouraging those wishing to isolate and take advantage of vulnerable people.

Agency hire

By the time you meet the candidate, you have already agreed to the agency’s policies, procedures, service offerings, and fees. You have also agreed to the agency’s screening or that the agency will do additional screening for you (at your expense). So, the purpose of the face-to-face meeting is to see if you and the helper can stand each other and get on well enough for this to be a workable match.

Private Hire

You must discuss the specific tasks and the business relationship with candidates you’re considering hiring privately. Remember, you are both the employer and the person seeking assistance, and this dual role creates a potential conflict of interest. You can reduce worries about overt and subtle pressure by proposing at the outset regular intervals, e.g., every three months, for a salary raise or bonus. Be realistic—even though you find it very expensive to pay for help, the helper is neither making big bucks nor getting the peer camaraderie and perks that come with most jobs. Occasional raises, bonuses and paid leave are a bargain when you consider the good will they generate.

Holding the interview – what to ask:

Whether an agency or private hire, good interview questions are one of the most important tools available for figuring out whom to hire. While it is impossible to find out everything about how candidates would behave and what they would do in every instance, strong interview questions can help you discover key information.

To get a feel for candidates’ maturity, judgment, appropriateness, and boundaries, you want to get candidates talking freely about what they have done and how they have behaved in similar circumstances. Because past behavior is the best predictor for future performance, work hard to learn about the candidates’ past experience. As much as possible, stay away from questions that require a “yes” or “no” answer. Focus on getting a feel for each candidate’s attitude, behavior, decision-making process and values. To do this, you will need to work your way through four sets of questions:
1. open ended questions,
2. temperament-based questions,
3. anecdotal questions, and
4. forced answer questions.

1. Open-ended Questions
• What did you like most about your last job?
• What did you like least about your last job?
• How do you show respect for clients’ dignity?
• How do you offer help?
• How do you handle emergencies?

Tell the candidate your wishes and consider the response. Choose something important. This is a critical area – it’s possible to hire highly skilled helpers whose values prevent them from following your wishes. To avoid this situation, ask follow-up questions:
•Have you been in this situation before? Tell me about it.
•What did you do? What did you opt not to do?
•How do you feel about my wishes?
•Have you ever been in a situation in which you disagreed with your client’s health care wishes?
•What did you do?
•If you are hiring through an agency, ask the candidate what the agency instructs helpers to do in emergencies and how much discretion they are given.
If you hire the candidate, give both the candidate and the agency a copy of your emergency information. You and the helper should feel supported by the agency, and you should be able to trust that the agency will talk the worker through the difficulties of following your wishes. If you hire privately, you and the other close relatives should reassure the helper of your support about emergency care.

2. Temperament-based questions: Be sure to have the temperament checklists handy at the interview. For each item on the checklists, explain where you fall and then ask the candidate about his/her preferences.

Use the following questions as a guide to help you assess the candidate’s temperamental fit.

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3. Anecdotal questions: This part of the interview is intended to get a feel for the candidate’s actual behavior in comparable situations and to learn more about the candidate’s judgment and attitude.
Ask the candidate to give an anecdote or two from recent jobs.
What do you think of the candidate’s tone? Was the anecdote appropriate to a get-acquainted conversation? Was the candidate respectful of the client and the client’s privacy, telling a story but not revealing personal information?

Ask for an anecdote about a disagreement with a client and how it was resolved.
See whether the disagreement was about something important like safety or an unimportant personal preference that nonetheless ended up in a disagreement. Is there an issue of authority? Are you going to feel bossed around? Did the candidate tell a story showing the use of humor, patience, and tact to resolve a disagreement?

Ask the candidate if he/she has children.
Say “tell me something about your children” and see what is volunteered. Ask how the candidate handled toilet training and toileting accidents, complaints about food, discipline, misbehavior, and other analogous topics. Does the candidate talk a lot about control, discipline, structure? What does the candidate say about normal frustrations? Or does the candidate share warm stories about enjoying the process of helping and teaching?

Ask about similarities and differences in caring for children and elders.
See if the candidate mentions that the elder is in charge and makes the rules.

Ask how the candidate shows respect for the client’s dignity and privacy while assisting with activities of daily living. Ask the candidate to share a difficult experience balancing a client’s privacy and need for assistance. Does the candidate minimize the concern for privacy? Or does the candidate describe a true appreciation of the individual’s dignity?

Ask the candidate about bathing and grooming tasks. Ask how the candidate prefers to handle these responsibilities. Follow this general question with a request for a story about a specific instance. Finally, give your preferences for bathing and grooming in detail and ask how the candidate would handle this routine. Does the candidate indicate a true ability to help you through your routines without imposing a new one? Are the stories about the aide deciding how to handle things or about the aide finding ways to accommodate an existing routine? How much flexibility is described in the stories?

That is not to say that a trained aide doesn’t change wet clothes or dressings on sores as he/she deems appropriate, but that an older person who has always showered before bedtime should not be forced to shower in the middle of the afternoon because the aide prefers to do bathing at the beginning of his/her shift.

The larger question is whether the aide assists or directs you. To some extent, this depends on your needs. If your needs are only or primarily physical, the aide should assist and take direction from you. If you have some memory or cognitive problems, the aide must take a more directive role—while respecting preferences as much as possible—to make sure that bathing, brushing teeth and toileting take place at regular intervals. Since this is a progression, you are looking for an aide who can assess ability accurately, and help without infantilizing you.

Ask the candidate about the normal challenges of in-home work. Tell the candidate that you know in-home work can be isolating, tiring and frustrating at times. Ask about a situation that was particularly challenging and how the candidate handled it.

4. Forced choice questions: Forced choice questions ask people to rank items in order of preference. All items must fit somewhere so forced choice questions usually elicit honest information and show priorities, likes, and dislikes. Ask the candidate to rank the activities of daily living in order of preference (all candidates should know what activities of daily living are). Next, ask the candidate to rank household chores and pet care (if applicable) in order of preference.

This information will enable you to determine if what you want help with is at the top or bottom of the candidate’s preference list. Pick somebody who likes doing what you need help with, both to create a harmonious match and also to reduce the risk of abuse.

For those candidates who seem suitable, discuss salary and schedule next.

Salary: Candidates told you their salary requirements in the phone interview. Now tell them how much you will pay, whether you will pay weekly, bi-weekly, or at some other interval, how often you will give bonuses, raises, paid sick leave, holidays and vacation time. Discuss overtime. Pay generously if an aide stays late to handle illness or an emergency.

Status: Will the candidate be an employee or independent contractor? This is a big deal to the IRS and determines who is responsible for withholding money to pay taxes. Generally, people who set their own hours, divide up their work as they see fit and have several clients are independent contractors. People who work many hours if not full time for one person who decides what needs to be done are employees. A house cleaner who cleans 10-12 homes a week, spending 3-5 hours at each home is clearly an independent contractor. A home health aide who works from 9-5 Mon.-Fri. caring for one person is clearly an employee. How many hours of assistance are you requesting? How many other clients does the aide have? The IRS Form1040-H needs to be filed annually with your tax return
For more information go to:,,id=99247,00.html, schedule H, household employment taxes. Nolo Press, , provides more information on this topic.

Schedule: Restate the hours you wish to have help and ask the candidate to confirm hours he/she will work. Stress that you need dependability. Make clear whether 9:00 means 9:00 on the dot or a window of 10 minutes one way or the other. Agree on breaks. Pull out a calendar and see what holidays are coming up in the next 3 months. Agree on days worked, days off, paid and unpaid holidays. Keep in mind that offering a few paid holidays generates a lot of good will.

Ask when the candidate is available to start if hired. Also ask and if the candidate has anything planned that would require time off after that date. Discuss how you want to handle interruptions in schedule (illness, for example), and how you will handle holidays.

Screening Candidates to Reduce the Risk of Abuse and Neglect

The interview process can seem – and in fact is – time consuming. But it is time well spent: with all this information, you should be able to select the person best suited to help you. Before making a job offer, however, you must attend to the final, most important step: assessing whether this promising candidate will provide safe, attentive care.

Frail elders and dependent adults are at risk for neglect, physical, sexual and emotional abuse and exploitation in much the same ways that children are. Having more assets than children, they are at unparalleled risk for financial abuse, fraud, theft and identify theft. They may be more isolated than children who typically go to child care or school, places staffed by mandated reporters (people required by state law to report suspicions of neglect and abuse to the appropriate protective agency). At a minimum, children play outside and tend to be noticed by neighbors. Children cry and scream when hit, distressing sounds that are often overheard by neighbors.

Housebound elders, on the other hand, may be invisible and inaudible to their well-intentioned neighbors and be isolated in general. Their human contact may consist of their in-home help and the occasional visit to the doctor and dentist. They might find it too humiliating and frightening to ask for protection from somebody caring for them. And they may believe they have no alternative.

You can reduce, but not remove, the risk of hiring somebody who might abuse or neglect you through prudent screening of candidates, including those provided by an agency.

A responsible screening protocol includes two key steps:
• checking references and
• screening against registries that can provide additional information about the candidate and validate or contradict information provided by the candidate.

Checking References

Remember the references you collected either in the phone interview or the face-to-face interview? They are of no value unless you call the numbers and ask questions about the candidates.

Unfortunately, references almost always say good things about candidates. People simply don’t volunteer the names of former employers likely to speak negatively about their performance and former employers fear being sued if they provide more than dates of employment. Beyond that, people with problematic pasts use the skills they developed along their troubled way to fabricate references using relatives and cohorts,
making reference checking difficult.

To help you get the most from reference checks, use the candidate’s chronological resume. This resume structure allows you to ask about specific jobs, responsibilities, and gaps of employment, gaps that could result from an illness, a new baby, or jail time.

Once again, the reference checking protocol varies slightly depending on the nature of the hire.

Agency hire

Although housekeeping agencies may not check references, home health aide agencies will. They are not likely to let you contact the references but may share what clients have had to say about the helper they are planning to send you. Ask specifically what people most liked and disliked about this person and what the agency sees as his/her strengths and weaknesses. These pluses and minuses should help you assess how the candidate fits with your priorities.

Private Hire

Candidates should provide the names and phone numbers of clients and relatives of clients. These people can tell you what it feels like to receive care from the candidates and can describe strengths and weaknesses from their perspective. The candidates should have let the references know to expect calls; they may also have told them what to say. So it’s important to ferret out actual information from the vague nice things people say and to consider references in concert with more objective indicators. Pin down the legitimacy of the reference by asking for specifics about when and where the person worked, the nature of the tasks, and the candidate’s strengths and weaknesses.

Remember that employers, wary of litigation, rarely do more than confirm dates of employment.

Be wary of vague positives or a lack of specificity, answers like “He tries hard,” “She cares.” “Well, I didn’t employ him in that capacity;” “It wasn’t a good fit.”
Be wary also of conflicting information, an unwillingness to share specific stories, or curt answers. These should be red flags.

If you get negative information from one reference, test it against the others. Say something like: “How did X handle _________ when he/she worked for you?”

If previous employers can’t speak well of the candidate or something just doesn’t add up for you, stop here.

If the candidate has good references, congratulations. You are moving on to the final step of the hiring process: screening.


Screening allows you to check your candidate against various lists of problematic people. Helpful information can be gained through
• the DMV,
• credit bureaus,
• sex offender registries,
• the child abuse and neglect index, and
• other criminal data bases.

These screens are vitally important because they allow you to intercept candidates who may be abusive financially or physically, who may have records as drug or alcohol abusers, who may have extensive driving violations, or who may have served jail or prison time for theft, fraud, or other criminal activities especially threatening to an older person alone in the house.

Agency hire

Housekeeping agencies may not screen employees at all and may not be bonded. This puts you at risk, especially for petty theft. And most home health agencies require nothing more than a DMV clearance and references. While these checks give useful information about a specific behavior and will weed out people with a history of drunk and dangerous driving, this limited screen is insufficient because it fails to screen for the potential of financial, physical, sexual, emotional abuse and neglect.

Because these jobs pay relatively poorly (no matter how expensive it seems to you as you pay the bills, these workers rarely earn more than $25,000 -$30,000 per year and many earn less), you’ll want to be wary of somebody with disastrous credit—the temptation is just too great and impulsivity is a large part of the debtor’s problem. Learning about this behavior requires a credit check.

The activities of daily living you want assistance with put you at a different type of risk and you’ll want to know how your helper fared as a parent when similar needs arose. If your candidate was hauled into juvenile court for beating a child who wet the bed, you wouldn’t want to rely on this person for assistance with toileting, changing wet sheets or any other intimate matter. If your candidate has a conviction for domestic violence, you wouldn’t want him working in your home. Learning about this background requires sex offender, child abuse, and criminal database checks.

Unfortunately, few home health agencies do criminal background checks and almost none include the child abuse data base in their screening. Their reasons for limiting their screening are worrisome. If you are working with an agency, it is helpful to anticipate and counter their rationale for limiting screening.

• But everyone likes him!

Most adults are happy with the employees provided through the agency, even those staffers who would not meet the mandatory standards for work with children. As a result, agencies see no need for, and do not want, a governmental bureaucracy telling them whom they can hire.

There is a difference between flying blind and making informed choices. You are bringing strangers into your home and giving them access to your person, property, financial data, charge cards, and everything else in your home and wallet. How tempting—and easy—to pocket a little something now and then, especially when the helper works hard, feels underpaid and perhaps underappreciated. Because this proclivity can be easily identified through a credit check, this check is critical before accepting an agency hire into the home.

• Do you know how expensive more screening would be and how much more we would have to charge….YOU?

Costs to fingerprint and screen are prohibitive. The candidate pays a nominal fee (usually about $15) to the DMV or police or sheriff’s department to be fingerprinted and the agency is charged about $85-100 for the state Department of Justice to run the prints against existing prints in their child abuse and criminal data bases. Agencies for seniors and dependent adults claim that the cost for fingerprinting is too high.

In other fields where safety is of paramount concern, this argument does not fly. Child care providers and schools must submit fingerprints of all employees who have contact with children, and manage to pay for it somehow. Many counties have a “warm line” or “trust line” that lets people fingerprint themselves so they can show their clearance to families considering using their services. Call your county’s child care referral agency to see if they have such a mechanism. There are also companies that will screen and check references for you; your local senior center and child care referral agency should be able to steer you to them.

Child care agencies and schools do not allow unscreened employees to work with children. Take measures to assure that candidates recommended by agencies to work with you are screened as thoroughly as those who would have worked with you as a child. Offer to pay the agency’s portion of the fee and to reimburse the employee his/her $15 after 3 months of good work.

• No way, I’m not getting sued.

Many agency directors really believe their liability is reduced by limiting screening to reference checks and a DMV clearance. They think their liability would increase if their screening were more extensive and a more thoroughly screened employee abused, neglected, stole from, or defrauded a client.

Limited screening increases risk – significantly – and therefore increases the agency’s liability.

Adults brought to juvenile court for neglecting, physically, sexually or emotionally abusing their (or their partner’s) children may be unknown to criminal and traffic courts. Thus, an applicant who abused a child for wetting the bed can apply for a job as an attendant for an incontinent elder and sail through the reference and DMV checks.

Further, a number of county jails and state prisons have pre-release programs that suggest that inmates become in-home care providers. Parole agents and probation officers often recommend in-home care jobs to their clients because they know the background checks are cursory and the staffing shortages are chronic in this line of work. These guys are strong (all that working out in the yard) and can lift non-ambulatory patients on and off furniture and toilet seats, a vital skill, and something many aides cannot do. These ex-cons will sail through the DMV check because they don’t drive while incarcerated. This is not to say you should never hire an ex-con, but that you have the right to pertinent history about the person coming into your home so you can make an informed decision.

Do everything you can in working with an agency to increase screening of candidates. Insist on measures comparable to those required for work with children in order to filter out people with records of financial, physical, sexual, emotional abuse and neglect: a safer situation both for you and the agency.

• We’re already short staffed. We can’t find enough people to work in this field. If we screen more, we won’t have anyone to send clients who need help.

Agency heads say, “If I knew more about each applicant’s background, I’d hire fewer applicants and have an even harder time filling the staffing needs of my clients.”

Consumers trust agencies to send safe people into their homes. This trust is misplaced and unfounded by today’s practices. Staffing shortages do not justify taking unnecessary risks with the lives of clients.

You can mitigate some of this risk by convincing the agency to agree to let you add an additional level of screening yourself. Offer to pay the added expense, about $100, then hire a reference checking agency to screen for you. Be sure to find out what data bases they will check and negotiate any additional screens you want included.

Private Hire
The lack of agency screening may give you cold feet about working with an agency. Your option is to hire privately and oversee the screening yourself. If you opt for this approach, five steps can significantly increase your safety.

1. Check references to be sure they are legitimate.
•Call the references the candidate gives you, and be rigorous about using the questions described earlier to detect whether these are employers, friends, relatives, or people asked to say nice things.
2. Get a chronological list of jobs so that gaps such as county jail and state prison time can be detected.
•Highlight gaps on your copy of the resume. When you interview, let candidates walk through the resume to tell you about their history. Immediately after that, ask about every gap you have identified. Probe for detail. If they say “I was out for a year because I had my second child” ask, with interest, about the child. “How wonderful for you. It must have been nice to be able to stay home. What did you like best? Did you have a boy or a girl? What school does your child go to now? How old is he/she?” And so on. You are probing for any inconsistencies.
3. Get a credit check.
•Ask the candidate to bring you a credit check done within the past 30 days. Look for defaults, bad debts, outstanding judgments, accounts sent to collections, high unpaid balances. Be realistic—people earning $25,000 per year are likely to have some debts, and perhaps high balances on a couple of credit cards. But, people can still be financially responsible. Are payments made monthly? Is anything in arrears? Have any accounts been sent to collection agencies? Is the car loan about the same as the candidate’s annual income?
4. Require the candidate to go through a fingerprint screen that is checked against child abuse as well as criminal and DMV data bases. You can do this through the warm/trust line if there’s one in your county. If not, ask if the local senior center or other community service agency can do it for you. There is usually a backlog and the clearance may take weeks. Schools and child care programs do not let people begin work until their clearances have arrived. Good in-home care providers will not wait around for a couple of months while you wait for the clearance to come in mail. And, submitting fingerprints is a pretty good deterrent in and of itself. Stipulate a probationary period to last until the fingerprint clearance arrives.
5. Get a signed statement documenting that the candidate agrees to protect you by complying with elder abuse reporting laws.
• The easiest way to accomplish this is to get a copy of the elder abuse reporting form from your local Adult Protective Services office. Have the candidate read it, agree to abide by its rules, and sign a statement saying he or she has read it, understands it, and agrees to comply with state law.

The Hire

Making the offer:

Congratulations! You’ve found suitable candidates, narrowed the list by interviewing for experience and fit, and increased safety by screening. By this time, you should know which candidate is best suited to come into your home and help you the way you want to be helped. Three final steps remain:

• offering the job,
• arranging payment, and
• getting off to a good start.

Agency hire

If you have worked with an agency, this step is simple: call the agency, say the candidate you met with is acceptable, and when you would like the candidate to start. Your new employee will show up on that day!

Private Hire

If you are hiring privately, this is still a fairly straightforward step. Call the candidate to offer the job. In the conversation be sure to restate the duties you discussed, the number of hours he/she is expected to work, and the schedule. Have a calendar in front of you and reiterate your earlier discussion about leave and holidays. Mark holidays – if any –for the next 3 months on the calendar and keep the calendar available as a working tool.

Adapt the model agreement for your circumstances. Review it with your prospective helper, then prepare two copies that both of you will sign. Give one copy to the helper and keep the second yourself.

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Paying the helper:


Agency hire:

Payment for agency hires is simple.  The worker submits a time sheet to the agency, and the agency bills you, probably monthly.  Remember, there should be no side agreements or requests for additional money between you and the employee.


Private Hire:

You’ve already made good decisions about the expense and nature of the employment.  You know whether the helper is an independent contractor or an employee and you’ve agreed about benefits and taxes.  A few additional questions remain:


How often will you pay the worker?  Will the worker give you a time sheet every week or two?  Resolve these issues as you and the helper negotiate the contract, decide which day is payday, and have payment ready at the end of that day.


Getting off to a good start:


No relationship is perfect right off the bat, and good hires, like good marriages, can go bad if people don’t address minor irritations. Older people who are not thrilled about needing help to begin with rarely speak up in the first few weeks when the employee is learning the ropes. Instead, they wait until their unexpressed frustration boils over and they fire the helper. A short checklist giving a little feedback (Am I talking too much? Too little?) each week can improve worker performance and your satisfaction. Put checkmarks in the appropriate columns and put the feedback form in the paycheck envelope. This spares everybody embarrassment and confrontation.


Here’s a sample that you can customize.



1.  Fill in the left column with the helper’s tasks and behaviors.

2.  Check a box, 1-4, for each task or behavior.

3.  Add a suggestion or two below the grid.


Weekly feedback gives well meaning helpers the information they need to help rather than annoy their clients. It’s a good idea to keep a copy of each week’s feedback in a folder, so if there are problems down the road you have a record of how things have been going.


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