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Four tips for hiring a long-distance caregiver

If a long-distance relative needs a little help, here's how to hire smartly:

Determine the appropriate provider.
Paid assistants usually fall into several categories. Agencies will hire, screen and assign their own staff, sometimes including a care manager to train and oversee the help.

Agency size can make a difference, says Steve Barlam, president of the National Association of Professional Geriatric Care Managers and co-founder of LivHOME Inc., a Los Angeles home-care management company. Larger agencies may have more workers, be able to provide for many levels and types of care and have backup employees available on short notice. Smaller ones might offer more personalized care or flexibility with scheduling.

Some geriatric care managers set up their own businesses, which operate much like an agency. Often for a flat fee, they will do an assessment of the parent's needs and set up a care plan, says Sue Maxwell, president of the Southern Gerontological Society. They usually have networks of people to help with whatever the senior might need, from lawn care to housecleaning. The manager will act as the surrogate family member to coordinate services and oversee the work.

An independent worker might offer more flexibility with scheduling and cost. But you have greater responsibility to screen, monitor and perhaps even provide backup care. You also have paperwork. You have to issue a W2 form at the end of the year and will likely have to pay Social Security and Medicare contributions, as well as federal unemployment insurance, says Barry Picker, a New York-based CPA. You also may have to meet state and local requirements.

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Ask questions.
If you go through an agency or care manager operation, find out how long it has been in business. What is its specialty? What are its credentials? Are there complaints against it with the Better Business Bureau or the state attorney general's office? Where does the organization get its employees, and what kind of screening is done? Will it share screening results? Is it bonded? Licensed? Insured? Ask to see proof. What is its current caseload?

What's the average length of employment, and does that tally with what you're hearing from the workers? Do the agency provide staff with ongoing training? Can it offer a whole range of care in case your parent needs change? If the agency provides medical services, is it Medicare certified? If so, it must meet certain standards and regularly report to the federal government, says Elinor Ginzler, manager for independent living and long-term care at AARP.

If you hire an independent worker, ask the same questions. Remember that the burden is squarely on you to check background, references and credentials.

Understand services and costs.
Find out exactly what you get for the money and what's expected of you. With an agency or care manager, you will likely sign a contract. Know what's in it, as well as what's required to get out of it. "You should only be paying for services you receive," Barlam says.

Is there a placement fee? Is there a backup policy if the caregiver can't make it? Who gets that call -- the senior, the adult child or both? If the worker doesn't show and you call in, will you be dealing with a live person or an answering machine? Test this in advance if you can, says Barlam. How much notice is required to cancel a visit? If you need to suspend service, will you get the same worker when you resume?

Some agencies will ask for a deposit and deduct that money from the final bill, returning the rest to the family, says Bartelstone, who runs Rona Bartelstone Associates Inc., a Fort Lauderdale, Fla., care-management firm.

Meet the workers.
Even if you don't live nearby, make a trip to meet the workers before you make the final placement, Maxwell says. Screening can help you weed out many candidates, but you'll probably feel more comfortable if you follow Maxwell's rule: "I want to see who's going to be taking care of my mother."

Dana Dratch is a freelance writer based in Georgia.

-- Posted: Feb. 26, 2003
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