Background Checks for Caregivers: Just the First Step

This past weekend, I was at a backyard BBQ and the hostess was telling about their move into their current home.  As her husband had been transfered to a few different cities for business, she was experienced at managing a move.  They had decided to stay in a hotel for a couple weeks in order to make some repairs to the home before living there.  She had labeled each box for the room the items would be going to and had separated out the items they would need in the short-term.

The moving company seemed very happy that she was well organized and the move went smoothly.  The day the moving truck was scheduled to arrive, she had been working on her laptop computer awaiting their arrival.  Once the movers drove up, she packed up her laptop and put it in a closet to be out of the way while the movers brought in the furniture and boxes.

The next day, she went to get her laptop computer out of the closet and it was not there.

The only people who had been in her home at that point were the movers, so she called the moving company and told them what happened.  After many more phone calls, one of the men on the moving crew did confess to stealing the laptop.  He had tossed it into the bushes by the house the day of the move and drove back that night to retrieve it.

My friend just wanted her information on the laptop back, but at that point all she was going to receive was a check from the the moving company's insurance to buy a new laptop computer.  She chose not to press charges, even though the moving company encouraged her to do so, because the thief knew where she lived, knew what belongings she had in her home and knew all about her family (which includes two small children).  She did not want the thief to retaliate in any way.  The biggest bummer of all, she said, was that the guy who stole her computer was her favorite guy on the moving crew.

If you talk to law enforcement officials, they will tell you this often happens - people choose not to press charges even when they have all the evidence to convict the guilty party of the crime, just because they don't want to deal with the legal bureaucracy, any negative publicity and backlash from the thief.  It is easier to just move on, lessons learned.

This is especially true when stolen items are either recovered or insurance compensation is received.  It then seems unnecessary to have the added headache of pressing charges.

However, what this means is that the person who is guilty of the crime will not have the crime information show on their record.  They can go and apply for a job the next day and their Background Check will come back clean  - because it is - no charges were "filed".  Similarly, sometimes a Judge will allow information to be taken off someone's record in exchange for community service.  Just like when you show up in court for a traffic ticket, sometimes if you agree to certain conditions, the Judge will delete the information from your official record so that your car insurance rates will not increase. 

Because of this, a Background Check should just be a starting point when hiring a Caregiver.  It should be used to verify that the name and Social Security number the individual provided do match their past names and addresses which are on record and that they are not listed as a Sex Offender or criminal.  It keeps the really bad guys and gals away. 

But then it is necessary to check multiple personal and business references to find out the person's character and to see if there is a steady employment history, long-term friends and associates who are able to provide feedback on their capabilities and consistent information.

Because another reality is that, just as in my friend's situation where her favorite mover was the thief, many times the person who is successful at having their crimes removed from their records or able to prevent charges from ever being filed is really charming - it comes with the territory! 

And these individuals, more than anyone, should not be caring for vulnerable seniors who may be lonely and looking for not just a Caregiver but also a friend.    




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Costs of Senior Home Care

How much does senior home care cost?

Senior Home Care Agencies charge an hourly fee and a daily fee for caregiving services.  The hourly fees may be discounted when more weekly hours are booked.

Usually the hourly fee is from $16 to $25 per hour and the daily fee for live-in care is from $150 to $275 per day.

These fees will vary, depending on the amount of care required and the area of the country you live in.

Senior Home Care Agencies deliver the added advantage of active care management (they will train and supervise the Caregiver and staff a replacement Caregiver when the regular Caregiver needs off).  The Agency will also provide policies and procedures for the Caregiver to follow and make sure a positive connection is established between the Caregiver and client.  The agency will staff a different Caregiver, when the situation requires a change.

In addition, agencies providing private-duty home care will employ the Caregiver and provide all the added insurance benefits required by law, such as Worker's Compensation Insurance and Professional Liability Insurance.  Most agencies also offer bonuses, performance incentives, health insurance and on-going training for their Caregivers.  Active case management allows the Caregivers to have a shoulder to lean on when they are dealing with daily care challenges.  Agencies also provide a Plan of Care for the Caregiver to follow.

The agency will also make sure they understand any special Caregiver requirements and will professionally address any client issues with the Caregiver.  It is important to provide the care in the manner the client desires and to understand any personal preferences, especially when providing care in a senior's home - the agency will not want to change the senior but rather adapt to their preferences.

One nice advantage of starting with care in the home through a Senior Home Care Agency is the ability to change the schedule.  Many times seniors need to adjust to needing additional help.  An agency can start with care just one day a week and then increase the hours as the senior becomes comfortable with allowing a Caregiver into their home and accepting help. 

When I owned a Senior Home Care Agency, many times we started out services for a client just one day a week because they were resistant to accepting care.  However, once the senior experiences the advantages of having assistance and realizes they are still the decisionmaker in their own home, they nearly always increase hours to match their care needs.  This is especially true when memory loss is just beginning.

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Senior Care Agencies offer Added Protection for Caregiving

Yesterday's Chicago Tribune reported a Caregiver was sentenced to 3 1/2 years in prison for stealing jewelry from the 61-year-old paraplegic client she was caring for as an independently hired Caregiver.

One huge advantage of hiring a Senior Home Care Agency to manage in-home care needs is that the agency, as a business, employees the Caregivers and provides Worker's Compensation Insurance (required by law) and carries a Fidelity Bond and Professional Liability Insurance.

In addition, the Senior Home Care Agency will do a Background Check on the Caregivers they hire, complete with matching prior addresses to the Social Security number the Caregiver has submitted and checking both professional and personal references.  The Senior Home Care Agency will also manage the entire care for their elderly and disabled clients, making sure that any valuables are managed effectively so no temptations are offered (as the Agency also must follow certain guidelines to maintain their insurance coverage).  In addition, as Caregivers are employees of agencies, they want to receive their employee benefits, such as Social Security so they can collect Social Security payments when they retire and other benefits such as health insurance, performance bonuses and the security of Worker's Compensation Insurance (Indpendently hired Caregivers, also called "hire-direct Caregivers" or "Independent Contractors" will not have these employee beneftis and their clients will not have the insurance protections either).  

Caregivers working for Senior Home Care Agencies are providing care as a career and because of this, if they suspect there is even slightly the chance of a situation which would place their performance in question, they will report this to their Supervisor.  Caregivers working for agencies will make sure that even if they are just  running an errand to purchase an item for a client that the agency is aware and that it is tracked through a Petty Cash account.  But even more importantly, the Senior Home Care Agency has created Policies & Procedures for both the Caregiver and the Client to follow to make sure proper care is provided and the opportunity for theft is eliminated.  The Agency would not stay in business and the Caregiver would not have a job if they were not professionally providing quallity care.

As Senior Home Care Agencies want to maintain a positive reputation in their community, in order for referrals from healthcare industry professionals to continue, they will make sure that a case is managed effectively and that any valuables are secured.  In the event that something did occur, they maintain insurance coverage to reimburse the client- just as we all maintain homeowner's insurance and car insurance.

A professional Senior Home Care Agency knows how to effectively manage the care to avoid situations that would provide an opportunity for theft.

The Illinois Caregiver who was stealing from her client had no insurance coverage - no Fidelity Bond and no Professional Liability Insurance to provide compensation for the rings she stole from her senior client  (she sold some of the stolen jewelry at a pawn shop and the transaction was caught on video-tape).  The DuPage County Judge Robert Anderson said that because there was little prospect of getting any restitution from the Caregvier, he did not order her to pay it (this Caregiver will also get free room and board for 3 1/2 years while she is in jail). 

If this Caregiver would have been employed through a Senior Home Care Agency, the agency would have made sure a system was in place to protect her jewelry collection and the insurance protection would also have been in place to provide restitution.  Not sure if the Judge thought to mention this so that in the future this paraplegic can enjoy the added protections a Senior Home Care Agency delivers.

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Paying for Senior Care: Medicare, Medicaid or ?

How do you pay for long-term care as a retired senior when your monthly income consists of your Social Security check and your savings?

It seems few of us want to think about long-term elder care, hoping that perhaps it will be something we just won't need.  However, the reality is that Americans are living many years past retirement age due to advancements in medical care (a baby born in the U.S.A. today has a life expectancy of 100 years).

How much care does Medicare provide for?

Medicare only covers a nursing home stay for up to 100 days, with a Medical Doctor's approval for medical need which usually must follow a major medical event, such as a stroke or hip-replacement.

Medicaid is offered for very low-income seniors and is required to provide long-term care in a nursing home.  If a senior does not financially qualify for Medicaid, they must pay for their care by using a long-term care insurance policy (if they purchased one) or with private funds.

Medicaid is a benefit which is managed by each state government and usually only pays for care in a nursing home, except in a few innovative states who have developed home care programs for long-term care, in addition to providing nursing home care (Vermont is one state which will provide Medicaid care in the home).

AARP's Public Policy Institute  (American Association of Retired Persons) recently issued a report showing that only 4 states spend more than 50% of their Medicaid long-term care dollars on home and community based services.  All the other state governments are still allocating all their dollars for Medicaid care to nursing homes, even though institutionalized care is more costly and surveys show a majority of senior citizens prefer to receive long-term care in their homes.

Only Alaska, Washington, New Mexico and Oregon spend more than 50% of their Medicaid dollars on long-term care through a home or community based program rather than a nursing home.

The AARP report, A Balancing Act: State Long-Term Care Reform, is the first to examine Medicaid spending on long-term care for seniors and adults with physical disabilities, separate from people with mental retardation and developmental disabilities who also use Medicaid long-term care.

Nationally, 75 % of Medicaid spending provides care in a nursing home for seniors and adults with physical disabilities.

However, states have succeeded in decreasing the amount of institutional care for those with mental and developmental disabilities to just 39%.

Perhaps as the Baby Boomers continue to age and vastly increase the amount of dollars needed to provide for care, the government will focus on more care options, beyond just nursing home care, for those seniors qualifying for Medicaid benefits.


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Alzheimer's Disease Care in Assisted Living

Alzheimer's Disease prevents challenges which some other age-related diseases do not, simply because the personality of the senior can change, along with the memory loss.  As is often said, Alzheimer's Disease is the "long goodbye" to a loved one.  And it can be even more confusing to family members because the senior can have a good day, tossed in with the bad days or they can seem just fine during short visits. 

Caregiverlist's Assisted Living Expert, Lisa Sneddon, with Senior Living Experts, just assisted a senior with Alzheimer's Disease to move to an Assisted Living Community which specializes in elder care for those with memory loss.

The family member sent her a note telling her that they visited their loved one and realized they were doing well and they then had their first night of peaceful sleep in 8 years.  You can read the entire note about this senior's move to Assisted Living in Lisa's blog.

Caring for someone who may become confused about "person, place and time" presents unique safety challenges.  Many times the senior will take out all of their anger about their condition on the person who is closest to them.  This is why in some instances, the best care may be at a senior care community which offers a special environment and is able to rotate Caregivers to prevent burnout when the senior is combative.

Some Assisted Living Communities have created rooms with memorabilia from certain eras and provide music and movies for times the senior can remember.  Many seniors are able to remember events from many years ago, while not being able to remember recent events.  Just as finding the right medical doctor who is able to specialize in certain medical conditions can be vital to obtaining the most effective medical treatments, sometimes senior care requires a specialized solution.






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How to Choose a Senior Home Care Agency

Caregiverlist has organized a checklist to assist in making sure you have the right information at hand when you begin the search for a Senior Home Care agency for elder care needs.  Sometimes family members are not aware of all the various care needs which an agency may be addressing in order to provide a quality Caregiver and to develop an appropriate schedule for the care services.

Most agencies will meet with the senior to conduct a Client Assessment Interview and then will create a Plan of Care which will include specifics on the care needs.  By effectively communicating the care needs to the agency, you will assist them to be successful in providing a quality senior care solution.'s Checklist: Choosing a Home Care Agency

  1. Needs

    First consider the actual care needs and write out a list of items that need to be provided. Be able to give an example of a typical day for the care recipient, from the moment they wake up until they go to bed and include a timeline of when they prefer meals, naps and other activities.
  2. Hands-on

    How much hands-on care is needed vs. companion care? If more companion care is needed, make a list of possible activities.
  3. Transportation

    Do you need a Caregiver who can escort the client to doctor's appointments and social activities? If so, what mode of transportation will they use? Will the Caregiver drive the client in the client's car? Keep in mind that you may need to research your car insurance coverage if this is the case. Will the Caregiver drive the client in the Caregiver's car? If so, be aware that it will be difficult to be 100% sure that the Caregiver's insurance policy is up-to-date even if you verify this in the beginning. If they have a late or missed payment the policy could be cancelled without your knowledge. Will they take public transportation (bus or taxi cab)? This is probably the safest method of transportation to prevent the risks of insurance issues. (Some cities provide special transportation privileges for seniors and you may want to contact your local Department on Aging for information).
  4. Memory Loss

    Is there memory loss? If so, have you had the type of Memory Loss diagnosed (Alzheimer's Disease, Huntington’s Disease, Pick’s Disease, Frontal Lobe Dementia, Frontotemporal Dementia, Lewy Body Disease, Normal Pressure Hydrocephalus, Vascular Dementia, Parkinson’s Disease)? Blood clots and brain tumors may also cause dementia. A diagnosis of dementia type will help the agency to better understand the care needs and assign a Caregiver with the right type of training and qualifications.
  5. Language

    Do you need a Caregiver who speaks a certain language?
  6. Hours

    How many hours of care per day will you require? Review the list of services you will need performed during the care visit and decide on the minimum number of hours per day which would work as a starting point. The agency will need to know the hours of service to assign a Caregiver and will allow you to adjust the hours after the first week to accurately meet the care needs.
  7. Dietary

    Are there any special cooking requirements? Communicate any food allergies or specific cooking requests and consider how groceries will be purchased or delivered if the care recipient is unable to shop for groceries on their own.
  8. Additional Skills

    Are there any "skilled" care requirements, such as taking blood pressure, blood sugar testing, wound care or a feeding tube? Communicate if these specialized services will need to be performed or monitored.
  9. Medication Management

    What is the care recipients method for managing medications? Do you know for sure if the medications are currently being taken correctly? Be able to provide a list of medications and the method of monitoring so the Agency will be aware of possible side effects and other requirements such as taking pills with or without food, etc.
  10. Case Management

    Will medication management be required (organizing the medications in a pillbox and obtaining refills)? Due to insurance purposes, this service usually must be provided by a Supervisor or R.N. depending on the state and an additional fee is charged for the service, separate from the daily or hourly caregiving rate. If the client is unable to manage their medications, determine if a family member will take on this responsibility or if you will need the Agency to perform this task too.
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Nursing Home vs. Other Care Options

As Medicare only pays for a short nursing home stay, after a major medical incident, seniors and their loved ones must evaluate if they want to private pay to stay in a nursing home or seek an alternative for their nursing care.  Alternative senior care choices include a Senior Home Care Agency providing a Caregiver and Care Management in the home or relocating to Assisted Living.

Most Nursing Homes accept Medicare and Medicaid patients but there are a small percentage of nursing homes which only accept Medicare patients.  At the same time, some nursing homes only accept Medicaid payments after a patient has spent all of their assets and qualifies for Medicaid.  They will not accept new Medicaid patients.  In 2006, 48% of nursing home care was paid for by Medicaid which matches the trend industry experts report:  seniors are seeking an alternative to nursing home care.

Reasons seniors may opt for an alternative to staying in a nursing home:

1) Staff to patient ratio:  nursing homes often staff one Nurse's Aide to 12 to 15 patients.  The nursing aide is the person responsible for assisting with personal care, such as  showers and bathroom visits.  Each patient's care depends on the ability of the aide to juggle the needs of multiple patients. 

2) Cost:  although the daily rate for care may be acceptable, sometimes the additional fees for everything from hair cuts to transportation can add up and cost much more than the cost of paying for an individual Caregiver in the home or a private apartment with part-time care in an Assisted Living Community.

3) Care needs:  many times a senior will recover from medical conditions which require rehabilitation in a nursing center, such as a stroke, heart attack or hip replacement, and be able to function on less care.

4) Specific care needs:  seniors who may need more specialized care for conditions such as memory loss or diseases such as Parkinson's Disease, may opt to find a community which specializes in this type of care.

5) Quality of nursing facility:  sometimes hospitals discharge patients to a nursing home for rehabilitation and do not consult with the patient on which facility they will be transferred to when they leave the hospital.  The nursing home may not suit the personal desires of the senior and this is often when families begin their search for elder care.'s experts on Assisted Living, Long-term Care Insurance, Estate Planning, Elder Law and Reverse Mortgages answer questions about all of these aspects of elder care to assist seniors to find the right option for their finances, medical needs and personal preferences.





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Elder Abuse

Monday's Wall Street Journal featured a story on elder abuse and reported that in many states there are no laws regulating Background Checks for senior home care.  While it is true that there may not be formal laws in place, any professional Senior Home Care Agency which carries professional liability insurance and covers Caregivers through Worker's Compensation insurance (this is a law - Worker's Comp Insurance must be provided for employees), will require all their employees to go through Background Checks.  These checks will verify the individual's name matches the Social Security number they provided and matches the addresses associated with that number.  They will also check the criminal records in the counties which the Caregiver applicant has lived. 

These agencies also will require that money does not exchange hands between the Caregiver and the Client, unless a special "petty cash" fund has been set-up and is strictly monitored, with proof of receipts, for tracking purposes.  At the same time, the petty cash is usually funded through the Senior Home Care Agency and then billed to the family to make sure accountability is in place.

Professional Senior Home Care Agencies are experienced in managing Caregivers and all the aspects of the care and will incorporate a Senior Care Manager to assist with the case when required.  This prevents financial and emotional abuse from happening. has created standards for the Senior Home Care Agencies we refer to, since there are no nationwide laws. also provides information on Background Checks.  It is important to make sure background checks not only match Social Security numbers and past addresses for an individual, but also check criminal court records in each county the Caregiver has lived in.  Even some websites that connect caregivers and nannies with families for direct-hire, do not provide complete Background Checks but only a Social Security number and name match.  There is always a risk with a hire-direct situation because the extra insurance liability of Worker's Compensation Insurance and Professional Liability Insurance are not in place to protect the senior and the senior's family.

Elder abuse is easy to avoid when there is active management of a Caregiver.  While Caregiving can be exhausting, a professional caregiver will know how to react to all types of clients and their Supervisor or Care Manager will be there to coach and support them.  In addition, professional caregivers are providing care as a career - they will be the first to report any unsavory activity by family members or friends.



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Assisted Living: Does it include a Caregiver?

Senior Assisted Living Communities vary widely in the services they provide their senior residents and the extra amenities offered.  There are no national licensing requirements for senior "assisted living" which causes even more confusion when you begin the process of looking for an appropriate community for yourself or a loved one.  Many times, communities which call themselves "independent living" may offer as many services as an Assisted Living Community.

Another challenge when evaluating an Assisted Living Community is learning about what elder care services are included.  While communities do hire a staff of Caregivers which usually including Certified Nursing Aides and Registered Nurses, they may only have a small number of these caregivers who are keeping an eye on all the residents .  These Caregivers are usually not available to work one-on-one with an individual senior resident to provide care services.  It is important to determine how much one-on-one care may be needed and how this will be provided.

Many Assisted Living Communities partner with Senior Home Care Agencies to provide private Caregivers for their senior residents, when more individual care services are required.  Seniors who have memory loss may require more care and some communities offer special customized services for these residents.  Other communities are not equipped to manage care for seniors with Alzheimer's Disease and other types of memory loss.

Separately, some Assisted Living Communities provide nursing care, just like a nursing home, and others do not.  Usually the nursing care is on a separate floor and will require the senior to move from their apartment to a room or bed in the nursing center area of the community.

What if the senior will eventually require nursing care which can cost as much as $80,000 per year - - will they need to move again or will the Assisted Living Community be able to provide this?  And what if the senior runs out of money and will need to go onto Medicaid?  Will the Assisted Living Community allow the senior to stay and accept the Medicaid payments or will the senior need to relocate to a Medicaid nursing home?

As an initial move into an Assisted Living Community may be connected with the death of a spouse or the diagnosis of a new medical condition, the emotional and social needs of the senior should also be considered.

Finding the right Assisted Living Community presents a complicated task because of all these dynamics.  In addition, another type of assisted living is called "continuing care" and available at Continuing Care Retirement Communities.  These communities usually require a large initial deposit (some seniors sell their home and use the proceeds to pay for this deposit) but guarantee the senior will be able to remain in the community as their care needs may change.  Usually condos or townhouses, apartments and nursing centers are all located on the campus and the senior may move between them, as needed. provides an "expert" to answer all your questions about Assisted Living.  Lisa Sneddon, owner of "Senior Living Experts" serves as a resource to families and a coach to seniors to assist with finding the right assisted living solution.

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Congress passes Medicare bill

Seniors depend on Medicare for their health insurance after age 65.  Archaic legislation would have decreased the Medicare reimbursement rates for senior's medical services by 10.6%.  This would have meant some medical doctors would opt to not accept senior clients as they could better cover their costs by focusing on clients who could pay their rates.  This especially becomes a problem in smaller population areas where there is already a shortage of medical doctors, leaving the elderly population needing to travel further for medical care.

Although President Bush says he will block the bill with a veto (since he doesn't need to worry about being re-elected), Congress has enough votes on the bill to over-ride his veto.  A few Republicans joined the "Yes" vote after Senator Ted Kennedy (also a senior) took a break from his chemotherapy treatments to fly to Washington, D.C. to break the dead-lock.

I have always thought it was interesting that Medicare will only pay to "rent" a manual wheelchair for a senior but if the qualifications are right, they will buy a power wheelchair for the senior  -  and pay what I have heard is as much as 4 times over the wholesale price for these power wheelchairs (you may remember the Scooter Store had hired their own "doctors" to write up medical authorizations for seniors to qualify for a scooter since Medicare was paying and they had no problem buying Infomercials to advertise this to seniors.  They also apparently hired telemarketers to tell seniors they could only qualify for certain expensive power wheelchairs through Medicare).  When the U.S. Justice Dept. filed suit against the Scooter Store in 2005, they had already billed Medicare for $400 million since 1997.

I am all for making a profit for providing a service that is of value, but I don't believe the government should be willing to foolishly over-spend on certain elder-care products and then be unable to pay for necessary senior services at a fair market rate.

Perhaps a new President will be able to help guide Medicare in a better direction as the voting population ages. And at least we know most most first-term Presidents want to be re-elected and should pay attention to the voice of seniors.

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