At some point during your journey with ALS, in-home help will most likely become a necessity. Many families choose to use a home health agency or a non-‐medical home care (companion) agency to match them up with suitable employees and coordinate the delivery of services. Other families opt to hire help independently, using personal referrals or an employment (registry) agency. The difference between an employment agency and the other types of agencies is that an employment agency simply matches clients with qualified providers - it does not handle any of the responsibilities of an employer, such as coordinating and overseeing the delivery of services, managing payroll and taxes, or providing ongoing training for employees.
There are pros and cons to both approaches. Hiring help through a home health agency or a non-‐medical home care (companion) agency relieves you of the responsibility of finding suitable employees, interviewing them, managing them, and handling administrative tasks associated with being an employer. Going through an agency also means that back-‐up helpers are usually readily available if your regular helper is ill, on vacation, or otherwise unavailable.
Hiring help on your own gives you more flexibility with regard to the duties you assign to your in-home helper and with scheduling, and often is less expensive than hiring help through an agency. It also gives you the opportunity to interview and evaluate potential helpers on your own (although the hiring process can be time-‐consuming and you need to do your due diligence to lower your risk for making a bad hire). If you decide to go the independent hiring route, here are some guidelines that can help the process go smoothly.
Before you begin your search, write a detailed job description. List out the tasks you expect your in-home helper to perform, as well as the necessary qualifications, skills, and abilities the person must have to do the job competently. For example, what level and type of health care training should the person have? Must the person have experience working with people with ALS or another neurodegenerative condition? What are the physical requirements of the job? Also think about when you would need the person available to work, in terms of the number of days per week and the number of hours each day. Knowing exactly what you are looking for in a candidate will make the initial screening process easier.
After you have defined your needs, begin your search. A good place to start is your local Area Agency on Aging. They may be able to put you in touch with an employment (registry) agency or offer suggestions about good places to find potential candidates in the community, such as local senior centers and colleges that offer nurse and nursing assistant training programs. You can also seek referrals from other people in the ALS community, members of your faith community (try putting a notice in the newsletter), and friends and neighbors. As a last resort, you can place an ad in your local newspaper or on Craigslist. Include a brief job description, the hours the person would need to be available to work, your telephone number, and the best time to call.
Screen applicants over the phone before scheduling in-‐person interviews. Review the job requirements, and ask the person about his or her experience, availability, transportation arrangements, and pay expectations. If the person seems like a good potential candidate, set up a face-‐to-‐face interview. Tell the person that you will send him or her a job application to fill out, and request that the person bring the completed application, a reference list, copies of his or her licensure or certification (if applicable), and a valid driver’s license or other photo ID to the interview.
During the interview, go over the completed job application with the person, clarifying information as needed. Give the person a copy of the job description and go over it with him or her in detail. Try to gain a sense of the qualities the person would bring to the job, in addition to his or her technical skills. Ask open-‐ended questions such as:
- “Why are you interested in this job?”
- “How would you describe your work habits?”
- “What part of your last job did you like the most? The least?”
Tell the person that you will be checking references and doing background checks before making a decision.
Trusting your initial impression about someone is not enough when you are welcoming that person into your home on a regular basis. Before extending a job offer, check the person’s references and conduct criminal background and driving record checks. You can use a background check service to do this, or do an Internet search to find out which state agencies you should contact. You will need the person’s consent, as well as basic information such as the person’s full name and address. A social security number is not required but is recommended.
After you make a job offer and the person accepts, prepare a written contract of employment and go over it with the person. The contract should specify:
- The tasks the person is responsible for completing, and a schedule for completing them.
- The days and hours the person is expected to work.
- The salary and terms of payment (e.g., weekly, bi-‐weekly).
- Your policy for arranging for planned time off.
- Your policy for notifying you of an inability to attend work, or the need to adjust scheduled hours.
- The mileage reimbursement rate (if the person will be using his or her own car to run errands).
- Conditions that are grounds for termination (e.g., excessive lateness or absenteeism, drug use).
- Your policy regarding breaks, meals, smoking, children accompanying the person to work, having visitors while on the job, and so on.
- How often you will conduct performance reviews, and eligibility for pay increases. Both of you should sign and date the contract, and retain a copy for your records.
Avoiding legal difficulties
As an employer, you have certain responsibilities. Failure to meet these responsibilities can result in penalties, fines, and legal headaches. To protect yourself, make sure you do the following:
- Learn how to withhold and pay taxes on behalf of your employee. IRS publication 926 provides information about withholding and paying federal taxes for household employees. Your state may also have requirements related to withholding and paying taxes; contact your state employment department for more information.
- Keep a completed IRS Form I-‐9 on record. This form verifies that the employee is legally allowed to work in the United States.
- Check with your insurance company. Find out to what extent your homeowner’s or renter’s insurance policy covers household employees in case they are injured on your property, and whether additional insurance coverage is needed.
“Hiring a Home Care Worker.” American Association of Retired Persons.
“Hiring In-‐Home Caregiving Help.” American Association of Retired Persons.
“Hiring In-‐Home Help.” Family Caregiver Alliance, 2001.
“Hiring Paid Caregivers for In-‐Home Services.” Michigan Office of Services to the Aging, Community Services Division, February, 2004.
“In-‐Home Companion—Privately Hired (Non-‐Agency) Tips.” Alzheimer’s Association, St. Louis Chapter, July, 2012.