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How to find a home health aide

Seven out of 10 Americans turning 65 this year will require long-term care at some point, according to federal estimates. (iStock)

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Five years ago, Judy and Jack Rothman, who live in Los Angeles, realized they needed to bring in a professional caregiver. Jack, now 97, had serious health issues that Judy, now 92, struggled to manage on her own. “It became very difficult, and I knew I needed help,” Judy says.

Fortunately, when he was working, Jack had been a professor of social work, so the couple was able to tap a number of knowledgeable contacts. Through one, they were put in touch with Lynn Anderson, a home health aide. Anderson now manages the couple’s care, including shopping, cooking and health needs. Plus she oversees fill-in caregivers when they are necessary. “We’ve really come to rely on Lynn, and we enjoy her company,” Judy says.

Chances are, you or someone close to you will need help at home at some point, whether it’s for a few weeks, like after a hip replacement surgery, or for a longer period, as in the case of a chronic illness. In fact, 7 out of 10 Americans turning 65 this year will require long-term care at some point in their lives, according to research from the Administration for Community Living, a division of the Department of Health and Human Services.

But how do you manage the daunting tasks of finding, managing and affording that person? Read on for important advice.

Figure out what you need

Before launching a search, think about the kind of assistance you need and for how long. “If someone is having surgery and needs help for a week, that’s one thing, but someone with dementia who can’t be left alone will have different needs,” says Amy Goyer, family and caregiving expert at AARP.

Then look for a caregiver with the appropriate skills. Here are the three broad categories of help. (The labels and certifications may vary depending on where you live.)

Personal care aides/companions: These caregivers aren’t licensed, but they can help you with shopping, cooking, light housekeeping and transportation. They can also provide companionship.

Home health aides: In addition to performing the duties of personal care aides, home health aides can also monitor the patient’s health and assist with activities of daily living, such as bathing, dressing and eating. To qualify, these aides undergo training, though the specific number of hours of training and other requirements vary by state.

Certified nursing assistants (CNAs). CNAs can provide the same services as home health aides, such as helping with daily living, but are required to have additional training that allows them to perform some medical tasks, like changing dressings, checking vital signs and monitoring nutrition. They work under the supervision of a licensed nurse or doctor.

If you need regular medical care, as well as assistance with daily life activities or tasks like shopping, you may want to hire more than one type of caregiver, Goyer says. For example, in addition to homemaking help from personal care aides, you might arrange for a registered nurse to check in once or twice a week to administer medication or address other medical needs.

Where to find help

It can be challenging to find a qualified caregiver, especially if you’ve never done it before and don’t know what to expect, says Christina Irving, client services director at Family Caregiver Alliance, a nonprofit group. But you have options. Here are the three main strategies, along with the pros and cons.

Go through an agency: With a home health-care agency, you benefit from convenience and support. The agency will find and schedule the caregivers, do background checks, and handle the paperwork and legal requirements, including taxes, workers’ compensation and liability insurance. If a caregiver can’t show up, the agency will find a substitute.

But you’ll have less control over the aides assigned to you, who may rotate on a regular basis. That can make it hard to build a relationship and ensure that your loved one’s care needs are met. You’ll probably pay more than if you hire someone on your own because agencies need to charge higher rates to cover their overhead, Goyer says. To find a home care agency, ask your friends and family for recommendations. You can also contact your local Area Agency on Aging, which can direct you to resources. (More on that below.)

Hire on your own: This way you can choose a caregiver who seems to be the best fit for your needs. And you’ll probably pay less per hour. But it’s your job to find a replacement if the caregiver can’t come in. You’ll also need to do the paperwork, including drawing up a contract, taking care of taxes and insurance, and doing background checks.

Many families end up finding caregivers through word of mouth. Some employers may offer elder care referral services as a benefit. Another option is to use a private care registry, a matchmaking service that puts you in touch with caregivers seeking work. Some services also do background checks and help with paperwork, says Lori Dahan, president of the Private Care Association, a trade group; go to privatecare.org to find registries in your area.

Two years ago, Sue Kinkel, an 80-year-old widow in Phoenix, used a caregiver referral service to help her find an aide to assist with shopping, cleaning and other tasks. Her personal care aide, Ashley Roberts, 44, has been working with her ever since. “We’re now really good friends,” Kinkel says. “She drives me to appointments, and we have lunch or shop afterward.” Roberts adds, “She records TV shows in the evening that we can watch together the next day.”

Bring in a care manager: Another option is to hire an aging-life-care expert, also called a geriatric care manager. These specialists, who often have backgrounds in social work or health care, can help you assess your loved one’s needs, manage the caregiving staffing — often through an agency — and help with problems as they occur. These services can be especially helpful if you’re trying to help a family member from a distance or if you can’t visit regularly. If you’re not sure how to get started, you can hire a geriatric care manager for a consultation and to get information about options and resources in your area, says Kate Granigan, president of the board of directors of the Aging Life Care Association.

What it all costs

Only a few government or insurance resources pay for long-term care, and some of these government sources may be in flux. Still, it’s worth checking to see what may be available to you or if you can qualify down the line. Here are the main options to consider.

Medicare: This coverage pays for only part-time home care for short periods and only if ordered by a doctor. You will need to use a Medicare-certified home care agency. Some Medicare Advantage plans may provide additional coverage, but the benefits are generally limited.

Veterans benefits: Veterans may qualify for home care services. To find out whether you’re eligible, go to va.gov and search for “home care.”

Long-term-care insurance: Few people have long-term-care insurance, but if you do, it can help cover some of your costs. Check the policy’s elimination period; most plans don’t kick in for 30 days or longer after the need for care starts. And be sure to understand which specific services are covered, as well as how claims are reimbursed, says Steve Gaito, a certified financial planner in Raleigh, North Carolina.

Medicaid: Under the current rules, if you are on Medicaid, you may be eligible for funded home care services through “self-directed care.” And in some states, you might be able to bring in a family member as a paid caregiver. Bear in mind, if you think you or your loved one will need Medicaid coverage, eligibility rules generally have a five-year look-back period; it can be helpful to consult an elder-law attorney familiar with the policies in your state.

Out of pocket: If you’re paying for care on your own, median rates for a home health aide run $33 an hour, according to a 2023 survey by Genworth, which is up 7 percent over the previous year. Those amounts vary depending on regional costs and caregiver availability, with median rates running as low as $22 an hour in Mississippi and as high as $40 an hour in New Hampshire and Vermont. In general, personal care aides are paid a bit less, about $30 an hour.

If you need more information

Local government, nonprofit groups and community networks may provide support and information. Many groups offer free or low-cost help that can supplement in-home care.

A good first stop is your local Area Agency on Aging, says Danielle Miura, a certified financial planner in Ripon, California, who focuses on caregiver needs. The agency can direct you to organizations that provide services for older Americans — everything from home care assistance to home-delivered meals. (Depending on your income, you may be asked to pay a sliding-scale fee for some services.) To find the area agency near you, go to eldercare.acl.gov.

You can also find resources at the websites of the Family Caregiver Alliance and the Caregiver Action Network. And AARP has listings of services in Family Caregiver Resource Guides for each state.

For more direct community assistance, you can turn to websites such as Lotsa Helping Hands and CaringBridge. These platforms allow friends, family and volunteers to schedule times to drop by or bring meals, or perhaps take the person to medical appointments.

And if you’re fortunate enough to live in a NORC, or naturally occurring retirement community, you may have some built-in support. NORCs are neighborhoods with a large proportion of older residents, perhaps an urban apartment building complex or a subdivision. NORCs typically offer services such as meal drop-offs and rides to doctor appointments. To see whether you live in one, contact your local Area Agency on Aging.

Hiring an aide? Here’s what to ask.

To find the right caregiver, it’s best to conduct multiple interviews with candidates. “Seeing someone once may not tell you enough,” says Miura. The conversations can give you a clearer idea of the caregiver’s personality and attitude. Here are key topics to discuss.

Do they have credentials, and are they valid and up-to-date? States have different requirements regarding how much training and what kinds of credentials caregivers need to have, with many requiring certified nursing assistants, for example, to pass an exam to demonstrate competence. So make sure you know what’s required where you live. (To find the rules in your area, check with your local Area Agency on Aging.)

Is the caregiver a U.S. citizen or otherwise legally permitted to work in the United States? And are they willing to undergo a background check? Noncitizens with green cards or work visas can legally work in this country as caregivers. But undocumented immigrants almost certainly do not have the government-issued identification they would need in order to undergo a background check and thus can’t be fully vetted.

How many hours of work are they looking for, and what sort of flexibility do they have? Many caregivers require a minimum number of hours per day, particularly if they have a long commute. But some may be open to working shorter hours, perhaps to fill in before taking on a longer commitment.

How many weeks of vacation do they expect? It’s important to discuss the caregiver’s requirements for time off, to avoid a last-minute scramble for a substitute. (Also discuss whether time off is paid or unpaid.)

Have they worked with a client with needs similar to yours or your loved one’s? You will want the caregiver to have experience with your family member’s needs, particularly if they have serious health issues or can be hard to please. If your loved one prefers certain foods, for example, is the caregiver willing to prepare them?

Do they have examples of how they improved a client’s living situation or helped them get a problem fixed? Ask the candidate to describe how they helped clients resolve issues or improved their care, says Tim Husted, senior vice president at CareLinx, a caregiver hiring platform. Perhaps they cleared away rugs that posed a fall risk, or helped a client call an insurance company to get a paperwork issue taken care of.

What do they find satisfying about the job? You’ll want to hear about their reasons for becoming a caregiver and about the aspects of the work they most enjoy and find gratifying. “I would look for someone who really enjoys helping another person and brings compassion to the job,” says Anderson, who also interviews fill-in caregivers for her client. “You don’t want someone who is just doing it for a paycheck.”

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