Erica Karp

Article Summary:

How you tell the good from the bad.

Choosing the Best Caregiver

People over 85 are the fastest growing segment of the population and many need help from a caregiver. But how can you tell the good from the bad? Reference and background checks are a given, but hiring the best caregiver requires far more.

The biggest mistake families make is to hire too quickly because they’re desperate. Many families are overwhelmed in trying to arrange or provide care for an elderly loved one. Care managers help them through the process. They can perform assessments, draw up care plans and even stay involved over the long term to help implement a care plan, and coordinate services. Family members who are unable to care for a loved one or who live out of town, for instance, often employ a geriatric care manager for a long period of time. The care manager acts as a surrogate family member who regularly checks to see how the aging relative is doing and changes the plan as the elder ages and needs more care.

Advice for families hiring caregivers:

Trust your gut
That’s the most important tool. If you have a funny feeling, trust it and don’t hire this person.

Go for test drive
Families often are too embarrassed to thoroughly probe a candidate’s background or put applicants through a few paces. Try to frustrate them just a little to see how they will react. For instance, keep a candidate waiting briefly and see if they get upset.

During the interview, ask lots of “what if” questions
… such as, “What if the elderly person in your care would not want bathe? What would you do?” Some stunningly bad answers may follow – from the ominous “I can get anybody to do anything” to the juvenile “I’ll call your daughter on you” to the downright negligent “If you don’t take a bath, I’m going to leave.” Candidates who are truly ignorant about working with the elderly will dig themselves a big hole fast.

Look for the lemon
You glean a lot from observation and knowing how to ask questions that illuminate personality deficits. Look for the problems. Dig to discover their strengths, personality and weaknesses and how they fit with what you are looking for.

Make a custom fit
Hiring a caregiver is not a one-size-fits-all situation. The personality of the caregiver should be one that the elderly loved one can tolerate. Some elderly clients really do well with a take-charge caregiver. People who are more independent bristle at that approach. Some people can’t stand having someone around who is a big talker. Others like that.

In addition to the right personality, the caregiver has to have the right abilities
A nice personality is a good start, but you also want to know if they can do the job – and prove it. For instance, when hiring a caregiver for a diabetic, ask a job candidate to detail a typical diabetic diet for the day or to demonstrate taking a blood-sugar reading.

Always call references, and keep them talking
Do not accept written references. Too many people list friends as bogus references. Develop your own screening tool to use when calling references. Always ask, “Would you hire this person again?” It’s not surprising for references to give a glowing review and then answer that question with: “No, I wouldn’t hire the person again because things were missing” or “She left my Mom alone.” Then, the real interview begins.”

The good news is that skilled, loving caregivers do exist. Families who trust their instincts and who employ a careful, strategic and thorough screening approach can find them. For many families, though, the best solution is to hire someone else to do the hiring.

It helps to have an objective, outside person helping with the process. Many families have never had experience hiring someone. An experienced person will be looking for the red flags.

Erica Karp is the principal and director of Northshore Eldercare Management, Inc., a private geriatric care management firm in Evanston, IL. She is also principal and director of Eldercare Guardianship, Inc., a not-for-profit corporation providing guardianship for older adults. Ms. Karp received her bachelor’s degree in psychology from the University of Illinois and a master’s degree in social work from Ohio State University. She is a licensed clinical social worker (LCSW) and a certified case manager (CCM). She is a former faculty member in the Gerontology Department at National-Louis University in Evanston, IL and a current board member of the Mental Health Association of the North Shore. For more information, visit

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