The vast majority of frail older adults live at home — not in independent or assisted living and not in nursing homes. So, If you’re managing your parents’ care, sooner or later you’ll come up against the question of whether you should get them more help at home and how to go about it.

Hiring someone to help your parents can be expensive and awkward.  It’s often hard to get your parents to accept a paid caregiver into their home and even harder to find a person you can trust.  But, at the same time, it feels like doing so is the only way you can keep your parents where they are.

And, keeping them at home very often feels like the least heartbreaking way to proceed.

So, as is often the case with daughters, we try to perform miracles.  We try to make our parents safe and happy in an environment that’s not really set up for their frailty or inability to get around.

And, then we feel guilty that we are failing…

But remember, you’re not failing! I promise. You’re up against a problem that’s too hard for any one daughter to solve by herself.  Our typical homes and communities are not set up to support frail older adults.

So, when you are beating yourself up just remember that you’re trying to do BY YOURSELF something that whole senior housing communities and nursing homes are set up to do.

There are some real advantages to hiring someone to help if you can find the right person.  It can reduce your parent’s social isolation, give you a break and at the same time provide a more neutral perspective on your parent’s situation – a paid helper without family baggage can be good for everyone.

Paid help at home is often referred to as “home care,” or “personal care.” Home care can help your parent with a wide variety of tasks ranging from the really personal activities such as bathing, dressing or eating, to the really practical like driving, shopping, food prep, and light housekeeping.

One point of clarification around something I find incredibly confusing: there is a difference between the terms, home care and home health. Medicare-covered home health refers to physician-ordered medical services at home delivered by medically skilled professionals like nurses and therapists. In contrast, home care is not medical and it isn’t a covered benefit under Medicare or other health insurance.

Most of the time families pay for home care out of their pockets.  (Or, more rarely through long-term care insurance or Medicaid)

If you’re going to hire help for your parent, it pays to take the extra time to learn how the system works.  Here are the four steps to follow that will increase your odds of success.

Step 1: Consider Going Through a Home Care Agency

Like Medicare-covered home health, home care is often provided by agencies (often the same agency will provide both).  You can get a list of home care agencies in your area by visiting one of my favorite resources: the Alzheimer’s Association Community Resource Finder.  

This same website has a great guide for interviewing home care agencies and the questions it provides are exactly the right ones to ask.

Here’s the problem though.  When I put my zip code into the community finder, 66 DIFFERENT AGENCIES popped up.  Am I supposed to interview all 66 agencies?  Not likely.  How do I whittle that 66 down to the 4 or 5 I should interview?  Well, I wish I had an answer for that question.  A friend of mine who has worked in this field for 30+ years said to me, “Even I wouldn’t know where to start.”

If you have any thoughts or views on this problem, let me know and I’ll investigate and get back to everyone. In the meantime, call every girlfriend you have and ask her if she has recommendations or knows someone who might.  Check out reviews on Yelp and Angie’s List.

Our daughterhood team and advisors are working on ways that the daughterhood community can fill this gap!  

Step 2: Be Realistic About Working With an Agency

Without question, one of the biggest frustrations I’ve heard voiced by friends, colleagues and readers is that working with an agency is really hard.

There’s too often a huge mismatch between what you want and what a typical agency can usually provide.

Understanding this mismatch and adjusting your expectations is key to getting the most out of an agency.  

Because it’s our parents, of course we hope that the agency will send us a senior care version of Mary Poppins who is well paid and very happy to come in for just an hour or so to help out.

The reality, however, is that the agency is paying around $10 per hour for someone who relies on public transportation, is working for multiple agencies and/or multiple jobs, and may or may not be getting benefits, supervision, or training.

It’s just important to be realistic about what’s possible under the agency-model of home care, and to know what your absolute must-have needs are.  The more home care hours you buy from the agency, the greater its flexibility in scheduling the times that are your highest priority. Plus you’ll also stand a better chance of getting the individual aide you prefer.

Step 3: Consider Avoiding an Agency

Because of the limitations of the home care agency model, many people prefer to avoid agencies and find a home care aide on their own.  The reward of this approach can be high – in that you have a greater opportunity to choose someone who may, in fact, be very special and a great match for your parent — but the challenges are high too.

This option requires you to find the person without the benefit of an agency and to handle all the screening and scheduling yourself. In short, you have to be the employer with all that entails, and there’s no backstop on training or quality.

There are also internet-based companies that create marketplaces online with varying degrees of management and oversight.  For example, allows you and prospective caregivers to meet online and then provides follow-up background checks and eventual bill payment.

If you live in the West or Southwest, check out Carelinx and Honor and let me know what you think.  It appears they’re taking steps to pay aides more. Also, I like that Honor will create a care plan and provide care managers.  And, Honor and Carelinx seem to be doing a good job of balancing the need for in-person communication and digital communication (something that traditional agencies are struggling with).

For the more routine tasks like driving, groceries, and home upkeep, consider using services that aren’t necessarily geared towards older adults — like internet grocery delivery, online transportation services (like Uber), unconventional service providers like TaskRabbit or Amazon Home Services. A friend of mine told me that his grandmother has a great relationship with an Uber driver in her community that’s worked out really well for them.

Step 4: Manage it All

In the end, the toughest thing about bringing in home care is that – most of the time — YOU still have to manage it. I was talking to someone recently who told me that his wife gave up a really good job just to “manage it all.”

Why? Well, it’s not just the day-to-day tasks and home-care workers you’re managing.  It’s also the crazy medical care system, the legal complexities and many other logistics.  And, you’re trying to do all of this while minimizing expenses and family conflicts.  This is quite a lot to carry on your shoulders.

As best as I can tell at this point, there’s really only one solution and that’s to hire another daughter…and the closest thing to that is an Aging Life Care Professional, usually a social worker or nurse who will take on these more complex and multi-dimensional responsibilities.

Even if you can’t afford for one to be your full time manager, please pay for a few hours to at least get a consultation and care plan.  Also, they can help you narrow those 66 agencies down to 4 or 5.   To find one of these professionals, go here to the directory, type in your zip code into the “radius search” and then just hit “search” (ignore the confusing request for “member choices”).

Taking these foundational steps of care planning and professional recommendations will make a huge difference in the end and your sanity is worth it.

If you’ve tried to find help at home for your parents, we want to know what has worked and what hasn’t. Please join the conversation here at daughterhood!