My grandmother is 96-years-old. She's lived through both World Wars, the Civil Rights Movement and the inauguration of the first black president. She's seen it all. And while she's always had a graceful embrace for change, the one thing she would never accept was leaving her home. She's lived in the same three-bedroom house in Seattle that my father grew up in, and she couldn't imagine living anywhere else. But following the death of my grandfather and her own failing health (she's now blind in one eye) we didn't know if living alone was even a possibility at her age.
So, like the 40 million other families a year who are in need of finding non-medical care, we went through our short list of options: a nursing home, an assisted living facility or finding a way for her to stay in her beloved home with onsite care.
As an only child, my father was first in line to take over as a primary caregiver. While he was up for the emotional and physical challenge, his biggest obstacle was a geographic one -- he lived 2,500 miles away in Columbus, Ohio. As it turns out, this situation isn't at all uncommon. Since 1980, the average distance between an elderly and their closest adult child has increased from 32 miles to 56 miles (2013 Private Duty Benchmark Study). For my father, the only option was going to be finding the proper caregiving situation for his mom, so he took a leave of absence from teaching at Ohio State University, flew across the country and began what would become an exhaustive search for a caregiver.
Having heard horror stories about this process, I decided to fly up to Seattle to help my father (at the time I was working on a mobile payments startup in San Francisco).
Early discussions with my grandma made it clear that outside facilities were simply not an option. She was adamant that "over her dead body was she going to be put in a home." And studies suggest that she's in the majority with this sentiment. Since 1980, the average age of a senior leaving their home went from 74 to 90, and by 2030 over 70 percent of seniors will be living alone, compared to 40 percent today (2013 Private Duty Benchmark Study).
So the next step was to explore our in-home care options. We started with the old-school agencies, of which there are about 1,400 worldwide. And when I say old school, I mean old school. As a Gen Y active in technology startups, all I could see were inefficiencies. These brick-and-mortar storefronts were extremely paper-based (with file cabinets and pencil sharpeners) and took a very slow, hands-on approach to the whole process. These were the H&R Blocks of the home care world.
My personal biases aside, there were other problems with the agency model -- the costs were really high (with rates starting at $22-$25 hour), there were high hourly minimums and a lot of price ambiguity. And even if we were willing to pay, we had very little choice over which caregiver we were given. We could specify gender, but not much else; you were assigned a person and hopefully it was a good match.
At this point, my generational instincts kicked in and I turned to the internet. Craigslist was my first stop, but that didn't resonate with my father very much. Sure it's a great place to find some weights or a used Schwinn, but not the best resource to find someone to bathe and dress my grandmother. After seeing the variance in quality on Craigslist, we decided to move on.
Next, I looked into Care.com, which took a more high-tech, low-touch approach to finding caregivers by listing caregiver contact information online. Like other "digital native" Gen Ys, I could appreciate anything that was fast, efficient and flexible. So this sounded like something that might work. But with Care.com, we had the opposite problem. There were thousands of caregivers and not enough differentiating factors. We didn't know these people, and it was hard to identify the really good ones when all we had to go by was some text, a CV and a bathroom selfie. Just like Craigslist, there was no social validation within our personal network, and once we found a match we were on our own to manage them.
At the time, there were very few other places to turn so we went outside the system and found a nice young lady through my dad's church. She had no proper training as a caregiver (CNA, RN or LVN certification) but she was loving, responsible and a good cultural fit for my grandmother. And most importantly, she came highly recommended by a reliable source (she had cared for another senior member of my dad's church for many years and they adored her). Essentially, she was vetted for.
So finally, after a 10-day search process, my father flew back to his life and work in Ohio and I flew back to San Francisco. Then, an entirely new problem arose. My father became frustrated that he didn't have an open line of communication with our caregiver. As a result, we were in the dark about what the caregiver was actually doing day-to-day. Was she showing up on time? Was she taking care of the necessary tasks? How was grandma doing? How is her health and her mood? My father and our caregiver were constantly debating about hours and some days she would miss her shift entirely due to changes in the bus schedule (she didn't have a car).
Although we trusted her, we had no real idea about how this new relationship was working out, mainly due to the distance. The distance also presented a problem with payments, as my dad was sending checks across the country each week.
While I acknowledge that high-touch and in-person communication has its place, my generation's embrace of real time technologies can be an asset in situations where we need real time information on loved ones and distance is an issue. Services like texting, social media, iCloud, Dropbox and Google Docs gives us the flexibility to not only be present, but active participants in important decisions. So I recommended that my father use Skype or Facetime to check-in with our caregiver each day and stay in the loop. Even for a few minutes each day, it relieved a lot of the tension between my dad and our caregiver and give us all a little more peace of mind.
Following my experience with my own grandma, I discovered some key steps and helpful tools to make finding a caregiver a much more efficient process.
1. Do your homework:
Learn the difference between an Assisted Living Facility, a Nursing Home and the option of "aging in place." The option of having help at home is almost universally preferred, but isn't always the right choice. Here's an article and infographic I put together, comparing the three options: HomeHero Blog.
2. Utilize listing services and registries:
Using sites like Care.com and Grizwold, can save you money, but will require a little more of your time, as you'll be looking through a lot of profiles and doing the vetting of caregivers yourself. To ensure that your screening process is efficient, you will want to make sure you are asking the right questions, including less obvious ones like: "Do you have a smartphone?" and "Have you ever taken a TB test?" For a cheat sheet of interview questions go here: Seniors Resource Guide.
3. Manage payments for your caregiver online:
There are a number of web and mobile apps such as Venmo, Google Wallet or Chase QuickPay that are easily accessed and free, and can help you manage payments with your caregiver from far away.
4. Consider using a non-invasive in-home monitoring system:
MyLively and Care Innovations are examples of two inexpensive in-home monitoring systems that can increase the transparency between you and your senior loved one without making them feel like they're constantly being spied on.
5. Consider using a lightweight phone tracking system:
There are a number of online tools available that can help families manage independent caregivers through phone timesheet tracking, daily activity summaries and automated payments.
6. Consider hiring a Geriatric Care Manager (GCM):
A GCM is a social worker who helps families caring for seniors. Their services include in-home assessments, care planning and safety inspections. They are experts in their field, and I highly recommend hiring one for a one-time or ongoing consultation if your family is at odds about how to meet the needs of your aging parent. NAPGCM is a free online directory of care managers nationwide.
Kyle Hill, along with Mike Townsend, recently launched HomeHero, a suite of products designed to help families find, hire and manage in-home care for seniors.