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By hiring a private caregiver, you can often get a highly qualified professional at affordable rates. With the latest developments in licensing, insurance, and on-line resources, you might consider hiring a licensed CNA.

When considering a CNA, ask for the caregiver's license number, and check it out with your state's Department of Health, either on-line or by phone.

Licensing. Exams for CNA's have become standardized across many states. State licensing also includes law enforcement checks, with FBI checks as appropriate. Many states maintain easily accessible databases of licensees. License holders also have continuing education (CE) requirements.

Insurance . Professional liability insurance is now available for individual caregivers. Check that the person you engage has a professional liability policy. If your favorite caregiver doesn't have a policy, you might suggest that she obtain one.

Self-employed contractor. Much has been made about the risks of being an 'employer.' To stay clear of problems, use a licensed professional who offers services to the public as an independent contractor. Quoting the IRS: "the general rule is that an individual is an independent contractor if (the person for whom the services are performed) has the right to control or direct only the result of the work, and not what will be done and how it will be done or method of accomplishing the result ." Use a licensed professional who has the necessary training and experience to do the job.

Internet resources . Most states have on-line databases of licensed professionals, which provide the licensee's status. For those that want a more current background check than provided by the state licensing board, there are numerous on-line services. These typically charge nominal search fees.

Spot-checking. One of my clients' families had a motion-sensor video security system installed in the foyer. If desired, comings and goings could be monitored, spot-checked, or even communicated by email. The added advantage of that system was that, combined with cell-phones, it could be an entertaining form of communication. Of course this is only appropriate if used with discretion.

Affiliations . If you are planning to use a CNA extensively, check that she has back-up resources available. Many independent CNA's have good networks, including caregivers with prior hospital or other institutional experience. Some private caregivers have close affiliations with RN's. This can be especially helpful in complex cases.

Long Term Care insurance eligibility. Licensed caregivers are eligible providers under many LTC policies (including the AARP long term care policies offered through Genworth). Check with your agent or refer to your policy. You may be able to get more 'bang for your buck' hiring directly.

Financial & Quality advantage . By engaging a caregiver directly you can sometimes get professionals of caliber that you might not have access to through an agency, and at significantly lower cost.

The result. For short-term needs, or in transitional situations, using an agency may make more sense. For longer-term situations, the key relationship is between the actual caregiver and the care recipient. With the developments in licensing, the availability of professional insurance, and advanced technologies, private hiring can be a rewarding alternative.

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