Finding a caregiver is one of the hardest jobs a family faces after a stroke or brain injury. You may be tired, short on time, and unsure who to trust in your home which are all completely normal.
But making sure you get the right help matters for two big reasons because 1) it protects your loved one’s safety and recovery and 2) it protects you as research shows that many internal family caregivers experience burden, depressive symptoms, and lower quality of life.
The good news is that you do not have to figure this out alone.
In this article, we will take a look at what kind of help you should look for, where to find it, what to ask for before you hire, and most importantly for many, how families pay for care.
Table of contents
Step 1: Decide what kind of help you need
One of the first things you need to figure out before looking for a caregiver to help is determining what you need. So before you search, write down what your loved one needs help with.
A clear list makes every later step easier and it also keeps you from paying for services you do not need.
Most needs fall into a few groups, based on how the National Institute on Aging describes in-home services:
- Health care support: nursing care, medicine management, or therapy at home.
- Personal assistance: help with bathing, dressing, grooming, and moving around.
- Household help: cooking, laundry, cleaning, and shopping.
- Companionship: someone to visit, talk, and keep your loved one company.
Then from here you can determine which hours will you need coverage. Do you need a few hours in the morning? Overnight cover? Someone for appointments? Your answers will tell you whether you need a skilled nurse, an aide, or a companion.
If you are unsure where to start here, ask your loved one’s doctor or therapist what level of help they recommend. A hospital social worker can also help and our guide to leaving the hospital after stroke can help cover what to ask before discharge.
Step 2: Know where to look
When you are trying to find a caregiver you have more options than a quick web search.
Start with people who already know your area as well as your loved one, for example:
- Your care team. Ask the doctor, rehab therapists, or hospital case manager for names. They often know which local agencies are reliable.
- Your Area Agency on Aging. The Eldercare Locator is a free public service from the Administration for Community Living. Call 1-800-677-1116 to find local programs.
- Home care agencies. An agency hires, screens, and schedules caregivers for you. If one caregiver is out sick, they usually send a replacement.
- Independent caregivers. You hire this person directly, often from a referral. This can cost less, but you take on more of the screening and backup planning.
- Friends, neighbors, and faith communities. Word of mouth is useful. A stroke support group is another good place to ask what worked for other families.
- Veterans programs. If your loved one is a Veteran, call the VA Caregiver Support Line at 1-855-260-3274.
Don’t wait until you’re exhausted or overwhelmed to ask for help. Start your search early as good caregivers can often have waitlists.
Step 3: Ask these 8 questions before you hire
The National Institute on Aging offers a worksheet of questions to ask before hiring a care provider. It also advises getting as much information as you can before you sign an agreement.
Use these questions as a starting point:
- What training do you have? Ask about stroke or brain injury experience, not just general care.
- Are you licensed or certified? Check any credentials with your state agency.
- Can I see references? Call at least two and ask what the caregiver did well.
- Do you run background checks? Agencies should explain their screening. For independent hires, ask permission to run one.
- What happens if you are sick or late? You need a backup plan before you need it.
- How do you handle an emergency? The right answer includes calling 911 and contacting you.
- What is the full cost? Ask about hourly rates, minimum hours, and any extra fees.
- Can we do a trial period? A one or two week trial lets you see how your loved one responds.
Trust your gut during the interview and watch how the person speaks to your loved one, not just to you. For some additional questions you might want to consider, check out our article 20 Questions to Ask When Interviewing a Caregiver for a Loved One
Step 4: Look for a caregiver who supports recovery
Many families focus on safety and skip this step but finding a caregiver that supports recovery may be the most important one for long-term progress.
The brain changes through repeated, meaningful practice with a process called neuroplasticity. A caregiver who does everything for your loved one keeps them safe today. But it can also take away daily chances to practice.
Look for someone who:
- Lets your loved one try first. Buttoning a shirt or stirring a pot counts as practice.
- Offers just enough help. Assistance can bridge the gap to independence. It lets your loved one rehearse a movement they cannot yet do alone.
- Follows the therapy plan. Share the home program from your loved one’s therapist, and ask the caregiver to cue it.
- Celebrates small gains. Reaching a little farther or needing a little less help is real progress.
Your caregiver does not need to act as a therapist (you can read our post on supporting home practice without becoming the therapist).
Step 5: Understand who pays
When finding a caregiver, cost is often the biggest worries for many families. Plus coverage ruyles can be strict so be sure to check before you assume.
Below are some basic guidelines but be sure to check with your individual plan and ask if there are any other assistance programs available for your individual circumstances.
Medicare covers some home health services, such as skilled nursing, therapy, and some home health aide help. Your loved one must need part-time skilled care and be homebound.
Medicare does not pay for 24-hour care at home and it also does not cover personal care like bathing or dressing when that is the only care needed.
Other options to consider include:
- Medicaid programs. Some families qualify for Medicaid home and community-based services. Rules and waitlists differ by state, so ask your Area Agency on Aging.
- VA benefits. The VA offers training, support, and in some cases respite care and a stipend for family caregivers.
- Long-term care insurance. Check your loved one’s policy for home care benefits and a waiting period.
- Private pay. Many families combine paid hours with help from relatives.
Ask a hospital social worker or your local Area Agency on Aging to walk through what your loved one may qualify for and what is appropriate for your individual circumstances.
Moving forward
Finding a caregiver takes time, but you can break it into small steps. List the help you need, ask your care team for referrals, and interview with the questions above. Then start with a short trial.
Recovery has no expiration date, and the right caregiver can help your loved one keep practicing toward more independence. If you are looking for a caregiver or considering the option try one step: call the Eldercare Locator, or ask your loved one’s therapist, “Who do you recommend for in-home help?”
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Here are some additional articles you might be interested in:
- How to Care for a Stroke Patient at Home: 10 Essential Tips for Caregivers: Get practical, day-to-day tips for safe and supportive care.
- How to Support Stroke Recovery Home Practice as a Caregiver Without Needing to Become the Therapist: Learn how to help with practice without taking on the therapist’s role.
- How to Help Someone Who Had a Stroke: A Guide for Caregivers and Family Members: See simple ways family members can support recovery.
- How to Find the Right Stroke Support Group Near You or Online to Support Your Recovery: Connect with others who understand what you are going through.
- Leaving the Hospital After Stroke: How to Navigate the Next Steps in Recovery: Know what to plan for before and after discharge.
