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Caregiver resources · Escort and hiring carers

Escort Services and Hiring Care Help

Subsidised services have waiting lists and family members have full-time jobs. Many families end up filling the gap in between with money. The private-pay options run from escorts at a few hundred dollars a visit to live-in domestic helpers, and they are very different in nature. If the wrong type is chosen, the money is spent and the gap remains. This page first sets out a map of the options, and then looks at escorting to medical appointments, which looks simple but is not.

What the four private-pay care services are for

Before deciding which type of help to hire, it is worth working out what the gap at home really is: is it a lack of help for particular hours (nobody to look after the older person for certain hours), a lack of nursing skills (someone is at home but does not know how to handle things), or a need for round-the-clock help? These three situations match different services, as below:

Escort
This service is charged per visit and is mainly used to cover the half day of a follow-up appointment. It suits an older person who has difficulty getting around when family members find it hard to take leave to go with them. The real requirements of an escort service are quite demanding, as explained in detail below.
Hourly care worker
This service is charged by the hour and suits filling a gap at fixed times. Examples are a few hours in the daytime when someone needs to look after the older person or help with bathing, or half a day at the weekend so that a caregiver living in the same home can rest. If the care worker has professional training, skilled tasks such as lifting and feeding can also be handled properly.
Live-in domestic helper
A domestic helper is paid monthly and suits families who need someone present around the clock. A helper’s strength is looking after daily living and keeping the older person company. If lifting, feeding an older person with swallowing difficulty or handling behavioural problems is involved, these skills are ones most helpers have not been trained in, so the family needs to bring in a specialist or arrange training for the helper.
Private carer / nursing staff
This type of service has the highest hourly rate and is for clinical nursing needs, including wound dressing, catheter care, injecting medication and follow-up after surgery. These medical procedures should never be left to people without the relevant qualifications, so the higher fee is reasonable.

What escorting to appointments actually involves

Many people think “finding someone to go with Mum to her appointment” is just a matter of riding along and sitting beside her, but the real process is much more involved. Before leaving, the identity documents, medication bag and appointment slip are checked. The trip there and back means handling transport and wheelchair transfers. On arrival the escort queues for a number. Then, in the few minutes with the doctor, the escort has to explain the older person’s recent condition clearly and write down the doctor’s instructions accurately. After that the medication is collected, and finally the older person is taken home and the family is updated. The parts most likely to go wrong are the physical transfers in and out of the wheelchair, and passing on information in the consultation. Older people often find it hard to describe their illness clearly, and if the escort knows nothing about the older person’s recent condition, the visit can easily be wasted.

Whichever route is used to hire an escort service, a handover beforehand should never be skipped. The family should write down on paper the older person’s recent changes in health, the questions to ask the doctor and the main points of earlier appointments, and give it to the escort to carry, so that the appointment does what it should.

Questions to ask before hiring care help

  • Has the person had formal care training? Which organisation trained them? (This matters especially if the older person needs lifting transfers and special feeding.)
  • Has the person looked after similar cases before? (This includes older people with a similar illness and a similar level of physical dependence.)
  • Which tasks does the fee cover? How are overtime, public holidays and last-minute cancellation charged?
  • If the carer is ill or something unexpected happens, is there a back-up person who can step in?
  • Is the person hired through an agency or privately? If through an agency, is there service follow-up and a complaint procedure?
  • Never decide on price alone. If the hourly rate is clearly lower than the market rate, those services often lower their standards in staff training or back-up support.

Other sources of support besides private-pay services

Before deciding to pay out of pocket to fill the care gap, two things are worth checking first. The first is that government-subsidised community services (such as day care centres, residential respite and integrated home care services) may already take some of the load, at a much lower cost. Many families are in fact eligible and do not know it. For details, see day care centres and respite. These services need an application through the standardised assessment, as explained in standardised care need assessment and waiting list for elderly services. The second is that if the care gap is long-term and covers the whole day, the total monthly cost of piecing together private-pay services can come close to the monthly fee of a private care home. When the cost reaches that level, the family should put a care home into the comparison and weigh all the options, and not keep paying by the hour to fill gaps with no end.

Other kinds of system support besides care help, such as financial allowances, service assessment and arrangements for the transition after discharge, can be found in the overview of caregiver resources.

Isn't an escort just someone who goes along on the journey?
No. A full follow-up appointment involves many steps. Before leaving home, the identity documents, medication bag, appointment slip and wheelchair are prepared. The older person is helped in and out of vehicles and between seats on the way there and back. At the hospital, the escort queues to take a number. In the few minutes with the doctor, the escort helps the older person to describe how they have been and writes down the doctor’s instructions. Finally the medication is collected, and after returning home the family is told in detail what the doctor said. Physically, transfers between the vehicle and the wheelchair are the most demanding part. For communication, the few minutes with the doctor are the most important. Older people often forget or find it hard to explain their condition clearly, and whether the escort knows about the older person’s recent condition beforehand decides directly whether the doctor receives accurate clinical information.
Can a domestic helper look after an older person?
It depends on how much care the older person needs. For ordinary daily living, such as cooking, cleaning the home, keeping company and light support when walking, most domestic helpers can manage. Lifting and transfers, handling behavioural problems in dementia and feeding an older person who has a swallowing risk are professional skills, however. Attempting them without training is hard work and can injure the helper or the older person at any time. A safer and common arrangement is for the helper to take care of daily living and for trained people to do the technical tasks. For a high-risk procedure such as bathing, for example, a trained care worker can be arranged to help at home, or a therapist can first demonstrate the correct method in person and the helper can then follow it. In addition, the employment contract states that the helper’s duties are those of a domestic helper, so before asking a helper to look after an older person who is highly dependent, it is wise to assess carefully whether the workload is already beyond what the helper can manage.
How do I tell which tasks need a trained person?
The dividing line is quite clear: anything where one wrong step leads to immediate danger is a technical task. A mistake in a lifting transfer can cause the older person to fall or the caregiver to strain the back. Wrong feeding technique in swallowing difficulty can cause choking or aspiration pneumonia. Poor wound and catheter care can cause infection. Poor handling of an agitated person with dementia can make a conflict worse. These high-risk tasks should be handled by trained care workers or health professionals, and daily living tasks are shared by family or the domestic helper. Dividing the work this way makes sure that the money is well spent.
After someone is hired, can the family stop being involved?
No. The family’s role changes and does not end. After hiring, the family still has three core tasks. The first is handover: explaining the older person’s routines, restrictions and medication arrangements clearly. The second is observation: watching whether the quality of care has dropped and whether the older person’s health has changed. The third is decision-making: follow-up appointments and changes to the service are in the end for the family to decide. The most common problem is that the family thinks hiring someone has settled everything, and notices only months later that the quality of care had already fallen a long way. Visiting regularly in person remains the only reliable way to make sure the service stays at a good standard.

Related information

Check subsidised options first

Technical care tasks

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.