The Family Caregiver Forum
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Welcome to the NFCA's Family Caregiver Forum - a place where all family caregivers can post questions, receive support and communicate with others.
rzxq2y
Posts: 1603
Joined: Jun 2009
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Monday July 12, 2010 11:03 PM
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You can get home health aides from agencies, or you can hire your own. The advantage of hiring your own is that you can screen them more thoroughly, but the trouble is that you have to do a fair amount of paper work, pay the aides social security tax, and workmens compensation insurance. Otherwise you can get into legal trouble that you do not want to deal with.
Home health care and home care sometimes are interchangeably used. But more recently home health care agencies means those providing skilled nursing care, including nurses, physical, occupational and speech therapists, and home health aides. Some even provide medical services/ Home care agencies are typically a clearing house of home care aides. For home health care agencies, Medicare does have a quality rating that you can find at
http://www.medicare.gov/HHCompare/Home.asp
When I was working full time, we at first used a small agency through a referral. Initially it worked out fine, but then we get an increasing number of no-shows. Fortunately I was able to work from home at that time. Needless to say, we stopped using that agency. We did interview a number of home care agencies afterwards, beside the question of whether the aides are bonded, whether they are trained, etc. we always ask them how they deal with no-shows. We also ask for references. Finally we sampled the agencies, which is somewhat of an investment. We hired some from an agency for a few hours to see how was their aid. Usually from which we can more or less tell the quality of the agency. Well, I never finished this process, because I changed my mind and retired to take care of my wife by myself.
It is difficult for the aide to figure out what needs to be done. I think that it is a good idea to have a caregivers manual detailing out what needs to be done and how. There is a thread discussing caregivers manual. Since my wifes speech is very hard to understand, I think that I need to finish my manual before I can try to hire an aide. My plan for the manual includes a DVD of our daily routine. This will help an aide on things like how to help my wife to and from the lift chair, in and out of the shower, take her to the from the bathroom, etc.
Best Regards,
Min-Shih
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heatherrose
Posts: 18
Joined: Jul 2010
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Tuesday July 13, 2010 1:20 AM
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This is a very good thread. Thanks for starting it, Dave.
I have a question: Have you found a difference in the quality of the aides that you have hired and paid privately versus the aides that have been paid for by government programs such as Medicare or Medicaid?
I ask because last fall, I went through a well-known agency to get an aide for my father. The first one sat on the couch watching TV. The second one called at the time she was scheduled to arrive, to tell me she would be over an hour late. The third one seemed good, but stole my father's insulin pens. These aides were paid by Medicare. Each day, I didn't know who was going to show up and it was up to the agency to assign someone.
Then I decided to hire privately. I hired someone who used to take care of my friend's husband. I was paying her $20 per hour, even though she was not certified or skilled, and she ended up telling me she was coming for 4 hours each day, when she actually was there for 1 hour or less. I knew that was a lot of money to be paying, but I thought I had found someone I could trust, since I knew her through my friend.
I don't know if it matters whether you hire someone through an agency or privately, because I think you may get the same quality of aides either way.
How do you find someone you can trust?
Are the agencies cooperative if you ask them for references or for the background check on an aide?
It's very scary to me to let a stranger into your home because you really don't know what lurks behind anyone's facade. I had a plumber who seemed like a sweet, old man, and one day I heard on the radio that he had been arrested for raping a 9 year-old girl whom he had been molesting for years. I almost had a heart attack. I would never in a million years have thought that this man could have done such a thing. It was true. Ever since then, I have been ultra-wary about people because you just never know what someone is capable of.
Edited: Tuesday July 13, 2010 at 1:24 AM by heatherrose
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rzxq2y
Posts: 1603
Joined: Jun 2009
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Tuesday July 13, 2010 2:14 PM
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I hired a part time student through a friend for quite some time. She was very good, always on time and very helpful to my wife. But we also treated her well. When my wife was resting, we made sure that she can study and do her home work, rather than miscellaneous house chores. She took the bus to our place and then took the bus to her classes. When the weather is bad, I went to her place to pick her up before going to work and took her to school afterwards. I also have a friend who used to people privately to take care of his wife during the day, until home care was approved by workmens comp and they had to hire from approved agencies. She was disabled due to a very unfortunate incident at work. He told me that he can was able to get better quality people privately then through the agencies. With private hire, you can interview and observe them more thoroughly.
The people available for private hire and the pool of aides working for agencies are somewhat different. You can find students, retired people who are able and willing to work and wants to have some extra income, empty nest mothers who may not want to stay in the house all day, etc. But in general what you see, whether private hire and through an agency, is a sample of the society, from those who really care and do a great job to those who are dishonest and only care about money.
Heatherrose, I am sorry to know that you certainly have had more than your share of bad luck with home care aides. I would question the mental state of the person who would stand in the kitchen and wipe the sink all the time. About the one you knew through your friend, may be she has successfully deceived your friend, or maybe she has changed. The plumber story is really really to scary. If you worry about letting a stranger into the house, perhaps setting up surveillance camera(s) would be a good diea.
Best Regards,
Min-Shih
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myonly
Posts: 311
Joined: Apr 2010
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Tuesday July 13, 2010 4:08 PM
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A skilled, compassionate aide is worth their weight in gold. Unfortunately, we have never found one that doesn't take advantage once they get "comfortable".
Yesterday afternoon, I had to go into Philadelphia to pick up meds from the pharmacy for our satellite office. On the way home, I swung by our house unannounced to check on things. I HIGHLY RECOMMEND DOING THIS PERIODICALLY IF YOU HAVE A HOME HEALTH AIDE!!!!!! It was 3:30 pm and the aide was not there. DH said she "left to pick something up for me", and I found out last night when I got home that she never returned. I reported this to the agency. Now AGAIN TODAY, I stopped home at 3pm, and the aide has been gone for over 2 hours (she left just after lunch per the kids). I phoned the agency and asked them to arrange for a new aide as soon as possible.
Leaving my husband alone for more than 20 minutes is unacceptable!! I speak with the aides OFTEN and reiterate that his judgement is poor, and that to tell me "well, your husband said it was okay!" is not acceptable. For any situation! They have my cell # and are to call me regarding any schedule change/need to leave early/any and all anomalies during the day. This present aide we've had for 11 months, but unfortunately, the pattern has held true with every aide we've ever had. The most common problem we encounter has been this - the aide leaving my husband alone for hours without reporting their absence or checking with me first. We've had stuff stolen, and the lawnmower borrowed and broken (by this present aide as well - that's why today was the last straw!).
Between all this and then the car accident with the deer, the rainwater pouring into the passenger area of the van, and today's stress at work, I'm coming undone. I've been really proud of myself in trying to adopt healthier habits. I've lost 30 pounds since March and have been exercising. All I want to do right now is eat a dozen donuts!!! I told my co-workers this, and they're going to keep me in a muzzle so that I don't fall off the wagon. But something's gotta give here! The circus just got crazier...
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heatherrose
Posts: 18
Joined: Jul 2010
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Monday July 19, 2010 3:33 AM
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I am going to be interviewing a retired gentleman who is looking for work. He worked as a city bus driver for many years, and retired and drove the buses that drive the elderly and disabled around the city. He said he had to stop driving the bus because it would affect his Social Security income if he worked too many hours. He does not have any experience as a home aide, though. So, I'll have to see what he says when I speak to him. I think it would be better if I found someone who has already worked as a home health aide. Basically my father needs someone who will make sure he eats his meals and takes his medications. It would be great if I could find someone who could drive my father to doctor's appointments, because that is the hardest and most time-consuming part for me.
It seems that a lot of it is luck in finding an honest, trustworthy aide. Even though one of my father's aides had a lot of experience and came from a reputable agency, she is the one who stole his insulin pens. And even though another one took care of my friend's husband, she was the one who washed the sink the whole time, and who lied about how long she was there. So, even good references are no guarantee that the person will do a good job.
It's also going to be hard to keep an aide when my father keeps on telling them that he doesn't need or want them there. Plus, he is not pleasant to be around due to his refusal to shower. He won't let an aide help him shower or shave either.
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Chipper
Posts: 3
Joined: Jul 2010
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Monday July 19, 2010 2:32 PM
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Tired Dave,
Your tips are excellent. I have dealt with private home health aides and agencies with mixed results.
The private aids usually worked out in the beginning, but care detiorated over time. Perhaps it was burnout or maybe they just thought they could get away with more as time went on. I would say, if the disabled person requires 24 hour paid care, keep several caregivers on rotation and available.
The first agency was the worst. One caregiver had her excon boyfriend spending his nights with her while she was on duty and emptying out the refrigerator, driving the car, etc. Another one was homeless, just released from a psychiatric hospital!
The agency that my exH uses now is quite reliable. There are still issues with no shows, tardiness, drug use, but it is by far the best agency he has used, and many of the caregivers have been good.
Very important--treat your good caregivers with compassion. Write out clear instructions.
-------------------------
Former caregiver to two women with Alzheimers (now deceased.) Spousal caregiver 12 years, now divorced.
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heatherrose
Posts: 18
Joined: Jul 2010
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Friday July 23, 2010 11:39 PM
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I have serious reservations about agencies. This week, I interviewed a couple of potential aides, and did some investigations and background checks. There is a lot that needs to be checked out about a person who is being entrusted with the care of a loved one and who is going to have access to your loved one's home. I do not have faith in an agency to do a thorough enough background check and investigation. First, to do a proper background check, it costs money. There are internet services but they are not thorough and do not pick up a lot of criminal history. To truly get a thorough criminal background on someone, you need to either hire an investigator, which costs over $100, or you need to know exactly how to investigate and find criminal records, such as arrests, case dispositions, etc.. Most people don't know how to do this.
Besides a background check, it is very important to check references, including personal references. Checking past employers is not very productive because they will only tell you when the person worked for them, and usually will not give you any other information (unless you call a family that the person worked for, who may give you more information).
Even after doing all that investigating, there are sometimes less obvious red flags that an agency may not pick up on. For example, what if your investigation reveals that the aide has financial problems? If someone is in deep debt or bankruptcy, could that person be more motivated to steal? Even the most honest people can be tempted when desperate.
The good thing about an agency is that they are insured, and you have some recourse if there is a problem. You also can tax deduct payments to a licensed agency. When you hire privately, you have to deal with being an employer, or else have to pay someone off the books. If something goes wrong, you have no recourse. You might pay less for an aide you hire on your own, but the ultimate cost could be greater.
So, it seems there is no ideal solution when it comes to hiring an aide.
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Tigger
Posts: 44
Joined: Jul 2010
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Thursday July 29, 2010 1:49 PM
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One of the ways I paid for nursing school- many years ago now- was as a home health aide. Since I was certified as a CNA, I had no problems with providing my certification card to verify that I was qualified. The agency I worked for could send me just about anywhere- private home to hospital and nursing care facilities.
One of the things that was always a requirement was log signatures that needed to be accompanied by vitals. In hospitals, you woke the patient up to take vitals and entered to legal chart. In a home, it was a way for the agency to verify that you were checking on the patient regularly. Generally, I was called in to provide care in a home short term after surgery or acute illness.
You should never be afraid to ask your aide just about anything. If you want to hire privately, consider putting a notice up at local nursing schools. Students are always open to a part time job, especially if it is flexible.
The agency that I worked for- So California- differentiated between nursing assistance and home care assistance. An HCA often did house work in addition to providing care. An HHCA (Home Health Care Assistant) was expected to take medical action (like vitals) and chart but at a high level. Basically, they could provide some measure of bedside care and personal care. A CNA (Certified Nursing Assistant) was expected to provide all bedside care and personal care to include showering or bathing as appropriate, wound care, etc. A CNA generally won't also assist with housekeeping and generally an HHCA won't either. The caveat there is that they will change bedding and such. But the focus is always on the patient and the patient's direct needs.
Retired and former nurses can be great aid partners. If you can find one of these angels, you are in luck. Also, people with residential experience working with developmentally disabled adults are great. Generally an RST (Residential Service Technician) is accustomed to providing a very broad range of care.
Hope this is helpful!
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