Costs and Other Concerns for Choosing Home Health Care

In this economy, there are all kinds of health care workers that are jobless. I have been very lucky to have found a woman, who is a CNA, to help me out with Mom. She was employed by the nursing home that Mom was in for a few weeks. They down sized, and she lost her job. I met her in the grocery store just before Mom came home. She offered to help out when I needed relief. I am paying her $8/hour, "under the table". She is a Godsend and now a good friend. I have her come in on 3 afternoons, when Mom gets home from daycare. I am now able to get dinner made, and actually eat with my husband a few nights a week. She is also very willing to help out on weekends if we want to go out, and I can't get a sibling to cover. There are a lot of nice people out there who are willing to help. I was very lucky to find her when I did. Ask around, you never know. I did speak to several people at the nursing home to get their opinion, and was pleasantly surprised to find that everyone thought very highly of this person. I hope all of you who need help can be this lucking in finding someone to give you a break.

we were forced to hire whoever the agency could provide due to the holiday and short notice of mom being released from the nursing home, now 2 weeks later we are not happy as a family with who has been assigned to us. How to handle getting a replacement that we would like to interview and decide if we want???

Very helpful article. Thank you, Carol.

We were forced to hire 24 hour care urgently 2 months ago for my dad. Hospice gave me a list of agencies and I went with one that they thought had good recommendations from other hospice patients. The first caregiver spoke very broken English. She stayed for only a weekend. On Monday a second caregiver came. She spoke good English but the first red flag for me was when she told me she wasn't used to family living in the same home as the patient. She also didn't plan to cook except for frozen dinners. The final straw came as I was trying to leave for work, she stopped me to say my dad told her she couldn't take a shower in his bathroom. I went into his room to talk to him and very quickly determined that he was confused. As I went to get the device to measure his oxygen level, I told her not to worry, that she would be able to take a shower, and that he was very confused so I was going to check his oxygen level. I went back into my dad's room and as I got in there, off SHE went into the shower, even after I had just told her he was confused. So instead of her caring for my dad while I went to work, I stayed with him until she was out of the shower. I voiced my complaints to the agency and they assured me that the next caregiver they were sending was one of their best. The next one came and had a very strong accent that my dad couldn't understand. He was in terrible pain at the time and hospice had given us Morphine to give him to relieve it. It took a few days for me to realize he wasn't taking anything for pain all day, despite the fact that he was in pain, because when she would ask if he wanted Morphine he thought she was asking if he wanted a muffin. I cooked all of the dinner meals for him because she ate frozen waffles, rice and chicken legs. I truly believe that if I weren't there to cook dinner, my dad would have rather gone hungry than eat that. Needless to say, the expense for the home care was not worth the care that was delivered nor the aggravation. We had asked when interviewing the agency what they did to try and match caregivers to patients and we were assured that they worked very hard to find compatible matches. That was not my experience with this agency. I finally told them we would no longer require their services and now they are harrassing us for payment. We still have no care notes for the "care" provided so that we can submit the bills for insurance reimbursement. I would be very careful when choosing an agency and make sure you stayed involved in assessing what care they are providing. I would never recommend this agency to anyone.

If you are unhappy with a particular caregiver, you need to let the agency know immediately so they can arrange for another caregiver to be there. You are NOT stuck with a caregiver once they start coming to your house. We have had a care agency coming in once a week to stay with my mom for about 2 years now. We have found excellent caregivers, and others who were not. Some clicked with mom, some did not. One agency would let me speak with a caregiver before they even came to the house....which I HIGHLY recommend, and I most certainly prefer. Another agency had the attitude that once a caregiver showed up you were responsible to pay them for that day even if you sent them home. Be real specific in asking questions before you hire an agency and make sure you get it in writing. One advantage of using an agency is that if you are away and have an emergency that delays your return home, as we have had happen to us, the agency can send someone there to take over. You will have to go through a trial run of several different caregivers before you find one who clicks. You are the boss in who is there, not the agency.

One thing you need to be aware of is that every agency has certain caregivers who will work round the clock. Some will only work weekends, some only work days, some only work nights, some only work x number of days in a row. This greatly complicates your life and will be a constant source of irritation for you if you only need the occassional help of a caregiver.

One thing you can do to help your loved one is write down the things you think a caregiver might need to know about their needs, likes/dislikes, habits, and personality issues that affect their care and leave this in a spot in your house that will be accessible for any caregiver who comes to your house. This can be brief, but will go a long way toward helping both your loved one and the caregiver to adjust. Imagine yourself just walking into a house to take care of a stranger and the things you would want to know about them. That will guide you in what to write.

Great discussion. This one is near and dear to my heart; I am a professional Caregiver. I like to sit and talk with the family first, before starting my caregiving assignment so I can know what they like, don't like, want, and don't want. Some families just want care, companionship, and comfort for the elder. Some want full housekeeping and meals, as well as the other. Some are so new they don't really know WHAT they want; they just know they need help. I've worked privately and with an agency. Still do both. I agree totally with suethequilter who advises writing things down. I love it when a family member or other caregiver leaves a list of "to do" and likes and dislikes for food, activities, etc. I've had to sort of feel my way around with my current Demenia client, and I find she LOVES looking at books with me and discussing them. I rely on her live-in caregiver's notes about food likes and dislikes. When I arrive, I love it if there is a note that says, for instance "Bed should be changed today. Please run the vacuum if you have time. Could you clean out the fridge?" LOVE it. Holiday care is something else. It hurts me to know how few seniors have family with whom to spend the Holiday season. But those I work with DO have family; they just won't do the personal care the client requires. They want the caregiver there during the family time, and then to take the senior home and get them to bed, etc. In this case - you better like your caregiver! :-)
I take notes during all of my shifts. It's a good idea to leave the "to do" and likes/dislikes list in a notebook with some blank pages so the caregiver can note what she did that was on the list, as well as anything important from the day or night. For instance - on my last shift a very ambulatory lady suddenly asked that I take her to the bathroom in her wheelchair. This was HUGE. Normally she gives me a curious glance as I follow her while she uses her walker. She thinks she is in need of no assistance (95 1/2, Dementia), and I joke about being her shadow. So, the family needed to know she asked for a wheelchair. That's just an example. I also note appetite, attitude, activities, etc, for the day. (Breakfast: Cream of Wheat, slice of toast, orange juice, coffee - ate 100%)
WOW I'm rambling.
OH one more thing. If your senior has Demenia of any kind, and has a family member on their mind - please let the caregiver know. I love it that I know all the kids' names and locations of all of my clients. I can then enter into the conversation OR use them as the reason I'm in the potty with the client. "Oh, you know how fussy Debbie is about you! She's worried that you might fall, so she hired me to stand by and help keep you safe. Debbie really loves you! You raised her well!"

Ruth, you are such an exception; you are like US--caregivers who are family, and you care like family does. I have learned so much from you this last year. Blessings to you, and thank you for all you do:)
I was glancing through our Penny Saver the other day, saw an ad offering jobs for caregivers. Requirements were 2 years "experience"--what the heck does that mean?-- and they were going to pay only $9.00 an hour! CRIMINAL!
Caregivers deserve much, much more than that. Demographically, this was more than a rip off to the caregiver.
Additionally "You get what you pay for". You may run into an occasional Angel who will work for that amount, but not often. We need respite and good help, but our loved ones and us don't need the aggravation of untrained "cheap" help.

Thank you, Christina28! I do care like family. Sadly; MORE than some family. Those types would never be found on a forum like this oneI have no idea what you could learn from ME, but I'm grateful that you say you have.. I recently interviewed for a position I would love to have but can't "afford". The pay offered was $10 per hour, increasing as the business grew. It was an AFH with 6 residents. Soooo... I am to work 6 times as hard, get a TB test, food handlers' permit, and take a week of training, to take a huge cut in pay? Eh. Nah. The agency I work for pays well. I really like private pay, not "only" because it's more, but because if the client wants her toe nails clipped I can do it! Likewise - if the family wants the client to have a Tylenol I can give it. That kind of thing.