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A bit unusual, I guess. We were approved for a home aide for 7 hours x 7 days/week. But there is not that much care needed currently. Maybe there will be in the future. Plus, it's a small apartment. The agencies say they will not do less than 7hrs x 7 days. We probably need 4 hours 3 days a week. What do we do?

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Let the caregiver sit and read a book.

Let the caregiver do a puzzle with your loved one.

Let the caregiver take your loved one for a walk outside.

We gave ours the WiFi codes so they could study for their college courses. One just got her RN degree. One got her BS degree in Social Work.

Let them do laundry.

Have them do crafts with your loved one.

Some days they will be short staffed so you won't get anyone even though you are approved.

They can change the bed and wash the sheets once a week.
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Not unusual at all.

Like you, we thought a caregiver for 4 hours, 3 days a week for my parents would be all we needed.

But soon that changed to 5 days. And as their dementia progressed, we continued to add shifts. In less than two years we needed 24 hours of care.

Light housekeeping was added. Meal planning. Med organizing. Grocery ordering. Laundry. Closet organizing. Cabinet organizing. Nail care. Help with puzzles. Help with eating. Then help with just about everything.

Downtime was spent in an extra bedroom, but “at the ready.”

We were relieved to have someone there.
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Things can change on a dime. Don't give up what you have, you might not get it back when you do need it. You are in a good situation, keep it that way.
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Take it 🙏🙏🙏
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The agency already told you the rules, so just take the aid. This is our Government at work. It's all so big and so onerous that there aren't ways for them to easily adapt. Start thinking. You may find some things for them to do. Meanwhile you can give those workers a rest between laundry, cleanup, getting lunch, maybe even helping you downsize and organize a bit.

You have tried to be truly honest. So good on you. On you go.
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The aides that come into the home are probably Home Health Aides (HHA). They are there for the client. You should be able to keep them busy for an hr. If this is not for you, run an errand or just take a walk. Here are the duties of an HHA.

Duties and Responsibilities:
1. Assists with personal cares such as bathing, dressing, grooming, feeding, toileting, routine 
catheter and colostomy care, ambulation, transfers or positioning.
2. Performs simple dressing changes that do not require the skills of a licensed nurse.
3. Assists with physician-ordered medications which are ordinarily self-administered under 
the direction and supervision of the Registered Nurse. Typically, this involves reminding 
the client of the specific times to take their medication.
4. Performs simple procedures as an extension of therapy services under the direction and 
supervision of the therapist.
A. Range of motion exercises
B. Home exercise program
5. Reports changes in the client's condition and needs to the Registered Nurse.
6. Performs household services essential to health care at home, including, but not limited to:
A. Meal preparation/feeding
B. Laundry
C. Light housekeeping
7. Completes the appropriate records to document care given and pertinent observations.
8. Communicates effectively with all members of the interdisciplinary team.
9. Maintains a safe client environment and identifies and reports of any suspected vulnerable 
client abuse, neglect, or financial exploitation. 
10. Maintains client confidentiality; treats clients and families with respect.
11. Understands, accepts and responds to the emotional needs of each client.
12. Participates in in-service programs to meet compliance requirements.
13. Accepts and fulfills assignments and exercises judgement in accepting assignments.
14. Understands and follows infection control policies including proper handwashing 
technique.
15. May assist with precepting other HHA’s.
16. Performs other related duties and responsibilities as assigned by RN.
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Take the 7 hours, 7 days a week. You may not "need" them now but you never know what is going to happen in a month, 2 months...
Start doing things that you want to do and either get out of the house or you now have help going through the boxes in the bedroom that you have been meaning to sort.
And if you are going some/ a lot of the things the caregiver should be doing STOP...let them do what they are being paid to do.
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Take the hours. My uncle got more hours than needed but just liked having someone there to talk to. He may not have needed all the hours, but he did need help (preparing meals, going to the bathroom, waiting for laundry to dry) during day and limited hours would have meant that the help he needed would have left for the day.
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Absolutely take the hours. With all the task listed above the social interaction is priceless and something they look forward to. Playing cards with, even watching tv with someone who talks between commercials about the show. All these little things support mental health and confidents
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Check other agencies and their policies
Or arrange a meeting with the manager they can book their 7 hours but you only want 4
I’d check other agencies. Bc they’d policies first tho
my father has a lot more care than needed
when people arrive I just say he’s sleeping feel free to book it but I don’t want him disturbed
that said
Maybe your relative does need extra cleaning - loose bowels or incontinence issues?
it also depends on what you can cope with
check out a couple others and see if this is standard or negotiable
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If it’s like the VA, once given the hours, it’s better to keep them. If you give them up, it might take time to get those hours approved again if needed in the future. Are those hours consecutive or will they come more than once a day? I think I’d find a way to make it work, even if it’s just for companionship for TV time.
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Grandma007: The offered hours will no doubt be needed in the future.
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My stepdad didn't want the care that was arranged by social services for my mum - 4 visits a day, 7 days a week, for 6 weeks after she was discharged from hospital.

He sent them packing, then called me for every little thing he felt was too much for him to do. The carers could have been getting Mum out of her chair for little walks to improve her strength and stamina. They could have done puzzles with Mum. They could have helped with meal prep, or hanging out clothes.


Take the care available. Your lives will be improved by having care. If you don't have it, you will find there are times you desperately need it and don't have it. That's worse.

Speak with the carers or the agency to find out what they can and can't do for you, then go from there.
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While other respondents have provided good suggestions, I sense you are feeling overwhelmed with having someone in your home all day every day!
I get it! I like my privacy, and I enjoy quiet solitude.
I would suggest 1) making a to-do list for the aides to keep them busy,
and 2) establish your boundaries first thing! Express your desire to have your quiet privacy respected - YOU ARE NOT THERE TO ENTERTAIN THEM like company!

I had a hard time with this. I had a woman come into our home and she saw me as her friend. She blurred the lines of who is the client. My husband is non-communicative, and she preferred to see me as an elder in need of a companion, rather than devote her attention to him. She was actually in need of adult companionship, and used this job to fulfill that. I dreaded seeing her come.
If I didn't direct her and give her specific tasks, she would sit and scroll through her phone, or follow me around talking about her life.

You are in a small apartment. Try and carve out a designated space for the aide to sit when they are not providing hands-on care or doing work. And let them know you are uncomfortable sharing your space with a stranger all day.
Write up a schedule - if their tasks include cleaning the kitchen, or making lunch, or laundry, or changing the bed linens, vaccuming, getting the patient out of bed, taking the patient outside, or playing a game or otherwise engaging with the person, make a schedule listing the times those activities should be done.
Remember the person is there to do a job. They are not company.
And if there is little for them to do currently, give them space and the opportunity to do their own quiet activity, reading, browsing a laptop or phone, knitting, but remind them that you are really not interested in socializing with them!
If you have someone who regularly intrudes on your boundaries, call the agency and let them know, and ask if they have another provider to send who will better meet your requirements.
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If approved by medicaid, try the "to do list". If you try to scale back, would you be able to get more hours going forward? Why are you forced to have 7/7?

If it is private out of pocket arrangement, then switch agencies
1) Find a new agency, interview caregivers, and hire a new caregiver before dumping the current agency.
2) Look at your current contract and make sure you give them notice as specified in the contract before you bring on the new person. They may require 1 month, 2 weeks, 48 hours notice -- make sure you follow it to the tee.
3) Be nice in the process, you never know if you need them again in pinch or the caregiver. If they ask you why, just say, "we enjoyed working with you and the caregiver, but our needs have changed and we need less caring hours now.
Thanks!"
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