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Mom has had a Home Health Agency providing companions to her twice weekly for bathing and outings. I got a surprise email last evening that they were terminating our contract due to issues with communication among various providers. Mom is very attached to this companion and will be devastated by the loss. Mom does have a lot of people in her care plan. She moved to a new Catholic assisted living two months ago because they finally had an opening for her and its where she wanted to end up. Then she was hospitalized this month for a PE so we have all the new staff at the assisted living plus now we have some interim rehab help for PT and for INRs by nursing. Certainly there is room for imperfect communication but I really got no indication of any issue from the agency until I got the termination email. Does anyone have an experience like this? Do agencies terminate you because the contract is not big enough? Do they have any duty to explain or try addressing issues if they have them? I am her guardian. I answer all the messages and emails related to her promptly and daily but got no message from the agency that there was any issue. I can get another agency, but I feel really sad for Mom who will be heartbroken for sure. These relationships are business, but Mom is really bonded to her companion.

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Very often Mom would be with her agency companion and somebody else would just pop in. Even this week it was the agency 'case manager'. I feel I need a care manager since I am in another state and she has psych appointments and internal medicine appointments a regular companion can't go to. But indeed it is too many I think. She goes out for hair appointments when she could stay in. I could attend her medical appointments by Facetime or Skype. She could be forced to accept the bathing at the facility. Lots of luxury, and yet she sure needs the AL...needs help changing diapers at odd times, help to know when to go to a meal or to church, unable to cook even microwave, not able to take meds on time or at all on her own. Sigh.
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Too many outside forces are at work. I'm willing to bet the aide would get there and mom would be tied up with someone else. Let the AL provide and schedule services themselves, with their in house personnel. That is their job. Mom's AL provided bath aides, outings, PT, podiatry and hair care on site.
We did not need a care manager, either. The Head Nurse took care of that.
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Kathy, I know it is so important to have one common "face" in the crowd. I hope you can work this out with the Agency.

No wonder some elders get exhausted by mid-day with so many people around, they need their own down time. My Dad had me cut back on the hours and days for his Caregivers, since he went from a large house into a 2 bedroom apartment... the Caregivers ran out of things to do as the facility has housekeeping and maintenance crews included in the rent. Dad wanted to read his newspaper and watch the news stations without interruption in the afternoon.
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I spoke with the President of the Agency (a person I had not heard of) and she was very good at telling me very little. She just said 'communication'. She suggested we consolidate to the agency providing interim care on Medicare, but did not know they will be out of there by next week as Mom is not homebound. I checked with the assisted living 'homecare agency' who provide all the RAs, housekeeping, and nursing other than labs, and they all think communication is excellent. My Geriatric Care Manager and I (an RN who goes to the higher acuity medical appointments) think its excellent. So at the moment I wonder if the new case manager who supervises the companions for the agency felt that we did not reach out to her enough. She was assigned this month, and met Mom two days before the termination letter. Maybe because she was not invited to the care meeting at the assisted living? So many maybes.

Yes there are so many people in mom's case that sometimes it looks like a Chinese Firedrill in there, most of which I don't know how to decrease. They have different people for meds, for housekeeping, for meal reminders, for room checks at bedtime, for bathing, and now we have the PT and the INR nurse. All of those are out of my control, can't change. But this one companion from the agency is by far the most important one in Mom' life. I am going to ask if we can schedule a meeting to sort out these issues.
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Deep thoughts! Oh man! I'll will write more later but that NASGA (National Association to stop Guardian abuse) is a really interesting site and I can't believe I had not even heard of it in all the months I've been in my particular bee's nest. While I sure know that there are a lot of sides to every family story, I can confirm that we chose professional guardians because we had a difficult Mom and sort of a dysfunctional family. We just thought we were doing the right thing. The average monthly charge for the two years of their agency services was $4,500. We would have gotten a mediator a lot sooner had we ever imagined this.
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Sorry for the typos in the last paragraph. Sometimes it's hard to proofread in this itty bitty response box.

Another thought: ask the caregiver your mother likes so well if she's going to continue with that care agency and/or if there's any way you could continue to retain her services. I'm not suggesting anything under the table, but it might be that the care agency is under fire for whatever reasons and the staff might be thinking of finding other employment.

This happened to the best home care agency we had; Dad liked the nurse, therapists, and everything was well for the time we worked with them for post-fracture PT. Then the agency was reconstituted from a nonprofit to a profit agency, staff jumped ship, and we eventually just gave up and found a different agency.
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Kathy, I really appreciate your update and sharing the advice of your attorney. I'm saving that in case I ever have to address a similar issue, especially the issue of approaching the situation from the responsibility of a guardian. Your attorney is very astute. The suggestion completely bypasses the issue of friction between the agencies.

Just to make sure I understand....there was a commercial company that handled guardianship, presumably appointed by the court. It contracted with a care agency, which provided a caregiver with whom your mother bonded.

After you acquired (or should I say "wrestled") guardianship from the commercial agency, you continued to work with that care agency.

If I've got this straight, I see a potential problem right there. The agency continued to provide care directly rather than through the guardianship agency. There might have been some noncompetitive agreements in the contract between the guardianship agency and the home care agency, a sort of noncompete agreement, such as consultants are often required to sign.

The home care agency continued to provide services to a client of the guardianship agency might have been a breach of contract, for which punitive damages might have been the penalty to the home care agency.

It wouldn't surprise me that there are issues as well with what appear to be exorbitant changes by a guardianship agency. It's one of the reasons I'm so opposed to guardianship by "pros". Even though my experience has been limited, it's been an eye opener to see the chargers run up faster than a 4 minute miler.

You might want to google the name of the Catholic facility your mother is in now as well as the guardianship agency. I wonder if you're find that the facility administration, or a higher level of authority with the church structure, may have initiated the issue of costs with the guardianship agency.

Out of curiosity, I did a quick search and learned that a "prominent Minneapolis guardian and conservator" has "stepped down" over accusations of misconduct in handling a Vet's finances. I'm P'Ming you the link so you can read the article. I wasn't aware there was such an organization as the Natl. Assn. to Stop Guardian Abuse. There might be some enlightening information in that article.

As to calming your mind, I have that trouble all the time. Reading, especially something intense like a mystery is helpful, as it "woman's work" such as cleaning, reorganizing some small area of the house. But better yet is taking out my material, yarn, embroidery thread, or even music, and indulging in crafting. Baking or cooking helps as well.

So pop a nice chocolate cake in the oven. We all know that chocolate is the best therapy yet!

And please let continue to update us as you learn more. This is an interesting situation which I think could help others who might eventually face similar circumstances.
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Both of you (FreqFlyer and Garden Artist) have provided some good clues, and I know from experience on this discussion board that you have good sense to offer and I appreciate the input. I talked to my attorney this morning. There has been some kind of blowup this week in Mpls about the nursing home Mom is in and also about professional guardian agencies charging too much. The agency we had spend through $500,000 in the two years we had them, and all we could do was fight to take back family guardianship. This Home Health Agency was first hired by the professional guardianship agency, but I have kept them for the 8months since I took over. God this is hard! So many emotions: sadness, frustration, anger, disappointment all come about kind of on an unending basis, and its just part of the job I have to do and accept. When I was appointed guardian the 'referee' told me twice I had to have my own attorney while being Mom's guardian. My attorney and I worked out a phone call script which is neither demanding nor angry, focusing on my not understandingwhat has happened and emphasizing that I need to know if there are perceived deficiencies in her care because I am responsible for her. I will make that call today provided I can get my brain calm enough to do it without confrontation or accusation. I like some of the phrases you have used in what you wrote, they provide good principles of constructive process.
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For bases of termination, check the contractual agreements you initially signed. Contracts generally have termination provisions for cause as well as w/o specific cause; it's a way out for them without having to address specific reasons.

Perhaps no one wants to address this in writing and hasn't responded to your e-mail for that reason. Try calling. If that doesn't work, call the other facilities/agencies involved with providing care and ask if they're aware of any communication issues.

I would think if the agency wanted more money it would simply institute a price increase, rather than terminate. I think there's more going on here, such as a conflict with someone at AL, or on the PT staff. Try to find out if any accusations have been made toward the agency.

Perhaps you could ask for a meeting at which representatives, or the actual staff providing the care, get together to sort out issues and define responsibilities so there's no question on those issues. I have a feeling that folks aren't talking to each other, or if they are, there are overlaps and jurisdictional boundary issues involved.
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Is it possible the Assisted Living no longer allows outside agencies to come in?

If not, call the Agency and talk to whomever is in charge and ask them directly what is the problem and can we work it out. It could be there are too many people tending to Mom and yes, there will be miss communications. Kinda like too many cooks in the kitchen.

Each Agency have their own rules and regulations. I've had good luck with any change request I made with the Agency who has been helping my Dad. Now that he is in IL/AL, he wants to phase the Caregivers out and use the staff at the IL/AL to help him save money. He has gone from 24/7 to every other day for 6 hours each day.
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