I have a different caregiver as a fill in daily. My aunt has dementia and is acting up as a result of the changes. It seems as though I need to accept who they send me. There has been thief, damage to home, yelling and screaming. If I do not keep the aide, I will receive just a very little or no care. I am asked to leave the company, do it myself, or put them in a nursing home. I have spoken with the company administration, CICOA case manager and the options above and all I get. Thanks for your assistance. Documentation will be in the number of aides and companies.

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I don't know where everyone lives, but where I live we have used Home Instead for about 16 years. They started with just housekeeping and now, bathe, clean, and can lift father into bed with a hoyer. Over the years we have had more good HHA's than not, and the ones we didn't like was because they were inconsistent and those didn't last with the company anyway. They came daily for part of the day, and we took up the rest. This company helped us to keep my parents in their home for many years beyond a point that they qualified for more nursing.
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You've essentially been "fired" from 20 agencies over the care of your aunt? Something is definitely not OK here.

True, HHA's are notoriously underpaying their workers. I worked Elder Care and it was brutal on me. Ruined my back for life...for $9 an hour. I was trained and I had done in home care for my father and FIL until their deaths. Very little "threw me" but there were a couple of clients I saw once and said "absolutely not, will not take them on".

Perhaps your aunt needs to be in a NH with other people with similar conditions. Having a daily switch out of workers is confusing and makes a difficult situation worse.

Are you perhaps demanding just a little too much from these hard working, underpaid aides? I know when I was asked once to do a "liquor run" for a client and I refused, he blew up. That wasn't my job. His daughter let me have it for not getting him liquor! Seriously, some people think that aides have no lives of their own--and no rules to follow.

If 20 agencies have "dropped you" look deeper at the situation and try to see why they would do that. If it had happened once or twice, no big deal, but 20? It is not possible that it's always the aides who are causing issues.
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tyant2, so sorry you are having such a difficulty finding "good help" that you had to fire 20 agencies in your search. Being you were asked to leave, that tells me there was a major communication problem.

For my Dad, who had mild dementia and was a major fall risk, I called just one company and had this company daily for over a year. Dad choose which caregivers he had a lot in common and they were more than happy to be scheduled on a regular basis. Nothing was every stolen, damaged, and the caregivers arrived on time, even in the dead of winter.

My Dad was quite happy, and I don't remember ever calling the Agency with a complaint. Now, this Agency was quite expensive, and to Dad, it was worth every penny.

When my Dad moved to senior living, he brought along his favorite caregivers, who were willing to work shorter hours, as the facility had their own Staff. Having this routine for him was sooooo very important.
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May I give a view from the inside?
While I was looking for a nursing job, I worked for a home health agency as a HH assistant (no medical care). I made $11./hr. (In southern California) with only 25 hours a week, no benefits offered and no guarantee of full time work. As far as I know, no one can live on that salary here. For this meager amount of money, you may be required to clean urine and fecal incontinence, turn/lift dead weight (even though the company says not), cook and feed the patient, give bed baths, drive the client to appointments, deal with confused and combative clients, etc. I hurt my back repeatedly doing this job.

No one wants these jobs, or the pay, (neither do the family c/g's) so they attract possibly less than 'perfect' employees. The company I worked for had dementia training (actual classes) which even taught this old nurse a thing or two.
My coworkers, who I really never saw, certainly had no medical training and often not much caregiving experience. Most companies check background history and require fingerprints.

This job, as any caregiver knows, is demanding with essentially no benefit for the employee.

Yeah, they probably aren't the cream of the crop but look what they have to deal with.
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Have you actually witnessed how the home health care aid performs or are you relying on what your aunt tells you? Dementia can impair the person's ability to perceive and report things correctly. And are you sure things have been stolen? Perhaps, your aunt has hidden them, (forgetting it) or given items away. I know that happened with my LO at a certain stage.  I'd just try to sort out what is actually happened and what your aunt may be perceiving as true, when it's a delusion. 

Have you been able to get feedback from the caregivers as to what causes the problem? Do they give similar answers? I'd try to figure that out, so that you might be able to get to the problem. I wonder if the caregivers are trained in dementia behavior. If not, they could be trying to manage her care using all the wrong tools. A well informed caregiver might have better results. You'd think that would be a biggie for professional care agencies, but, maybe not. If they keep thinking that she can operate like a person who does not have dementia, then they are going to have unsatisfactory results.  

I'd also keep in mind that managing the care of a person with dementia can be challenging for any caregiver, no matter what setting they are in.  This is the case in Memory Care, nursing homes, etc.  It can be quite challenging and require a team of professionals 
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I'm going to take a different approach, as my experience with private duty agencies hasn't been one that created a positive impression. In fact, I see private duty as a last resort.

These agencies are not monitored or evaluated by any federal agency, other than one which I've found that has higher standards than others. They're not really accountable to anyone except the client, typically a family member, with little power to do anything except cancel services. This lack of oversight leaves the clients with very little legal protection.

Many are franchises, run by people with obviously little business acumen and even less understanding of elderly, or even of how to work with clients. And that lack of business knowledge is one of the glaring deficits in these companies.

They have advance people who promote the agency, in flattering terms, but getting past them to the admins reveals different and less cooperative aspects of their operations. I've caught some of them in blatant, outright lies.

The biggest problem I've seen is that they have accountability to no one, and there is little recourse against them other than firing. Their contracts are sloppy, poorly done, but protect them and not the client.

Some are affiliated with hospitals, but don't make that affiliation known.

I don't have any good recommendations, but wanted to let you know you're not alone in your dissatisfaction.

To me, this field is like the wild, wild west, with self interest, profit, and ability to capitalize on the elderly being the driving factors.
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