If you have an in-home paid caregiver that helps you, what tasks do you expect them to do?

Mom (91) lives with us.

I found out last month (after 18 months of Homehealth providing an aide for "custodial care " that Mom's insurance doesn't cover that. So, I called an aide to see if she would moonlight. She's not with our current agency because of contract negotiations going south at the top of the food chain. BTW, we use a physicians group agency that manages EVERYTHING except Mom's appts with her regular drs. It's great.

Back to the aide biz. from experience, different aides do different things. So, ask what the will do. We had one that was supposed to be able to make a small meal or snack, but said flat out that she doesn't do that - she also had an attitude towards the males in the house, was routinely late and would rush doing things with Mom instead of adhering to the rehab plan setup by the agency for Mom to relearn how to become more independent. Needless to say, I had her replaced asap. We've had some great aides. One thing our agency aides can't do is handle wound care or dispense meds, even though they know how to. But private ones can do a lot more. I'd assess your needs in the home.

Since insurance won't pay for custodial care, the private aide comes for two hours in the morning M-F so I can go to my PT job, then my almost 20 son who has a singing gig Wednesdays and Sundays takes over when she leaves. Then I take over when I get home. Everybody pitches in (hubby and 25 yo who both work fulltime).

I hired a cleaning crew once a week - at first to scour and disinfect Mom's quarters, then decided to double that pay to include the community areas, bathrooms and our bedroom. I wash the laundry, and they fold it and put it away (I hate laundry). So our aide doesn't clean; she picks up and straightens Mom's room daily, including trash take out. Our aide provides custodial care (bathing, grooming, dressing, bed change, toileting (currently diaper changing) and helps Mom with her morning ADLs. She also takes vitals, makes sure Mom takes her prebreakfast meds and gives Mom her breathing treatment. She checks equipment and lets me know if something is wonky. She and my son cook breakfast. This week, she will start getting Mom out of bed into her chair in the mornings. She also provides joyful companionship since Mom is depressed and has anxiety. She inspects Mom's body for skin breaks and attends to bed sores and whatnot, leaving me notes on what she sees so I can tell the nurse who currently comes bi-weekly. She'll find things on the TV or computer that Mom likes. She may do light nail care if Mom asks her (agency aides would not do that).

I'd assess your household needs - what you can't do, don't like doing, or just don't have time to do - and ask the aide you're screening if they will provide custodial care, including A, B, C and X, Y, Z.

Also find an aide that lives close to you. Define the hours you need them and days of the week.
I've found that they are more expensive by the hour the less time you need them (per visit).

IMO, everything is negotiable.

Before I hired a service for my father, I drafted a list of all potential activities, then discussed them with the nurse who handled the intake process.    I was surprised how many they would not be willing to handle, but to be fair, most of the "rejected" tasks arose from my father's dysphagia.  They felt it was too much of a liability for them to address.

Since that was a primary concern, I had to hire a different service, which was more flexible, but not as professional.   Out of 3 people who saw Dad, only one was worthwhile.  

You might want to consider something like that - making a list and discussing it with your new caregiver to ensure you're both "on the same page" as to what's expected.

And I want to emphasize FreqFlyer's advice on liability issues.    At one point we considered hiring someone from his church, a young woman who allegedly had CNA experience.   I was in for a rude awakening when I contacted my father's  homeowner's insurance carrier.   

I was advised that any potential injury of the caregiver wasn't covered under HO insurance; we would have to purchase a business type liability policy, at about $700 a year (at that time, some few years ago.)  I was also warned that the premium would escalate annually.

I discussed the issue with a friend who owns his own business; his position was DON'T take this route.    Liability coverage could raise the cost so high that the services weren't worth it.   Better to let a company provide someone and cover any potential liabilities.

Remember, when you are an "employer", where you directly pay the caregiver, you need to contact your homeowner's insurance carrier. It is important to have a "workman's comp policy" in case the caregiver should get hurt while on the job.

RNewman, I am in the same boat. My mom lives with us and needs a lot of prompts to eat, take her meds, take a shower, etc but not much else in the way of nursing care. I would love to find a caretaker who would sit and keep her company when she's awake but also do light chores during the lengthy downtime. I have had 2 caregivers tell me that there isn't enough for them to do when they are here but they also didn't want to take on housekeeping tasks. I sympathize with you that it's very hard to strike the right balance.

They only clean up after themselfs and my Dad.

They only do my Dad's laundry.

They only cook for my Dad.

You should just ask the Caregiver what they consider their job to be.

You didn't hire a Maid, Cook, ect.

So I would think anything to do with the person being taken care of would be the Caregivers responsibility

The main purpose of a caregiver to me was caring for mom. Chores weren’t a priority for us. The caregivers from the agency felt that we were being shortchanged if they didn’t do certain tasks.

I looked at if mom was comfortable and satisfied most of all. I think it took the caregiver awhile to get used to relaxing with mom because they were used to doing more with other clients.

Mom would tell them to join her for coffee, tea and a sandwich or her favorite snack such as cookies and ice cream.

I do feel that there was always a shortage of caregivers. The turnover seems to be high in the caregiving field. Mom had one favorite caregiver that we ended up with but overall did not complain if they rotated caregivers.

Some people don’t like a rotation of caregivers. I don’t know how that can be helped if the agency has a shortage of caregivers. I suppose that you would have to interview private pay and see if they are willing to stick around longer.

I have a caregiver for my husband 3 days a week. He has Parkinsons and dementia. If she has down time, like when he's napping or watching TV, I've asked her to do things like empty and load dishwasher or help with folding laundry. She also helps with our 2 dogs. She is new to us (our other caregiver is having a baby), so we're not fully vetted into the routine. I think you should ask for help. You may want to check with the agency if there is something written into your Dad's care plan. If not, you can add simple chores, like you mentioned.

Imho, I had a caregiver at night for my late mother BEFORE I could arrive there. This individual's responsibilities (she happened to be not only an LPN, but also a friend, who worked pro bono for me) were to remain awake in a 12 hour shift from 9 PM to 9 AM, to monitor night time toileting, to provide water, to prepare breakfast (and leave a sandwich for lunch) and to react to a medical emergency. While much different than a day time caregiver, it was probably even more difficult as the individual had to be accustomed to STAYING AWAKE.

I had a co-worker who had assistance for her mother and had a limited amount of hours available. Co-Worker would strip Mom's bed and get that load washed and into the dryer and then have Mom's clothes in the wash. When the Aide arrived the sheets were ready to be put back on the bed and the clothes into the dryer. Before the Aide left she put Mom's clothes away. The rest of the time the Aide helped Mom bathe and prepared lunch and cleaned up after Mom was done. My friend would have left for work when the Aide arrived and her husband would be coming home when the Aide was leaving. They made the most of having a two hour block of time available.

I’m a caregiver, in home. The daughter and son in law of the woman I care for moved in with her when she could no longer be alone. On the weekends, they go to their home while I stay the weekend with the “client”.
I asked for clear expectations before I accepted the position. Since the three of them live there together there are different dynamics where I’m concerned. Lay it all out on paper for the care giver, just a list of what you need her (or him) to do and anything you specifically do not want her to do. Address any issues that arise immediately. Hopefully the caregiver isn’t easily offended but instead welcomes your feedback. Common sense tells me that I want to leave the home just as tidy as it was when I arrived. I don’t leave a single trace of me behind when I leave on Sunday night. But you’re dealing with personalities in choosing caregivers so it can be tricky. Say a prayer that you choose the right one and let the candidate know that you have to insist on certain things from the beginning, that it’s not personal, but you need her to know what you expect. Since the caregiver is there to care for your dad, then it’s really not appropriate to ask for chores to be done unrelated to your dad unless you are paying for that as well. But keeping things at least as tidy as you left them is a given and hopefully the caregiver will go above what’s expected without crossing boundaries. Good luck!

What they actually do and what you expect them to do are two totally different things.

The morning shift is supposed to do 2 med reminders, sponge bath, make coffee or tea, breakfast, juice, dump and clean commode, empty the small waste basket next to chair, bathroom at 8, 10 and 12, sweep crumbs off floor next to her chair and swiffer it, dishes used for breakfast and laundry. It may sound like alot but most can be done while she is on commode.

Night shift is to serve her food I cook, sweep crumbs, bathroom, put pjs on and wash her privates, dump commode and get her a snack and water or juice to last until I go up later. The Thursday night lady washes and combs the short haircut because the others do not know how to comb "white hair."

Throughout the week, they are to do a supply and grocery list and give it to me Fri night.

None of it really happens, they play on the phone alot.

Lots of good advice here. My only thing to add is that I kept a little notepad that the caregiver wrote down what they did in order to eliminate the same task being done unnecessarily twice. That notepad was also helpful for leaving me any questions or notations that a particular supply was getting low, or any concern regarding mom. The daily log was very helpful. Mom had more than one caregiver that came in during the week. We learned what strengths each one possessed and played to that.

There is a lot of good advice here, and you can read for an hour. It boils down to: private pay = whichever tasks you assign. Agency care = whatever tasks are on the agreement, usually limited to activities that support the person staying home rather than activities supporting other members of the household.

Keep in mind that people who work in this field are usually "natural" caregivers and will say, "yes" if they are asked to do something extra, or may even offer (and not tell the agency that they are doing it). A third party should stay tuned in to what services ARE being provided. I have seen caregivers writing checks to pay bills just out of a desire to help. Boundaries are important.

We have the same situation and our home care giver is lovely. She makes mom breakfast and lunch, gives her a shower and does the dishes. We usually cover vacuuming and most general cleaning and I do Mom's laundry. She will come with on doctor appointments during the day and will try to get her outside to take a short walk if Mom is feeling up to it. It's a little bit of an odd transition at first to have someone in your home but in the long run it is such a great sense of relief to know that someone is there just to keep an eye out when we cant.

Agencies will specify what services they offer. Private pay is totally up to what you and the caregiver decides is appropriate.

Just know that with an agency what they specifically do depends on if the client lives alone or if they live in a home with other family members. They are only hired to help the client, not other family members.

I had one caregiver that offered to help me as well with other things but I always told her that I appreciated her offer but I didn’t expect her to help me.

I have at least 5 different people each week who fill in the 70 hours per week that my wife's insurance covers. Each one of them have different abilities, strengths and willingness to do things around the home.

One woman will scrub the floors, clean and straighten the cabinets, scrub bathrooms, almost anything to keep busy.

another one is content to sit in a chair and only do what she is asked to do and usually reluctantly. Last week after I had asked her to empty my wife's catheter bag and it was still when the next aide came on, she was asked by the second aide "What, are you afraid of the catheter bag? We have plenty of cloves to use!

Most are in between these extremes. Some have the attitude that anything that they do that helps me, also helps my wife as it gives me more time to care for her.

I asked each to make a list of things that they do while on duty and combined them into a list of :
Required things to do or check each shift.
Suggested items to keep busy.
Items that will allow me more time with my wife when they are not working.

We do NOT have any live-ins so I don't know if this will help or not.

First, do not pay rates for a CNA if you do not need one. They generally are trained and more skilled for more personal/hands on care If your fil needs that (i.e. help with shower, meds etc) fine, OR if you like this person, and especially if finances are not an issue paying for her, also fine. Your expectations are reasonable and should be part of a written plan that the agency this person is coming from or you, if you have privately hired. If you are paying then you have a right to determine what will be done. Since your fil shares your space as well, I find it reasonable that shared areas be clean and tidied as well...just think on it and make sure you DO want this person who we'll assume is not inept as was my personal experience....actually cleaning YOUR spaces. For instance the plan said clearly NO KITCHEN CLEANING/kitchen off limits because I knew it was bound to make me unhappy, and it did. Our inept aide that was supposed to give ME respite/relief was like a 2 year old who needed to be patted on the head for what a good job she did emptying the crumb tray of the toaster oven and putting it back in backwards; She used glass cleaner with an abrasive paper towel on the stainless steel fridge. You may need to be very specific and think things through before providing a list that I would hope would be prioritized in what you see as most important at the top. Good luck!

they should be only tending to your FIL......so that means YOU clean out the frig, you clean the floors, etc. To me it would mean that the caregiver gets him up, makes HIM breakfast, cleans up HIS dishes, cleans HIS clothes, anything to do with him..........UNLESS you ask them to do all the dishes which would not be fair, if the rest of the family does nothing and then she would be considered a maid. make sure you state up front what is expected and if you are asking her to be the families maid of doing everyone's laundry, etc., you may have a hard time finding someone. Sorry to sound so harsh, but unless you are retired and there everyday that person would be helping you to help the FIL......but if you are working then they are there to care for him and him only. I don't know what else to say other than make sure upfront what you want done for the FIL and nothing else. so if you come home to other dirty clothes, etc and you didn't specify that she was to handle everyone elses laundry then you will be doing that. wishing you luck.

Only task that directly involve your my love one.( to keep their area neat and clean, to keep them neat and clean, to pick up after them, to prepare them a meal, clean what was used to prepare the meal and he eat or drink from, to do his laundry, and to entertain them).

You want a maid service or house keeper I am so tired of people wanting to lump all that into a CNA or sitter And dont want to pay for that. The basics on here are correct but walking the dog, cleaning out the fridge.... Really.

You can expect the same thing.
By the way if you are hiring through an agency from what you described you do not need someone that has the qualifications of a CNA at this point. A "regular" caregiver would be fine at this point. Later as FIL declines you may need someone that is trained as a CNA. (the last 2 caregivers I hired happened to be CNA's, I was looking for caregivers and decided to contact my local Community College to see if there was anyone that had just completed the CNA course that was looking for a job..I got REAL lucky with the 2 I hired. That was the last 5-6 months of my Husbands life)
Change bedding on FIL's bed,
Clean the bathroom he uses
Fix his meals if he is not eating with you
Clean up after fixing meals
Take FIL out for walks, or if appropriate to the store, for a haircut, out for coffee
Engage FIL with activities.
You should also expect that they document/journal what they did if they noticed any decline. this could be anything from weight loss, trouble walking, trouble dressing, mood changes, problems eating, anxiety.
It is not out of line to ask that they also clean common areas. Talking a light cleaning, picking up items, running a broom over the kitchen floor, let the dog out...
The best thing would be to write out a list of duties and expectations.
I would have a contract drawn up and a clause that would review the contract at 6 months. At that time if there is significant change more tasks might have to be added as well as a pay increase if the tasks have become far more than when the caregiver started. Review again every 6 months if necessary.
Also since this is a CNA that is trained when she/he says FIL is declining and they need more or better tools (gait belt, walker, Sit to Stand, Hoyer) heed the advice. It keeps FIL safer and your employee safer.
And since you are hiring a CNA allow time off for "CEU's" this is required to maintain certification a specific number of Educational Credit hours are needed each year.

The easy answer is whatever makes your dad and you happier.

Our CNAs cooked meals, cleaned, did laundry and entertained my parents: conversation, checkers, activities. I only hired CNAs with clean driving records- the chauffeuring responsibility was a huge help for me.

if the need arises, it’s helpful to have someone who can help your parent in the shower.

Dad’s CNA took him to the gym everyday. I also provided a list of “field trips” to make life more interesting and to make the job fun.

You have to draw up a contract of expected duties, and I assume you are not using an agency. The problem there is that after a certain amount, which I think is $2,200..you legally become there EMPLOYER meaning you MUST file Federal income taxes and must pay Social Security, Medicare, and federal and state unemployment taxes on the wages paid to that employee.

If you fire the person they can collect unemployment. Further, if that person gets injured in your home they can potentially sue the estate. Granted that is probably very rare but it can happen.

That is why it is better to hire from an agency. That way if they get injured they cannot sue the estate but collect Workman's Compensation and they take care of all that legal stuff such as taxes.

Nanny tax information:
https://www.investopedia.com/terms/n/nanny-tax.asp

Mine is provided by state with copay that depends on mom's ss amount.
She is responsible for all personal care of my mother while she is on clock.
She bathes her daily, lite cooking, monitors her eating and drinking at meal time.
Lite housekeeping for my mother only.
She cleans her room, changes sheets, does her laundry and cleans her bathroom, bedroom and vaccums.
She is a babysitter with my mom as her responsibility 6 hours a day.
She also now assists me in taking mom to Dr appts too.
Hope this helps, the help sure does. Well worth 37.00 monthly co pay.

With my MIL her aide is not a CNA, however she currently does the following

Makes MIL lunch cleans up after lunch. Most days are a sandwich so a plate and silverware no real dishes maybe a bowl and pot if she has soup.
Shower her 2-3 days a week (she is inconvenient)
Straighten her room, My MIL likes to fold clothes over and over (not very well) the aide takes them when she is done and redoes them.
empty her room trash.
Clean her bathroom ( she has her own bathroom and shower).
Do her laundry if the bedding gets wet. Changes her clothes and starts the load it depends on the time if she is here she does it.
Put in and take out movies in her player and be a companion.
If my MIL spills in the kitchen she cleans it up but she doesn't sweep or take the trash on a regular basis. She has offered to take my MIL out, but her physical state has declined such that walking to our porch can be over taxing.

Nope.

If our client were living with his family as part of the family we would not be doing any domestic routines. We do, out of ordinary courtesy and respect, leave bathrooms, kitchens and any other shared areas as clean and tidy as we would hope to find them, and we do obvious things - such as change a bin liner or wipe a table - when they crop up within our support plan.

But the daily tidying and light housework, no. You want a cleaner/housekeeper, not a CNA.

Having said that, all things are possible to those who agree them openly beforehand as part of a contract. Write out your ideal support plan, and negotiate!

Caregivers are not housekeepers, so if it doesn't involve your FIL, it's likely out of bounds.

Making meals for him -- yes. Cleaning out the fridge -- no.

We have a private pay helper for various days, in my home, where my parents have come to live with me. I try to leave or stay in my office during the two hour span. Here is my list: do exercise list and walk around, maybe outside. Have him check his blood sugar. Set up supper, Clean up from lunch/supper. Pick up newspapers for recycling. Clean and set up coffeemaker for morning, Check that they took their meds. Take the dog out. Empty urinals. Feed dog and cat. Help with laundry in the cellar. Take out trash and recycling. Take barrels out to the curb on trash day. My parents don't think they need this help - but I DO.

Ok, these answers are helpful, thank you! We are asking them to help him change clothes (give verbal cues), be there when he takes a shower just in case and to give verbal cues from the door, the caregiver helps with exercise (he walks around the house in a circle and does some arm things from his chair), and we want him to stay engaged through the day (with puzzles, toys, tv programs, conversation and anything that keeps him from sleeping) because he had recently declined mentally and was getting up and wandering at night. A doctor told us if we would keep him awake and more engaged, with no more than short 30 minute naps spaced out throughout the day, he would sleep through the night and regain some of his mental strength. We’ve been doing that for three weeks now and are shocked at the difference it makes. It means he has to be out of his room in the center of the house though, which means his things aren’t confined to his room. It seems like everyone we talk to who is a CNA does not want to do anything additional, which means they sit a lot throughout the day. If they aren’t a CNA, they are happy to do more light housekeeping tasks, but his long term care insurance requires a CNA.

When I finally received a few hours per month from Council on Aging, I was ever so grateful, as there is a long wait time for help.

Council on Aging had a contract with a specific agency in our area. They told the residents what services were offered.

The services included in mom’s care was:

A companion to mom. If mom wanted to do a puzzle, play a card game, watch a favorite television show, sharing a cup of coffee or tea with mom. The caregiver was happy to accompany her in these activities.

Bathing mom. Helping her dress.

Light housekeeping for her room only. Change bedding. Place her sheets in washer and dryer. Vacuuming her room. Dusting end table and vanity.

Preparing a light meal or make snacks.

Sitting with her for me to run any errands.

This was an agency. You are privately hiring so you can discuss your needs with the caregiver. It’s important to agree on tasks before you hire them. I would have every detail in writing. This will protect each of you.

As long as there is appreciation and respect on both sides, you should have a pleasant but professional business relationship. Some people become close to their caregivers. They often bond with those they are caring for and become part of the family. You have find what works best for you and your household.

Best of luck to your family.