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I’m new to the Medicaid aide service through MLTC. New aide started Monday for six hours a day. She is nice but hard to read. I’m not seeing her really trying to engage with my mom. She gives her dinner and helps shower her. The rest of the time is spent watching tv. She does the bare minimum of the list I made for her. Basically I asked she clean up kitchen counters and bathroom after use and quick vac the floors. She has not taken the trash out. When watching tv, she sits on another couch that’s about 12 feet away from mom. I have cameras in plain sight at my moms home so I can see there is very little interaction. This makes me sad. I don’t want to jump the gun and complain or offend the aide as this is just her first week. My mom has dementia and when I ask her what she thinks of her she just says “she's ok” or “I don’t know”. ( It’s important to note that with her previous aide right from the start Mom said “I like her, she’s good! That aide had to leave after only 2 weeks). But I don’t get that happy response from Mom with this current aide which troubles me. How do I get the aide to be more interactive with Mom and take a more active role with light housekeeping without being confrontational or offensive? Is it too early in the game to seek someone else who will be a better fit? On the other hand, I don’t want her to think this level of care is fine. I really need help with this ASAP.

I had 4 different caregivers from the same agency before I found one that was the right fit. One chided my DH when he cursed( not his normal behavior. Thank you dementia for that personality change - sarcasm) and spoke to him in baby talk. She interjected in conversations that didn't concern her.
The second one spent all her time on the phone. Sitting on a bar stool in the kitchen and only did anything when directly asked. The 3rd one kept having personal family issues so she had to leave early all the time.
The wonderful lady who has been with us for 1 1/2 years was actually a substitute for #3 who couldn't make it one day because of a " fender bender". Lorraine has been a God send. She treats my husband with kindness and respect, can get him to shower and take his meds when he's being hateful, is right there when he's trying to stand up to help, but won't insult him if he tries to do it himself.
She makes him all different kinds of things to eat, she doesn't care if he wants to eat pie for breakfast, she just fixes it and gives him a protein drink along with it.
If she had her way my house would be vacuumed and mopped every day, we compromised with mopping his bathroom everyday and the rest of the house as needed.

I did inform the agency of the deficiencies of the other workers. I felt they needed to know how some of their employees acted.
So, it's okay to request another caregiver until you find the right one. Its better for your LO, and you will be happier too. And thats
Important!!
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Primecut Jan 23, 2021
Im glad you found a good carer finally. Its very hard to find a good one. Trouble is caring is a vocation more than a job so the people who do it, have a different mentality to those who do it for the money.
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Hi! I am an in home care aid and I hear this a lot (when I fill in). It’s always the first impression that counts! Please don’t ‘settle’ for someone that won’t interact with your Mom. It’s just too important that you have some in her home whom you can trust and who loves what she does! Good luck.
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pjby12 Jan 23, 2021
I totally agree. Please take steps immediately to find someone who will interact with your mother, do all they can to make her happy, comfortable and be a companion to her. Each caregiver, nurse, aide, physician or practitioner is not right for every patient. Please keep searching.
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go with your "gut" don't second guess your feelings or your mom's...

you know... trust in your instincts and your mom's..... not sure? talk with the aide and point blank ask her why she is not engaging so much..; maybe she is tired or her heart wasn't in this to start with.
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Yes, Mayday, or maybe she only met mother two days ago and hasn't yet got a feel for how much interaction mother is going to enjoy.

When you're working in a person's home and establishing a relationship, you can't just go at it like a bull at a gate. Some clients do like the bright'n'breezy approach, true, but others are far more reserved; so it's a mistake on a caregiver's part to make assumptions.

I've been doing a double-up round this week, attending calls with a co-worker to clients who need two people to support them. My co-worker is great, very experienced and conscientious, but ohmygod she NEVER shuts up! - but it didn't seem to bother anyone apart from me :) I expect they'd describe her as chatty and friendly. I was mentally calling her other things by the end of the round...

NYCmama, if the tasks and routines that have been specified are being done to a reasonable standard, I should give the interpersonal stuff more time to develop. You say this lady is nice? - so maybe she's just not quite as extrovert as the short-term aide your mother liked.

The more active role with light housekeeping: again, a caregiver can't make assumptions, and this part you have to take VERY seriously. I might think "I'll just take the recycling out and wipe down the counters," and you might think that harmless enough, BUT!!! - if it isn't on the support plan, it serves me right if I get my ears ripped off by my line manager because the client's family has complained that I interfered. You cross boundaries at your peril.

Sitting on the other couch - also correct - "hands, face, space."
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NYCmama Jan 20, 2021
Thanks for your input! Everything I asked for is in writing - so no assumptions. There is a closer sofa nearer to my mom but still distanced well enough for Covid protocol. There is a difference between talking too much and barely engaging at all. Or doing a couple of cleaning tasks or doing none at all. My gut is on high alert - yet as you suggest, I am going to hang in there and see how the rest of the week and the relationship progresses.
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First of all we are living in Covid times. The aide is being smart sitting away from your mom. You did say she's nice enough. She feeds and showers your mom but only does the bare minimum on your list of chores. Considering your mom is getting her service for free and her pay is just pennies above minimum wage if that, then count yourself fortunate that you did so well getting her. Even if she's just sitting watching tv, her time also has to be paid for. Personally, when I take work I'm happy if there's cleaning or chores because actually having something to do is usually appreciated on most caregiving jobs.
Many times people don't really know what a hired caregiver's job is and will often attach other duties onto it that are not part of the job. Agency caregivers who earn next to nothing, have their job duties laid out from them by their bosses about what they are supposed to do and what they're not supposed to do. The only real concern of whatever agency they work for is that they put their time in. The time and hours are really the only think the agency itself has to answer to the state for. Anything else is on the aide personally. People sometimes don't understand that we are not entertainers. You've probably seen the tv commercials for homecare agencies that show some senior and their aide cooking together, playing cards, doing puzzles, and having a great time. It's NEVER like that. Think about an aide on a six hour shift (like yours). After the feeding, hygiene care, and light housekeeping is done there's probably four or five hours left on her shift. Maybe play a game of cards or do a puzzle for an hour like in the advertisements. Then what?
In addition to the totally gross and laborious chore of bathing, toileting, diapering, wiping a**, and feeding some elder the aide also has to make sure the home is adequately clean and safe. They have to make sure your LO doesn't get hurt or into trouble during their shift. This is the job.
The job is not become a one-person circus to make sure the senior that aide is getting minimum wage for, doesn't experience a moment of boredom.
If your aide is doing an adequate job, isn't ripping your mother off, and not being abusive then consider her a good aide. You will not get better unless you're hiring and paying privately.
As for her not meeting your chore list requirements. Offer to drop her a fifty extra in cash each week and watch how much she starts cleaning. I will tell you honestly speaking as an in-home caregiver for almost 25 years (private pay many of those years). If I was making minimum or just above on some job and some elder's adult child made me a chore list, I'd throw in their face and walk away.
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worriedinCali Jan 22, 2021
It really doesn’t matter who writes the caregivers check. OPs mom isn’t getting anything for free. Who do you think funds Medicaid? We, the people of the United States. The tax payers. If you’ve spent years paying in to the system, you have every right to use the system.
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The list of duties that you made for it, is it compliant with Medicaid’s rules? There are only certain duties that Medicaid is paying for. If there are things on the list that aren’t part of her official job description, that may be why she’s sitting & watching TV. (Not that it excuses we though). But that said, I think a week is too soon to tell. It takes time to build a relationship with someone. If nothing has changed after 2 weeks, then I would say you have a problem. I would give it another week and gently encourage her to complete all her duties. If she is still not Engaging with your mother after 2 weeks, personally that would be unacceptable & I would seriously consider replacing her. They don’t need to be best friends after 2 weeks but she needs to engage with your mother and talk to her.
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I live in assisted living where there are many aides and I see it all. I can assure you, from what I read above, this person is NOT the proper caretaker in this situation. There are some aides here who are cheerful, who smile, and who interact with residents. Others are like your caretaker - no communications, no chemistry, etc. Whether it is just their personality or if it is just a boring job to do and spend time doing, they are NOT a good fit. you must try to check out a few more before you find the right one. This one is a disaster waiting for something to happen. Please end this and keep searching. I know - I see this daily. There are some good ones - you just have to find them.
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NYCmama Jan 23, 2021
Rusty2166 You hit the nail on the head. This aide's vibe was flat and bored and just not interested in my Mom, who btw is just the sweetest, wittiest granny ever. She inhibited my Mom and put me on guard. By Day 3, I knew I would not rest with her alone with my mother, and requested a change.
I put it out there because I'm new to this process, and needed feedback - but I'm no pushover. With Covid-19 still so rampant, of course I'm reluctant to have aides coming and going; so I'm praying I can find the right "one" ASAP.
Your response was spot on - thank you!
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I work with and train caregivers.
Realize that caregivers, generally speaking, are not well educated and focus on cleaning/housekeeping and feeding, changing soiled garments. Some are there to 'sit' with a elder (and deal with hygiene needs) to insure they are safe.
* It is critically important to be very specific with a caregiver what your expectations are.
- Write out a list and go over it with her.
- Show her exactly what to do so there are no misunderstandings; ask her "do you understand?
* Why do you NOT want to confront caregiver? This is education and training, and is essential.
* If you allow a caregiver to sit and watch TV rather than do\ her job, you cannot expect anything different.
- What skills and qualities do you want in a caregiver?
- If a caregiver doesn't want to work, she'll do what she wants and test your boundaries.
* You must deal with your own fears of asserting yourself. What is in your way to communicating clearly what you need and want. This is a job; it is 'work' - people have to know what to do based on what you tell them you need them to do.
* Once you talk to her and go through a 'to do list,' ask her "Can you do this?
* Role play talking to your mom and see if she can do it. She may not have - both - the skills, maturity, or interest in actually interacting with your mother. She just wants to get paid for doing the bear minimum.

* Ask her if she wants the job and if she is willing and able to do what you ask her to do. If she doesn't do it, get someone else. Why would you even consider keeping her on?

It is like training a dog - the one who really gets trained is the dog's owner. The dog does what it wants until it is told what else to do, or how else to behave.

* SETTING BOUNDARIES and EXPECTATIONS are essential.
* Get assertiveness training for yourself. Don't be a door mat . . . for anyone. This may be a life long learning, indicate low self esteem, overwhelm and or a combination of a lot of factors. You need to step up to the plate or give someone else the responsibility of training and working with the caregiver.
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jacobsonbob Jan 23, 2021
Some excellent points, TouchMatters!
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Just curious if you were able to find a good replacement for this aide? Hoping you did. My father is in an AL home, and I do appreciate the aides/caretakers who go the extra mile to smile, talk to, and interact with dad on a regular basis. Covid has made their lives so different. It’s almost like being in jail - even if it’s a lovely one.
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NYCmama Jan 23, 2021
New aide starting Monday fingers crossed!
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Go with your gut instinct. I’m on about Medicaid aide #30. They are just as you described and more: watching tv, checking email or their phone constantly, never engaged with mom, lazy, takes no initiative, forgets the daily schedule, watches the clock, and just wastes time. Most are only working in the career field because there’s lots of openings. But sadly, they stay around only to collect their pay. There are really good ones out there, but very few. If I see that they are not performing, I call the agency to say that they don’t need to bother coming back.
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NYCmama Jan 23, 2021
Thank you. I was so lucky with out first aide, but she had to leave for personal reasons. 2 other weekend aides cancelled 3 weekends in a row before even meeting my mom. Monday I start with a new one and I’m PRAYING I don’t have to go through 30 like you did. It’s disappointing to see that caretakers can be so unmotivated to do their best.
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