I've read so many negative experiences with in Home Care, AL, NH -- can anyone share their positive experiences?

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Thanks for your kind words, GardenArtist.
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Jola, your posts are excellent and thorough, and provide good insight into a very organized approach. Thanks for taking the time to share them.
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A few (more) things from my heart about home care (continued from above).

(PART 2 - FOR AGENCY CAREGIVERS - A few things to help keep your client happy)

1. Before visiting a new client home, find out if possible the family's PRIMARY CAREGIVING CONCERN (in addition to knowing your agency's care plan for that client.) For example, perhaps the family's primary concern about the new agency caregiver is that the caregiver gain confidence in learning how to put on and take off a special type of external catheter. Or that the patient is always in bed by 9 pm or at the breakfast table by 8 am. If your boss can't tell you the family's primary concern, ask if he can possibly find out before you're sent out the first time. If he says no, ask the family yourself when you get to the house.

This one thing can make a big impression on your client AND save frustration over something that may seem small to you but a big thing to us.

2. We appreciate someone who wants to make our loved one as comfortable as possible. If you're wondering whether Dad would prefer the grape juice or the orange juice, just ask.

3. (My number 1 gripe). If you're someone who likes to talk and talk, please recognize that your client may not necessarily be someone who likes to listen. Conversations should be give and take, not long lectures about the caregiver's prior work experiences and personal life, especially at the beginning of the care relationship. (I know this one is really hard for some people.)

I can't tell you the number of caregivers we've had to reject after their first week simply because they could not stop talking about themselves--even when we've specified ahead of time to the agency that we need someone on the quiet side. To Extreme Talkers: PLEASE learn to recognize body language. If your client's daughter is squirming while you're finishing up a 5-minute lecture about your son's toilet training, don't begin another one about your daughter's.

While many clients need a caregiver to give a lonely family member some company, other families need a caregiver who recognizes their elderly parent wants more than anything to feel comfortable in their own home with their normal routine--which doesn't include entertaining a caregiver. (When appropriate to the caregiving situation), ask a family whether you should sit in the same room or in another room while your patient is watching TV, etc.

4. Something extra that is SO appreciated: Taking someone to the bathroom one last time near the end of your (day) shift.

5. Recognize we're sometimes stressed. If we're not smiling today, it likely has nothing to do with you. For your own health and well being, try not to take things personally when possible.

What you do for our loved one is SO important. Although most of us realize that, we may not be thanking you nearly enough for all you do.
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My positive experience is with our current home care agency. We have tried four or five different agencies over the past 15 years. The one we have now is the best so far. We've been with them about a year.

We currently use agency caregivers approximately 48-50 hours a week. The current agency employs only CNAs, who typically have more training than an HHA (home health aide). The agency we use is pretty strict about caregiver attendance, unlike the last agency. This has been immensely helpful.

A few things from my heart about home care:

(PART 1 - FOR FAMILY CAREGIVERS - How to get the most from your home care)

1. Document your primary care needs BEFORE you meet with the agency for the first time. Prioritize your must-haves and provide that list to the representative. Stress the number one thing you need and insist they send only caregivers who can meet that need to your satisfaction. Do you need someone who is excellent with transfers? A good listener for a lonely parent? Would a caregiver who talks endlessly about her own life get on your parent's nerves (and yours?) Would your elderly dad prefer a male caregiver instead of female?

Don't be shy if an item or two is critical to a good fit. It's easier for the agency to screen out what won't work up front, instead of sending endless people to your house only to be rejected later.

2. Be organized. Caregiving agencies can have A LOT of caregiver turnover. If home care is your long-term plan, you're bound to be answering the same questions over and over whenever a new caregiver is sent to you. A simple way to make this less painful is to develop a set of documentation for new caregivers to use as a reference until they get familiar with how it works at your house.

For example, here are some of the typed sheets we post in the house for our caregivers

a. Daily Caregiver Requests sheet (on a clipboard). Our caregivers often refer to this as 'daily charting'. It's a typed sheet with today's date/shift at the top and a list of the main items we need done regularly (with an 'X' next to each item we want done on this particular shift): before-breakfast meds, after-breakfast meds, evening meds, breakfast, lunch, shower, shampoo, oral care, PT home exercises, speech exercises, cleaning the bathroom, making the bed, feeding the cats, and so on. (I also include other items as little reminders--such as: Remember to remove your food/drink from the refrigerator before leaving.)

All the caregiver has to do is scan the list for the items we want done, and check the items off as they complete them. I find this also helps ensure that things actually DO get done consistently.

b. Dad's Daily Peri Care and External Catheter Instructions (from his doctor)
c. Description of each PT home exercise.
d. Description of each Speech exercise.
e. Dad's Daily Foot Care Instructions (from his doctor)
f. Instructions for cleaning Dad's shaver.
g. Caregiver Updates Sheet (on a clipboard. Here I post updates about Dad's health that they need to be aware of; for example, results of a recent doctor visit, something they need to do differently when he eats lunch, a new topical, and so on.)

All together we have maybe 20 or so separate sheets on different topics taped here and there in the house-- on Dad's dresser mirror, on the bathroom mirror, in a binder next to his lift chair, in the kitchen, in the foyer, on a clipboard, and so on. Saves countless time and stress, both to me in having to repeat myself again and again and for the new caregiver who may be shy about asking.

3. Pick your battles with the caregivers.

In agency home care, the caregivers typically have other clients besides your family. Each home is different and there are SO many things to remember. Prioritize the items that MUST be done a certain way over what would be NICE if it was done a certain way. Don't nit-pick over how they make the bed when the more important thing is that your mom with poor circulation is left sitting with her feet up, not with her feet down.

4. Pick your battles with the agency.

Likewise, the agency may have 100 or clients to please, each with a set of constraints that must be applied when trying to put together the weekly schedule. Each caregiver has a set of constraints of their own (the hours they can work, vacation, time they need to block off, items they're not willing to do, and so on.) And finally, the agency has their own set of constraints--for example, the need to limit the caregiver to 40 hours a week, total, to avoid paying overtime.

Give the agency as much notice as possible whenever you need to cancel, add, or change caregiving hours. (I would suggest always emailing your requests so that you have in writing what you asked, for if it's disputed. If the agency insists phone calls are better, then provide both.)

Be firm when a caregiving situation isn't working out, but don't expect them to find someone new that's a good fit for you overnight. This is a field with mega demand and everyone wants their best people. Conversely, if it's clear you're not getting their best people no matter what you do and how patient you've been, consider making a change. Some agencies are clearly better than others.

4. Smile. It really does go a long way.

5. Be gentle. Be grateful. It's so easy when already stressed to forget the caregiver (and agency) who's only trying to help. Remember that he or she is dealing with her own challenges in her own home. Say thank you. A LOT!
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Happy in Omaha, that how we are with our IN HOME CARE, I do 90% of the care for my wife now in her 12th year of Alzheimers and only 61 years old. We then use HomeInstead Senior Care, Inc, corp. office is here in Omaha and I personally know the founder Paul and Lori Hogan...great christian couple. We love the caregivers that help us. They bring cards, etc. things Frannie likes, as they love sharing with her. They have over 900 franchises world wide...over 700 here in US.
What I personally like is they do more than just care for Frannie, they do our dishes, put in a load of laundry, mop or sweep the floor, all while caring for her also. At Christmas they helped decorate the house with Frannie and I over the three days it took to do so. They are about $26 per hour so here in Omaha, but well worth it, with all the extra we get for the time they are here. hope this helps!
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As a caregiver, I have been in the business for more that 10 years and I have noticed that alot of family members rely too heavily on the ALs and NHs for alot. I would advice that you advocate for and represent your parents in a way that will satisfy their emotional needs......visit them......hug them....let them feel that they are still a member of the family and are not abandoned by you.......sometimes the negative is not the facility.....it is the relationship that the the family membr has with the parent that is not forthcomeig......those unfruitful relationship...breeds fear, anger, depression and sadness in many seniors that are moved to these facilities.......so my advicde is that you should do your research and stay on top pf things and lovongly love and visit your parents who have to live in these places.
Thanks
Andria
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This is coming from North Western PA., Mom was a resident in a ALF for 5 years and just loved it there. The aides were extremely professional and very caring, I was there almost everyday, so I kept an eye on things before maybe there could have been any problems. No one place is perfect, you just have to find the right one, and from the start be visible. Mom passed last Thursday, and everyone of the staff had tears in their eye, I guess that says it all. Kathy
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I am sure you let the good CNA's know how much you like their work habits-it is a hard job to do day in abnd day out and a little praise goes a long way in making the job a little easier and even writing them a short note would be great.
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Mom adjusted easy than i did at the NH. I trust them now although their activities are much to be desired
Medically they care for her, bath her, watch her and make sure she is safe The CNA's except for one (I won't allow him to touch mom) are good. Some are great! The other day a CNA was dancing with my mom and she loved it. Many walk with her indoors and out. Mom just loves some of them and tells them so. They are gentle with her. I am unemployed so I do the activities and mental stimulation and take her out every day.
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As with everything else, you should research your options carefully and carefully interview any agency which offers in-home care. There are some really good services out there and some really bad ones. The best firm I have ever encountered is Golden Days Senior Services in Torrance, California. Joy, the owner, will come to your home and do a thorough assessment, answering all your questions. Their caregivers are extremely competent. I cannot recommend them highly enough.
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