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I live in a diff. State as my parents (1 hour away) my brother is local but currently stays there at night and prepares their meals. He is a Veterinarian and has busy work schedule. I feel guilty when no one can cover so it falls on me. I have middle school age children with a busy schedule so it’s hard to change things at a moments notice.

If the caregiver call out is rare, then it may be that you have to take on the inconvenience of filling in the for the day. Life happens, and it may happen that the kids will have to miss an event or practice because "grandma needs help" that day. Your brother is already doing a fair amount for them by preparing their meals and staying with them at night. An hour away isn't really that far, it's all inconvenient, but sometimes it just has to be done. Yes, it's difficult to change things at a moment's notice, but sometimes it just has to be done. It's part of the process of having aging parents. Unless they are in assisted living, you'll rarely have 100 % coverage. It's not easy, it just is.
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Reply to Tynagh
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I have to agree with those who said you must be certain before you hire an agency, that they will be responsible for every shift you need and hire them for. I did not do that. It was a problem, which in the beginning, was doable. However, as my mom needed more care, I could not physically be the sub. My mom lived with us. So, the agency figured I would step in when needed. In fact, they told me at one point, some of our clients don't have the luxury of having someone on the premises or nearby. You understand, of course. No, I didn't understand. Why would I hire an agency to begin with, and spend all that money! We needed help. Clear and simple. Finally, the agency fired us. They told me that my mother needed help beyond what was possible for the girls to manage. It was a blessing in disguise. We connected with a group of private caregivers, which was composed of nurse aides, retired, one RN, who did home care on the side, and other older women who have been caregivers for many years. They were a self-made group, who covered for each other, and shared resources with each other, and worked as a well-oiled machine. We were blessed. I'm not saying it would be a snap to find something like this. But, you can ask around. These kind of groups are known in the network of private homecare workers. Agencies are a hit and miss. I imagine some are wonderful, with no glitches. But, it is so true.....this is one area of need where you must have 100% cooperation. This is your loved one, or yourself. Good luck to you. All these responses have given you food for thought. I wish I belonged to this site when we were dealing with care for my mom.
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Reply to carine4ster
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Don't assume that it's the agency's responsibility to find a replacement. That's what I did, and boy, was I sorely disappointed!

I had caregivers through an agency for my parents 7 hours a day, 7 days a week. The agency took no responsibility for making sure the caregiver was in the home. We had numerous "no shows," which the agency wouldn't know about, or care about, unless I called them and yelled.

If they had a caregiver cancel, the agency would supposedly try to find a replacement, and sometimes they would. The agency was famous for telling me they were "looking" and then never getting back to me to say they didn't find anyone.

I finally got fed up one holiday weekend after yet another "no show." I called the agency and demanded to talk to the owner.

The owner actually told me that they don't guarantee to send someone. Yes, those were his words. I then told him that they should be very upfront with this fact in their ads, and when they initially come to your home to sell you the service.

I was all new to this at the time I hired this agency. I specifically went with an agency rather than the cheaper option of hiring an independent caregiver, because I knew I'd have problems when the caregiver needed a day off. I assumed an agency would provide the service they were hired to do. I didn't ask how they handle no shows and caregiver cancelations.

The owner also told me that he thought his agency was doing well in providing coverage, because they covered a little over 90% of the shifts. He then said that 90% is top-notch service in the caregiving industry and better than the other agencies are providing.

Ninety percent is good in some things -- like amount of words spelled correctly on a spelling test, or games won in baseball -- but NOT caregiving. Would people find it acceptable to say that their infant was watched and fed 90% of time?

When I'm driving, if I pass 90% of cars safely and smash into the other 10%, do I have a good driving record?

Plus, the agency skewed the statistics. If at any point I told them to call off the search for a replacement because it was already well into the shift and I have to make arrangements to take the day off from work, the agency marked that down as "canceled by client."

At one point I asked the owner if they report themselves to the Aging Office when they neglect to send a caregiver to an elder person's home. The owner then said that it sounds like my parents need medical care. I told him that my parents don't need medical care, but they do need to eat and go to the bathroom several times a day -- all services which the agency says they provide.

I ended up pretty jaded by the whole "hire a caregiver and age at home" experience. I recently fired the caregiving agency and moved my parents to memory care. It broke my heart to do that, but they need dependable care.

We had some good caregivers through the agency, but the overall performance of the agency, especially for what we were paying them, was poor. This particular agency might be good if you only need them for a few flexible (for them) hours per week, and if your loved one is pretty self sufficient, but not for daily necessary care.

My advice for anyone thinking about hiring daily in-home care: Ask the agency right up front about how they handle caregiver no shows and cancelations, because this will be one of your top headaches. Ask what their statistics are for no shows. Keep in mind that statistics can be skewed. And, will having 90% of your shifts covered be good enough for your loved one and you?
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Reply to SwampOphelia
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If you live somewhere else…I suggest placing her in Assisted living…if you live with her & …Nobody usually shows up when you need them…so you need to learn to do everything yourself…unfortunately. That’s my experience. …Then if they do show up, they usually run screaming out as soon as they arrived…my mother a very difficult dementia patient. Hugs 🤗
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Reply to CaregiverL
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Imho, it is the agency's responsibility to provide a backup caregiver, not the client's.
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Reply to Llamalover47
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My relative had to swap agencies a few times, sometimes their staff just dried up, the good ones retrained for better jobs, moved on etc.

What I found was when the agency called to say, sorry aide will be late, needs to reschedule or can't come, my relative lacked the skills to deal with this. Would say ok - but then call family for help. Didn't want a different time or different person.

I was getting the calls to go fill in. At first I believed it, then the resentment grew. Especially as it seemed to always be a weekend or my day off... so I called the agency & got their side of the story & pieced it together. Was even told my relative said didn't want to pay extra for public holidays & that family would do!

I'm just saying, it can be the agency has limited staff - or it could be something different, something like I went through.

Love to hear more about the OP's Dad here. He's relying on meals delivered (by family) overnight care (family) & daytime backup service (family). Poor guy may be stressed, unslept & just hanging in there... Or he may be sitting in his chair while his family scramble to take care of everything for him ???
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Reply to Beatty
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A reliable agency will always find a replacement caregiver, even if the owner of the agency has to be the one to do the job.
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Reply to Taarna
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The agency should have the responsibility of finding their own replacement - even if it means they have to pay more for someone from another agency. They should have their own back-up plan in force. I have a feeling this has happened more than once and you led them to believe - it's ok, I'll cover it today. If you allowed this in the past, it's time to redefine their responsibility to provide coverage so that a patient is not left alone.

Review the contract with them and then call to find out: What if your patient had no son staying overnight or a daughter who lived an hour away? Certainly you couldn't leave a patient in a house alone.

If they really don't have a plan to cover all their own gaps, start calling other agencies and ask the same questions. Also find a few people in the area that you, personally, could call that could/would arrive at a moment's notice. Maybe a neighbor or other relative who lives closer. You might also see about hiring a caregiver/housekeeper for one day a week outside of the agency you use: local person who might be available to work on-call as needed. Cut agency by one day and give it to the outside person. Then you'll have two sources of help and both will get to know your parents.
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Reply to my2cents
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Choupette May 16, 2021
I need to find a backup. Your ideas are great. I was able to leave work as an aide called out sick and they couldn’t get a backup. I was going to switch agencies but the new guys didn’t even show up for a meet so they could find out about mom and her routine. It’s tough but I need to find a backup this summer.
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The only thing you can do is have someone lined up that can do a late notice taking care of the kids while you're gone or bring the kids with you if it's just an occasional thing.

You can check with the children's friends parents or other relatives.

Other than that, since your brother does nights, it will have to be you that fills in for days if there's a blip and it deffiently happens.

I had to do a 12 hr shift watching my Dad at his house when a Caregiver called in sick.

Not fun but you do whatcha have to do.

Just get back up for a baby sitter, friend or a substitute Caregiver ahead of time.
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Reply to bevthegreat
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Beatty May 16, 2021
Totally disagree.
The OP does not have to live her live "on call" dropping her kids here & there because of other people's needs in other households - regardless of being her parents or not.

It is Dad's responsibility to arrange the care, he lives there. Not either of his kids to be there all night or all day. If Dad cannot call the agency, it is all enabling.
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IF it is a very rare occurrence, you could be the back up. Is their a neighbor that could help out? friend, other family member or perhaps a church member?
You also may consider another agency.
I understand why you want your Mom to stay at home for numerous reasons...familiarity, safety, etc.
We have been fortunate to have Mom (93) stay at home. We have hired our own caregivers.
Best wishes to you.
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Reply to Chickie1
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It is the agency's responsibility to find a caregiver for the day and time that has been contracted for.
If they can not find a replacement you might want to contact another agency and ask what they do in such a situation.
In your profile you mention mom with dementia. Is dad fully able to care for her if there is no one else there? If so it does not seem to be a safety issue. It would just mean that things get left undone for a day. That is IF dad can manage by himself. Have a few frozen meals in the freezer for him so he does not have to worry about lunch and dinner. BUT if dad has any problems caring for mom then that is negligent on the part of the agency to leave them alone for the time they are supposed to be providing care.
Is it possible that the agency is taking advantage of the fact that you can "jump in" and take care of them if they have a scheduling conflict? If they are depending on the fact that you can take a shift maybe you should ask them to pay you...😉
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Reply to Grandma1954
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You must be well off to be able to afford a regular caregiver agency. Sitters alone (who just watch and do no hands-on care) are about $20 an hour. CNAs (hands on) charge more. Regardless of how many agencies you use, everything has to be pre-planned well in advance.

That is why the government only pays for nursing homes (Medicaid) because they are frankly a LOT cheaper than around the clock home health. The average nursing home patient costs about $80,000 to $90,000 a year. A private sitter (who does NO hands-on care) would cost $175,000 a year. You still need to hire someone for feeding, cleaning, bathing...so it would probably go up to a quarter of a million dollars a year (seriously).
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Reply to cetude
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If it's just meal prep, and just occasionally, and only a limited number of hours during which they'd be left alone, can your father be trained to manage by himself? It won't hurt your parents to have a cold lunch or a microwave meal once in a while.

I see from your profile that your mother has dementia, and I'm assuming that your father is her primary caregiver, with your brother acting as primary caregiver for them as a couple, and a regular agency acting as the lead service provider. Is that roughly correct?

What irks me about the situation, assuming it is as outlined, is the flawed thinking about whose responsibility it is to solve this problem. If your father is not affected by dementia and remains the primary decision maker for himself and your mother, then this is for him to figure out. Of course you will still want to contribute when it's sensible, I'm not suggesting you should refuse to be involved, or anything unkind, but he has to plan ahead AND plan for contingencies - i.e. he needs to sort out his own back-up strategy.

And if the agency regularly lets him down then he needs to find another agency or two.
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Reply to Countrymouse
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Beatty May 16, 2021
Good points. Lack of a hot meal or a skipped shower is survivable. (Bread & water for dinner, just as Grandma would threaten 😉).

My rellie continues to accept that risk as part of living alone.

Wonder if Dad can phone for backup aide? Language barrier? Hearing issue? Phone tree system to navigate? Just easier to call family & ask them to do it or come over?
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We solved this problem for my mother by using 2 agencies. We used one much more than the other, but also had some regular hours for the other agency. When one agency couldn't find a sub, which happened occasionally, we were almost always able to get someone from the other agency for a sub. Both agencies were aware of and on board with this arrangement. My brother and I both lived out of town, so we needed to be sure we could get someone. Occasionally I'd get a call late at night or early in the morning about a problem, but usually it could be resolved.
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Reply to caroli1
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SJ, I see now, YOU are the backup hands-on help, but you live one hour away, have your own responsibilities & including care of your children.

I was in a similar situation, kids old enough to get home alone (just) but working part-time & I lived 15 mins away. Not ONE HOUR!!

Ask yourself now: is this working for you?

It's not selfish to try to make it work for everyone. It's common sense.

What if you were the Vet? Or a man? I'm not dissing your brother, but I was asked this kind of thing. I was asked what if I was a man? Maybe a truck driver? Would there be the same expectations on me? This led me to thinking... How much pressure is coming from family & how much did I signed myself up for?

I think you are on the *slope* right now... by slope I mean slippery slope. I think it's wonderful that siblings band together to help their folks stay in their home as long as possible. It's a gift. But it's a gift that keeps on giving! It's not a static thing - the needs keep increasing until you find your own life slipping away & you are living your folks life All.The.Time. Suddenly you don't know your kid got in trouble at school, less & less meals are home cooked, chores at home not done, marriage stress.

My advice would be to have a family meeting. Not to get your brother to do more (I just re-read & saw he is staying o/night & doing meals) but to both LOOK at the situation.
Is it still working for you all?
Sounds like you are both at your capacity?

That day was always going to come... So time to plot the next course.
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Reply to Beatty
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Right now, there is a shortage of in home caregivers. Who would want to that work with that type of pay, not me. Plus, the demand. Anyways, if she needs the help and you cannot do it, it is time for placement.
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Reply to Stacy0122
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I think that it is time to get a needs assessment for your parents.

It sounds like they would benefit from a live in caregiver that does nights, meals and fill in for the agency caregivers that don't show up.

A private duty nurse is not going to keep their schedule clear for "just in case" without being paid for that service.

If your parents can afford to have someone that lives in and daily, or almost daily, caregivers then you can find a way to keep them home. If they can not, then their needs may be better served in a facility setting. Have you looked into board and care homes? They can share a room and stay together with 24/7 care in a home environment and it tends to be the cheapest option.

Just curious, how often does the agency not do their job? The unfortunate thing is that right now, people make more money staying home than going to work. Until that stops, every place is going to have an employee shortage that effects every single one of us.

Best of luck finding the best solution for your parents care.
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Reply to Isthisrealyreal
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This is exactly why home care doesn't work any longer for some people.

Depends on the level
of need - how OK they are without the service?

1. Miss a shopping day but have enough supplies until tomorrow? Inconvenient.
2. Miss a doctor's appointment? Frustrating.
3. Be left wet, dirty, unwashed, undressed? Very poor.
4. Left in bed, unable to reach meds, food & water? Crucial.

My relative has had years of home care, many different providers, usually with good regular service but stuff happens occasionally :
no shows/late/unknown fill-ins etc. My relative has functional decline & now at the level 4 I listed. Even at 3 I felt this tipped the balance in favour of residential care.

Sj, when you say it falls on you, do you mean to start calling around for replacements? So you must always be available? Ready to drop everything? Must be exhausting!
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Reply to Beatty
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Sjmomoftwins May 14, 2021
Falling on me meaning I need to Rearrange my schedule and plan to be at my parents to cover. I have middle school age children and sometimes it’s hard to rearrange the schedule at a moments notice even though my husband is very helpful. My brother is local but is a veterinarian with a busy schedule although he has been sleeping at their house and prepares their meals.. I’m just wondering if I should have a private duty nurse or someone available to call either last minute or a days notice.
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I suppose that all agencies have issues from time to time. If a caregiver has an emergency at the last minute and no other caregivers are available at that time, the client will be without a caregiver.

It’s a common issue to have a shortage of help in caregiving. It’s a tough job, with low pay, so there is always a high turnover of employees.

There may be an independent caregiver that would be available to help. You could even check with a nursing school. Students always need extra money. It would depend on their school schedule and if they are doing online or campus classes.
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Reply to NeedHelpWithMom
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Frankly, this is why facility care can be a blessing.

Can you change agencies to one that will send a substitute? Is there a neighbor or other caregiver who can pinch hit once in a while?
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Reply to BarbBrooklyn
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