• The home health care profession relies on its caregivers to travel to each patient’s residence. The further away the home care office location is from your home, the less likely that agency will have caregivers that live close to you. Typically, a home health agency or nurse registry cannot successfully recruit caregivers who live more than fifteen to twenty miles away.
• The best reason for doing business with an agency, versus hiring someone on your own, is the immediate availability of a wide selection of qualified caregivers. Local agencies will have the largest supply of local caregivers. In addition, if you have an emergency that causes you to need help immediately, a local provider is your best bet.
• If you need a caregiver to provide you with transportation, then you defiantly want someone who is familiar with the city in which you live. Otherwise, every trip to the grocery store or the physician’s office may have needless delays. Local home care agencies have the advantage of recruiting local caregivers.
• Nurses and nurse’s aides do not like to commute great distances to get to a client’s home. (Just like most workers!) As mentioned above, it is difficult to get a caregiver to travel more than fifteen miles one way to reach the job. Sometimes, a caregiver will, out of immediate necessity, agree to take a job with a long commute. Nevertheless, most caregivers will quit that job when a closer job becomes available. From the patient’s point of view, this means having to change caregivers and train new caregivers. This can be very stressful on patients and their families!
• Unfortunately, many nurse’s aides are likely to drive older model cars that use more gas and require more repairs. The number one reason for an aide to cancel a job without notice is auto breakdown. Obviously, long commutes only compound these problems. The result for the patient could be unreliable help.

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Tip # 1: Keep up the continuity of your schedule of care & respite. Going without a caregiver means reverting back to having no help and no backup. Skipping help tremendously increases the stress on the family caregiver. It dumps all the responsibility back onto the spouse and family. Going without help usually means cancelling all the plans you have for the day. This is either medically unsound, such as cancelling a doctor’s appointment, or emotionally upsetting. All of these factors need priority over your “fear factor” of having a new caregiver come over to fill in.

Tip # 2: Avoid the stress of “having to tell a new person what to do.” Write down your care routine, or save it on your computer, and have a copy ready to give to the new caregiver. This is what the professionals at home health care agencies and nurse registries do all the time! If you want breakfast at a certain time, put it on your list. If you want your sheets changed every Friday, put it on your list. Create your “to do list” and update it over time. Then you are always prepared to “break in a new caregiver.” You can expand your list to include your medications, your list of doctor’s, regular appointments, such as the salon, diet restrictions, and anything else specific to you. Your new caregiver can keep your list handy, rather than ask you a bunch  of questions. Remember, over time, your caregiver will learn your routines. Just be patient until then. 

Tip # 3: Rome was not built in a day, but you can build a good foundation with your new caregiver. First impressions can be tricky. Most of us are picky about certain things, especially within our homes. One client that I know is picky about her floors. When her new caregiver arrived, she asked her to remove her shoes to prevent tracking in dirt. The caregiver followed this rule, but she also felt insulted. As the day went on, the relationship deteriorated to the point that the new caregiver wanted to quit. If you sense that something is negative in the new relationship, please pluck up the courage to tactfully discuss it. If your caregiver belongs to a home health agency or a nurse registry, then you have the additional advantage of discretely calling them. Sometimes a third party intervention can help clear the air. Better to risk an uncomfortable conversation than to have to start over, again, with another new caregiver. 

Tip # 4: Whenever possible, have your spouse or family caregiver present at the beginning of the shift of a first-time caregiver. This gives you extra “trainees” to help break in the new caregiver. It also helps family members get to know the new caregiver, which increases their comfort level. It is also a good idea to share emergency contact information with the new caregiver. Add this to your list, the names and telephone numbers of those loved ones that you would want to be contacted in an emergency.

P.S. The dirty shoe story is true and it has a happy ending. I was tipped off by the client’s son that his mom and the new aide were not getting along. I visited the client and the aide the same day, in an effort to help reconcile their differences. The aide told me her side of the story, privately, and the client told me her opinion, privately. I successfully reassured the aide that the “no shoes in the house” rule was not unusual and she should not take it personally. I made it clear to both parties that this was a two way street, and both sides had options. Fortunately, both decided to give each other another chance. It worked out.

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In addition to preparation of this type, those who are at risk, such as the sick and aging, require an extra measure of assistance from a caregiver. Home health agencies and Nurse Registries are required to have an emergency plan on file for each and every person served. The plan should include whether these individuals need to have their caregivers with them throughout the storm, or if they will be staying with family members/friends. If living in an evacuation area, the location each person will evacuate to must be included in the plan, as well.

Ways that Champion Home Health can help you:

1.    Provide you with a list of emergency management telephone numbers, area shelters, and maps.

2.    Provide you with instructions on how you can prepare a disaster supplies kit in advance.

3.    Help you with registering in advance for a special needs shelter, if needed. (If you require a continuous supply of electricity for life sustaining equipment, such as oxygen or if you suffer with dementia, you could be eligible.)

4.    Discuss your emergency plan with you, before, during , and after the event to ensure your safety.

5.    Provide you with a caregiver before, during, and after the emergency.

What your Champion caregiver can do for you in advance of a hurricane:

1. Shop for needed supplies.

2. Pick up prescriptions.

3. Provide transportation to a shelter or other place of safety.

4. Make necessary preparations such as filling tub with water, placing flashlights  

     throughout the house, etc.

5.Stay and care for you or your loved one throughout the emergency (in your home or a shelter).

6. Fill up your car with fuel.

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One dear eighty-year old told me she is scared to answer her phone now, because of the harassment she gets from the private aide she just fired. She got rid of the aide because her jewelry and $250 disappeared. Her jewelry is irreplaceable. It was her wedding rings and other sentimental reminders of her 60-year marriage. The aide is constantly calling her because she is angry over being fired. The elderly lady’s son had to fly from out of state to stay with her until this crisis is resolved. He may even have to get a restraining order to protect his mother from this “pirate” aide!

The elderly woman told me that she had prior, smaller problems with the private aide. For instance, the aide would invite her own family and friends to visit her on the job. Then there were plenty of times when the aide would come in late and demand to be paid anyway. Basically, the aide was taking advantage of the woman whenever she could. The elderly lady felt helpless to make any changes. That’s why she put up with the aide until the final blow of the theft of her money and jewelry.

After I heard this horrible story, I offered some ways to help this lady. In spite of her bad experience, she still needed help from a caregiver. First, the elderly lady should never set herself up as the employer any more. My home health care agency can do this. Then, down the road, if she wants to change the aide for any reason, we will take care of it. If any question comes up, such as, “Is the aide allowed to do this?” then my Agency can step in and handle it. My Agency requires all aides to submit time cards, showing the actual times worked. And most importantly, my Agency’s Director of Nursing personally visits the client at least every other month to make sure that everything is satisfactory. All home health care workers are supervised by my Agency.

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Live-in help is very economical and a wise choice for any client who needs ten or more hours per day of help. The cost is about the same and the amount of help doubled. Another situation ideal for live-in help is the client who can no longer live alone, due to cognitive impairment or physical decline.

* There are many advantages in having live-in assistance  *

Consistency in Caregivers:

Live-in’s stay in the client’s home day and night.   The client doesn’t have to deal with multiple shifts of caregivers each day. In addition, the primary aide usually works five or more consecutive days. A substitute aide provides relief as needed.

Daily Rate versus Hourly Rate:

The labor laws exclude live-in help from minimum wage and overtime laws. To qualify for this daily rate exemption, the client provides room and board to the live-in help. A separate bedroom and bathroom for the aide are preferable.

Higher Comfort Level:

Most clients prefer as few caregivers as possible.  Live-in cases require a minimal amount of caregivers, such as one primary live-in and a couple of  back-up aides.

A good way of evaluating the need for live-in help versus hourly round the-clock help is to determine if one person can handle the care.  If not, then the caregiver  will “burn out” and quit the job after a short period of time.   Analyze the hours each day that the aide must be attentive.  A major factor is the work load.   A live-in needs a good night’s sleep in order to provide care the next day.   Some client’s suggest that the aide can catch up on her/his sleep during the day.  They assume that the aide’s sleep patterns can mirror their own; that is, getting up several times during the night and napping during the day.   Rarely does this work out for the aide, who starts to feel “worn out,” after a few sleepless nights.

Another factor in the work schedule is the time that the client wakes up and goes to bed. For example a client who routinely stays up past midnight should not expect the live-in to stay up with her/him. The sleeping patterns of the client must be amenable to the caregiver and provide adequate rest for the caregiver.

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You have made the decision to let an aide come into your home to assist.  That was hard enough on you!   Now you are getting apprehensive about what to expect when the aide arrives for work:

- Will I like the aide?  What if I don’t?  How would I handle this problem?

- What will the aide do for me?   Do I have to tell her what to do?

-What if I don’t like the way the aide does her job?   Do I have to tell her?

- What if the aide will not listen to me or do things my way?   Who supervises?

You are not alone in your fears.   With no prior experience in having in home assistance,  your imagination is probably conjuring up all sorts of “worst case scenarios.”   Assuming that  you have hired an aide from a home health care agency, then you can expect a lot of support in resolving your anxieties.  

It is the agency’s job to answer your questions in advance and resolve any issues that arise once the aide starts to work in your home.  Good communication with the agency management and with the worker in your home is the key to facilitating your satisfaction and comfort level with the home health care services being Provided

Here are a few tips to help you establish positive relationships with your home health care professionals:

Be completely honest about your needs.

Overcome any embarrassment or guilt associated with describing why you need help and what you need help with.   Remember that you are dealing with professionals who have helped a variety of clients and are experienced in helping to meet the needs of their clients.   Home Health Care professionals are prepared to deal with tough problems, such as Alzheimer’s, alcoholism, Parkinson’s, strokes, incontinence, and stressful family circumstances.

State your preferences from the start.

The best way to get exactly what you want is to be specific. Give a detailed request to the agency so that the aide they send will meet your needs. Items to include are your household rules, such as “no smoking” or “kosher kitchen”. Also express your daily routines and how to follow them, such as “up at 7am”, “breakfast first, medications second, shower last”, “let me have privacy from 9am until ll am”, “light lunch at noon”, “laundry once a week”,  “transportation to salon every Friday using employee’s car”.

Give feedback to the agency on a timely basis.

“Nip it in the bud” is good advice.  Most problems start out small and can be best resolved when addressed promptly.   If you are experiencing a problem with the aide, call the agency.   This benefits you in two ways: it alleviates your involvement with reprimanding the aide directly and it prompts the agency to diplomatically resolve your problem.   Employee supervision is the responsibility of the agency.   If the employee problem cannot be resolved to your satisfaction, request a different aide from the agency.   The agency will handle the hiring/firing arrangements for you.

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The reality is that illness and loss of endurance impede a person’s ability to perform basic chores. A physically impaired person may still willingly struggle to bathe, dress, and toilet themselves. A large sense of personal dignity and empowerment stems from continuing to care for one’s self. The trade-off is that in order to save up the energy to continue with these tasks, a physically challenged individual must delegate the more mundane, non-personal chores to an able-bodied helper.

Clients utilizing home health care assistance usually request a caregiver’s help with cleaning up and straightening up. Here is a list of household chores that can easily be delegated to an aide or companion:

- cleaning the bathroom after use

- cleaning the kitchen after use

- changing bed linens

- washing laundry

- taking out the trash

- bringing in the mail

- cleaning the dinette table after use

- loading and unloading the dishwasher

- making meals and snacks

- running errands

- buying groceries, medications, and supplies

- answering the telephone and taking messages

Clients should allow extra time in the caregiver’s work schedule to accommodate completion of these chores. It is also advisable to retain a “cleaning service” for monthly or biweekly cleaning blitzes. The aide or companion can take care of the routine chores in between.

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I reassured the daughter that a suitable, seasonal caregiver could be arranged in advance of the trip and over the phone. Calling a home health care agency or nurse registry for a seasonal companion is as easy as calling a travel agency for a vacation! Another caregiver/daughter came up with a real “win-win” idea. She, her octogenarian mom, and her husband hopped in their motor home and headed South. They rendezvoused with the seasonal companion at the mother’s Florida condo. After a day of orientation with the new aide, the daughter and son-in-law resumed their motor vacation alone. They planned to pick up mom on the return journey in a month or so.

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Social Considerations:

Some spouses do not like to share! When one-on-one attention is demanded, then “His” and “Her” aides are essential to family tranquility! Otherwise, an aide can be caught in a “tug of war” between the two needy clients. The result is that neither client will receive a satisfactory amount of attention AND the aide will quit in frustration.

Logistical Considerations:

Unless both spouses plan on going everywhere together, a second aide is needed to accompany one spouse on the alternative destination. Let’s face it, being “dragged around” to someone else’s appointments or errands is tedious! Many times, the other spouse is too incapacitated to “tag along.” This happens when one spouse is homebound and the other actively participates in outings. “His” and “Her” aides are necessary when neither spouse can be left unattended.

Medical Needs Differences:

Each spouse has unique medical problems and needs. One spouse may require a skilled nurse while the other only needs a companion. One spouse may need at attendant continuously, but the other only needs assistance occasionally. It is important to correctly match the skill level of the caregiver and the amount of care to the needs of each spouse. This sometimes requires “His” and “Her” caregivers.

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How do the training programs vary for “HHA’s,” “CNA’s,” and “PCA’s?” Training programs are offered by vocational schools and home health agencies. Home Health Aide courses run from a minimum of 40 hours to 75 hours, or more. Certified Nursing Assistant programs are more extensive. These curriculums include and surpass the HHA course, with a minimum of 75 hours, and more typically, several hundred hours, and include clinical training at hospital standards. The Personal Care Assistant courses are the longest of all and supersede both the HHA and CNA programs. There are some notable exceptions in the training requirements allowed by Florida government agencies. For instance, an individual can “challenge” the CNA exam, without prior enrollment for training, and become certified if he or she passes the test. If that is too tough, then the individual can take a Home Health Aide competency test, again without prior training. If he or she passes, then certification is issued.

How do the training differences effect the patient? All three skill levels are qualified to work in a home setting. If the patient desires private duty assistance in a nursing home or hospital, then all three qualify. (However, skilled nursing facilities and hospitals are only allowed to hire CNA’s and PCA’s as staff.) For basic care duties, such as bathing, dressing, and toileting, the HHA is fine. However, if a patient requires more advanced care, such as assistance with swallowing restrictions or care for a colostomy, ileostomy, or catheter care, then a CNA or PCA has more clinical training. In the final analysis, an “Aide’s suitability” for a particular client will be based on his or her combination of training, experience, and personality.

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