How to work with hired home caregivers

Home caregivers can provide you and a relative of yours who is recovering from surgery, disability, or illness or who is aging with medical and personal care services. The nature of these services depends on what the individuals is trained and qualified to do. This is a case in which title does dictate behavior; as such, you should expect different things from a home health aide than from a personal care attendant. Both supply assistance with daily activities like eating, bathing, walking, and dressing, as well as certain chores such as grocery shopping, meal preparation, and laundry.

Additionally, home health aides are authorized to perform some medical tasks including taking temperatures, monitoring blood pressure, and change dressings. They can also help patients with stretching and range-of-motion exercises. Personal care assistants have many of the same duties but what they are able to do depends on each state’s training requirements. For example, a home health aide must be certified – which can be checked with the state licensing bureau. If not a certified home health aide, the person can still bill themselves as a personal care attendant, homemaker or companion – though some states have certification for the former two. Titles like a ‘companion’ are nominal and entail no qualifications, licensing, or certifications.

Regardless of whether you hire a home caregiver through an agency or privately, it is important to clearly establish everybody’s roles, including your own. For instance, neither home health aides nor personal care attendants are maids, nor should they be expected to wait on you or perform household chores not directly related to the care receiver – though an agreement may be reached with privately contracted workers. You should also be ready and able to step up to the plate if the caregiver is late or has to cancel. In general, you must stay on top of things, even if you don’t live with the relative who needs care; in that case, you may call during the day or just stop by unannounced.

Important considerations

·         Terms and expectations. If you hire privately, make sure the caregiver understands your terms; if you hire through an agency make sure you agree with its terms. These may include hours and pay, vacation time, cost of meals (included or not), backup plans in case the caregiver can’t make it as stated above, etc.

·         In case of emergency. Prepare a list of regular and emergency phone numbers and put in a place where the caregiver can find it easily. Devise an emergency plan or ask the agency if it has one and how it works if it does.

·         Valuable possessions. Remove temptation by removing cash, important papers, and valuables in a safe place whenever the caregiver is due to make a visit.

·         Personal relationships. Agencies do not allow caregivers to have visitors. Once again, an agreement may be reached with privately hired workers.

Insurance may cover home care, but it may not do so for as long or as comprehensively as you might want it to. Once coverage runs out, you may want to cut out the middleman and continue hiring the services of the same agency on your own dime. Alternately, you can hire an individual directly; either someone you know and trusts – and that the patient knows and trusts as well (more on that later) – or by advertising online or in a local newspaper. You can also compile a list of suitable candidates from your state’s database of nurses and home health aides (if there is one available) and narrow it down by interviewing these prospects, and should they be interested in the position, asking them for references in order to find out about their working and personal habits, attitude, and dependability. Again, be sure to establish whether the person is the right fit for your relative.

That can be accomplished not only by matching the services the caregiver is qualified to provide with the needs of your loved one, but also by doing your best to ensure that caregiver and care receiver can and will get along. Patients tend to reject carers due to two major barriers:

·         Resistance to outsiders. Most aging individuals are averse to the idea of having a stranger spending most of their waking hours with them or even living with them, claiming that they don’t need help and can look after themselves just fine. Actually, they may need help and be perfectly aware of that but fail to comply out of a fear of theft and abuse. They may also be hanging to their last threads of independence. Communication is essential to let them know on one hand that outside assistance can actually help them to be more productive and healthy, and on the other hand remind them that you have other responsibilities that preclude you from caring for your relative yourself, but that doesn’t mean you don’t care about them or that they can’t trust you or count on you anymore. While a combative patient is not ideal, it can serve to test the caregiver’s mettle. An aggressive patient can either fire the worker or make it so that they will want to quit. But a seasoned caregiver will not take it personally and make use of a variety of techniques to handle and ultimately win the patient over.

·         Cultural differences. Patients and caregivers can come from different cultural backgrounds that may result in a clash. For instance, the caregiver will almost certainly be younger than the patient, and the patient might understandably expect them to respect their elders; i.e. calling them Mr. or Mrs. as opposed to being on a first name basis. Religious practices are another sensitive issue, as is language, but it’s important to make sure that everyone is on the same page even regarding the little idiosyncrasies that may seem just a mole but could turn out to be a hill. As the potential mediator between caregiver and patient, it’s your duty to foster reciprocal respect for the customs of each of them.