For those who wish to age in place at home, a first step often involves hiring someone to come in to help aging parents. Sometimes the elder is able to hire on their own, and sometimes family does so. At AgingParents.com, where we advise families about healthcare and legal issues, we normally recommend using a licensed agency to provide the workers. With well run agencies, the workers are background checked and the agency is licensed and bonded.
No Close Supervision
The issue we see is that the worker is placed in the home, with many long stretches of time when they are completely unsupervised. No one is watching, and the worker does not take notes nor account for how they spend their time. The cost of home care has risen with the pandemic, inflation and the nationwide labor shortage. From our viewpoint, with that higher cost, there is no increased accountability. There are widespread policies in many agencies, designed to protect the agency from clients “stealing” their workers and hiring them outside the agency for a lower cost. These policies may not allow the client to even know the worker’s last name. All questions are directed to the supervisor, who communicates with the client or client’s family.
With cognitively impaired clients, hiring a home care worker can be a financially risky setup. The elder receiving care is not capable of supervising the worker nor keeping track of what they do. The family has no weekly report nor any communication with the agency supervisor, other than the bill they receive for services. And a high bill it is.
When we at AgingParents.com dig into these matters at the request of the elder’s family, it is usually because the family is alarmed at the billing and wonders if it is too much for what their mom or dad is getting. Here is a case, typical of what we find in some matters:
Tanya’s mom, Daniella has dementia, and needs full time caregivers. Daniella can walk and talk, as well as feed and dress herself. She sleeps pretty well, with occasional waking and wandering during the night. Tanya was concerned that the caregiver agency was there all night and Tanya had no idea what they were doing during that 12 hour shift. (Overtime was charged at time and a half for anything over eight hours, according to state law). I contacted the agency. I could only speak with the supervisor, who was very cooperative. He broke down Daniella’s caregiver duties for me in an email.
The accounting of time revealed that the caregiver was sleeping at night, and the family was being charged $45/hour for a sleeping caregiver! Of course I brought that to Tanya’s attention and recommended that the agency be fired and replaced with one that had more ethical practices.
We have no data on how often this goes on. We can only say from experience that it is not uncommon. What it teaches all of us is that caregiver accountability is essential for all the hours the family is paying for someone to attend to an impaired aging loved one. There should be no sleeping on the job!
- When hiring an agency, ask what their policies are about recording what caregivers do on a daily basis. If caregivers do not keep daily notes (most don’t), ask for this to become their practice for your loved one. The supervisor can maintain the notes, and communicate them to the family weekly.
- When there is resistance, which we hear from caregiver supervisors, that the workers are not computer literate or don’t use computers in the home, you can be sure they all know how to text. Ask the supervisor to summarize the texts and provide family with a summary of the work done.
- Options are available for families when the agency has no specific way to track caregiver activity. AgingParents.com has created a Google
doc form for daily caregiver reporting. Your family can do the same. Include every item you are paying the caregiver to provide and have them check off the list of what is done daily.
- Home care workers are unlicensed, non-medical service providers. They may be unsophisticated about health care in general, but they should be capable of noticing changes in behavior, mood or activity levels in clients. Ask them to specifically note anything unusual in aging parents’ mobility, alertness, appetite, elimination, sleep, etc. for family to address.
- Requiring caregiver accountability prevents inappropriate charges for services the family or elder is paying for but may not be getting, such as someone awake and alert to watch over your loved one at night.
Get the basics on how to safely hire a home care worker in my short book, Hiring A Home Care Worker: What Could Possibly Go Wrong at AgingParents.com.