The Duty of an Aide

When interviewing a new aide from an agency or outside hire I would ask them what they thought was the most important thing in regards to their duties. Over the years I received many answers, but never the correct one. Some girls told me "to keep the house clean". Others said "to make sure Mrs.______takes her medications". Still others said "to make sure Mrs. eats and drinks and to call the doctor if anything happens." I would have to straighten them out.

Your PRIMARY DUTY, I would tell them,is to try to make sure that when you come in to work, you do your everything in your power to make that this will be the very BEST and HAPPIEST day of your patient's life.

I would meet with them personally every day, or if that was impossible, by telephone and we would discuss exactly how we planned to accomplish that goal.

[ireneo]

I'm collecting information now (phone numbers and general info) on agencies that can provide some in-home care for my mom. From what I've read, going over the list about "should this person still be at home?" she should NOT still be living alone. So I'm going to start with small steps. I hope to find someone to come in once a week to help her with errands, medications, cleaning up. She recently mentioned this herself. Mostly I think she wants company; she's alienated all her neighbors.

My question: how do you know if the person you hire is really there to help or whether they want to weasel in on the elderly person's affections and bank account? I've heard of this happening so frequently that I'm more than a bit concerned.

I do spend 2 days a week with my mom, call her at least twice a week as well, more often than that lately because she's so fearful of everything. But more than house cleaning and running errands, I think she needs more company.

[caregiver222]

That is a very difficult question to answer, ireneo, In my own experience the problem was never dishonesty. It was a lack of common sense and conscientiousness. In order to obtain insurance reimbursement one is almost forced to hire through an agency. Worse, under some new state regulations under the new Obamacare, you may no longer be able to hire aides directly, but must employ a "care supervisor" (who will choose and "supervise" the aides), a new layer of bureaucracy, expense,  and unnecessary licensing. The perfect solution to which no known problem exists. The issue of "needing more company" is most important. The sense of "affect", or caring for another human being is, apparently, not genetically distributed in equal amounts. For different people In have hired aides from agencies (never ever satisfactory), hired sand trained them myself (best), and had an ocasional live-in. The live-in was for three months. He was an elderly physician from Australia recovering from heart surgery, agreeing to provide medical help and companionship in return for room and board. Another "live-in" was a European nursing student who was in the United States for six months of training. She also provided companionship in return for room and board.  In these cases the number of hours they were to devote to the patient were spelled out clearly. I also had great sucess with several Korean girls, who I hired to come over and take my little camper out to the park and play with her. I hired these girls because I was totally upset at the ones sent over by the agency. These girls were wonderful and sang songs and prayed and laughed. I obtained them through a Korean pastor. They had immigration issues and would only work off the books. That proved to be an issue. The only problem was that they tended to cook inedible (understatement!) meals. In the Korean (and asian cultures) elderly people are revered and worshipped. This proved to be true. They disappeared when they found American husbands. It takes patience to find the right help-person, and observation and supervision. They are out there. I finally ended up with four aides who were absolutely positively wonderful in all respects. That is, after thirty-seven of them went through the meat grinder.

[ireneo]

Looks like I have my work cut out for me. At this stage I spend more energy and time with my mom than I do with my own grown children and grandkids who live only 5 minutes away while mom is 30 minutes away and across the border. But dear old mom still expects more.

Today she was complaining that people ignore the elderly and she told her doctor that she had no family to help her. Somehow I managed to keep my mouth shut but I'm sure steam was coming out my ears. She thinks as people get older, all the family should be parading in and out day and night to care for the senior. I calmly told her that in this mobile society I don't think people live close enough to do that. She still expects it though. Thus I'm willing to go through all the hoops to find some extra companionship for her.

[caregiver222]

Finding someone to assist is a somewhat labor-intensive operation, but it is possible. To evaluate I would take the girl out with my little one and explain that I wanted them to make her really have a good time, and then excuse myself and tell them I would be back in an hour or two. I would then go over the hill and observe with tasco binoculars. A beautiful 33 year old Korean girl named Sua took my little one to a pond where there were ducks, and I could see her point to the ducks and laugh, then kneel down next to my little one, hold and kiss her hand and sing songs to her and brush her hair for an hour. So people exist who can be very worthwhile. I hated to lose her, but she got a full time job at a doctor's office and I couldn't use her more than a few hours.

[caregiver222]

I have hired girls to be "companions" for several elderly people and find things work out best when there is no "hourly" fee, but a "flat" rate for up to ten hours for two weeks. Bi-monthly. These were not certified "aides". Circa 2012 you can do quite well for ten dollars an hour or a hundred dollars cash for a ten hour "flat".  Invariably the girls ended up spending far more time that ten hours. If you don't agree on a "flat" you will be involved in aggravating niggly-piggly over hours worked every week. Arghh! ("I came in at seven-ten and left at nine sixteen....how many minutes is that") Let the girls keep their own hours. I would pay them bus fare and the cost of snacks (usually tea, coffee, pastries and juice). I would reimburse reasonable expenses without question. They enjoyed watching television and would often spend an additional eight hours watching movies with the patient. I have hired agency girls on 12 hour shifts and others on a semi-live in basis of two or three days duration. On the books.  The problem with the 12 hour shifts was that the aides would come in from another job and in the morning leave for another job. My standing rule was that "duty" on a 12 hour shift would be exactly that. I prohibited second jobs where the aide would work either before or after a shift. Trust me on this one.  If you don't insist on this they will consider the shift to be "sleep and rest time". Most of the agency hires were useless as a screen door on a submarine, with one exception. Many spoke no known language. For the "live-ins" on two or three day shifts I would spell them for a minimum of three to four hours during every day and an hour at night. They would have to buy outside supplies at times and I would designate one girl to do so on her own time, estimating four man-hours (or girl-hours) a month and give that person an extra $40 cash to pay for this. I would also give the live-ins a ten dollar daily meal allowance (for themselves) and usually cook them lunch (an extra one). I would prepare the meals myself and store them in the refrigerator to be microwaved. I have had terrible experiences with so-called "clean teams". I would divide the patient's room into four quadrants and "G.I." one quadrant every day.

[caregiver222]

The professional care services have one advantage if your loved one requires 24/7 care. That is, they always have someone from their pool available to "fill-in" if an aide cannot be in for work. The downside is that the aides (in general) do not get paid for sick days and will show up with the flu, coughing and sneezing, so as not to miss a days work. In general, their aides arrived with the common sense of a moth. My little one required special feeding (she had dysphagia) and the fill-in aides invariably failed the "feeding" test. And the service would not call me if there was a fill-in. I would always offer to pay aides their salaries for three days if they had to stay home because of illness. For a while I engaged the services of what is alleged to be "the largest and best provider of senior aids in the United States", founded by a late physician who "wrote a book on geriatric care", with a web page chock full of testimonials. I would describe my experience with this care providing service (their website shows smiling aides in bright uniforms and laughing seniors in wheelchairs) as "A nightmare on Elm Street". There was the aide who deliberately forced boiling hot soup down the throat of my little one (true) because she was "mad", the other aide who showed up with the flu and coughed in my little one's face, then spit yellow flem (phlegm) on her finger and forced it into her mouth, the other one I fired who deliberately threw away her favorite stuffed animal (Inez cried for days). My experiences with them upset me to this day. Then they had a male supervisor who would have ended up in a duel with me had it been 1810. So if nothing else it proves that internet web sites are no guide to the care these people can provide. I eventually worked out a back-up plan for instances where no aide was available. I engaged the services of a church-non-profit who ran a nearby clinic several blocks away with nurses who agreed I could wheel my little one over in an emergency and they would park her in an air-conditioned patient room to watch television and feed her. For a few dollars one of their aides agreed to come over and pick her up, if necessary.