Expectations for Home Health Aide

Imo

My father has hired a Home Health Aide to help with my mother's care; she has middle stage dementia.  What are the expected duties/job definition for that type of position?  While she is kind to my mother she is passive in all her activities.  She does not react unless my Mom directly addresses her.  For example, my Mom asked my Dad to use the bathroom and the Aide who was next to her did not react.  Or my Mom asked if there was milk and cookies (I was on video chat) and I had to tell my Mom to ask the aide who was once again, next to her.  My siblings were visiting and state that when my Mom does not ask for things the aide puts in one ear bud and watches videos on her phone.  She never engages my Mom in any activity without being prompted.  Our mom complains of being bored (she can't read anymore).  Before we strongly push our Dad to address this - either ask her to be more responsive and keep my Mom active or even request a new aide.......are we expecting more than the expected job description?  None of us have experience hiring and in home aide.  And the closest one of us lives is 1.5 hours away.

dayn2nite2

Request a new aide and tell the agency you expect any aide they send to initiate conversation and activity with your mother and NO PHONE USE during working hours.  If she asks to go to the bathroom, the aide should take her, same with any requests for food or drink.  

Even sitting and just having conversation is an activity.  It is unacceptable to me for a person who is caring for my LO to have an ear bud in and watch videos.  That is a solitary activity.  If they were watching TV (only a show your mother likes) that would be acceptable and having some conversation about the show would be an activity too.

abc123

Did he sign up with a home care agency or did he hire an independent aide? I just spent three weeks at my parents house researching agencies and hospices. The person you described is in the wrong line of work. If she is a volunteer thru a hospice, she is "eyes only". I learned that a volunteer can not be hands on. 

This is what I learned about caregiver services thru an agency( I interviewed 3 agencies in the area, all offered the same services at the same price, $25 per hour, minimum of 4 hours per day.) All employees are trained, bonded, and vetted, it also states they all have caring hearts. The following is from the list of services provided:

Meal preparation, Medication reminders, Accompany to Doctor visits, Grocery shopping and errands, Discharge assistance/Prescription pick-up, Laundry and linens, Light housekeeping, Encouraging engagement, Keeping seniors safe, Pet care, Respite for families, Assist with personal hygiene and grooming, Bathing, Dressing, Incontinence care/Toileting, Mobility assistance, Transfer assistance, Assist with exercising, 

My dad just lost one of his dearest friends, he will leave today at noon and return home Thursday at noon. Mom will have round the clock in-home care while he is gone. The two dogs will also be at home. The neighbors are available for backup. I will let you know how this turns out. Dad is a nervous wreck because this is the first time he has left his wife of 62 years in the care of what he calls strangers. He will be staying at my house tonight so I will work on keeping him calm and reinforcing the fact that he has made some very wise choices for the both of them. The past three weeks were extremely difficult, there were moments when I thought I would loose my mind. 

I hope this is helpful to you. I'm so sorry. I know how hard it is to live far away from your parents. Don't give up, there is a way to make things better. Please let us know how things are going. 

LovingAwareness

We had two different aides from the same agency care for our Dad prior to the pandemic so I could work. Aide 1 was similar to the one you describe. She was very passive and only did anything when directly asked. She would take him out for a walk and make him a sandwich for lunch and that was all she did. She and Dad watched tv, mostly. We would ask her to turn on news, nature/zoo, travel or history programs for him, and ask him if he was enjoying the show, but then when I would come up from my work office to check on them she would have her wedding shows or some Karadashian crud on the tv. The phone was constant. She was more trouble to have around and than she was worth. After a few weeks she started a school program and we got Aide 2.

Aide 2 was much better - she was caring and attentive. She did laundry and cleaned Dad's bathroom without being asked. She tried to engage him in practicing his musical instruments. It did not work, but she kept trying. She put on exercise dvds, tai chi, etc. and tried to engage him in those. I trusted her to drive him to the doctor or take him for a haircut in his car. I thought she was about as good as it gets, but unfortunately, Dad really resented having her around and was very grouchy with her. He became agitated on the mornings when she was scheduled to come. It was a relief to work out more family coverage and let the agency service go.

But if I had to do it again (and I might), after seeing what Aide 2 brought, I wouldn't accept Aide 1. I would request another person. You and your Dad can draw up a written care plan for the activities and help you need for your Mom - what should be done for your Mom each day, meals, activities - and provide a copy to the agency and aide and make it clear that way what you expect. If they can't do it and "be here now" for your LO, work with the agency to get a better fit or try another agency. You are paying a lot of money for this service. It is hard to manage a person from long distance - I found it hard even while being in the same house. Do you think your Dad can be more assertive? Unfortunately even with the best aide you still have to manage them as an employee. Hope you can get someone who will need minimal management.   

mommyandme (m&m)

Having a list of what is expected during their shift set out in the open is very helpful. 

 I had a great caregiver that was a self starter. I didn’t need to tell her anything.  Unfortunately she has small children and had to leave.  Now I have to leave a list.  

Also the cameras are amazingly helpful to supervise both mom and what’s going on when I’m not here.   One caregiver fell asleep… I know it can be very boring or you could call mom an “easy gig” but… ARE YOU SERIOUS! 

Sending hope for peace your way even if just for today. 

Cobalt

We have 24/7 caregivers for my son in my home.  This is because he has always been a DDD client (developmental disability) or we would have no help at all.  There is a big difference between respite care, home health aide, caregiver,  personal aide and quality of life aid.  Those labels make a big difference. The state here sets out standards and duties of a caregiver.  While most of the care is supervision and then "attendant care" like toileting, showers, meal prep and helping him eat, there also are listings for "leisure time" and "socialization".

When insurance pays for care, the guidance may be more specific on activities, not just "care".  "Respite care" is mostly just adult babysitting and there is no requirement for social interaction. Caregivers here are supposed to do anything the family would do in care, which includes interaction and conversation. Caregivers help him do his home exercises from therapy. Caregivers don't do meds but they can and do put out the pill cups for my son that I have filled for the 4 times daily does. They prompt my son to take them and he does. I do any OTC meds for headache, constipation, etc that are PRN.  But  again, I authorize and get them out.

It's very tricky because caregiving of any sort cannot do "nursing care".  Once anyone decides that a nurse in the home is needed weekly or several times a week, my son may be likely to lose his caregivers.  In this state if "nursing care" is needed, then the state will pay for nurses to come in but we no longer get caregivers.  Hope all this just laid out helps some.  It's something we had to learn about to be very careful to qualify for caregivers and respite.

Imo

Thanks everyone.  The aide is through a private agency, not covered by insurance.  My Dad is less assertive in his personal life than he was at work (he was a leader/boss).  And I'm not sure he realizes how bored my Mom is since he is often so focused on everything else.  I like the suggestion of a list of responsibilities/expectations for the aide.  My siblings and I (there are 4 of us) can help him draw that up.  Then he can talk to the current aide about our expectations.  If she is unwilling or not doing what is asked he can go to the agency and ask for a new aide.

Cynbar

Trust your instincts, that aide is not doing a good job. The right one should be warm and friendly, attentive to your mother's needs. She should try to get to know her, get an idea of what she enjoys, try to interest her in those things. She should also have a good idea of what your mom can tolerate --- constant conversation or activities are probably too much, for instance. But in the end, it's all about the attitude. A good aide is focused on your mother, a bad aide does as little as possible and focuses on herself, her phone, her chosen TV program, etc.  You know what to do here, encourage your dad to request a different aide. We are all just confirming.

aod326

We had a live-in carer for about 10 weeks. She was marvelous, both with DH and actually as moral support for me. About four weeks in she needed to take a week off (which I'd known about from the first day) and her replacement sounds like the aide you're describing. Did nothing unless specifically requested and even told me to do things like "raise the bed", "wash his back" when I was helping to change DH. I was having to put the bedding in the washing machine, or it would stay on the floor for hours.

Knowing it was only for a week, I didn't insist on a replacement, but made sure I told the agency what she wasn't doing and that she was a poor ambassador for their company. (They were very receptive.) You can't train attitude though - sounds like your current aide, and my replacement one, are in the wrong profession.

Having an aide is expensive, and, you deserve to get the services you expect. I would say, though, you also can't expect someone to read your mind - your father needs to tell the aide what he expects of her, even if it appears obvious to him and you. After 2 or 3 days of being polite - after all, she was living in my home, and I didn't want an unpleasant atmosphere - I started to direct the new aide as to what she needed to do. In my state, NJ, an agency providing a home health aide is required to complete a care plan, which clearly lists what is expected. I would ask them about that for when you replace this one. Which you need to do, ASAP!

Good luck.

Imo

Just wanted to update - my father sat down with the manager of the the Aide company.  They gave the current aide a chance but she only engaged with my Mom for one day.  A new Aide started this week.  I gave my father the suggestions shared here to set up a list of expectations on day one.  Hopefully now my Mom's care will be greatly improved.   Thanks for all of the advice.

mommyandme (m&m)

I hope so! Thanks for the update.