Ombudsman Program Newsletter Article
Tips on Dealing with Home Health Care Providers
- "My aide frequently shows up late without calling to warn me."
- "The number of hours that my aide works for me varies from day to day."
- "My client is expecting me to work past the number of hours that we agreed to."
- "We are using my car to take my client to the grocery store and hairdresser, but I am not getting reimbursed for gas."
Home care consumers and the independent home care providers that serve them have made comments like these to the Long-Term Care Ombudsman. The problems expressed often stem from a simple yet critical oversight: the provider and consumer did not put their employment agreement in writing.
Among other things, it addresses the care to be given; days and hours of work; terms of wage payment and benefits; designation of a backup worker; advanced notice of termination of service; and who to contact in an emergency. Perhaps most importantly, the form provides space for the consumer and provider to designate a future date to meet and review their agreement. Addressing the conditions of their agreement should not be a one-time event because, if nothing else, the consumer's care needs will likely change over time. The agreement should be signed after each review and both parties should retain a copy.
When both parties take the time in the beginning to sit down, explore, and record their expectations, needs, and preferences, many simple misunderstandings can be avoided. This is because they cared enough to openly communicate and formalize their agreement, and the result is that they feel mutual respect. Both have a clear understanding about the expectations of this home care service, which gives rise to a greater level of comfort.
During the hiring process, consumers are advised to inquire about and verify a home care provider's training, credentials, and prior experience. Consumers should ask for references and call them with forthright questions. A preliminary face-to-face interview with the provider is a must!
One home care consumer who needed home care services nightly, called us out of frustration because the home care agency was sending a different (and often new) aide to work there almost every night. This meant that each night she had to orient or reorient the aide, and the two had to become accustomed to each other. This was disruptive, time-consuming, annoying, and anxiety-producing. Her home had a revolving door. The resolution? The home care organization decided to create a pool of 4 to 5 aides who would rotate and serve as back-up to one another in caring for this consumer.
Too Many Cooks Spoil the Broth
The Long-Term Care Ombudsman received a call from the son of a gentleman who was receiving home care. The home health agency aides caring for his dad weren't doing what they were supposed to, he said. After the Ombudsman interviewed all of the parties involved, the source of the problem became clear: there were too many "bosses" in this situation. The home health aides were receiving directions from the son (who did not live there), the man's wife, the housekeeper, other adult children of the recipient, the agency Nursing Supervisor, AND the care recipient himself! The agency policy (appropriately enough), was to follow the wishes of the recipient, but in this case those around the recipient had other ideas and created difficulties.
The moral: When a home care service is engaged, make very clear to everyone who, if not the home care recipient, is to give directions.
Lead Us Not Into Temptation
Consumers, please do not give your home care workers your credit cards in order to make purchases!! If you need your aide to perform shopping, create a petty cash box containing a set sum of money. Sit down with the worker and explain how all receipts for purchases must be placed there, and that the total of cash and receipts must equal the amount you started out with at all times. Then monitor the box!
Drop By to Say "Hi"
If your relative lives alone and is receiving home care, it is advisable to stop in occasionally when the worker is scheduled to be there to see how things are going. Pop over when the worker is NOT scheduled to be working as well. Frequent phone call check-ins with your relative are certainly helpful, but not a substitute for in-person observations. This is a good idea whether the services are being provided by an independent individual or by an agency which says that it supervises its workers.
There's a Method to my "Madness"
One consumer complained that his home care aides were not taking his disabilities into consideration as they cleaned his home. They did not appreciate the importance of making the bed in such a way that the consumer could get into it by himself at the end of the day. They would see the telephone receiver placed backwards on the phone and instinctively, impulsively turn it around. The consumer used a wheelchair and did not have use of his left arm, so he purposely placed the receiver that way out of necessity.
The solution: explain your methods to the worker the first time he or she comes to serve you. Or write some of these things down and have the new aide read and refer to it. If the aides still do not comply after reminders, bring it to the attention of their supervisor.
For further information on the hiring process and registries of home health care providers maintained by county agencies in Northern Virginia, please call the Long-Term Care Ombudsman at 703-324-5861.