Caregiving Blog: 10 Tips to Manage In Home Caregivers

Skills to manage in home caregivers are necessary when considering hiring in home caregiving support for an older adult. Assuming that caregivers are trained or experienced is an inaccurate belief. Few in home caregivers are trained or have extensive experience. Turnover is high in these positions. Many have a desire to help older adults and learn by doing. By having an understanding of the in home care industry, you will be better able to manage for success. 

Here are 10 Tips to Manage In Home Caregivers and to ease the transition to receive care in the home for yourself or a loved one. As we age, there will be a strong likelihood that we will need a caregiver. An in home caregiver is a person who comes to the home to help with activities of daily living, often referred to as ADLs, and other daily tasks. 

Activities of daily living include assistance with bathing, continence, eating, dressing, toileting, and transferring. In home caregivers also provide support with light housekeeping, meal preparation, laundry, running errands, physical activity, and socializing. In home caregiving support is helpful because family members and friends cannot be relied upon to provide daily assistance on a regular basis.

The Decision to Accept an In Home Caregiver

In home care agencies employ caregivers who come into the home. The transition to accepting help in the home can be filled with frustration when the older adult or family caregiver make an incorrect assumption that in home caregivers are trained, trustworthy, and do not need supervision. This is rarely the case.

The greater hurdle to establishing a routine with in home caregivers is usually the older adult resisting the idea of having strangers to come into the home. The broken record statement, “I don’t need any help,” will be made until having in home care is confirmed as a need and not an option by the family caregiver initiating the service. Even after this, the in home caregiver may arrive and be sent home by the older adult.

Boundary issues are common when assistance comes into the home. In home caregivers require repetitive training to maintain professional boundaries. The caregiving relationship is frequently misconstrued by the in home caregiver as a family relationship.

In home caregivers have been known to bring their children to work, speak on cellphones during the entire shift, eat food belonging to the client and participate in other activities as if they were a resident in the client’s home or a family member. This faulty thinking results in situations of conflict of interest, safety, and potential abuse.

1) Interview the In Home Agency Owner or Supervisor

Interview the owner or supervisor of the in home care agency in person or on the telephone. Request educational backgrounds, copies of resumes, certifications, and ask about the qualifications of management staff. Ask how long the company has been in business.

Request a copy of the company’s liability and workers compensation insurance. Visit the company website. Many companies are required to be registered with the state department of health. There should be a website or office you can contact to inquire about complaints filed against the agency.

Request permission to speak to clients of the company to gain a sense of the type of services provided and client satisfaction. Due to privacy regulations, companies will have to ask permission of family members to give out their information.

Confirm the person who will be your main contact for all concerns. Ask about the process and time frame to identify a caregiver who will be a good match based on the needs of the situation.

2) Ask for Background Information About the In Home Caregiver Selected for You

Ask if all in home caregivers are background checked and what specific areas of the background are checked.  If the agency runs only a criminal background check, other qualifications like a poor driving record that indicates irresponsible behavior, substance abuse, or a credit record that indicates poor money management may be missed.

Issues with any or all of these may potentially expose you or a family member to issues of safety, abuse or neglect. You can ask the agency to confirm in writing that the caregiver has a perfectly clear background check.  Because of staffing shortages, agencies have become more lenient in accepting caregivers with poor driving records or minor criminal citations.

Be specific about other qualifications and disqualifications, for example, non-smoking and having a vehicle to drive to appointments that are important to a care situation. Ask about training for dementia, bathing, cooking, and other skills that are desired. By providing a specific description of the characteristics and abilities of perfect caregiver, agency management is more able to make the best match.

You can request to interview several caregivers and select the one you feel will be the best fit. Hiring and managing an in home caregiver is a two-way relationship. 

3) Ask About In Home Caregiver Turnover

Staffing turnover averages 50% at in home care companies. This means that the in home caregiver assigned may leave employment after several weeks.

Ask what actions management staff takes when a new caregiver has to be identified and introduced to the situation. Does the agency take responsible for training the replacement caregiver? Does the responsibility of training fall on the client or family caregivers?

4) How Is Time Kept and Billed?

The better in-home care companies use automated time and attendance systems whereby the caregiver “calls in” from the home of the client and “calls out” when leaving. This serves as a time clock to ensure billing occurs only for the time the caregiver is in the home.

Automated systems alert the agency if the caregiver does not call in at the scheduled time. If a paper system is used, request a copy of time keeping to be included with the invoice so that the accuracy of the reported schedule can be verified.

5) Participating in Honest and Ethical Behavior

Older adult clients unintentionally initiate boundary issues that cross the employer – employee relationships. These boundary issues result in the in-home caregiver losing his or her job. Do not be the client whose actions result in the caregiver being fired for dishonesty or unethical behavior.

Typical are older adult clients who tell their in-home caregiver to leave early and sign to falsify the time sheet so that the caregiver is paid for the entire time. This request results in concerns of dishonesty for the caregiver who knowingly falsifies paperwork at the request of the client and them may be terminated. 

6) Ask About the No Call – No Show Policy

No call – no shows are also frequent in the in home care industry. Caregivers call off work at the last minute or do not call to report an absence at all. Older adults are left without caregivers. Clients with mobility issues who depend on physical assistance to rise from bed in the morning or go to bed at night are at greater safety risk if the in home caregiver does not make the scheduled shift.

Older adults with advanced dementia, who should not be left alone, may be unable to call the agency to make the report. How does the agency ensure that caregivers show up for shifts? How does that agency ensure that coverage will occur if there is a no call – no show?

7) Set Up a System for Frequent and Ongoing Two-Way Communication

Establish a relationship with the owner and the supervisor of the in home care agency to support open communication about concerns and ways to identify solutions and alternatives. Never hesitate to call with issues.  Ask how often supervisory staff will contact you to request feedback. Ask about the frequency of supervisory visits to the home to ensure customer satisfaction.

If you are dissatisfied with the assigned caregiver contact that agency and request a replacement. Not all matches are made in heaven. By establishing an understanding of care expectations, the agency can work to meet the care goals.

8) Create a Daily Check Sheet

In situations where the older adult receiving care is unable to direct the in home caregiver, make a daily checklist for the caregiver to avoid unproductive time. Then request the caregiver to document in a notebook projects completed on the checklist or those that were uncompleted and why. This system of checks and balances ensures that you are not paying for an in home caregiver who does not complete the requested responsibilities.

9) Confirm Medication Reminding Rules

In home caregivers are not permitted, by most state laws, to take medications from prescription bottles and provide the medications to a client. If you or a loved one are unable to complete this task, ask a family member or friend. If this is not possible, a nurse may be hired to confirm medications prescribed by a physician, pick up medications at the pharmacy, and place the medications into medication reminder containers.

The in home caregivers are permitted to provide reminders to the older adult so that medications are taken. In many states in home caregivers are also not allowed to assist with eye drops, ear drops, over the counter supplements, or wound care. Be certain to discuss needs specific to prescription medications with the agency owner prior to initiating services to avoid surprises.

10) Maintain a Professional Relationship

No matter how close you or a loved one becomes with the hired caregiver, remember that the caregiver is not your family. By creating and maintaining a professional relationship you ensure that the care requested is the care provided. Ask for a list of professional boundaries or rules of the company so that you are aware of permitted and not permitted activities so that you do not create complications for the caregiver.

The inappropriate sharing of information by in home caregivers when clients ask personal questions is shocking. Agency caregivers are directed not to provide personal information to clients. This includes personal cellphone numbers, family information, and distress about financial matters, or work situations.

Often personal information like financial struggles or disagreements with spouses is discussed with the older adult. Concerns about children and other matters expressed to a client by an in home caregiver adds burden and worry to the situation. In home caregivers should lessen worry and burdens, not become a burden or a worry to the care situation. 

Another area where boundaries are often crossed is in the “giving of items.” Giving caregivers household items that are not needed is not permitted. Gifts, tips, or money should never be given unless during the holidays and with the prior approval of the agency. By crossing the gift boundary, clients are “training” the caregiver that accepting items is okay. Accepting gifts from a client is cause for termination.

Managing In home Caregivers Takes Effort

By following the 10 Tips to Manage In home Caregivers you might feel as though you are personally training the agency and caregiver. You are! Each individual and situation is different. Most in home caregivers are average people without extensive training or experience. You are paying for a service. You should receive the quality of care your loved one needs and that you expect. 

Pamela’s book, The Caregiving Trap: Solutions for Life’s Unexpected Changes® offers more practical tips and solutions for caregiving situations and caregiving problems.

© 2018 Pamela D. Wilson, All Rights Reserved.

Pamela D. Wilson, MS, BS/BA, CG, CSA, is a national caregiving thought leader, caregiving expert, advocate, and speaker who solves caregiving problems. Online support and programs are offered to caregivers seeking support and advice for the care of aging parents, spouses, and other family members. Pamela supports adults, age 50+, with positive aging advice and online programs to advance health literacy and self-advocacy. Collaboration with professionals in the specialty areas of estate planning, elder law, and probate, financial planning, and healthcare raises awareness of and sensitivity to stressful family caregiving and healthcare issues.

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