How difficult is it to find a good home health aide?

"Short leash"?? My god, you're hiring a human being, not walking a dog! The only people you could get to work for you are those who couldn't find other jobs.

I can't even begin to describe how offensive that remark is. I even wonder if you're serious or just another troll trying to jerk our individual and collective chains.

I'll bet you're rolling in dough, maybe you're even an investment banker, and treat your staff like crap.

I'm talking about a man who can legally work here; otherwise an agency funded by Medicaid could not hire him. However if his English is heavily accented and more a less a beginner level that doesn't bother me.

I have to admit that I am very frugal. A penny saved is a penny earned! I expect a good work ethic, no "attitude", and I like to keep workers on a very short leash.

I have to agree with the above posters. I am a nurse who works in home healthcare and I'm not sure your expectations are realistic.

There are 2 types of overnight shifts. A "resting" overnight and a "non-resting" overnight. The resting overnight means that your aide is guaranteed at least 6 hours of sleep a night. The non-resting means that the aide is up while your father sleeps and for this you will pay more. Here in St. Louis a daytime shift costs about $10-$15/hour for an aide. If you need overnight it costs more. For someone who needs 24-hour/day care we staff 2 aides in 12-hour shifts. This is easier on the patient and the family and the aide. You have a day shift and a night shift. The night shift makes more than the day shift and makes much more than $50. That's only 5 hours of a daytime shift (figuring conservatively). I wouldn't accept a night shift for $50. I wouldn't even consider it.

Aides don't sleep in the same room as the patient regardless of whether the aide is male or female. Separate sleeping quarters are required.

And getting your dad up and down 3 steps while in a wheelchair would require strength that even a male aide may not have. Your dad may weigh 115 lbs but the wheelchair weights 40 lbs. Not to mention how unsafe that would be without a ramp, for your dad and for the aide. To get up the stairs the aide would have to turn your dad around backwards (in his wheelchair) and drag him up those stairs. This is very unsafe for your dad as he will be pitched forward. To get down the stairs the aide would, once again, have to turn your dad around backwards and let the wheelchair bump its way down those 3 stairs. The aide cannot push the wheelchair up or down as your dad wouldn't be secured. It has to be done backwards.

Calling every 2 hours is inappropriate and will interfere with the aide doing his/her job. It also demonstrates a lack of trust on your part and a need to control everything while you are not there. Not good for morale at all. You either trust the aide you hire or you don't. If I had a family member calling me every 2 hours I would communicate to them that it's unnecessary and that they hired me, they should let me do my job. If the overbearing nature of a phone call every 2 hours continued I would quit. Plus, I chart everything, any changes, anything out of the ordinary, and if it was just a regular day I chart that too. I chat what the person eats, when they take their meds, when they use the toilet, if they've had a bath, etc. I chart everything. There's no need to call every 2 hours. And even IF.....IF.... you could find some person who would clean your house top to bottom during all of this how do you expect this person to take care of your dad, take care of the house, AND answer your calls every 2 hours? That sounds like a nightmare of a job to me but I wouldn't be cleaning either so maybe I could take a phone call occasionally.

As you said, you're in an area with a lot of immigrants and maybe you can find someone to work this very strange job and maybe this person would be grateful for $50/night but it's exploitative and you get what you pay for. If the pay is too low, and it is, you're not going to find someone qualified and experienced. And from what I gathered you're basically saying that you can find "immigrants" (let's just call it what it is, illegal aliens) to do this job for less money and if that's the case I think that's disgusting, not to mention illegal. Because they're illegal aliens they'll take whatever you offer and be grateful for it. That's what I'm reading in your post.

It's obvious that you love your dad and you want what's best for him but again, as a nurse who works in home health and with all due respect for you and your dad, you're going to have to amend your expectations. Unless you find people to exploit in which case good luck with that. I have a patient (she's my favorite patient right now) and she's in a nursing home. The aides there are all immigrants (Bosnia, Jamaica) and they are cruel and uncaring to most of the residents and this is at the nicest NH in town. Certainly the nicest facility I've ever been in and I've been in too many to count. And these aides work for a huge corporation and they still treat the residents horribly!

My point is that if you're trying to go cheap, trying to get the most bang for your buck, the one person who's going to pay dearly is your dad.

GA makes some very good points. First the non-fluency. Just this past week another caregiver spoke about the difficulty his wife is having when non-fluent caregivers are brought in. It is not only difficult for her, but also for him. Because of her advanced Alzheimer's she becomes more confused and agitated that she does not understand the caregiver. It is not at all unusual for families to request fluency in a caregiver it is for the parent's well being. The steps with a wheelchair creates another problem. It does not appear that you have thought this out well and are naturally concerned about cost, but there is no way around it, home care is very costly to provide a safe and comfortable environment.

He would probably be best in a nursing home, or think again about your apartment. You could spend the nights with him, bring in care during the day while you are at work. And you would be paying for one place to live, not two.

You need to reevaluate the situation and reconsider your options.

Yes, I believe your demands are unrealistic.

Your father may be light, but wheelchairs even when collapsed are bulky and not necessarily lightweight. Open them fully and add 115 pounds and you have a challenge for a body builder.

Realistically, you'll need to add a ramp over those 3 stairs. Expecting someone to lift a wheelchair upward over steps, alone, with a delicate and/or fragile man with advanced Alzheimers in it, is very, very unrealistic, and very, very unsafe.

I tried that when my sister was in the last stages of cancer and only had 2 steps. It was impossible for me to do, even after a therapist showed me how to manipulate a wheelchair up and down steps.

Then there's the issue of transport. If you don't have a wheelchair equipped van you'll have to hire a specially equipped van. Lifting a wheelchair into a vehicle that doesn't have a mechanical lift is not safe or wise, for either your father or the aide. You would need someone skilled in transfers of an immobile person as well as a specially equipped transport vehicle.

Anyone who could do upward wheelchair lifts probably spends his spare time at Powerhouse Gym practicing for bodybuilding contests.

There's also the gender issue. You wrote that you want a male aide to spend the night with your father but that you also want a "very good cleaning lady." The two are dysjunctive.

A cleaning lady isn't going to have the skills to care for or lift your father, and a male aide isn't likely to have the cleaning skills you want for a "spotless" house. They're two disparate skill sets.

If you hire immigrants, I assume you're aware that it's incumbent on you to ensure they're documented. However, acceptance of someone w/o "complete fluency in English" troubles me, very much.

From your description of your father, I suspect he's weak and frail and also has difficulty communicating because of his apparently advanced Alzheimer's. I wonder if he would even be able to communicate his needs to someone who is a native English speaker, let alone someone who's not.

I see the potential for miscommunication and misunderstanding, especially for someone in the advanced, aggressive stage of Alzheimers. Your father may become even more agitated if he isn't able to have his needs addressed because of communication difficulties. The aide could be blamed for problems and events that aren't his fault.

I don't see how what you want could be accomplished without a full time live-in caregiver for your father.

I also think that 2 hour contact with an aide every 2 hours is insulting to the aide and will interfere with his attention to your father. If he's struggling to move your father, do you expect him to stop to answer a check-up call?

Seriously, you need a live-in aide just to care for your father. Forget about the extra cleaning tasks because an aide is going to be too busy just caring for an immobile, uncommunicative, incontinent and apparently sometimes combative person.

This is a bad, bad plan.

We have a Hoyer lift but the bathroom is not modified. There is some lifting involved. The apartment is three steps below street level so that means that the wheelchair with him in it must be maneuvered up and down those steps. But he only weights 115 pounds.

The hip fracture healed without surgery. The doctors decided not to operate.

I'm in Brooklyn. There are plenty of new immigrant aides here and I don't require complete fluency in English. If we can basically communicate that's fine.

Agencies here, by law, pay $10 per hour and $12 overtime. Then I'm adding $50 for overnight.

I don't want to spend the extra money on a cleaning lady.

So for my $50, plus the agency salary of course, I'm hoping to find excellent 24 hour care and a very good cleaning lady.

But is that actually unrealistic?

From looks of things you are in New York. I would be very surprised if you could find anyone that would meet you expectations. You've got my GOAT.

If your father's not walking at all, there's an additional burden on anyone caring for him. Do you have a Hoyer or other type lift? Has the bath been modified so his wheelchair can be rolled in for showering?

I agree with the other posters. If you want a spotless house, you'll need to hire a cleaning service. That is well beyond what any aide could be expected to do.

You may have to temper your expectations as I honestly don't think they're realistic.

I'm also wondering about his post-hip fracture situation - was the therapy unsuccessful?

If the aid is in the same room there will not be much sleeping going on. Maybe you should look for a live in maid for the spic and span house and a caregiver for dad's awake hours.

The aide will be able to sleep at night - most of the time. However I want him to sleep in the same room with my father and help my father if he wakes up and is upset, which may happen especially towards morning.

$50 per night adds up and I cannot afford more than that.

I cannot have my father live with me because I work. I do however plan on calling the aide every two hours during the day and receiving a detailed explanation of what has transpired. I'll be keeping a close eye on things.

I'll also vist dad before and after work to make sure dad is fine and the house is spotless as well.

I wouldn't dream of dehumanizing my father by placing him in a nursing home.

I work in home healthcare as a nurse and we've had clients who expect our aides to keep the house 'spic and span'. This is not what our aides are for. They are expected to clean up after themselves and to keep the patient area clean and neat but they are not maids. If you're lucky you might get an aide to wipe the kitchen down before she leaves. They don't do windows, they don't re-grout tile in the shower, and they don't work in the garden (some of the things our aides have been expected to do).

If there is down time then the aide can bring a book, or have a snack she's brought with her, or eat her meal she's brought with her. 12 hours is a long shift and the aide needs a couple of breaks too.

If he needs 24\7 and is on Medicaid maybe it would be best to place him in a facility. Paying $50.00 for overnight seems to imply that the caregiver will be able to sleep all night. But unfortunately, you cannot sscheduleor know which nights dad will need help. We have a caregiver come once a week. Her instructions are do not concern yourself with cleaning! Her job first and foremost is to keep my mom engaged and comfortable. In addition if someone were cleaning the house my mom would become very suspicious then agitated (and who knows where that would go). She has tried to throw caregivers out of the house before, yes physically. If you want a good working relationship with the caregiver realize that person's job is to take care of dad and cleanup necessary messes. That is enough. Hire a housekeeper to come in one every week or two.

Private aides (self employed or hired through an agency) get on an average $20 an hour and more for awake overnights. They are not employed to act as housekeepers.
Housekeepers (self employed) get on an average of $15-25 an hour to keep a home spic and span.
Urine or feces soaked sheets are usually not part of the deal.
Home visiting LNA's will charge $50 a visit just for a bath.
If you are so concerned about your parent and his needs then best coarse of action would be to do it yourself. Have him move in with you or visa versa.
Home carers and housekeepers are the most unappreciated of the working class. They charge well below what they worth. Perhaps you need to do the job before you hire someone else? It might give you more perspective.

Most agencies do not allow off the books moonlighting. The agreement I signed with an agency forbade hiring the employee privately. Additionally $50 is not enough for someone that needs overnight care. If he did not need overnight attendance, you would not be looking for that. If the Aide is on shift morning and night when does she sleep?
Might as well face it. It get very expensive to have 24 care at home. An agency charges $17 to $25 per hour. You can get an individual for as low as $10 hour, but you do not have the backing of an agency.

With sundowners and evening incontinence, you cannot assume the night hours are idle, they can be some of the busiest.

The Aide is there for dad, she may prepare meals, pick up after that, pick up after dad....maybe do some light housekeeping, such as soiled sheets. She is not paid by Medicaid to keep the apartment spic and span, so temper your expectations on that. Do not expect she will clean windows, baseboards and vents or vacuum drapes.