How to handle scope of caregiver duties?
I'm looking for people with experience on this.
My mom just started having aides at home for one shift/day. Since she lives with me (I am disabled with Chronic Fatigue), I am basically supervising the aides. The managed l-t care Medicaid insurance company came in and did a detailed and extensive (exhaustive -- it took 7 hours of answering questions) study of my mom's requirements. But they provided us with no kind of care plan or paperwork which might be helpful with aides. The agency which provides the aides is very casual -- "their duties are between you and them; if you need housework, we will find you someone willing to do light housework."
One of the aides is extremely hard-working and also very friendly with my mom, and my mom really likes her. She sweeps the kitchen and cleans it once a week; she also cleans the bathroom and floor weekly. She also sweeps the hardwood floors in the other rooms in my mom's area. She does not cook; she says she'd rather clean than cook. She works 2 days a week.
The other aide is very quiet and hardly talks to my mom. She sits and reads a book while she and my mom are sitting on the porch. She will change the bed when my mom wets it, but she leaves the sheets for me to wash out in the sink. She will wash the dishes that she and my mom use for lunch, but she leaves the dishes that me and my mom used the breakfast. She has training and 10 years of experience with physical care -- she is good with lifting out of bed, changing diapers, using the wheelchair, etc.
I'm not sure how to handle the second aide -- I'd like her to do a little more, such as wash my mom's sheets when needed and do all the dishes in the sink. Do I just ask her politely, and then remind her if she doesn't do it? Should I try to put a care plan in writing, outlining her duties? How detailed should that be?
Thank you for sharing your experience. If you feel that home health care aides should never do housework, please don't answer my question. The agency and the insurance company have both told me that light housework of my mom's whole area, room and bathroom (I have my own bathroom on a different floor) are reasonable tasks for the aide. I'm not talking about washing the windows.
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I agree that it is weird to only do half the dishes (how exactly does she manage that?) I would make a list of tasks for the day and go through it each time she comes.
Separately from that, Medicaid paid for a certain number of hours for personal care assistance. We had a wonderful young woman who did jigsaw puzzles with Coy, helped him with his exercises, watched television with him, helped him dress and shave and brush his teeth every morning. She brought her own lunch and heated up whatever I indicated for Coy's lunch. She pushed him for walks in his wheelchair. The contract with the agency said she was not to do housework. When Coy went on hospice and slept a lot, she was bored out of her mind. I had her straighten out our linen closet and a few similar tasks. I told her that she certainly did not have to do that ... that she could play games on her phone or watch tv, but if she wanted to have something else to do the sorting would be helpful.
Apparently in my county the Medicaid program wanted to pay housekeepers at housekeeping rates and PCA's at the going rate for that, and did not see fit to mix the assignments. It appears to be different in your location.
I think you need to get your answer about scope of duties from the Medicaid case worker. We can only tell you what the policies are where we each live. You need specific advice for your situation.
My Dad has had a variety of caregivers, and I found every caregiver had their special skill.
One lady just loved to cook and she would even prepare food for the next caregiver to give to Dad, just heat and serve. And she was about the only one would was finally able to convince Dad to have her help him with his shower [he was very shy]. She would also get Dad outside for a walk.
Another caregiver liked cleaning but didn't care to cook [I know how she feels]. One day she had rearranged the furniture in the living room and it worked so much better. She would go outside with Dad, with his walker, and help do some yard work.
I found asking the caregivers for their "suggestions" on how to do things will open up the line of communication.
She has improved through gentle requests and reminders -- she washes the sheets and does the dishes most of the time, and she has taken over putting my mom's many pills into her pillbox. She is also a bit more friendly at times, and she does word puzzles with my mom once in a while.
Yesterday, there was a problem with her timesheet which the agency discovered -- she said she was here on a day she was not, and it happened to be a day someone else had worked. She refuses to clock in on my phone like the other aides do, and she does not give my mom a copy of her timesheet.
It's funny, I am reluctant to let my mom supervise this aide more because my mom is so abrupt with her also! My mom doesn't like that she doesn't work harder. Perhaps I should just let them be abrupt with each other and get out of the middle.
I guess I will just ask my mom to get a copy of the aide's timesheet when she signs it, so we can go over it, and leave it at that, appreciating the rest of our progress.
Your feedback welcome!
I see that your mother is living in your house with you. It makes it hard to know what the division of duties is for the caregivers. I know CFS makes things hard, but maybe it would be good for you to wash the breakfast dishes after you finish eating. To me this would be showing respect and wouldn't take a lot of effort.
The first time a caregiver made dinner for my parents, my Mom took away the dinner dish from Dad and threw the contents into the trash... it was like how dare another woman cook a dinner for my Dad. Oh dear, we have a problem in the room. The caregiver tried her best even saying that my Mom's husband was hungry, he should eat.
The turning point was when another caregiver noticed my Mom finally dozed off in her living room chair and the caregiver decided it would be a good time to clean the inside of the refrigerator. Oops, she got caught, and that was the end of the caregiving.
Once Mom had a serious fall at home, and spent her final 3 months in long-term-care, I quickly got back these caregivers to help Dad. Dad was more than happy to see them. These wonderful women were from an Agency. The Saturday caregiver was certified to do the pill box, so that was good. One caregiver even brought from home her own vacuum cleaner as the one my parents had wasn't doing the job. So I believe a lot has to do with one's own personal work ethic.
In the months she's been here, she's been out one or two days a week and late many days. I would bet she's been paid for all that time due to lying on her timesheet.
Filling the pill box was the only work she was eager to do, and offered to do. She is not so interested after the first time, though, as my mom has no 'interesting' medicines, no pain meds or psych drugs.
However, the expensive probiotics I bought my mom to help when her c-diff went missing after I talked to the aide about them and the aide got a cold and was taking antibiotics.
I've decided I want her to go. The care coordinator is away from the office until tomorrow so I left a message and will talk to her then.
I would like her to leave immediately but she works four days a week, and I'm not sure that's practical. On the other hand, the woman is definitely dishonest!!
This has been a real learning experience for me. I am going to be a lot more clear in my expectations after this. Well, live and learn.
The client was our focus but if there was a husband/wife there I always did for them as well but we weren't required to. We are not required to pick up after anyone other that our client, if we did so, that was fine. Sometimes I saw that the spouse of my client was more in need than the client. In one case, I had to call 911 for the spouse when I arrived, he went into the hospital and died 2 days later.
Getting back to the subject, I believe you should have been given paperwork on what the aides are required to do. If not, ask for it. We always had a folder in the home where we worked and to sign in and out with the time. We also needed a signature of a client for payroll.
An LPN or RN was there monthly to assess how things were going, to see if they have the right aide for the client. Get a phone number you can call if there are future problems, aide late or not showing up.
Is your mother the person to deal with the agency or you? Again, we were required to only listen to the one who signed our worksheet.
The care manager did not call me back today - the office was closed the previous day. I sent her an email, and will call every day to get a temporary aide if possible while I interview other ones.
Yes, I too am totally puzzled why the agency did not require this aide to follow time recording procedures like others. They seem conflict avoidant, a bit unprofessional. I'm a bit stuck with them, though, as they were the only agency in the county that was willing to let me be employed as an aide p-t and also provide agency aides for other shifts. The other agencies said I could either hire myself and friends and relatives OR their aides but not a mixture of both. Don't know why - I'm very unimpressed by the senior services available in my area. Other counties in the state have MANY more options for all kinds of home services. Don't want to get started on my usual tirade, haha.
I'm hoping I get a new, competent, friendly, reliable aide within a week or so. Pls send prayers and hugs. Thank you all for your help & support!! 💕💕