New aide started Monday and I’m not getting great vibes. Is it too early to make a judgement? How do I proceed?

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New aide started Monday and I’m not getting great vibes. Is it too early to make a judgement? How do I proceed?

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I’m new to the Medicaid aide service through MLTC. New aide started Monday for six hours a day. She is nice but hard to read. I’m not seeing her really trying to engage with my mom. She gives her dinner and helps shower her. The rest of the time is spent watching tv. She does the bare minimum of the list I made for her. Basically I asked she clean up kitchen counters and bathroom after use and quick vac the floors. She has not taken the trash out. When watching tv, she sits on another couch that’s about 12 feet away from mom. I have cameras in plain sight at my moms home so I can see there is very little interaction. This makes me sad. I don’t want to jump the gun and complain or offend the aide as this is just her first week. My mom has dementia and when I ask her what she thinks of her she just says “she's ok” or “I don’t know”. ( It’s important to note that with her previous aide right from the start Mom said “I like her, she’s good! That aide had to leave after only 2 weeks). But I don’t get that happy response from Mom with this current aide which troubles me. How do I get the aide to be more interactive with Mom and take a more active role with light housekeeping without being confrontational or offensive? Is it too early in the game to seek someone else who will be a better fit? On the other hand, I don’t want her to think this level of care is fine. I really need help with this ASAP.

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Because you are using Medicaid, you are going to be limited in your options. I would consider a couple of things:
1. Is the helper competent? Is she doing the things she is supposed to do and competently? What is she supposed to be doing according to the Medicaid guidelines?
2. Maybe try and feel your mom out a little more when she's having a good day to again confirm how you think the two of them are connecting. Does your mom want a relationship, or maybe doesn't care one way or the other.

I had the same issues/concerns when I was using helpers for my now deceased mom. However, I was using (and paying for) a private company. And this was before Covid. It IS sad to see a helper not connecting with her client, particularly if your mom is a nice person and would value that. Depending on your answers to all of these things, maybe give it a shot with another person. My experience has been that the relationship building cannot be coached, and if this helper is just mailing it in, it ain't gonna happen. Best wishes!

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Imho, you must speak to her supervisor. How else would the supervisor know that she is not performing what is asked of her (or could improve) unless you mention it? Prayers sent.

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My wife had another aide start last week to cover about 16 hours a week that the other 2 aides can't cover. I had an appointment the first day she worked and needed to leave as soon as she arrived. Before I left I gave both the aide and my wife instructions " Pretend like you two are old friends, went to high school together, worked together, etc., and haven't seen each other for about 15 to 20 years, Tell each other what has happened in those years, school, family, work things such as that They both spent much of the 3 hours I was gone telling their life story. This was a good tool to introduce the two of them. Sadly after working 2 days, the aide was a no show, no call for the next 3 days. I told the agency I needed someone else that I could depend on. My wife is bipolar with advanced dementia so she has a hard time connecting with new aides so each time we need to replace or add another due to increases in her hours, it sometimes 4 or 5 different ones until we find a good fit.

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Seems like the majority of these aides don’t take pride in their work. Very disheartening to learn this.

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Get a supervisor involved, maybe a meeting of all 3 of your for fine tuning clarifying the expectations and what is reasonable. We're all not gonna love everyone but some basic decent interaction should be expected. And for the money...regardless of your own or federal dollars, you should get something out of her PAID FOR services. So there SHOULD be a care plan and task list of what should be done and how often...daily, weekly etc. I learned too much of this the hard way and won't make the same mistakes again. They should have a minimum competence to do the tasks, be able to follow a care plan and not sit on their ass watching TV.

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Agree. Thank u.

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Go with your gut instinct. I’m on about Medicaid aide #30. They are just as you described and more: watching tv, checking email or their phone constantly, never engaged with mom, lazy, takes no initiative, forgets the daily schedule, watches the clock, and just wastes time. Most are only working in the career field because there’s lots of openings. But sadly, they stay around only to collect their pay. There are really good ones out there, but very few. If I see that they are not performing, I call the agency to say that they don’t need to bother coming back.

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Thank you. I was so lucky with out first aide, but she had to leave for personal reasons. 2 other weekend aides cancelled 3 weekends in a row before even meeting my mom. Monday I start with a new one and I’m PRAYING I don’t have to go through 30 like you did. It’s disappointing to see that caretakers can be so unmotivated to do their best.

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Just curious if you were able to find a good replacement for this aide? Hoping you did. My father is in an AL home, and I do appreciate the aides/caretakers who go the extra mile to smile, talk to, and interact with dad on a regular basis. Covid has made their lives so different. It’s almost like being in jail - even if it’s a lovely one.

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New aide starting Monday fingers crossed!

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Nip problems in the bud at the beginning. If there are tasks not being done, you're aware of it, and say nothing - that's the same as letting her know you don't care if tasks are completed or not. Many employers 'create' the bad employee. Go over the task list again to be sure she knows you are paying attention and that she totally understands what is to be done during each 6 hr shift.
How to address without being confrontational... Can you talk to them via the camera system? If so, pop in pretty often and ask how it's going to make her aware that you are observing. You gave her a list of chores - so print multiple copies of the list with check boxes. Ask her to initial it as she completes it. After she leaves for the day, go there and see if all the things are done. If anything is left undone, highlight what was not done,leave her a note and take a picture of it, that says 'there were dishes left in the sink, please make sure they are all washed before leaving so we don't create a bug problem' or something similar.

It is possible that you have not given her enough to do. If you check behind her and see everything was done and you also notice her sitting on couch a good while, there just isn't enough tasks to fill 6 hrs. Watching tv w/mom - if that's what mom likes to do - inhibits conversation. If she is on a cell phone all the time, there is NO conversation and never will be. Cell phone use should be very limited when you're on the clock. If mom is not a real tv watcher, then tell caretaker you don't want the habit started with mom. Perhaps encourage mom to do some leg lifts/arm lifts, etc to stay mobile

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If caregiver is from an agency, call the manager immediately and discuss.
Do not allow this to continue.

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Done

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I work with and train caregivers.
Realize that caregivers, generally speaking, are not well educated and focus on cleaning/housekeeping and feeding, changing soiled garments. Some are there to 'sit' with a elder (and deal with hygiene needs) to insure they are safe.
* It is critically important to be very specific with a caregiver what your expectations are.
- Write out a list and go over it with her.
- Show her exactly what to do so there are no misunderstandings; ask her "do you understand?
* Why do you NOT want to confront caregiver? This is education and training, and is essential.
* If you allow a caregiver to sit and watch TV rather than do\ her job, you cannot expect anything different.
- What skills and qualities do you want in a caregiver?
- If a caregiver doesn't want to work, she'll do what she wants and test your boundaries.
* You must deal with your own fears of asserting yourself. What is in your way to communicating clearly what you need and want. This is a job; it is 'work' - people have to know what to do based on what you tell them you need them to do.
* Once you talk to her and go through a 'to do list,' ask her "Can you do this?
* Role play talking to your mom and see if she can do it. She may not have - both - the skills, maturity, or interest in actually interacting with your mother. She just wants to get paid for doing the bear minimum.

* Ask her if she wants the job and if she is willing and able to do what you ask her to do. If she doesn't do it, get someone else. Why would you even consider keeping her on?

It is like training a dog - the one who really gets trained is the dog's owner. The dog does what it wants until it is told what else to do, or how else to behave.

* SETTING BOUNDARIES and EXPECTATIONS are essential.
* Get assertiveness training for yourself. Don't be a door mat . . . for anyone. This may be a life long learning, indicate low self esteem, overwhelm and or a combination of a lot of factors. You need to step up to the plate or give someone else the responsibility of training and working with the caregiver.

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Some excellent points, TouchMatters!

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I live in assisted living where there are many aides and I see it all. I can assure you, from what I read above, this person is NOT the proper caretaker in this situation. There are some aides here who are cheerful, who smile, and who interact with residents. Others are like your caretaker - no communications, no chemistry, etc. Whether it is just their personality or if it is just a boring job to do and spend time doing, they are NOT a good fit. you must try to check out a few more before you find the right one. This one is a disaster waiting for something to happen. Please end this and keep searching. I know - I see this daily. There are some good ones - you just have to find them.

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Rusty2166 You hit the nail on the head. This aide's vibe was flat and bored and just not interested in my Mom, who btw is just the sweetest, wittiest granny ever. She inhibited my Mom and put me on guard. By Day 3, I knew I would not rest with her alone with my mother, and requested a change.
I put it out there because I'm new to this process, and needed feedback - but I'm no pushover. With Covid-19 still so rampant, of course I'm reluctant to have aides coming and going; so I'm praying I can find the right "one" ASAP.
Your response was spot on - thank you!

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You are wise to be able to view your Mom’s home.
For home health, the key is documentation.
Design, then print out a form that documents what is to be done and when.
Each shift must be filled out and approved before payment is meted out.
For example
Arrived-
Greeted-
Observed for-
Breakfast given-
Client ate-
kitchen cleanup-
Bathing-
Note Bowel results-
Rest-
Remove trash-
Check for supplies-
Sign out-
Then, at least you have a framework of the job at hand
As far as personality, I’m afraid that is the luck of the draw.
We are caregivers, yes, and if you get a nice one, great.
But what you are describing may be more under the role of family than caregiver.

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Spend time together with your mom and her aide. Help the aide to understand your mother's likes, dislikes and usual routine. The aide may see her job as having "eyes on" your mother at all times, which is easiest if somebody if plopped into a seat in the same room - usually watching television. If your mother rarely watches tv, that is something the aide needs to know. Try a few nonjudgmental conversations about what you, or your mom normally, do at certain times of the day that the aide covers - and that you expect the routine to be adhered to. Gradually ease out of being there while the aide is there, but let the aide know you will most likely drop by unannounced - and do so frequently. If you find you have to have "conversations" every day for a week, it is an indicator that this is not a good match.
If she doesn't work out, call her supervisor for a replacement. Let the supervisor know that it wasn't a good match for your mother.

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My first comment is, if an aid truly does not like what they do then stop doing it! The one aid Who commented that she thinks bathing someone is totally gross is in the wrong field! Having empathy for a person who needs help and is no longer capable of taking care of them self is where her heart should be. By gods grace alone, it could be her, you, or me tomorrow. I have been taking care of my mother for 12 years now with The help of aids. I have learned by going through many of them that they do need guidance, frequent review and updates on how they are doing, and Compliments on a job well done also helps! Let’s face it, many of us would not be working if it wasn’t required, so participating as a team member versus a boss often helps. I made out a list of potential activities and then went and got some very basic interactive crafts for them to do at the house until they got to know each other a little bit better and that helped them break the ice. It’s also good for mobility for your mom‘s hands and her mind. It’s the simple things like planting a flower in a pot, doing puzzles, and even simple things like coloring pictures or painting a small picture that will help them get to know each other and to bond. It’s difficult to be the daughter and watch her mom decline, you only want the best for her. The right caregiver will admire the love, the concern, and if she’s the right one she will be empathetic as well. Give it a couple of weeks and if there still is no further interaction, then move on and try another one. Everyone’s communication skills are different, cultural views plays a big part of it, education place of big part of it, So after you have helped guide her and given some structure for her to follow, let her go if it still does not improve. Wish you and your mom well.

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Try talking to the aide on how best to engage with your mother. Can you speak with her over the phone? Maybe tell her some things that your mother likes to do.

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Hi! I am an in home care aid and I hear this a lot (when I fill in). It’s always the first impression that counts! Please don’t ‘settle’ for someone that won’t interact with your Mom. It’s just too important that you have some in her home whom you can trust and who loves what she does! Good luck.

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I totally agree. Please take steps immediately to find someone who will interact with your mother, do all they can to make her happy, comfortable and be a companion to her. Each caregiver, nurse, aide, physician or practitioner is not right for every patient. Please keep searching.

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The opposite happened with me. The first caregiver I hired hovered over my father and was sort of bossy with him. On the first day he totally flipped out and I had to quickly pay her and rush her out of the house. The next few I hired I asked them to just be present but not in the same room with him unless he needed something. One of them I had no requirements for and he just sat and read a book unless my dad needed something. The other one did housekeeping for us but she also made a point not to make my dad feel he was being “watched” and it was better for us that way.

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good answers. deal with any problem swiftly and directly. take it by experience. the longer it goes, nothing is better

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Have a discussion with the aide about the expectations of her shift. I created a daily log for my mom's and aunt's sitters to fill out each day. Remind her she is expected to be a companion to your mom as well. What can your mom want and need to do? Can you list some activities that would encourage interaction like going for a walk, sitting outside, clipping coupons( my mom loves this) or playing a game/cards, painting fingernails. Somehow a written list helps and if there is no change then let het go. She may not be a good fit for your mom.
I had to let an agency caregiver go for similar reasons.

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We've tried much of this. Most of the aides (24/7) are...adequate. They don't read the notes/lists we leave. It's difficult to find help here (anywhere?) and my sister is already making comments similar to your's about one of the new ones. Hey, at least they aren't stealing from her like the one we tried to so hard to help succeed...

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I would nip this problem in the bud if she isnt interacting with your mother. I had the exact same problem. 2 carers would come 3 times a day to see to my partner and there was very little and close to no interaction with her. I just got rid of them and got a new company who do interact and are a lot mor friendlier.

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Thank you for your reply. I did just that!

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Trust yourself. Be sure you and the aide set out guidelines. But start looking for someone else. You and your Mom have a right to get the right person. Time for big girl panties!

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You need to consider your self the employer and have a discussion about your expectation. Don't just ask her to be more interactive -- be specific about the things you want her to do. Review that agency job description -- anything they have identified it is reasonable for you to have that expectation. BUT besure that you are not expecting more than the job description -- specifically light-housekeeping

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NYC,

Will they send out a replacement caregiver for her?

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I think I would speak with the Medicaid agency that is sending your aid about just what her duties are. I do know, when we briefly used the services of a paid care provider, that the services were completely discussed with us down to the most minute thing. That was a commonly used one, Visiting Angels. They were very clear about what we could expect. That really helps.

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AlvaDeer: You are correct about the task list. The agency nurse checked off many chores that I could expect to be done from the aides which included the few simple tasks I requested. This aide did none. More importantly I ended the aides service when I learned she lied to me about something and left that day without reminding my mom to take her medication. I guess she didn’t want to interrupt her 6 hours of watching tv. My sweet Mom was not comfortable with her. My gut was correct.

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First of all we are living in Covid times. The aide is being smart sitting away from your mom. You did say she's nice enough. She feeds and showers your mom but only does the bare minimum on your list of chores. Considering your mom is getting her service for free and her pay is just pennies above minimum wage if that, then count yourself fortunate that you did so well getting her. Even if she's just sitting watching tv, her time also has to be paid for. Personally, when I take work I'm happy if there's cleaning or chores because actually having something to do is usually appreciated on most caregiving jobs.
Many times people don't really know what a hired caregiver's job is and will often attach other duties onto it that are not part of the job. Agency caregivers who earn next to nothing, have their job duties laid out from them by their bosses about what they are supposed to do and what they're not supposed to do. The only real concern of whatever agency they work for is that they put their time in. The time and hours are really the only think the agency itself has to answer to the state for. Anything else is on the aide personally. People sometimes don't understand that we are not entertainers. You've probably seen the tv commercials for homecare agencies that show some senior and their aide cooking together, playing cards, doing puzzles, and having a great time. It's NEVER like that. Think about an aide on a six hour shift (like yours). After the feeding, hygiene care, and light housekeeping is done there's probably four or five hours left on her shift. Maybe play a game of cards or do a puzzle for an hour like in the advertisements. Then what?
In addition to the totally gross and laborious chore of bathing, toileting, diapering, wiping a**, and feeding some elder the aide also has to make sure the home is adequately clean and safe. They have to make sure your LO doesn't get hurt or into trouble during their shift. This is the job.
The job is not become a one-person circus to make sure the senior that aide is getting minimum wage for, doesn't experience a moment of boredom.
If your aide is doing an adequate job, isn't ripping your mother off, and not being abusive then consider her a good aide. You will not get better unless you're hiring and paying privately.
As for her not meeting your chore list requirements. Offer to drop her a fifty extra in cash each week and watch how much she starts cleaning. I will tell you honestly speaking as an in-home caregiver for almost 25 years (private pay many of those years). If I was making minimum or just above on some job and some elder's adult child made me a chore list, I'd throw in their face and walk away.

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It really doesn’t matter who writes the caregivers check. OPs mom isn’t getting anything for free. Who do you think funds Medicaid? We, the people of the United States. The tax payers. If you’ve spent years paying in to the system, you have every right to use the system.

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I had 4 different caregivers from the same agency before I found one that was the right fit. One chided my DH when he cursed( not his normal behavior. Thank you dementia for that personality change - sarcasm) and spoke to him in baby talk. She interjected in conversations that didn't concern her.
The second one spent all her time on the phone. Sitting on a bar stool in the kitchen and only did anything when directly asked. The 3rd one kept having personal family issues so she had to leave early all the time.
The wonderful lady who has been with us for 1 1/2 years was actually a substitute for #3 who couldn't make it one day because of a " fender bender". Lorraine has been a God send. She treats my husband with kindness and respect, can get him to shower and take his meds when he's being hateful, is right there when he's trying to stand up to help, but won't insult him if he tries to do it himself.
She makes him all different kinds of things to eat, she doesn't care if he wants to eat pie for breakfast, she just fixes it and gives him a protein drink along with it.
If she had her way my house would be vacuumed and mopped every day, we compromised with mopping his bathroom everyday and the rest of the house as needed.

I did inform the agency of the deficiencies of the other workers. I felt they needed to know how some of their employees acted.
So, it's okay to request another caregiver until you find the right one. Its better for your LO, and you will be happier too. And thats
Important!!

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Im glad you found a good carer finally. Its very hard to find a good one. Trouble is caring is a vocation more than a job so the people who do it, have a different mentality to those who do it for the money.

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The list of duties that you made for it, is it compliant with Medicaid’s rules? There are only certain duties that Medicaid is paying for. If there are things on the list that aren’t part of her official job description, that may be why she’s sitting & watching TV. (Not that it excuses we though). But that said, I think a week is too soon to tell. It takes time to build a relationship with someone. If nothing has changed after 2 weeks, then I would say you have a problem. I would give it another week and gently encourage her to complete all her duties. If she is still not Engaging with your mother after 2 weeks, personally that would be unacceptable & I would seriously consider replacing her. They don’t need to be best friends after 2 weeks but she needs to engage with your mother and talk to her.

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One would need unlimited funds for a team, which is not the case. My Mom is on Medicaid. I believe an aide should provide safety and companionship and should leave the home as clean as she found it. Taking the initiative and going above and beyond would be fantastic, but not required. As you say, it's a bit early - so I will hang in and go by Mom's reactions (though she forgets) and any progress or lack of progress. Thanks for your input!

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I don't understand how the funding works but I can't see why two or three people providing the same amount of hours would be more costly, I'm pretty sure most of the home care workers who are employed by an agency provide care to more than one person 🤔

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In my opinion it is a little too early, other than not showing any initiative to look beyond the stated tasks I'm not seeing anything terribly wrong. It's a fact of life that some of us are not social butterflies and are slow to warm up and feel comfortable in situations, that doesn't necessarily equate with lack of concern or the inability to get the job done. If you want to make changes then my personal belief is that arranging for a team of workers rather than one is a better approach, deficits of one may be balanced by other members of the team, plus there is always someone familiar on hand when any of them need time off.

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It’s never wrong to expect that the care be good. I’d communicate in a friendly, non confrontational way about what is needed and how she perceives the job. It’s also a good idea to give some time for both to get to know each other a bit, to see if she’s a good fit

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Its hard to do that without sounding like I'm questioning the level of care.
She isn't an effusive person at all and a bit opinionated about certain things. If I'm feeling that way, what is my mom feeling? Hard Hard for me but I will wait a bit more and see if I'm still feeling the same way by week's end.

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One of the reasons we hire an aide for our LOs is not merely to offer them dinner and help them shower, but to be a companion to them and engage them mentally and physically, if possible. Companionship is not merely being within view of the client, it's talking, going for walks, doing puzzles, paging thru picture books and doing any other activities that show care and interest by the aide. It appears your aide doesn't realize her role and why your paying to have her services. I don't think she'll come around. You can usually tell very quickly whether it's a fit or not. Doesn't appear that this aide is who you want.

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That's my feeling too. I'll wait the week out and continue to check in with my mom, then make a decision. It may be as simple as it not being the right "fit".

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New aide started Monday and I’m not getting great vibes. Is it too early to make a judgement? How do I proceed?

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