Do you have problems with retaining a caregiver from a company if your parent's caregiving is paid for by Medicaid?

Medicaid Long Term Care has definitely NOT been phased out in NY State and covers Level II personal care, home health aides, nursing services, adult day health care, therapies in the home, and consumer directed personal assistance services as well as nursing home care.Medicare DOES NOT pay for LTC services. Most dual eligible (people on Medicaid and Medicare), must enroll in MLTC plan to receive services. Criteria: Program for dual eligible adults who need more than 120 days of LTC, LTC and other Medicaid services are provided through health plans. Medicaid pays the plans to provide services and it is mandatory in all counties statewide, each county must have at least two MLTC to provide services. Long term care and additional services include: nursing services at home, therapies in the home, home health aides, personal care, adult day health care, consumer directed personal assistance nursing home, social adult day care, home modifications, medical equipment & supplies, non-emergency transportation, personal emergency response system, home delivered meals, podiatry, optometry, audiology, and dental. The amount of coverage is governed by the need.

Yes as the ICAN Ombusman for ACR Health I have run into a variety of problems with home health agencies however, not with the Medicaid coverage. Medicaid is fine with providing the coverage. The problem arises with complete coverage of hours approved. I've been told HHA agency refuses to pay for any hours over a 40 hour week. They charge the Client $25 per hour for the aide and the aide gets paid $9.00, very reminiscent of temporary agencies here in New York State. Also have met with resistance when trying to advocate for a raise for HHA upon client request for retention, insurance refused to reveal criteria used to obtain said raise.

If your full-time senior caregiver is employed independently by you and your family, operate under the one-week-salary bonus rule or two weeks for caregivers that have been with your family for multiple years. If he or she is employed through an agency or works at your senior's facility, be sure to check with the management regarding policies on tipping. If you know that the caregiver has really gone out of their way to make your aging parent or loved one as happy and well-cared for as possible, give a little extra – check out The Gift of Relaxation section from last week.

Luvawgs...good genes...I'd say. Bodes well for you. I feel your pain on the caregiver issue. I do think a lot of the problem in turnover is simply low pay issues. Perhaps if you "tipped" his agency caregivers a decent amount from time to time, special perks now and then, you'd get them stay longer, as OhMyGod suggested... To help make up for the low pay.... you can call these gifts and as I'm sure you know, you can gift up to 10,000.00/yr to anyone without having to claim it on taxes.

Luvdawgs: Unless you hire a private individual, I believe you will run into inconsistencies. And in general, off the subject, people DO NOT want to perform their job, e.g. fast food worker, office staffer, et al.

Luvdawgs hit the nail on the head!! As a former paid caregiver, when I was treated as an important part of the family dynamic, I felt much more inclined to do a better job (though I always did, anyway). Treating a paid caregiver as a piece of furniture or worse, an indentured servant is a sure way to lose them.

My "family" respected that I had a personal (and at the time, VERY stressful homelife). We spoke each Friday about the upcoming week, what was needed by the client and what was needed for me to be the sole caregiver at home to a very, very sick husband and also to a daughter who still lived at home.

They DID give me Christmas and birthday gifts and actually treated me as one of the family. That was not necessary, but it made me feel that I was cared about...and honestly, the pay was so bad, if they had been a difficult family I would have gone FT at my 2nd job.

You MUST respect the caregiver. But you must also do your own background checks and such. I was bonded by my company, but the fact that I was of the same religious background as my client and we actually knew a lot of the same people...didn't hurt. I told them to please, check me out.

Any problems that arose were dealt with swiftly and in a professional manner. I was not an 18 yo kid, I was a 50 yo woman with a lifetime of caregiving behind me.

Not to say the younger people have a disadvantage--but they did tend to be much less serious about their jobs, they'd talk on their phones all day...etc. My phone was OFF while I was at work. Maybe being older I had more respect for my client, I don't know. It just worked well for the family and for me for almost 2 years. I'm sure I'd still be with her if she hadn't declined to the point she could not live at home.

Sometimes it takes a long time to find that good fit. Hang in there.

Lassie, they at least say that Medicaid will pay here but since hub's aunt and uncle never qualified I'm not sure

Hi Luvdawgs,
I have had the same problem for about 10 years. I finally get it fixed more or less. It doesn’t matter who is paying. We had private pay. So here is what I recommend:
Find a local agency and ask about their turnover rate. Review their rating on the internet. Also ask the agency about hiring practices. Where and how they hire? If it’s a collage or school forget about them and find someone else. Why: Students schedules change at a maximum of every 3 months. Students also graduate and usually get better jobs. We have had many student caregivers and they all have left in a very short time. Find an agency that hires locally and people like housewives and retirees looking to supplement their income. They may not be as capable as someone younger but they will stay longer. Don’t be afraid to ask the agency to send someone else if they send someone who can’t do the job and be sure to let the agency know so they don’t send them to another client. Believe me the agency doesn’t know about these people.
If a care giver needs to be off for whatever reason ask how the agency will backfill for them. When this occurs don’t let the agency off the hook but be reasonable. Have then start early to find a backfill and make them send them to you to get them up to speed and yourself confident in them before they really need to be there for you.
Get the agency to train 2 or 3 care givers for backups before they are needed. Even if you have to add some hours to do this. It just gives you some peace of mind.
Once you get a care giver assigned to you, talk to them about their personal life. Are they taking care of any children? The more the less reliable they will be. If they are of school age they will most likely leave when the summer break starts. Married or single? If married ask about their spouse. Are they working and where? Try to determine if the marriage is stable or not. I have had care givers leave because the spouse got a new job and they were moving, they got devoiced or the spouse graduated and got a job somewhere else. Is the care giver taking any classes (a student)? Where are they are living and how far or long they have to drive to get to you. This is a big indicator of how long they are going to stay! Is the schedule OK for them? If not what would be better for them (maybe you can be flexible). Ask them if they like the agency they are working for? If not they will most likely leave soon and you will have an indication about how good the agency is.
I schedule the care givers when the work load is greatest. For me it’s the AM. It’s a lot of work getting my wife up and out of bed in the morning. I also give them some time each shift to be social. It's a lot harder for a care giver to leave if they have formed a relationship with you and you have shown how much you appreciate them. I always thank the person for all they do for us at the end of each shift. I don’t care what the agency policy is I give Birthday and Christmas gifts directly to the care givers.
I address small problems with the care givers. For example, putting thing away in the wrong place. Big ones like doing something unsafe go directly to the agency. For example, sitting in their car smoking while my wife is taking her shower.
I have found texting to be a problem. Make sure the agency knows this. My policy is the care giver can have the cell phone on them for emergencies but phone conversations need to be kept short 1 to 2 minutes. If they abuse this the phone must be kept in their car. Even if the care giver is just standing by waiting for my wife to complete something I don’t want the focus on them texting. If they do the quality of care is affected.
This is mostly trial and error but don’t feel locked to and agency. I did and it cost me a lot of money, time and grief.

I've never heard of Medicaid paying caregivers here in NYS, despite being LIED to by several people who assured me this was so. Medicaid would pay for a few hours a week of day care and that was it. Home care through Medicaid was being phased out.... What I wouldn't have given for paid caregivers sent, even with a big turnover rate!

I worked for a large elder care company. When I went to work, I lucked out on my first job--with an elderly lady with whom I "clicked" instantly. I loved her and caring for her was challenging and hard. She, however, was sweet and I learned so much from her.
The pay is LOUSY. That's probably the worst side of caregiving. It was a second income for us, and while at the time we desperately needed it, it was truly lousy. AND I only got one 50 cent per hour raise in 2 years. This was typical, as the turnover rate for a 2 year employee base was close to 80%. My clients family "tipped" me, regularly, and that is probably the only reason I could stay on. I also worked another PT job, and make a lot more there.....Caregving is hard on the body and spirit. I personally hastened my own health and required 2 major back surgeries a couple of years after I quit. (My client went into an ALF). My 2nd experience with trying to do caregiving--I lasted one day at one job (client gave me a black eye) and 1 day at the 2nd one (client tried to sexually assault me). I then quit the biz altogether and worked elsewhere.
Private pay--yes, you'll pay a lot more, but you can be pickier about who works and how many hours. I could NOT work over 32 hrs or they had to pay for health insurance...as a private care, I could have worked 50 hours, straight pay.

If you simply can't afford private care ( and most people cannot) keep trying with the agencies. Ask for someone who is older and more experienced and just keep on hoping. My client had been through 3 caregivers in the few weeks before I met her. I realize now (9 years after I began working for her) that we were both truly blessed through this relationship. I do wish you luck. This is hard and I know firsthand how hard it can be.

My father is 104 and is very polite and loved by all of the caregivers. My husband and I bend over backwards to treat them well. The employees of the agencies themselves told me that their agencies don't pay well, and also, some of them have life changes such as graduating from school, etc. The caregivers themselves told me about the high turnover at their agency. He can't afford private pay or I would have done that long ago. My father is very strong and healthy, but the cartilage in his knees has worn out, so he needs to be transferred to a wheel chair. He can feed himself and has no dementia or Alzheimer's issues. We only get 30 hours a week from Medicaid and 10 hours from the VA to care for him. My husband and I do the rest, sometimes hiring an afternoon caregiver because we need some time to work on our own home business, shop, have a quick nap, etc. My father has lived in our house since Sept. 2014. He took care of himself in his own apartment until he was 103 and fell and broke his pelvic bone. He has some good genes!

I'm amazed that your father has had so many caregivers in a relatively short period of time. It leads me to believe that there are some challenges with serving him beyond the norm. I'm going to speak from the prospective of an agency considering that I am an administrator with a home care firm and also own a care home. I hire attendants ALL the time. I wish that people would stop blaming the agencies for problem workers. The State requires background checks, etc. on all workers you even think about hiring. You'd be a fool not to conduct such checks regardless to what the State requires anyway. At my agency our workers are insured, bonded,competency tested, and trained. They are also paid WELL beyond the minimum wage! We have some workers whose hourly wage is so much that when they go into overtime we make very little money! Some clients are extremely difficult to work for and are very demanding. We've had some that Mother Theresa wouldn't satisfy! Most workers prefer not to work with such clients.

As someone previously commented, many of the workers work for other agencies because work is based on client demand and if your client passes away or reduces hours for whatever reason you're out of work. It's then incumbent upon the agency to find another client for the worker. Sometimes this is easily done, sometimes it's not and there may be a break in work. This is when we lose our workers typically. Therein lies the challenge for most companies--keeping steady work for staff. Given the nature of the business it is not always possible.

At my care home finding reliable workers has never been a problem. I don't have the turnover that my home care office experiences. However, in both cases workers are always paid and treated well.

Joy, we have the same situation but not sure considered respite; caregiver comes 2 hrs./day for 4 days for sure through VA, then 5 hrs. on Fridays, possibly all through AAA or possibly 2 of those through VA as well, with just the other 3 through AAA; originally she was supposed to be coming for 3 hrs./day through VA but she said they cut the hours; I didn't think it had been time for that yet, but possibly with them being notified, which not sure they had to be but the agency's fairly new to this and was concerned so she did, they may have just decided no need for them to pay for so much, the AAA could have picked up those extra hours daily but they give you more flexibility, as I'm sure you know, in how you want to pay and have them come so 2 hrs. had been plenty anyway; she only basically does his personal care on those days, then put the other all on one day and she does more housework that day. But there have changes this year, with the aide that had been coming retiring, then the next one was older and let him fall in the shower, then the next one was young and young acting and he was uncomfortable with her but the one have now seems to be working out; there have been issues getting someone, however, due to the distance; at least the first one and this last one both live in the area, which I think is part, at least, of why they seem to be working out better; know I talked to someone with another agency when we were thinking of changing when it seemed they couldn't get anybody and they said they wouldn't come out this far for what they got paid, so there it was just honest. And do try to be good, letting her have something to drink out of fridge/eat snacks around. But, true as well, there were some who just didn't seem to want to work.
Ironically, the one we have her for is named Joy as well. :)

My mom had 24/7 care through Medicaid. I don't think Medicaid or private pay is the issue. I think the agency is the issue. The agency should be treating their people well enough and screening them well enough that this kind of flakiness doesn't happen. Whether you use Medicaid or not is of no consequence to the caregiver. Their pay is the same. Switch agencies. I did (3x).

That being said, not many caregivers are capable enough to take care of a person with Alzheimer's. When we started going through a lot of caregivers, that was the issue: they weren't prepared, or equipped, for my mother's condition. Good luck.

The caregiver agency has sent so many different caregivers over the past year that I've lost count. This is for 6 hours every two weeks of respite care paid for by the VA and also limited respite care paid for by the Area Agency on Aging. Both are providing caregivers from the same caregiver agency.

If you want consistant caregivers you need to hire private caregivers. No matter what an agency says they will not be able to give you consistant people. It doesnt matter if medicaid is paying or you are paying the agency only pays min wage or a bit more to its workers and thus they have a high turn over rate. They will be having even more problems with the new laws regarding overtime for homecare workers. They now have to pay overtime so they will be cutting workers hours to make sure they dont have to pay overtime. Check with your medicaid worker and see if they allow you to hire private. I am sorry for you and your loved one. I know how hard it is to have to deal with someone new all the time.

How kind are you to a good caregiver? If she needs to go to the doctor, what are *her* needs? Can she support her household on her hourly wage? Can you give her a gas card with $50 on it? Does she need good shoes? X-mas money? You are not supposed to give money for gas but . . . And truly, many do not want to work. They want the check but don't want to work. I encourage my worker to sit and take it easy at times. I try to be kind.

Dawgs, it is the nature of the business. It is very difficult to find reliable caregivers because they are paid so little and change agencies frequently, even to make just a bit more.

I know some people who personally pay for a caregiver and they have had the same person for several years. Usually this is not someone found through an agency, however. You also have to make allowances for vacations, reasonable working hours, etc. so it is not the same person 24 hours per day. If someone needs coverage day and night, week days and weekends, 52 weeks per year then they will experience a number of caregivers because no one works 24/7/365. Agencies can have a significant turnover in staff due to the relatively low pay and low skill requirements for the position.

Just the nature and economics of the home care business no matter what agencies try to tell you.