We care for my Father-in-law who lives with us. We are hiring a paid caregiver (registered CNA) to come in and help with daily tasks. He needs verbal cues to complete tasks but he generally does them willingly and with a good attitude. If he lived alone we would expect his helper to help keep his home straight and tidy on a daily basis. Not as a full maid, but to do daily small tasks like throwing away newspapers, taking out the trash, sweeping the floor periodically, maybe cleaning out the fridge on occasion. But since he lives with us those boundary lines are not as clear. If you have a hired caretaker in your home, what tasks do you ask or expect them to do?
I found out last month (after 18 months of Homehealth providing an aide for "custodial care " that Mom's insurance doesn't cover that. So, I called an aide to see if she would moonlight. She's not with our current agency because of contract negotiations going south at the top of the food chain. BTW, we use a physicians group agency that manages EVERYTHING except Mom's appts with her regular drs. It's great.
Back to the aide biz. from experience, different aides do different things. So, ask what the will do. We had one that was supposed to be able to make a small meal or snack, but said flat out that she doesn't do that - she also had an attitude towards the males in the house, was routinely late and would rush doing things with Mom instead of adhering to the rehab plan setup by the agency for Mom to relearn how to become more independent. Needless to say, I had her replaced asap. We've had some great aides. One thing our agency aides can't do is handle wound care or dispense meds, even though they know how to. But private ones can do a lot more. I'd assess your needs in the home.
Since insurance won't pay for custodial care, the private aide comes for two hours in the morning M-F so I can go to my PT job, then my almost 20 son who has a singing gig Wednesdays and Sundays takes over when she leaves. Then I take over when I get home. Everybody pitches in (hubby and 25 yo who both work fulltime).
I hired a cleaning crew once a week - at first to scour and disinfect Mom's quarters, then decided to double that pay to include the community areas, bathrooms and our bedroom. I wash the laundry, and they fold it and put it away (I hate laundry). So our aide doesn't clean; she picks up and straightens Mom's room daily, including trash take out. Our aide provides custodial care (bathing, grooming, dressing, bed change, toileting (currently diaper changing) and helps Mom with her morning ADLs. She also takes vitals, makes sure Mom takes her prebreakfast meds and gives Mom her breathing treatment. She checks equipment and lets me know if something is wonky. She and my son cook breakfast. This week, she will start getting Mom out of bed into her chair in the mornings. She also provides joyful companionship since Mom is depressed and has anxiety. She inspects Mom's body for skin breaks and attends to bed sores and whatnot, leaving me notes on what she sees so I can tell the nurse who currently comes bi-weekly. She'll find things on the TV or computer that Mom likes. She may do light nail care if Mom asks her (agency aides would not do that).
I'd assess your household needs - what you can't do, don't like doing, or just don't have time to do - and ask the aide you're screening if they will provide custodial care, including A, B, C and X, Y, Z.
Also find an aide that lives close to you. Define the hours you need them and days of the week.
I've found that they are more expensive by the hour the less time you need them (per visit).
IMO, everything is negotiable.
Since that was a primary concern, I had to hire a different service, which was more flexible, but not as professional. Out of 3 people who saw Dad, only one was worthwhile.
You might want to consider something like that - making a list and discussing it with your new caregiver to ensure you're both "on the same page" as to what's expected.
And I want to emphasize FreqFlyer's advice on liability issues. At one point we considered hiring someone from his church, a young woman who allegedly had CNA experience. I was in for a rude awakening when I contacted my father's homeowner's insurance carrier.
I was advised that any potential injury of the caregiver wasn't covered under HO insurance; we would have to purchase a business type liability policy, at about $700 a year (at that time, some few years ago.) I was also warned that the premium would escalate annually.
I discussed the issue with a friend who owns his own business; his position was DON'T take this route. Liability coverage could raise the cost so high that the services weren't worth it. Better to let a company provide someone and cover any potential liabilities.
They only do my Dad's laundry.
They only cook for my Dad.
You should just ask the Caregiver what they consider their job to be.
You didn't hire a Maid, Cook, ect.
So I would think anything to do with the person being taken care of would be the Caregivers responsibility
I looked at if mom was comfortable and satisfied most of all. I think it took the caregiver awhile to get used to relaxing with mom because they were used to doing more with other clients.
Mom would tell them to join her for coffee, tea and a sandwich or her favorite snack such as cookies and ice cream.
I do feel that there was always a shortage of caregivers. The turnover seems to be high in the caregiving field. Mom had one favorite caregiver that we ended up with but overall did not complain if they rotated caregivers.
Some people don’t like a rotation of caregivers. I don’t know how that can be helped if the agency has a shortage of caregivers. I suppose that you would have to interview private pay and see if they are willing to stick around longer.
I asked for clear expectations before I accepted the position. Since the three of them live there together there are different dynamics where I’m concerned. Lay it all out on paper for the care giver, just a list of what you need her (or him) to do and anything you specifically do not want her to do. Address any issues that arise immediately. Hopefully the caregiver isn’t easily offended but instead welcomes your feedback. Common sense tells me that I want to leave the home just as tidy as it was when I arrived. I don’t leave a single trace of me behind when I leave on Sunday night. But you’re dealing with personalities in choosing caregivers so it can be tricky. Say a prayer that you choose the right one and let the candidate know that you have to insist on certain things from the beginning, that it’s not personal, but you need her to know what you expect. Since the caregiver is there to care for your dad, then it’s really not appropriate to ask for chores to be done unrelated to your dad unless you are paying for that as well. But keeping things at least as tidy as you left them is a given and hopefully the caregiver will go above what’s expected without crossing boundaries. Good luck!
The morning shift is supposed to do 2 med reminders, sponge bath, make coffee or tea, breakfast, juice, dump and clean commode, empty the small waste basket next to chair, bathroom at 8, 10 and 12, sweep crumbs off floor next to her chair and swiffer it, dishes used for breakfast and laundry. It may sound like alot but most can be done while she is on commode.
Night shift is to serve her food I cook, sweep crumbs, bathroom, put pjs on and wash her privates, dump commode and get her a snack and water or juice to last until I go up later. The Thursday night lady washes and combs the short haircut because the others do not know how to comb "white hair."
Throughout the week, they are to do a supply and grocery list and give it to me Fri night.
None of it really happens, they play on the phone alot.
WTH? Since when does white hair require a special set of skills to comb?
What is wrong with those people? I might think perhaps they don't like touching someone else's hair, but seriously, they have to empty the commode. Is there really anything much worse than that???
Keep in mind that people who work in this field are usually "natural" caregivers and will say, "yes" if they are asked to do something extra, or may even offer (and not tell the agency that they are doing it). A third party should stay tuned in to what services ARE being provided. I have seen caregivers writing checks to pay bills just out of a desire to help. Boundaries are important.
Just know that with an agency what they specifically do depends on if the client lives alone or if they live in a home with other family members. They are only hired to help the client, not other family members.
I had one caregiver that offered to help me as well with other things but I always told her that I appreciated her offer but I didn’t expect her to help me.
One woman will scrub the floors, clean and straighten the cabinets, scrub bathrooms, almost anything to keep busy.
another one is content to sit in a chair and only do what she is asked to do and usually reluctantly. Last week after I had asked her to empty my wife's catheter bag and it was still when the next aide came on, she was asked by the second aide "What, are you afraid of the catheter bag? We have plenty of cloves to use!
Most are in between these extremes. Some have the attitude that anything that they do that helps me, also helps my wife as it gives me more time to care for her.
I asked each to make a list of things that they do while on duty and combined them into a list of :
Required things to do or check each shift.
Suggested items to keep busy.
Items that will allow me more time with my wife when they are not working.
We do NOT have any live-ins so I don't know if this will help or not.
On May 11, 2021 OP's comment included:
"...but his long term care insurance requires a CNA."
Sounds like a "need" to me.
Have you examined your own feelings to respond this way?
Are you angry or feeling resentful?
If the recipient of care 'uses' or 'needs' area(s) or appliances, then I believe "yes," they are to clean out the refrigerator and clean the floors:
Depends on if the CNA or care provider:
* Is hired directly as an ind contractor, they can be asked to do whatever care is needed that supports the well being of the recipient.
* Is contracted/ hired through social services who pay or contribute financially to the care, they yes - clear guidelines need to be addressed with the agency involved.
* If an ind care provider, the person hiring needs to ask the CNA or care provider what they will do and take it from there.
* If an ind care provider, the dishes and refrigerator foods will be co-mingled. And, unless hired by an agency or paid by social services, are there any reasons why a caregiver cannot do these things?
* If the care provider is an ind contractor, they can make their own decisions of what they will and will not do. They are not forced to take a job if they do not want to do it.
By the way if you are hiring through an agency from what you described you do not need someone that has the qualifications of a CNA at this point. A "regular" caregiver would be fine at this point. Later as FIL declines you may need someone that is trained as a CNA. (the last 2 caregivers I hired happened to be CNA's, I was looking for caregivers and decided to contact my local Community College to see if there was anyone that had just completed the CNA course that was looking for a job..I got REAL lucky with the 2 I hired. That was the last 5-6 months of my Husbands life)
Change bedding on FIL's bed,
Clean the bathroom he uses
Fix his meals if he is not eating with you
Clean up after fixing meals
Take FIL out for walks, or if appropriate to the store, for a haircut, out for coffee
Engage FIL with activities.
You should also expect that they document/journal what they did if they noticed any decline. this could be anything from weight loss, trouble walking, trouble dressing, mood changes, problems eating, anxiety.
It is not out of line to ask that they also clean common areas. Talking a light cleaning, picking up items, running a broom over the kitchen floor, let the dog out...
The best thing would be to write out a list of duties and expectations.
I would have a contract drawn up and a clause that would review the contract at 6 months. At that time if there is significant change more tasks might have to be added as well as a pay increase if the tasks have become far more than when the caregiver started. Review again every 6 months if necessary.
Also since this is a CNA that is trained when she/he says FIL is declining and they need more or better tools (gait belt, walker, Sit to Stand, Hoyer) heed the advice. It keeps FIL safer and your employee safer.
And since you are hiring a CNA allow time off for "CEU's" this is required to maintain certification a specific number of Educational Credit hours are needed each year.
OP posted on May 11, 2021:
"...but his long term care insurance requires a CNA."
It isn't so much need but what the LTC insurance requires.
Our CNAs cooked meals, cleaned, did laundry and entertained my parents: conversation, checkers, activities. I only hired CNAs with clean driving records- the chauffeuring responsibility was a huge help for me.
if the need arises, it’s helpful to have someone who can help your parent in the shower.
Dad’s CNA took him to the gym everyday. I also provided a list of “field trips” to make life more interesting and to make the job fun.
If you fire the person they can collect unemployment. Further, if that person gets injured in your home they can potentially sue the estate. Granted that is probably very rare but it can happen.
That is why it is better to hire from an agency. That way if they get injured they cannot sue the estate but collect Workman's Compensation and they take care of all that legal stuff such as taxes.
Nanny tax information:
https://www.investopedia.com/terms/n/nanny-tax.asp
And, the laws may change year after year.
It is important to both the hiring entity and the worker to check into these things. Thank you for your response. I'd hope an attorney - perhaps offered through Aging Care - would provide their legal opinion.
She is responsible for all personal care of my mother while she is on clock.
She bathes her daily, lite cooking, monitors her eating and drinking at meal time.
Lite housekeeping for my mother only.
She cleans her room, changes sheets, does her laundry and cleans her bathroom, bedroom and vaccums.
She is a babysitter with my mom as her responsibility 6 hours a day.
She also now assists me in taking mom to Dr appts too.
Hope this helps, the help sure does. Well worth 37.00 monthly co pay.
Any information would be kindly appreciated.
Makes MIL lunch cleans up after lunch. Most days are a sandwich so a plate and silverware no real dishes maybe a bowl and pot if she has soup.
Shower her 2-3 days a week (she is inconvenient)
Straighten her room, My MIL likes to fold clothes over and over (not very well) the aide takes them when she is done and redoes them.
empty her room trash.
Clean her bathroom ( she has her own bathroom and shower).
Do her laundry if the bedding gets wet. Changes her clothes and starts the load it depends on the time if she is here she does it.
Put in and take out movies in her player and be a companion.
If my MIL spills in the kitchen she cleans it up but she doesn't sweep or take the trash on a regular basis. She has offered to take my MIL out, but her physical state has declined such that walking to our porch can be over taxing.
If our client were living with his family as part of the family we would not be doing any domestic routines. We do, out of ordinary courtesy and respect, leave bathrooms, kitchens and any other shared areas as clean and tidy as we would hope to find them, and we do obvious things - such as change a bin liner or wipe a table - when they crop up within our support plan.
But the daily tidying and light housework, no. You want a cleaner/housekeeper, not a CNA.
Having said that, all things are possible to those who agree them openly beforehand as part of a contract. Write out your ideal support plan, and negotiate!
Making meals for him -- yes. Cleaning out the fridge -- no.
Council on Aging had a contract with a specific agency in our area. They told the residents what services were offered.
The services included in mom’s care was:
A companion to mom. If mom wanted to do a puzzle, play a card game, watch a favorite television show, sharing a cup of coffee or tea with mom. The caregiver was happy to accompany her in these activities.
Bathing mom. Helping her dress.
Light housekeeping for her room only. Change bedding. Place her sheets in washer and dryer. Vacuuming her room. Dusting end table and vanity.
Preparing a light meal or make snacks.
Sitting with her for me to run any errands.
This was an agency. You are privately hiring so you can discuss your needs with the caregiver. It’s important to agree on tasks before you hire them. I would have every detail in writing. This will protect each of you.
As long as there is appreciation and respect on both sides, you should have a pleasant but professional business relationship. Some people become close to their caregivers. They often bond with those they are caring for and become part of the family. You have find what works best for you and your household.
Best of luck to your family.