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 Advice from a Home Health Aide 
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Post Advice from a Home Health Aide
These are great tips for anyone hiring a home health aide.... ... alth-aide/

The New Old Age
New York Time

January 21, 2009, 12:39 pm
Advice From a Home Health Aide
By Jane Gross

The men and women who do the backbreaking and often thankless work of home care are not the typical readers of this blog, nor is Helene Alison a typical home health aide. Still, what she has to say is worth sharing.

Ms. Alison, 63, from Chadds Ford, Penn., is first and foremost a horse lover who left a theatre arts program at Pennsylvania State University shy of a degree to pursue that passion. She was a stable manager, horse trainer, dressage instructor and part-time animal portrait painter.

But as a single mother in the 1980s and 1990s, she needed an additional source of income, and so she trained for a new career working with mentally challenged children and adults in group homes and with the frail elderly. Currently, she works weekends and two overnight shifts at a group home, along with additional overnight shifts as a private caregiver for an elderly stroke patient.

Ms. Alison spent about a year employed by an agency, but most of her work with the elderly has been outside the agency structure. She also has personal experience as a 24/7 caregiver for her mother, now 89, following a paralyzing stroke in 2005.

What follows are Ms. Alison’s free-flowing observations on home health care, sent at my request after she posted a comment here a few weeks ago. Some of the restrictions in her agency work I find surprising and often ridiculous, and I am curious whether any of you have encountered these or others like them. And her advice to the consumers of these services — you and me — includes some very clever strategies for screening aides and winning their loyalty. Again, please weigh in with both opinions and what has worked for you.
— Jane Gross

By Helene Alison

This was not a career that I chose for monetary compensation or because I always wanted to help seniors when I grew up. The work suits me, however. In my 25 years of helping seniors and the mentally challenged, I still look forward to going to work. The days flow easily. The exertion is usually not too strenuous, and the good feelings I get from helping people realize what happiness they have in their lives are a major part of the job satisfaction.

I worked briefly for an agency that did not provide medical services and found it was exciting to be part of a vibrant team. It was comforting to know that a client would still receive care from another aide in the event of my absence. Another advantage was that a new job was found for me when one assignment was over, and training and advice were readily available. On the other hand, I sometimes felt like a chess piece with much less say in the assignments that were offered to me. I felt obligated to take jobs that I might not have on my own.

In spite of the advantages, including benefits and a decent salary, I discovered that working for an agency was not for me, mostly because of the restrictions on what you can do for the client in everyday care — no shaving with a razor, no massage and no eating the client’s food. Also, the agency policy that aides are only allowed to remind the client to take medications with no other involvement seemed unrealistic when seniors often need help.

The agency policy that I found most awkward was preparing meal after meal and never being allowed to eat with the client (live-in being the exception). In an eight-hour shift, an aide may prepare one or two meals for the client but must pack a meal for herself. I had never been excluded from meals that I prepared. If you want a loyal aide, please allow the caregiver occasionally eat a meal she has prepared with your loved one. It is so unnatural otherwise, and sharing a meal is a loving benefit to both aide and client.

Working privately with a family, without agency rules like this, allows for a closer commitment.

Over the course of my career, I have passed many child abuse and criminal background checks for the purposes of agency clearance or for my privately contracted positions. You might think that this is not necessary in hiring your staff, but the peace of mind about the well-being of your loved one is worth it.

Here is a drug-screening ploy you might consider. Once a prospective employer said to me, “I require a drug test sometime in the next two weeks, but I have to make an appointment. Can you tell me now when you can come, or get back to me later on this?”

I had no objection. But before the test was scheduled, she called back to hire me without it. Much later, she revealed that the request was her own drug-screening technique. She eliminated the applicants who never got back to her and saved on tests.

I was my mother’s primary caregiver at home after her stroke, but when hiring extra help after she was in a nursing facility, I always talked to the applicant’s family members, as well as getting professional references, because of the personal nature of the work. I would ask if the applicant was strong enough to handle the transferring [from bed to wheelchair], patient enough for the job, and a kind person who would allow my mother’s dignity to remain intact.

Surprising answers came back to me from the families of applicants. “My daughter just got out of detox, so I don’t think….” Or: “Heavens, my niece doesn’t ever carry her own groceries!” Interviewing these family members can be eye-opening!

If you are hiring a full-time staff person, please don’t let the lowest salary be your first consideration. Entry-level positions are the most transient, and you want to retain your staff. Also, it is difficult to live on $8.00 an hour. Affording health benefits will be impossible for your aide. Perhaps you might consider only hiring those who are covered by a spouse’s benefits.

Here’s an idea that will be the most wonderful affirmation to your prospect. Say you want to pay $9.00 to start. Advertise the position at $8.00. When you have selected your candidate, tell her that she is the most outstanding applicant and because of what her family told you of her situation, you’d like to give her $8.50 per hour to start with a 50-cent raise after 30 days. You will double her self-esteem, create undying loyalty, and train her for 50 cents less.

Even the most reliable help can be temporarily unable to work. You can find fill-in or part-time help by checking employees at your local school or home for the mentally challenged, because they are often perfect for pinch-hitting. These group home employees are usually well trained and medication certified for the state in which they work. College, nursing and certified nursing aide students are also good for back-up purposes. And younger seniors may be ideal companion caregivers and welcome the part-time income when you need to fill scheduling gaps. They also might have more in common with your relative.

I’d like to close with two suggestions that apply to any family caregivers.

Make sure your loved one has made clear to the family his wishes about death and has a living will in place. Families sometimes hesitate to do this for fear of upsetting a loved one. But an individual has a right to die on his own terms. When there is not a living will, conflicts occur. Doctors naturally try to keep their patients alive. Nursing homes may send a client near death to the hospital for treatment, while heartbroken, confused and indecisive relatives may approve painful and unnecessary procedures and treatments in order to prolong the life of a loved one. A living will saves everyone a great deal of emotional turmoil and preserves the wishes of the dying patient.

Finally, to assist medical communication, use a technique from hospice: Keep a three-ring notebook that has a complete medical history of the loved one and can be used to record each doctor’s visit and medical procedure, especially blood tests and X-rays. The aide(s) should record in the notebook all medical information, including logs of symptoms and medication compliance. Any information or forms that come from a medical trip should be added. There is nothing more frustrating to a doctor or specialist than to hear “I don’t know” on important health concerns. And if there is employee turnover, the information is always there.

As I look back over the last 25 years, I realize that the positions that I cherish were those where I was treated like a member of the family. That’s easier to achieve in a private agreement. It’s something to think about.

Mon Jan 26, 2009 3:32 am
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