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 Hiring Private Caregivers 
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Hiring Private Caregivers
I have recently gone through the experience of hiring three private caregivers and I thought someone might benefit from my experience. I decided to pay less money, $16/hr, rather than $22/hr by hiring my own caregivers rather than going through an agency to sit through the night with my LO in an ALF. I followed the instructions in a self-help pamphlet that I got from a senior resource group and interviewed each one, checked references, wrote up a contract, and had them meet my LO. The ALF insisted that they have a thorough background check and I'm glad they did! Two out of three of them could not pass the background check. One of them showed up high on drugs for one of her nights.

I'm a pretty smart middle-aged, middle class lady. I don't have much experience with crime and while I am conscientious this was out of my depth. I recommend STRONGLY, that if someone hires a private caregiver they contact their sheriff's department or whichever agency is in charge and get a background check.

No harm done to anyone in this case, but being an employer and making this mistake and having to fire people isn't easy either.


Wed Jan 27, 2010 8:02 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
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Thanks, Annie. Yes, it's very important. And even a background check doesn't always turn up problems. As a home health RN, I have worked for several agencies and they are very thorough in their background investigations. I only remember one instance of someone slipping through the cracks. I decided to go with an agency for a respite caregiver, although hiring someone privately on the recommendation of a friend might be OK, or someone with really excellent and accessible references.

Just curious: Is it really more affordable to hire someone to stay with him overnight at an ALF than to place him in a dementia care unit or a SNF? $128/day plus the cost of the ALF? It's none of my business, of course, I just wondered why you opted for this combination.


Wed Jan 27, 2010 8:29 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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Several in our local support group have been burned by private caregivers and, as a result, they encourage others to only hire through agencies.

There are also tax/accounting implications when you hire private individuals.


Wed Jan 27, 2010 10:02 pm
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
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I've been making an assumption, and I might be wrong, but aren't agencies bonded or don't they indemnify their employees?

_________________
Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Wed Jan 27, 2010 10:40 pm
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3436
Location: Vermont
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I think agencies can vary in what they do, and what they carry for insurance, and it probably varies a lot.
Robin's point is a good one too - if an agency doesn't meet the criteria for the IRS and long term care insurance, you may have a problem. My dad's long term care insurance had a 90-day waiting period before they would start paying towards his monthly ALF expenses. Because the in-home helpers I hired in June were from an "approved" agency, those days counted towards his 90-day waiting period. The 3 weeks he was in a nursing home/rehab facility also counted towards the 90 days. An unapproved agency or private caregiver would not have counted. So we would have been another 3 weeks of not being able to get his long term care money. Not sure what the IRS regs are but you should check into that.
The last thing any of us need would be to hire someone with serious issues (like AnnieN's person on drugs, etc.). Annie - I'm glad you were able to get rid of the problem quickly.
Get a good night's sleep everyone! Lynn


Wed Jan 27, 2010 11:01 pm
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Extra Care Cost
Mockturtle, I think the question was why did I hire private caregivers instead of having my LO in a dementia unit or SNF. Well, my LO was in an ALF that specializes in dementia care. When my LO moved there they were clear with me that they could not provide one-on-one care throughout the night with my LO. They had other residents to care for too. At the time that she moved to the ALF, my LO was recuperating from a negative reaction to Seroquel and multiple falls. The family spent about a week taking shifts staying up overnight with her and we were exhausted. As it turned out, I hired private awake-staff caregivers for nights for about two weeks. The cost was exorbitant but after two falls in one day and a trip to the emergency room, it was worth it. After that, she acclimated to the ALF and they acclimated to her. She still has falls occasionally and we're working on the peeing once an hour at night problem.

About SNF, my mother had attacked a caregiver at the adult family home where she was living. Of the three nursing homes I contacted, not one of them would call me back after they had spoken to the AFH owner.

The end result is good. I could not be happier with the assisted living facility. As things change (and they will) I will hire caregivers from an agency or ones that I know have passed a background check.

As a side note, I found out today that my LO was prescribed aricept 6 years ago although we never filled the prescription. I had no idea that so much time had passed since the onset of this disease.


Thu Jan 28, 2010 9:52 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
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AnnieN,

Any recollection as to why you never filled the RX? Is your mother still being seeing by the same MD?

Did I already suggest to you to talk to the MD about DDAVP (desmopressin) for nocturnal polyuria?

Robin


Thu Jan 28, 2010 11:33 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
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Annie, you've been through a lot with your Mom. I remember once when my husband was supposed to go back to a SNF after a hospitalization and found out--when he was dressed and ready to be discharged--that they refused to take him back because of 'behavioral problems'.

I think it's a shame that there aren't facilities that can take care of 'problem' cases. A friend of mine had to put her husband in four different SNFs before she found one that would keep him. Another friend's husband finally ended up in the state mental hospital for the same reasons. It's sometimes tough having my husband at home, but at least I don't have to worry about that. YET! :(


Fri Jan 29, 2010 12:31 am
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Joined: Sun Oct 04, 2009 10:18 am
Posts: 276
Location: Washington State
Post Desmopressin
Hi Robin, my Lo starts desmopressin today and I'm in discussion with her PCP and a specialist in Seattle (Dr. Leverenz) about which cognition drug to start her on (aricept or excelon, etc.). She is so extremely sensitive to drugs and gets side effects more often than not. We start one at a time and go slow. There are some bad side effects to desmopressin but there doesn't seem to be an alternative for a female with LBD who is aware and won't pee in a pull-up.

I'm pretty depressed today and don't want to talk more about this today. We're doing our best but the falls continue, the hallucinations and delusions continue, the mood and autonomic nervous system fluctuations. It's a race between the progression of the disease and finding solutions to the problems. Sometimes we win the race, more often we lose.


Fri Jan 29, 2010 10:37 am
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3436
Location: Vermont
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I, too, can't figure out why a facility in this era cannot find solutions to "problem cases". 25 years ago my grandmother was in a supposedly "very nice" facility, with advanced Alz. She started screaming all night long that she had to poop. They got sick of dealing with her and some genius recommended that this frail, 89 year old woman have a colostomy. Well, guess what, she died on the operating table..... Surely there must have been a better options than that!
And back to my discussion elsewhere on Slow Medicine.....

I sure hope my dad doesn't get kicked out of the place where he is. I truly don't know what we'd do at this point.....


Fri Jan 29, 2010 10:42 am
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Joined: Tue Dec 29, 2009 2:28 pm
Posts: 464
Location: Minnesota
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I do wish there were some better solution for those that have been called "problems." My grandfather, with Alzheimer's, was committed to a state hospital for a time because the first evidence of his disease involved his always controlled temper getting the better of him - in a big way. This was in the 1960's. I was a young teenager at the time and there are images from that experience that I can still see. They did eventually send him home - so drugged he had no idea of just about anything.

But, I can also understand caution about patients who might present a risk. This past year, an old pro-wrestler, in a SNF with Alzheimer's, killed his roomate, with nothing suggesting this was something to be concerned about before it happened. Just got mad and beat the guy to death. So yes, I do understand some concern, within reason. (Honestly, I would think there would have been precautions taken with a pro-wrestler with Alzheimer's.) Yes, facilities can err too far in their quest for safety, but they do have to protect the other patients, too. And I don't want to think what will happen if Mom is ever considered a risk.

Please understand that I'm not saying that any of your LO are dangerous. I just think that there really does need to be a safe alternative. Something that would care for those deemed "risks" while protecting patients who haven't (yet) caused any concern. And maybe some way of challenging this kind of label that appears to blacklist those who have in someway offended.

Just my 2-cents,

Kate

_________________
Kate [i](Cared for Mom for years before anyone else noticed the symptoms, but the last year of her life was rough and we needed to place her in an SNF, where she passed in February 2012)[/i]


Sat Feb 06, 2010 1:16 am
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Joined: Fri Jan 15, 2010 9:33 pm
Posts: 3436
Location: Vermont
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Maybe I should see my dad's complete immobility and almost no strength as a positive - he at least couldn't be viewed as a violence risk! But, he could be the target of someone else...... That story about the pro wrestler was awful but a good wake up call for those of us who haven't even thought of such scenarios.
Oh, this disease always has us thinking and searching and coping, doesn't it? Lynn


Sat Feb 06, 2010 9:24 am
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Joined: Wed Oct 28, 2009 7:53 am
Posts: 5
Location: Australia
Post paying for in home help
Hi, I can't help but be greatful, here in Australia we have home help at about four dollars an hour as well as home respite at the same rate,our government puts in the rest of the total amount.
Mum has her showers three times a week and dad has a cleaner every fortnight.
As well as that, pensioners over here pay about five or six dollars per prescription and when they tally up to three hundred dollars every prescription there after is free!
We have bulk billing which means you see your doctor for free as well as free public hospitals,
If you want private hospital you have to have insurance but if patience is on your side the system we have here is not too bad.


Sat May 08, 2010 8:23 am
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Joined: Mon Mar 08, 2010 9:32 pm
Posts: 120
Location: Dumfries Va
Post Australia
Yes, I don;t understand why our Government doesn't take care of the elderly either. Meidcare and the rules stink. If I was to put my wife in a ALF, Which I hope I never have to do, they would take everything we have. So where does that leave me? A Street person.


Thu May 20, 2010 6:43 pm
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Joined: Wed Oct 28, 2009 7:53 am
Posts: 5
Location: Australia
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Well mum now is not able to walk, I've been given a hospital bed by the palliative care nurses,and an air mattress, the Hospital doctor has been out to see how mum is doing, they also sent out an OT to see how I'm managing, they have been wonderful.
The reason we have this care in place is to lessen the burden on hospital waiting lists.
Our Government also helps out with incontinence aids a total of $495 per year.
When I read other posts I feel so sad that the help needed is not given, after all these LO were once hard working taxpaying citizens. Yes as we say in Australia we are the luck country, I thank God every day that my family came here.


Mon May 24, 2010 2:05 am
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