Elder Care: How to Hire a Competent Care Giver

Elder care is one of the most pressing problems today in the lives of families. Often the children because of jobs or finances cannot care for their loved one themselves. They must hire a care giver to come into the home. I took care of my parents for years and went through a number of both good and bad caregivers. I learned what to look for, how to interview, and how to judge their performance. I want to state first ,there our many capable, competent, loving care givers out there in the work place. They deserve our respect and admiration. The job requires so much love and patience. It is one of the most difficult jobs out there and one of the most demanding. There are also many who should not be taking care of anyone. They get away with shoddy care and abuse of those we cherish and love. Here is what I have learned over the years:

Private or Agency Hire: Both can be a problem.

When you hire a private caregiver, you must do the interview and background check. You must give them precise information of what is needed in care and how you want it done. You must supervise their performance all the time. If they don't show up, you must find an emergency substitute or give the care your self until someone can be found. You do have more direct say over who is there and how the job is done. You will pay less and have more influence on the hours and days of care. An agency will require a certain number of hours and days and a signed contract.

Interview and Background:

Pay for a criminal background check. Some of the girls you may hire from reference or newspaper may have criminal records, may have drug problems, may have been thieves. They can get away with it because often clients do not take them to task legally. They just disappear and work for another family. References are easy to falsify. It is best if they have agency references that you can call on. Check thoroughly anyone who is in your home on a regular basis. Find out about her training, ask for her CNA license if she has one, ask her questions that will tell you if she is competent. Ask about her family, health history, and personal background.

Find out what she likes to cook and how she cooks. Does she understand about a diabetic diet, a low fat diet, or other dietary needs your loved one might have.. What does she consider good cooking: Fried food, TV dinners, gravy, cakes and sweets, junk food? You would be alarmed at the caregivers who consider a good meal a TV dinner or fried, overcooked food. Many of them will not fix a salad or fix a meal that they themselves do not like to eat. If your loved one is vegetarian, make sure they understand this and know how to provide a well rounded vegetarian meal.

See how your loved one and the caregiver get along. Is there any cultural or racial issues that could be a problem. Some clients just have bias and what are you going to do with someone who is 90 years old. They are set in their ways and you are not going to get them to change.

Find out if the religious background of your loved one and the care giver is a problem. Are they willing to take them to church.

Do they have a reliable running car? Have them show you their drivers license, insurance, and a copy of their driving record. What kind of medical coverage is on their policy? Is your loved one covered by their insurance in the case of an accident. Often insurance does not cover transportation of clients for business. Do they have alternate transportation of their car breaks down? How are the tires? Does it leak oil? Does the heater work or air work? All these questions are important if they are going to be transporting your loved one on errands.

Have them show you a negative TB test. Do they need to know CPR and if so do they have a CPR certificate. Do they know what a DNR paper means?

How physically fit are they? If your loved one needs to be lifted, they have to be able physically to do that. Many of the caregivers have hurt their backs and are only capable of taking care of patients who are mobile or just stand and assist clients.

Agency Hires:

Not all agencies perform the same quality of background check on their caregivers. Find out exactly what kind of background check is done. Find out if the agency has had law suits filed against it. Some of your agencies give extremely bad service and the girls they send out are not much better than you hiring them blindly. Ask a lot of questions such as are the extent of the girls training, what kind of training and experience is required by their company, how do they supervise the girls, do they give spot checks on their performance, are the girls bonded, what procedures are put in place in care of theft, in case they just don't show up, or if their performance is not up to your standards. You will pay a much higher rate to an agency. Just because they are from an agency does not mean they are going to give a good job. I have seen many caregivers who are CNAs but were lazy, didn't give medication or care as expected. One stole money and another just walked off the job. DO NOT assume that because you have hired from an agency that you don't have to spot check their performance yourself. You want to keep an ever present eye on her, the job she is doing, and how things look. The problem is that most elder patients have mental impairments, memory problems, or no memory at all. They cannot remember when they ate, what they ate, or if they had a shower. They forget where they place their money or jewelery. They cannot always tell you that things are wrong or not being done because of their memory or communication problems.

Many agencies will Not let their caregivers talk directly with the family. Anything that is wrong can only be reported to the supervisor. The agency then talks to the family or solves the problem. This works with a good agency but often agencies hide problems from the family. Often agencies do not let the family know of improper behavior for fear of losing the families confidence or losing the job. Agencies must be carefully watched as the performance of the individual caregiver.

Agencies often keep girls who do a less than adequate job because they are short handed or not aware of the girls poor performance. It is easy for girls to get away with bad care in the home because there is no one to see it. The client is not aware either. Medication not given is just thrown away and marked down as taken. The girls may not tell the agency staff about problems that exist.

Your Job Once You Have Hired Help:

When care givers are in the house, do not have money or jewelry present. Do not leave checking account or bank records that are easily accessible.
Check medication usage. Make sure the medication is not being used up more quickly than should be. Check to make sure the meds are being given.
Make sure showers are being given and your loved one smells clean and is wearing clean clothes. Come in unexpectedly at meal times to see what food is being prepared. Check on the house...is the bathroom clean? Are their odors? Wet clothes not washed? Food not prepared in a clean manner. Does the bed smell of urine? Is the bed damp? Are their stains on the sheets? Are their unexplained bruises? Often care givers do not report to you or to the office that the client has fallen because they are afraid of losing their job. Look for red places on the skin where bed sores might be a problem?

It is your responsibility to have a book with emergency numbers of family and doctors, emergency directions, list of medications, what hospital to call in an emergency, what protocol to go by if the client falls, any information of importance.

Use your eyes, ears, sense of smell, and intuition at all times!