Home Health Aides

At a certain point, you might consider getting home health care. Understand that there are home health nurses and home health aides. Nurses are obviously more expensive. Yet, if what your loved one needs is someone to make meals, tidy up and help your loved one get dressed, an aide is probably all you need.

Different states have different regulations for home health givers, and you should familiarize yourself with them. Generally, there are agencies which deal directly with the home health givers. In my experience, they will meet with your loved one and do an assessment of their needs and match them with a person. In our case, they tried to have primarily one person work with my mom and having others come just as backups. Again, it is crucial for you to be actively involved. Meet the person and see how they interact with your loved one. 

Again, be a little jaded here. Realize the agencies are running a business. Make sure the agency is as respectable as the aides that you are dealing with. Be honest with the aide about any problems.

Things to consider at the beginning:

1. Is the agency Medicaid and Medicare-certified? Medicare and Medicaid may cover home health care costs for eligible patients if care is provided by a certified home health care agency. 

2. What services are you really looking for? A companion to keep your loved one company and provide light help? Someone to help them get around? Full-time nursing care? Be very specific about your needs and what you envision the situation to be in order to get the best match. Ask all the questions you have and do not assume anything! Most aides do not consider themselves housekeepers and while they should clean up after themselves and your loved one as they go about their day, do not assume they’ll clean the home too.

3. How thoroughly does the agency check their staff? Credentials and background checks are a good thing, but also do a little online research yourself. People’s social media can really tell a lot about a person. Actually, check references if you can get them.

4. Consider the online reviews of the agency with a grain of salt. Online reviews always tend to have a lot of complainers. I found that a lot of online reviews of services and facilities, if read objectively, often were more negative because of the situation the writer was in, rather than telling regarding the service itself. Yet don’t ignore the reviews completely. If you find one that concerns you, ask the service what their response is. Similarly, often incentives are given out or friends are asked to write favorable reviews, so be careful of glowing reviews as well.

5. Ask how long they have been in business. While there are no guarantees, a business that’s been around for a while could mean that they deal honestly and know what they are doing. Be careful though if you hear stories about the business’s name changing or even generational changes.

6. Realize that one of the best ways to find a good service is to ask physicians you know, staff at assisted living facilities, and people you know that have used them. If your loved one is at an assisted living facility, you will often see people who are in some type of uniform (which can even be a shirt with a logo on it), but it’s not the uniform of the facility. I noticed people like this helping residents in the dining room at my mom's one facility. You can ask them what company they work for.

7. Be honest and candid about your loved one’s condition and quirks and do not underplay it.

8. Realize that aides are people too. They have their own lives. Recognize you may have to make some trade offs to have the best person for your loved one. 

Meeting the Aide

The most important thing to remember is not to be desperate. Often, we wait until things are dire to tend to them and obtaining help is no different. You cannot simply be willing to have just anyone take care of your loved one! 

1. Meet the aide with your loved one and carefully watch their interaction. Is your loved one amenable to that person? No matter how fabulous a person is, if your loved one, for whatever reason, does not like them, it will not be a good match. Warmth, kindness, compassion and patience are all non-negotiables. 

2. Are they physically capable of handling your loved one? If lifting your loved one is part of the job, make sure the person can do it.

3. Do they understand the job you expect?

4. What are their other work obligations? When I hired an aide at the beginning of Covid-19 to keep my mother occupied in her room as much as possible to reduce contact with others, I specifically wanted an aide that did not have any other jobs so that she wouldn’t be bringing infection in from another facility. Often aides have several assignments at a time, which might also cause more difficulties with scheduling or being on time.

5. What is their private life like? Since this is a one-on-one situation (often in the home), you should probe a little to find out things that may affect the care of your loved one. We had one wonderful woman who unfortunately had a good number of children and inadequate coverage for them when they were sick which led to a lot of missed days. The agency sent back up, but often these others were unfamiliar with my mom. Her companion at the time decided that it was getting to be too much. However, I never liked the woman they had her replaced with and wished we had kept the first one!

6. Recognize that you are paying for a service and that while you shouldn’t be ridiculously overdemanding, neither should you look to make everything easy for the aide. With one of the aides, my mother’s companion was having her feed my mother ham sandwiches for lunch ostensibly to make the aide’s life easier. I found this out from the aide herself and was flabbergasted. I did not consider this particularly healthy nor was it what my mom usually ate. Spell out the job clearly to the agency and the aide and be reasonable in your expectations, but do not accept minimal care.

7. Spend a complete day with the aide and your loved one. You don’t have to be like a hawk on top of them, but a full session together will give you a clue as to certain things that they see nothing wrong with that to you is a problem.

8. Have a written list with instructions and even a schedule. Understand that you must be flexible. 

Once the aide has started.

1. Make sure you still pop in to keep your eye on things.

2. Keep open lines of communication. Make sure you get your aide’s personal cell phone number.

3. Use things like FaceTime to “see” your loved one when you are not there. In our case, my mom could no longer talk, but she could listen and see and we regularly used the cellphone to contact her. If the aide does not want to use their phone, then consider buying one just for use with your loved one. There are free services that can be used, but often the quality is not as good. Tablets, rather than phones may be even better.

4. Listen to your aide’s suggestions. From little things like buying my mom a new lipstick to more inventive ideas like having big pictures of family around them so they could be identified more easily when they called, our aides came up with solutions for my mom.

5. If you see a problem, deal frankly with it immediately. I personally found that those who specifically deal with elderly dementia patients are a very special group who did really want to do a good job. There are many jobs out there and dealing with those with dementia is an extremely difficult one. Think in terms of reaching solutions rather than criticizing.

6. Remember, nobody is perfect. In life, it’s easy to think the grass is always greener, but it is not necessarily so. You must always keep in mind what is most important and that is the health and safety of your loved one.