Hiring and Managing Professional Caregivers

Last month, I wrote about hiring private caregivers to care for a loved one in your home. I explained that one of the first questions that needs answering is whether the help is needed to assist rehabilitation — in which the individual being cared for will regain functional abilities and possibly get better — or if caregivers are being hired to care for someone slowly declining or at the end of their life.

Whatever the specifics, when hiring someone it is your responsibility (and in your best interest!) to do all you can to provide support, training, and guidance, to help that person succeed. An investment of time, energy, and commitment up front increases the likelihood of a positive experience and a successful relationship.

Further, and as a result of our years working with clients, we have developed “tools” that can be customized to meet individual circumstances. I share them in the sections below and encourage you to amend them as needed.

Planning and Introduction

You’ll want to set aside time to develop an orientation plan and schedule. Think about how you can relay your “insider knowledge” regarding your loved one — their health status, routines, likes and dislikes, etc. — so that you provide as much data as you can about the person being cared for.

But first, and before the actual caregiving begins, be sure to create an opportunity for the caregiver and your loved one to meet and get to know each other. This is an important first step in what will become a deeply personal relationship. Sometimes, in the haste of making numerous arrangements (especially if someone is being discharged from a facility), this is overlooked and can contribute to a poor outcome.

Orientation / Training / Setting Expectations

The first tool we create is a Daily Schedule / Routine. This may require revision over time, but initially, it provides a roadmap for the caregiver to “fill-in” as needed while preserving the functional abilities your loved one is capable of executing independently. The goal is for the caregiver to ease into a routine that allows your loved one to graciously accept assistance that they may not initially perceive as needed.

When this phase is not well executed, caregivers often feel that they are unable to anticipate the needs of the person for whom they are caring, while family members feel that the caregiver took too much or too little initiative. This can lead to resistance on the part of the person being cared for, leading to the often-heard comment, “I don’t want a stranger in my home.”

This important first step helps to avoid disruption, frustration, and a revolving door of caregivers being hired and fired in search of “the right one.” As in any hiring relationship, an investment at the beginning pays off in the end.

Emergency Procedures

Unfortunately, emergencies do occur. Establishing and documenting an Emergency Procedure reassures both the caregiver and your extended family by clearly specifying responsibilities.

Additionally, the Emergency Procedure tool becomes the face sheet of the ‘Grab-n-Go Kit’ discussed in a previous newsletter.

Responsibilities / Priorities / Home Health Aide

This tool mirrors the Daily Schedule / Routine but provides much more detail to the caregiver about their individual responsibilities in support of that routine.

Because individuals being cared for at home may require a caregiver to perform functions that began in institutional settings, more detailed training may be necessary for the caregiver, whether by a professional or family member. Examples include caring for a Foley catheter or periodically testing blood sugar.

Think ahead and capitalize on the opportunity for hospital, skilled nursing facility, or visiting nurse agency staff to provide such training.

Household Responsibilities for Home Health Aide

A common question from families is whether it’s alright to ask a caregiver to assist with household responsibilities such as cooking and laundry. The answer is yes; the physical environment in which your loved one resides must be kept neat and clean, thus ensuring their safety and comfort.

This tool provides an example of how household responsibilities were compiled and clearly specified within a simple document.

Responsibilities When in Rehabilitation Mode

When caring for someone who has recently returned home from a hospital or skilled nursing facility following an acute illness or injury, real-time data gathering is important — it contributes to the decision making that will eventually lead to greater autonomy on the part of the person being cared for.

For example, when one of our clients who was still quite ill returned home from the hospital following surgery, this toolallowed the caregiver to monitor and document items that were critical in the beginning but that became less so as time went on. Items included fluid intake, urine output, blood pressure, weight, number of times per day getting out of bed, and whether or not the outlined list of daily exercises were performed as recommended. Additional notes described observations about eating patterns, pain management, and overall mood.

The caregivers were encouraged to offer suggestions for each other and for family, thereby facilitating the sharing of insider knowledge among members of the support team. This communication step is important and should not be overlooked.

Interests and Social Activities

This tool helps outline the specific activities an individual enjoys — it is invaluable information for a caregiver to have.

Knowing what motivates a person or what can make them smile helps to facilitate conversation and can provide an activity to look forward to accomplishing in a given day.

Final Thoughts

Developing successful caregiver relationships between loved ones, caregivers, and extended family takes planning, training, and constant nurturing.

By sharing your “insider knowledge” about a loved one with caregivers, and by caregivers, in turn, gathering real-time information to share with you and other team members, you help to ensure a positive experience for all concerned.