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Be Careful With Those Caregivers…

A new study, undertaken by Dr. Lee Lindquist, an associate professor at Northwestern University‘s Feinberg School of Medicine and others, tells us something we already knew, or at least feared: many home aides who care for our elderly loved ones have absolutely no training.  In fact, more often than not, they barely undergo screenings for drugs or other problems.  These caregivers are also often very poorly supervised.

Uh oh.  That’s not good.

Hiring agencies find candidates through advertisements, including such internet sites as Craigslist.  And some agencies, anxious to satisfy their clients’ endless demand for cheap, energetic staff members (turnover in the care industry is very high), appear to flat-out lie about their employees’ education or backgrounds.

That’s even worse.

This is not to say  there are not fine, compassionate caregivers and excellent agencies out there, but you’ve got to be very careful about which ones you hire. This latest study was published this month in the Journal of American Geriatrics Society.  They note in the report that laws regulating these agencies vary by state.  Caregiver providers are not regulated, as a rule, while nursing homes, whose services may be paid for by Medicare, are regulated.  The typical aide was found to be a recent female immigrant, earning $7.25 an hour, on average.  Live-in help earns an average of $5.44 per hour.

These day-to-day caregivers help our seniors with many intimate, personal tasks, including dressing, bathing, housekeeping and meal preparation. Many aides help out with financial transactions, too, such as bill-paying and bank account management.  They are not nurses; they have no medical credentials.  But while these aides  are legally prohibited from actually dispensing any medications, they are expected to remind their charges to take their pills.

Suppose something goes wrong?  Suppose patient and caregiver just don’t get along?  Remember these are our loved ones we’re talking about.  They may put up a brave front and talk tough to us — they don’t ever want to be seen as burdens or slackers — but they are frail and sick nonetheless.  They are very vulnerable to fraud, neglect, even abuse but they are often too frightened or too embarrassed to complain.

A great deal of focus lately in health care for the elderly has been on keeping seniors in their own homes and sending teams of caregivers out to them.  This is the American business model at its finest, apparently.  And it sounds great, even ideal, but just consider the logistics for a moment, the coordination challenges, even all the driving around but still staying on schedule this means.

Given ever-tighter budgets, uneven or altogether nonexistent supervision and the inevitable daily staffing shortfalls all businesses endure, how truly practical is this plan?  And even if it can be made workable for the system, does it work for the patients?  You know how you feel when you’re isolated and ill, waiting for someone to show up to help you — it’s scary and lonely.  Once someone finally comes by, you’re so grateful for the company you forget the neglect and put up with almost anything to have someone to talk to.  Is this what we want for our families?

Surely not.  So what can we do?  According to experts, including Beth Kallmyer, vice president of constituent services at the Alzheimer’s Association, pay close attention when sorting out care for elderly loved ones.  Pay surprise visits when the caregivers are working.  And ask questions, questions, questions.

For example, you might ask caregiver agencies the following:

  • How do you recruit caregivers?
  • What are your hiring requirements?
  • What screenings are performed before you hire a potential caregiver?  Criminal background checks?  Federal and state? Drugs?  Are all caregivers fingerprinted?
  • Do the aides have CPR certification or any health-related training?
  • Are the caregivers bonded and insured through your agency?  Can you prove this?
  • What skills are expected of the caregivers you send to the home?  For example: lifting and transfers; homemaking skills; personal care skills (bathing, dressing, toileting); training in behavioral management.
  • How, and how often, do you assess the caregiver’s capabilities?
  • Does the agency provide a supervisor to evaluate  the quality of home care on a regular basis?  How often?
  • What is your policy regarding substitute caregivers when the regular caregiver cannot provide the contracted services?
  • How does the agency handle complaints or concerns about caregivers from patients or their families?
  • If you are dissatisfied with a particular caregiver, can he or she be replaced ‘without cause’?
  • Does supervision take place over the telephone?  Through progress reports? In person at the home of the older adult?

Now of course, all this brings up yet another problem or challenge or (enormous) glitch in the whole healthcare equation: how do you keep your own job and your bills paid while doing your best to organize the care of your aging parents and relatives on one hand, and support your kids struggling with  school debt or a most unfriendly economy on the other?  And odds are, your children are in one part of the country and your elders are 1,500 miles away in the opposite direction.  And even if they’re only across town, it’s still a major juggling act.

We don’t have a clue, either.  But we’ll keep you posted.  And have a great weekend!

Special thanks Journal of American Geriatrics Society; HealthDay

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