How difficult is it to find a good home health aide?
My father is 86 years old, fairly severe Alzheimer's. He remembers almost nothing, he is very agitated and even a little violent (screaming, striking, pinching caregivers) about 25% of the time. He has urinary incontinence while sleeping. Due to a broken hip last year he cannot walk.
Medicaid will pay for an aide 12 hours a day. I would like to pay the aide another $50 to stay overnight as well. There will of course need to be two different aides so that the primary aide has a day or two off each week.
I except the aide to keep my father safe, fed, clean, comfortable, etc while also being an excellent housekeeper who will keep the apartment spick and span. I don't want to hire a housekeeper on top of the aide since the aide will have a couple of hours of downtime daily when dad naps.
This is in Brooklyn, NY by the way.
Do you think this is reasonable? Will it be difficult to find the right people? Any advice?
Thank you!
Might as well face it. It get very expensive to have 24 care at home. An agency charges $17 to $25 per hour. You can get an individual for as low as $10 hour, but you do not have the backing of an agency.
With sundowners and evening incontinence, you cannot assume the night hours are idle, they can be some of the busiest.
The Aide is there for dad, she may prepare meals, pick up after that, pick up after dad....maybe do some light housekeeping, such as soiled sheets. She is not paid by Medicaid to keep the apartment spic and span, so temper your expectations on that. Do not expect she will clean windows, baseboards and vents or vacuum drapes.
I agree with the other posters. If you want a spotless house, you'll need to hire a cleaning service. That is well beyond what any aide could be expected to do.
You may have to temper your expectations as I honestly don't think they're realistic.
I'm also wondering about his post-hip fracture situation - was the therapy unsuccessful?
Housekeepers (self employed) get on an average of $15-25 an hour to keep a home spic and span.
Urine or feces soaked sheets are usually not part of the deal.
Home visiting LNA's will charge $50 a visit just for a bath.
If you are so concerned about your parent and his needs then best coarse of action would be to do it yourself. Have him move in with you or visa versa.
Home carers and housekeepers are the most unappreciated of the working class. They charge well below what they worth. Perhaps you need to do the job before you hire someone else? It might give you more perspective.
He would probably be best in a nursing home, or think again about your apartment. You could spend the nights with him, bring in care during the day while you are at work. And you would be paying for one place to live, not two.
You need to reevaluate the situation and reconsider your options.
There are 2 types of overnight shifts. A "resting" overnight and a "non-resting" overnight. The resting overnight means that your aide is guaranteed at least 6 hours of sleep a night. The non-resting means that the aide is up while your father sleeps and for this you will pay more. Here in St. Louis a daytime shift costs about $10-$15/hour for an aide. If you need overnight it costs more. For someone who needs 24-hour/day care we staff 2 aides in 12-hour shifts. This is easier on the patient and the family and the aide. You have a day shift and a night shift. The night shift makes more than the day shift and makes much more than $50. That's only 5 hours of a daytime shift (figuring conservatively). I wouldn't accept a night shift for $50. I wouldn't even consider it.
Aides don't sleep in the same room as the patient regardless of whether the aide is male or female. Separate sleeping quarters are required.
And getting your dad up and down 3 steps while in a wheelchair would require strength that even a male aide may not have. Your dad may weigh 115 lbs but the wheelchair weights 40 lbs. Not to mention how unsafe that would be without a ramp, for your dad and for the aide. To get up the stairs the aide would have to turn your dad around backwards (in his wheelchair) and drag him up those stairs. This is very unsafe for your dad as he will be pitched forward. To get down the stairs the aide would, once again, have to turn your dad around backwards and let the wheelchair bump its way down those 3 stairs. The aide cannot push the wheelchair up or down as your dad wouldn't be secured. It has to be done backwards.
Calling every 2 hours is inappropriate and will interfere with the aide doing his/her job. It also demonstrates a lack of trust on your part and a need to control everything while you are not there. Not good for morale at all. You either trust the aide you hire or you don't. If I had a family member calling me every 2 hours I would communicate to them that it's unnecessary and that they hired me, they should let me do my job. If the overbearing nature of a phone call every 2 hours continued I would quit. Plus, I chart everything, any changes, anything out of the ordinary, and if it was just a regular day I chart that too. I chat what the person eats, when they take their meds, when they use the toilet, if they've had a bath, etc. I chart everything. There's no need to call every 2 hours. And even IF.....IF.... you could find some person who would clean your house top to bottom during all of this how do you expect this person to take care of your dad, take care of the house, AND answer your calls every 2 hours? That sounds like a nightmare of a job to me but I wouldn't be cleaning either so maybe I could take a phone call occasionally.
As you said, you're in an area with a lot of immigrants and maybe you can find someone to work this very strange job and maybe this person would be grateful for $50/night but it's exploitative and you get what you pay for. If the pay is too low, and it is, you're not going to find someone qualified and experienced. And from what I gathered you're basically saying that you can find "immigrants" (let's just call it what it is, illegal aliens) to do this job for less money and if that's the case I think that's disgusting, not to mention illegal. Because they're illegal aliens they'll take whatever you offer and be grateful for it. That's what I'm reading in your post.
It's obvious that you love your dad and you want what's best for him but again, as a nurse who works in home health and with all due respect for you and your dad, you're going to have to amend your expectations. Unless you find people to exploit in which case good luck with that. I have a patient (she's my favorite patient right now) and she's in a nursing home. The aides there are all immigrants (Bosnia, Jamaica) and they are cruel and uncaring to most of the residents and this is at the nicest NH in town. Certainly the nicest facility I've ever been in and I've been in too many to count. And these aides work for a huge corporation and they still treat the residents horribly!
My point is that if you're trying to go cheap, trying to get the most bang for your buck, the one person who's going to pay dearly is your dad.
You know, if you wanted opinions on your situation and whether or not it was normal, you could have just stated so. It wasn't necessary to be so dishonest with us.
I thought there was something very odd that a man who had fallen no longer walks. You mentioned nothing about post fall PT which I also found peculiar.
I have read of spontaneous fractures due to having taken Fosamax.
And regardless what you think may have happened to cause the fracture, I also find it inappropriate to speculate that an aide said nothing after a client fell. You impugn the integrity of someone you don't even know and even suggest the daughters have mental issues.
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