What instruction should be left for hired caregivers? How detailed?

If I was doing this I would probably think about how to set it out. I’d use clear headings for each topic (eg Toileting). I’d put the most important thing under the heading (eg every 2-3 hours), then leave a gap. Then put a subheading ‘detail’, and list by number (1) all the things you set out in your post. That way the carers can see the main jobs, and don’t need to read the detail if they are already confident.

I’d print out several copies. If one of the details keeps getting forgotten, I’d use a highlighter to make it stand out.

This might be worth trying out. But then, I once had a boyfriend who told me I had written the only love letter he had ever received with numbered paragraphs. So it may not be your style!

This is personal opinion from me as an RN, but were I caring for someone I would want instructions and thoughts and clues as COMPLETE as the family can make it for me. I cannot know all the idiosyncrasies of the patients, and they matter in my caring. I would love a 20 page letter if you are up to making me one. You can always head it by "I recognize this is overkill, and I don't want you to resent the length of it all, but just in case you are wondering about certain issues, I have made it as complete as I can in order to try to help with the matter. Please, if you have any questions, do give me a call. I am trying to be helpful, and hope I am not overdoing it".
I would love the info myself.

When I asked my RN daughter (who worked in NHs) if I should leave the aids notes, she told me I could, but don't expect them to read them.

If this person is from an agency, maybe yes. You hired them, what you wanted should have been spelled out in the interview. Its all a matter how you approach it and it should all be done with a please at the beginning. Don't talk down to the aide.

"Mom needs reminding/guidance/help with placing herself in front of commode, sitting on commode, wiping, help applying barrier cream, putting on fresh pullups, pulling up pants, changing pants/clothing if needed, disposing of soiled pullups and commode bag, putting in fresh commode bag, taking out trash, and so on."

Yes, I think you are too specific. If this is a seasoned aide, she may take offense. Really, if Mom soils her clothes I would think the aide knows enough to put clean clothes on her and after toileting a clean depends. I do think, you need to be there for the aides first day. Take her thru a day in Moms life. Show her where a change of clothing is. Why commode bags? Why when Mom is done can't the aide take the bucket and flush the contents down the toilet, rinse the bucket well and spray Lysol in it. A little bit of water should always be in the commode. Clorox wipes can be used to clean it. And soiled diapers. There are diaper genies. I bought a small trash can with a lid. Put a small plastic bag in it. When it was full, I tied up the bag and put it out in the trash. Had a deodorizer inside.

I am with Margaret, short and sweet.

If you can't be there on the aide's first day, then you need to be clear with the agency what you are hiring the aide to do for your mother. Be specific with the agency i.e. I need the aide to toilet my mother every 2 hours.

Make sure everything is easily accessible for the aide i.e. soap, water, washcloths, TP, clean clothes, diapers, etc.

Keep it simple. Commode bags may be a waste of money.

I would leave step by step instructions, they may very well be ignored but nobody will be able to say they didn't know what was expected of them.

When I left detailed notes for our caregivers it was because I had learned by trial and error what worked and what didn't and what was the easiest most expedient way to get things done. I also left notes about little things that might be different from home to home, for example "my shower has a temperature pre-set that can go from ice to scalding if you fiddle with it, please leave it alone" (they didn't 🙄).

Here's a story that is sort of related in a round about way-

Many moons ago when I was a live in caregiver to my nephews I left pages of detailed notes for their grandmother when she cared for them while I was on vacation, since then I inwardly blush when I think of it. But soon I'm going to be babysitting for my little great nephew and niece and I've gained another perspective; although I'm experienced it's been a while and caring in their home will be a very different kind of experience - I really wish someone would leave me that kind of detailed agenda!

If at all possible, spend part of their first shift with them, going through the routines with them, telling them the ins and outs of it. It takes more time, but gets across the 'gist' of what you expect from them, far more powerfully than anything you could ever write down.

Woah! #1 - we can't apply creams without a MAR chart in place. Is the barrier cream prescribed? Is there a body map? I don't know if the regulations are so strict where you are, but we require:
the cream to be prescribed by a qualified practitioner (doctor, nurse, PA);
a body map showing area of application;
application directions - frequency, quantity, anything else that's specified such as "allow to dry";
a MAR chart, (MAR = medications administration record).

No MAR, no cream. I keep rules, and have only once been driven to break them, when a lady was trying to apply ibuprofen gel to her shoulder blade and I could stand it no longer. My documentation for that visit read "worked with client to apply prescribed gel to shoulder blade" which I blush to say was at best stretching the truth. Some of my coworkers are more practical and gung-ho about it, leading to clients' oft-heard plaintive remark "everybody else just puts it on..." Well they shouldn't!!!

Anyway, so #1 - if there are creams or medications of any description, you'll need MAR charts. You can find easy to use templates online; but check their policy with your agency - they may supply their own. This should have been discussed at assessment.

Speaking of assessments, I have just been promoted (and, story of my life, taken a pay cut - don't ask). It is now part of my job to Write The Support Plan for my team's workers to carry out. I am trying not to make them all hate me. I know that they are good people who know very well how to make a client safe and comfortable and will immediately report any concerns; so what I am trying to do is design a format that is what I would have wanted to see when I was doing their job. It isn't easy!

Try this:

One page profile. This is quite fun to do, and you should do it with your mother. It can be decorative, it is for everyone who visits her to see, and it tells people a little bit about her as a person. It goes on one single page, and should include:
what she likes to be called
what's important to her
what sort of help she needs - verbal prompting, physical support, reminders, e.g.
her likes and dislikes
a paragraph about her life, such as you'd find on a book cover 'about the author.'

Key data page - this includes anything the caregiver might need for ready reference in an emergency:
Allergies
Any DNR or similar directives
Any health alerts (e.g. pacemaker, diabetes, Apixaban, splenectomy)
Her Covid status, including dates of vaccinations
Her medications
Her doctor's telephone number
Her emergency contact's details
Her date of birth
Her address (yes I know we're standing right there in the house, but you'd be amazed how hard it is to recall an address when you're speaking to the emergency services).

Next, schedule. I recommend you divide it into four sections:
a.m.
midday/lunch
p.m.
evening/bed

Each section has its own page. On this you list the scheduled tasks, e.g.:
a.m. -
support to get out of bed, prompt use of Zimmer frame
transfer to commode/toilet
support with continence care including skin integrity check and barrier cream
support with personal care, including oral hygiene [full body wash daily except shower and hair wash Tues/Fri]
support with dressing and grooming/make up
support with mobilising to kitchen
support with breakfast, fluids and medications
support with toileting
support with mobilising to living room chair.

Because we are a Reablement service our support plan is written in the first person, with the client's active participation, so it reads more like "please support me to get out of bed, allowing time for me to mobilise. Please prompt me to use my frame to walk to the bathroom." You might feel that's friendlier.

Things that seem obvious but then turn out not to be... It isn't so much the instructions that count as the ergonomics. Where's the bin? The pull ups? The clean towels? The trick is to make it all work for people who don't already know your house.

As they say with Ebay listings, "write it as though you have no photographs, and photograph as though you can't write a description."

If you write it out step-by-step, then there's no question as to what you instructed the caregiver to do. An experienced caregiver will know what to do without all the instructions, but an inexperienced one will have all the instructions at hand.

I had a caregiver for my mother who was also to do light housekeeping and had to teach her how to load a dishwasher, as she'd never had one of her own. I never assume someone knows anything anymore, even if it is in their job description.

You need to detail what you want done.
If you want barrier cream applied, you need to say so.
If you want new pull up put on even if the previous ones are not wet, you need to say so.
If you want the soiled pull up disposed of in a particular way, you need to say so.
If you want the trash taken out, you need to say so.
When you get a caregiver do you meet them and discuss with them your expectations? When you say "I'm not going to be there..." are you there for any length of time?
I always was there for at least half the day the first time so that the caregiver could see the routine and get used to where things were and how things were done. And I would get a chance to see how the caregiver did when changing, getting lunch ready. (I always made a meal that all they had to do was heat up.) And how they monitored or helped my Husband when he ate. (thickened liquids, pureed foods so I was concerned about aspiration)
but be as detailed as you can be. Make an extra list so that if they want to take instructions home to read over in case there are questions. If it is not detailed on the list and it does not get done that is on you not them.

For Aides in my area, English is a second language, so I think keeping notes as simple as possible may be better. Really someone with experience does not need a detailed description of everything they need to do. And if me, it would be insulting.

I was an in-home caregiver (mostly to elderly) for almost 25 years. I find that most of the time the written instructions left by the family member were usually pretty useless and often downright offensive.
You can tell the caregiver that they have to bring your mother to the bathroom every two hours and help her with cleaning up and changing. That will suffice.
If a client's family assumed that I would not have sense enough to dispose of a soiled pull-up or the commode bag the client just took a sh*t in without written instructions from them, I would walk off of that job. That would be an insult to me and I would not return.
Here's what you leave written instructions for.

-What time the client is supposed to take their medications and what those medications are.
-What foods the client likes for their meal (if you haven't left the meal prepared. Many families do this for their LO and the caregiver heats it up).
-What time do they usually nap during the day if they do.
-A listing of a few activities they enjoy doing

Most importantly is the family member in charge should be honest with the caregiver about what level of dementia their loved one has and how incontinent they really are. If a person is totally out of it, that is not 'a little forgetful and needs reminding'. If the client pees and craps themselves daily that's not the ocassional 'accident' so many families will claim it is. They should also be honest about whether or not their LO can actually do anything for themselves, and just how much housekeeping they expect from the caregiver.
We are not housekeepers, or a domestic servant there to do for the whole family. I'm not washing the dishes from the family's supper the night before. Or doing their laundry.
Caregivers do for the client. Not the family. We generally do light housekeeping for the client. Light housekeeping is not cleaning out grandma's filthy hoarded house. It's not scubbing floors on our hands and knees that have been down since the Civil War and not cleaned after it.

I have found over the last 25 years of service that families tend to skirt around discussing with the caregiver exactly what the situation is and what they expect from them.
Be honest with us about the things I've told you here. Don't micromanage and knit-pick about small things. If a caregiver does not have sense enough to dispose of a soiled diaper or pull-up properly, get a new caregiver.

I prefer relaxed atmosphere, some time ago I created total chaos, I was driving and took wrong turn and got lost. My bag fell with my phone in it.
I am on busy highway and cannot reach for it.
I am late by almost an hour, panic ensued and agency, my husband and caregiver trying to call me. My husband explained he is OK alone, it is just they cannot leave until they know I am coming back.
My point is there will always be things not going right and like in my case my screwup.

I want to add to Burnt's post considering responsibilities of an aide.

As I have said before I worked as a secretary for our local Visiting Nurses. We had a client who was bedridden and we were asked by his Dr to do a few things for him. His wife held down a full time job and there were middle school age kids. I knew the wife and she complained to me that the aide provided by the State did nothing. Nothing meaning washing the dishes left by her family and doing laundry for the family were two of the complaints. I asked my boss about this and this was her response.

The aide is there for the client. If a the client lives alone, then the aide should do a little light housekeeping and clean up any dishes left from feeding the client. Also, trash removal, bathroom clean up, and laundry.

Now, if there is family living there its different. The aide is only responsible for what she does for the client. If she prepares a meal, she cleans up. She cleans up after a shower and toileting. She makes any kind of mess caring for the client, she cleans it up. Strips the bed, she could wash the sheets. But, she is not responsible for the laundry of the family or cleaning the house. Keep the clients area clean, yes, but there is another adult that can keep the rest of the house clean.

This woman had children old enough to help her.

Absolutely leave written instructions. And also have the caregiver sign a copy of the duties for you to have assurance that they understand what is expected.
Also, I have installed cameras in every room of the house, even the bathroom which my wife uses. The caregivers have their own restroom (no camera there). I let them know that everything is recorded at every moment of every day.
I host a Zoom caregivers support group every 1st & 3rd Thursday of each month at 10:30 a.m., EST. I sign in at 10:25. Please join us. We’d love to talk to you. Here’s the link. copy and paste it into your browser.

https://nam12.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.google.com%2Furl%3Fq%3Dhttps%253A%252F%252Fus02web.zoom.us%252Fj%252F85885877283%253Fpwd%253DZjNJWTFOeVJXd2VvYzgyNWRRemt3dz09%26sa%3DD%26ust%3D1655950920000000%26usg%3DAOvVaw3AedRIS112pn6DPqVaDpSd&data=05%7C01%7C%7C964b6655d779469fa4b108da50d156ce%7C84df9e7fe9f640afb435aaaaaaaaaaaa%7C1%7C0%7C637911157289247004%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000%7C%7C%7C&sdata=Mix%2FbPqgT68yPiLZB5Lkyu7cKjumXdE2angTE5njSa8%3D&reserved=0

Yes, be as specific as possible! Most caregivers appreciate the information. If you don’t, then don’t be surprised if the caregiver is on her phone looking at Facebook!

My mom & aunt have several caregivers and including family we all need to be on the same page. I have a one page list of
instructions for the day shift and one page on the back for the evening shift. When family takes a shift we also fill out what is accomplished, what was eaten etc.

You can find daily notes templates online to copy & edit. I also ask all caregivers to sign their notes. Our caregivers work for other clients so this printed reminder helps a lot. It is a good idea to keep these pages for documentation.

For example-If either client becomes ill or has an upset stomach we can look back to see what they have eaten.

Caregivers are encouraged to text or call if they have concerns.

very difficult situation because aids don't listen , write the notes very simple

Since I live across country from mom and there has been change to her caregivers, I found that it’s not possible for me to walk them through with duties for caring for mom in person. What I found works is FaceTime to not only interview the new caregiver but show her where things are in mom’s house and caring for mom. Texting also helps to remind the caregiver daily or when necessary as to what mom might need ( sheets washed, hair washed, floors cleaned).

Many caretakers in our area are limited in English, sometimes dyslexic. intelligent people who could not manage the language demands of school can be in there rolls. I would suggest a few days of shared care to accustom them to your expectations and monitor how they manage.

The simple answer is yes, because in my experience as a Home Care Agency owner, caregivers generally do better with detailed instructions than being left to improvise, or assume what their daily tasks are. But, you don't want to go overboard with minutiae, or too many instructions. Depending on your caregiver's command of the English language, you want to keep it simple and top line. Verbal review by the agency or you is better. We always like to have written care plans with clear daily instructions in the house for our caregivers.

Personally, just have a sit- down with whomever you choose and let your wishes be known. As a former caregiver, a lot long letters and a bunch of “post its” everywhere is very annoying. Just know, no one will care for her the way you do.. but some will come 95% close. Because they take pride in their work in caring for others .. May take some hits and misses to find the right one for you but, you’ll know!! And if they’re doing something in a way you’d rather not.. then just speak it… but then too you may learn some of their secrets of the trade and how to’s 😊
Now some things can be written down like times medication needs to be given etc…. And even ask if they need a plan of care written that never hurts!

My mom has had in-home care at varying levels of support for the last 16 years, and I've tried it all the ways: in-person "training," posted handwritten notes, posted laminated notes, more notes, fewer notes, 3-ring binders, checklists, charts, daily sheets that have to be signed, PDFs to the agency, emails to the agency, you name it. At this point I've landed on a "happy medium" of 1) a binder with a big stop-sign logo on it that says "New Caregivers Must Read" that includes a list of tasks for each shift (morning, afternoon, evening); 2) a laminated "BEFORE LEAVING" sign on the inside of the front door that highlights safety-related instructions ("make sure space heater is turned off," "leave walker next to the bed," etc.); and 3) a few smaller laminated notes elsewhere for things that are less critical. No matter what you do, there will be times when your instructions aren't followed (for any number of reasons), so focus on health and safety concerns first and be prepared to let the smaller stuff go sometimes!

Pick the big items, not your personal habits. Write a thoughtful letter instead of instructions for a personal connection instead of a to do list. Leave it with flowers. The better the start, the better your caregiver’s attitude.

Yes. Absolutely write a list even if your mom is capable of telling the caregiver herself. Also for the first day, if you can manage it, be there to guide and observe the caregiver in case they may have questions. You never mentioned if your mom is capable of speaking for herself. If she is, couldn't/wouldn't she tell the caregiver how to handle things?

Good luck

I would think the more detailed the better! There are caregiver logs available (free downloads and printing online) or an actual physical log book. I have both for dad. Before I had a “care plan” or logged anything, there was a lot of miscommunication. Plus, this is a great way to communicate back and forth if something happened while you’re not there. Also, maybe different and new patterns would be noted.

I think I would start with just the every two-three hours request. We cared for my MIL in our home when she was on hospice and she needed about the same level of care. It took me about five seconds to determine what was needed though I had no clue what to expect beforehand. If you have problems you can get more detailed, but I’d think an experienced aide would know what to do.

Natasana: Imho, keep the list as simple, yet concise as possible. Keep the list free of superfluous words because the less the caregiver has to read, the better. If faced with a superfluous list, the caregiver may not be as keen on digesting it.

I made a CHECKLIST for the caregiver so at the end of the day/shift I would know how the day went including an area for notes. I was very detailed as in how much water she drank to avoid dehydration, all bathing and toileting. It didn’t need to ALL be done every day unless specified but it’s a reference. These were kept in a notebook, a new page for each day and it helps the caregiver learn her routine. Also place for caregiver name and hours. Best and last caregiver was great. She would note if mom was sad that day or happy, supplies needed, BP and temp what she had for lunch and how much she ate and when. I was 24/7 except for a few respite days and this made life for all of us much easier.
love and light
sabrina

Toileting: (And where to find items)
- Take mom to toilet every 2-3 hrs.
>Needs help to lower pants.
>Needs help to sit on toilet.
>Needs help with wiping/cleaning.
>Followed by protective cream application.
>New pull-ups in blue basket in linen closet.
>Clean pants, if needed, on chair in mom's bedroom.
You're very appreciated :D

Do your aids have a CNA certification? If you search online you will find that, in brief, (almost verbatim), "CNAs are trained to assist patients with toileting. They are trained to be vigilant when it comes to balance and preventing falls. They clean the patients and take care of toilet needs. They monitor a patient's toileting routine and their food and fluid intake…" They also take note of any problem with defecation such as watery stools, signs of dehydration, etc. They are trained to clean up areas immediately in case of toileting accidents.

I was as awkward as awkward can be the first time with an aid. Not exactly the same circumstance but my first CNA took charge. She broke me in. What a relief. She was not available the second time I needed her so she recommended a friend, also a CNA, who was skilled, a little reserved and shy, but capable. Not everyone is an absolute perfect fit. I like a take-charge, Radar O'Reilly type. Some are overly careful to do things exactly as you'd like. At least with a CNA you'll find that they're use to new situations and they'll catch on to your way of doing things. They'll always be more information needed and a reminder, and then after awhile you may find that they may be gently teaching you some tricks of efficiency.