What do you wish you had known when hiring home health aides for elderly relative?

[Anonymous]

We are in the process of hiring a home health aide for an elderly parent who is giving up driving. What tips or advice do people who have been through the process have? What do you wish you had known?

She is getting out of a rehab stay so initial plan is 6 hours a day, 6 days a week. She also has meal delivery (new) and a twice a month cleaner (longstanding). No cognitive issues yet but frail. Hoping the HHA can encourage eating regularly and daily walks.

When in rehab she did not seem to want to socialize with other patients/residents. She used to be social in her 55+ and still is friendly with close neighbors. It almost seem with energy level she has skipped over assisted living. She likes to socialize in her home one on one. Hoping the HHA adds a bit more safety, convenience re: driving in addition to car services, and companionship + help with daily tasks, esp now when still recovering.

What is realistic to expect? What are the downsides?

[Anonymous]

Have a plan in mind for when your aide is sick or has a conflict. If you're hiring directly rather than an agency, what's your backup plan?

[Anonymous]

Make sure the person is bonded and insured.

Honestly I would start looking into residential, ideally CCRC (continued care from independent living through nursing). The social part is key and peers help you exercise your brain because they aren't paid to kiss up to you. You are guaranteed meals and while many are understaffed at least there is someone there. No shows at home are a nightmare and even with adaptations a home can turn into a house of horrors.

The sooner you rip the bandaid off and have her adapt to a CCRC the better. Much easier to adapt when still quite capable and when social skills are somewhat in tact. Once they adapt my experience has been they do perk up A LOT! The activities make a difference and having some friends to eat lunch with makes all the difference.

[Anonymous]

Anonymous wrote:Have a plan in mind for when your aide is sick or has a conflict. If you're hiring directly rather than an agency, what's your backup plan?

We had a direct hire person in mind but are leaning toward an agency for that reason. They said they would try a few folks so if the primary person is unavailable the person coming would be a bit familiar. We have some family about 30 min away who can help in a pinch but wanted to have something reliable for day to day. It may be that as she gets back to baseline it will go to 4 hours 6 days a week, but rides to the doctor, etc will be very useful.

[Anonymous]

Anonymous wrote:Make sure the person is bonded and insured.

Honestly I would start looking into residential, ideally CCRC (continued care from independent living through nursing). The social part is key and peers help you exercise your brain because they aren't paid to kiss up to you. You are guaranteed meals and while many are understaffed at least there is someone there. No shows at home are a nightmare and even with adaptations a home can turn into a house of horrors.

The sooner you rip the bandaid off and have her adapt to a CCRC the better. Much easier to adapt when still quite capable and when social skills are somewhat in tact. Once they adapt my experience has been they do perk up A LOT! The activities make a difference and having some friends to eat lunch with makes all the difference.

The agency does have bonded employees.

She really did not socialize at all with other patients in the rehab, just some with staff and with visitors. She says she does not "identify" as an old person. She is a bit narcissistic and superior. I think in AL she would stay in her room(s). She occasionally does a book club or takes yoga or a class at the senior center and I will keep encouraging that. She really does seem happiest socializing one on one in her home.

[Anonymous]

She plays cards with people on her street, goes to church with a neighbor, goes to the hairdresser with a different neighbor, etc. In the rehab I encouraged socializing as did the activities director, but no luck. She did not even hang out around the nurse station as many patients did. 20 years ago she was social in her 55+, now she just does not seem interested in large group socializing, seems to find it draining. She spent a lot of time on the phone at the rehab. So, for now, going with staying in her house but with more help and support. If the caregiver is not available, the agency provides a different one. They will also drive her to appointments, the store, activities, etc.

[Anonymous]

A lot of LTC policies only cover people hired through an agency, not independent people you find on your own.

[Anonymous]

I agree with the pp to at least think about unassisted living, while she still can. I’m living the nightmare of a parent who didn’t feel old, is narcissistic and wanted to stay in her home. We would tour facilities as entertainment for her. But then she went from not driving to feeble and alone very fast. For someone that is extremely vain, there is no way she would ever be accepted now into unassisted, but more likely a nursing home. My advice is to just see the different places in your area,let her see the people, taste the food, see the amenities. She will fit in more now while she can be active, than to be miserable on the other side, there is quite a difference.

[Anonymous]

My sense if that if dementia care became needed that would be a move to a memory care facility? Otherwise, how has it worked to age in the home for those who went that route?

She has some significant back issues. If they become worse she would likely be more a skilled nursing candidate than AL. A HHA may buy some time or may last a long while depending.

The marketing all sounds great, just trying to get a sense of the pitfalls to anticipate.

[Anonymous]

Anonymous wrote:I agree with the pp to at least think about unassisted living, while she still can. I’m living the nightmare of a parent who didn’t feel old, is narcissistic and wanted to stay in her home. We would tour facilities as entertainment for her. But then she went from not driving to feeble and alone very fast. For someone that is extremely vain, there is no way she would ever be accepted now into unassisted, but more likely a nursing home. My advice is to just see the different places in your area,let her see the people, taste the food, see the amenities. She will fit in more now while she can be active, than to be miserable on the other side, there is quite a difference.

This. Plenty of other snobs there who don't identify as old. They just distance themselves from those with more issues.

If she chooses to age in place, be prepared for something to set off a rapid decline-like breaking her hip and then she will become enormously lonely and hostile fast. As soon as her friends sense she is needy or she starts making demands on them, they will stop coming around and she will be truly isolated. Make the move now.

[Anonymous]

We hired one for our 90 yr old mother, she came from 8-4 five days a week and she was wonderful. We got her through an agency after interviewing four or five people. After a few weeks she revealed that she had not gotten paid by the agency at all for our job and this was sometimes an issue. We offered her the job direct pay to her and she accepted. We were worried that she would lose her association with the agency and our situation was temporary since our mother was already on hospice. She said that was no problem, she had never had a problem getting jobs.

[Anonymous]

Anonymous wrote:A lot of LTC policies only cover people hired through an agency, not independent people you find on your own.

This was not true for us as long as the person was paid on the books. We used same payroll service I had used for my nanny. ah the circle of life!

[Anonymous]

Anonymous wrote:We hired one for our 90 yr old mother, she came from 8-4 five days a week and she was wonderful. We got her through an agency after interviewing four or five people. After a few weeks she revealed that she had not gotten paid by the agency at all for our job and this was sometimes an issue. We offered her the job direct pay to her and she accepted. We were worried that she would lose her association with the agency and our situation was temporary since our mother was already on hospice. She said that was no problem, she had never had a problem getting jobs.

Thanks, glad it worked well for you. Hoping for the same good fit. So far, so good.

[Anonymous]

We had my father in law with us at home with a home aide for about 2.5 years. Then there were too many no-shows even with the home aide via an agency. We eventually transferred to a nursing home. He wasn't happy but after a few months he actually ended up preferring it. The predictability of meals and certain activities helped him.

[Anonymous]

In the same boat. Working with an agency to find someone who is a good match. It’s not easy and MIL is resentful of us setting this up for her but she requires it.