Staffing in home even with $ to pay
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Anonymous
+1 I just went through this with my mom and decided a SNF was safer, due to staffing concerns. Unless money is no object and you can truly afford to operate and fully staff a 1-person nursing home, with a care manager, PT/OT, on-call doctor, and a team of nurses? Presumably housekeeping is already taken care of, and your mom can handle trips to the pharmacy, but at some point she might not be able to help and when it happens, it might be fast. Also, good SNFs are out there but they might not have a bed available right when you need it if he declines suddenly or further and your mom can't help him anymore. So that's a risk. |
Anonymous
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I'm not sure about the feeding tube care but I think a couple of my caregivers (CNA's) have done feeding tube care in the past with past clients.
We use CNA's. My Dad preferred not to have the CNA's. He liked the unskilled housekeeping aids but the CNA's are far superior on the job. I'm paying between $25 and $31 per hour. The two people at $31 have been with us 10 years. I'm starting at $25. This is the eastern shore of Maryland. We pay legal so workers get social security, workers comp etc. We give large Christmas bonuses. Our best have been direct hires and referrals. I have one person who has referred 4 others over the years. The direct hires (people we already knew around town and the referrals have been our best workers.) I found Care.com to be pretty useless. I never was able to get anyone to come out for an interview. I've also used Indeed. We got probably 300 resumes from Indeed. We talked to probably 25 from Indeed. We hired one from Indeed. The problem with the Indeed applicants is that most did not want to work over 18-20 hours and we needed folks who could pull 34-36 hours. The Indeed applicants also had a lot of restrictions, i.e. could only work this day etc. Be aware that Indeed is costly and makes it difficult to cancel the advertisement. I have accounts with 3 agencies and supplement with them during tougher times. I try not to use agencies. I've had too many times when they have called me day of and did not have any workers. I run 6-8 people to cover 24x7 hours/days of care a week. I found it is better to have more people working fewer hours. If you have too few people working say 44-50 hours per week no one will cover extra hours when someone is out. |
Anonymous
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8:20 here.
It may be better in the city but in rural Maryland I found it virtually impossible to pay private to get an RN or Doctor to the house. I really wanted a podiatrist for nail care but no one would come to the house. The excuse I was told was due to "insurance." |
Anonymous
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I’m really sorry, OP.
My dad had ALS and it was nigh impossible to find reliable caregiving. We would have paid anything but the issue then was the candidates on the higher end seemed like crooks. We wound up most helped by a decent older retired gentleman who would come by and bathe him, but he showed up any time during the day and took weeks off at a time. |
Anonymous
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Not sure if this is possible but could you arrange skilled nursing through Medicare and then unskilled for the rest of the care? I have a family member with a catheter and Medicare covers skilled nursing through an agency of my choice. Then cheaper unskilled can do the rest and you can find them on NextDoor.
The challenge is the feeding tube I assume needs to be administered at frequent intervals so not sure how that would work but you could call agencies and see what they say. |
Anonymous
| You definitely need CNAs. |
Anonymous
| I agree referrals and word of mouth are w best ways. The other methods are ok stepping stones. How we found our good caregivers was posting ads and then one thing led to another until we found what we were looking for. |
Anonymous
That’s $350k a year. |
Anonymous
OP, most of these are not difficult things to care for at all. Diaper/urinal changes are unpleasant but home health aides can handle that. It's just the feeding tube and medications that are causing the problem. If you mom can't help with those, then it's going to be hard. I would consider contacting an agency that specialized in ALS and MS and Parkinson's patients . people with really difficult care needs. https://www.bayada.com/homehealthcare/services/adult-and-private-duty-nursing.asp |
Anonymous
More from Bayada - I am familiar with them from the ALS association.
It's going to be expensive care, but it seems like they should be able to help you. |
Anonymous
Or if you find an older person who would rather not have to pay their separate mortgage/rent, you can negotiate. Anything is possible. |
Anonymous
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I don't think you need an RN 24-7 just to give your dad tube feedings, though.
You need an RN to supervise the feedings, train the home health aides, and be on call for any issues that crop up. A home health aide willing to do tube feedings might cost more than one who isn't willing though. The RN can do weekly medication set up. a home health aide cannot administer the medication, but could with medication tech certification if allowed in your state. If your mom could supervise the actual ingestion of the medication each day, that would be easiest. You don't need an RN to supervise tube feedings at night, so whoever lives in the home doesn't have to be an RN anyhow. |
Anonymous
| What state do you live in? |
Anonymous
Based on personal experience, that’s the ballpark. It could be considerably higher in the end. Overtime, scheduling problems, raises to retain good people, etc etc. |
Anonymous
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OP here, thank you all for your thoughts, advice.
I think we'd be fine with aides, it's really the feeding tube that complicates everything. Because of licensing, it seems like the aides won't do it, or won't participate enough to take responsibility for doing it. A private person we hired off the internet with no medical licensure, though, seems like they can do it. I can do it. My mom can do it. I'll look into that company for more complicated care at home situations, thank you. |