It sounds like you need CNAs for this position

I mean this with all kindness, but you are staving off the inevitable- that your father really needs to be in a skilled nursing facility. I think you would be better served to find a facility and then supplement their care with aides. That way your father has dedicated support from a 24/7 facility and a dedicated aide to provide individual care.

Here are our needs: He needs someone to manage his medications and feeding g-tube tube (aides will not want to do this).

He needs someone to adjust his bed, get his TV remote, clean up his diaper/urinal, help him sit up, help him try to walk if he wants (the rehab place claimed he was walking, I have yet to see it). I believe in reality he is likely to be largely or entirely bed bound. He will need help bathing/sponge baths. He will need help to ensure he does not get bed sores.

He is mentally competent and with it and is a generally pleasant person.

I would pay for 24/7 nursing care, if I could get an agency to arrange it. Maybe for now we could get away with not having anyone in the overnight and just having him have a call button to reach my mother for emergencies. But my preference would be to have care at night.

I appreciate any help/advice you can give. I recognize this is going to be a huge lift. I am lucky in that I have a reasonable amount of time off from my job, and $. I wish my parents had moved into assisted living long ago but they have always been adamant that they want to stay at home and this is what they did for their parents. I have no idea how they found caregivers, I think it was word of mouth.

Anonymous wrote:Thank you for this, that is what I think. Will a geriatric care manager take the job or running the nursing home? Like can you contract out to a geriatric care manager who will then be the point person for managing shifts, interfacing with the staffing company, etc?

If you can, I’ve never found it. I think this person would probably cost, idk, $75k a year? And why would someone good enough to do this want the job? It would have to be a unicorn person who was retired and wanted a smaller gig or idk what. It’s honestly a hard job, requiring a lot of skills. And they would still need your sign off for so much.

When you get a good person in any role, pay them more and give them time off and more responsibility. That’s the best option I think. But the reality imo is that no aging person gets to choose this for themselves. Someone competent has to choose to work to make it work.

Maybe there are billionaires with longtime personal staff, and they can manage it for them. I would bet those are salaried employees and cost a lot. And I don’t think your average personal assistant/estate manager is up for it anyway.

Thank you for this, that is what I think. Will a geriatric care manager take the job or running the nursing home? Like can you contract out to a geriatric care manager who will then be the point person for managing shifts, interfacing with the staffing company, etc?

Aides handle ADLs. If you need more than that you need to look at nursing care. You would need to find something like care.com but for medical people. I don’t know if that exists.

If you dad were to go into a facility, what level of care would he need? That might help people brainstorm ideas for you for inhome care.

Anonymous wrote:It should be possible to hire a local consultant who deals with assessing and arranging care for seniors. That person would hire and coordinate care for your parents. Sounds like it would be worth it for you to go that route since your parents can afford it and your dad's case is complicated.

From this post you can be assured this person has never tried to find this.

Anonymous wrote:Agency. You need shifts. A live in aide is not a 24-7 on call person and will also be sick/absent sometimes. An agency is the most reliable option. Imo there’s not really any point to a live in aide unless you’re hoping to exploit them somehow.

When the agency sends some one good, who you really like, you can try to poach them to hire them directly. You need to take care because this may/will blow up your relationship with the agency.

For 24/7 care we’ve averaged around 6-8 people including a few really anchor people who work a ton of hours. This is mostly nursing aides but also someone who can drive/shop/cook. It costs north of $300k/year.

I also want to say that even when you get periods of stability, this is a not insignificant admin lift. Someone is always sick/quitting/on vacation. Even with payroll services, the payroll stuff still takes time/attention. To say nothing of insurance paperwork, etc.

Even just making sure all the disposable supplies are stocked is time and effort.

The reality of doing this is that you’re turning your home into a nursing home with one resident. It’s like having a restaurant with one guest. It’s easier than a full restaurant, but it still needs all the things a restaurant has. Can you manage this from out of state? It’s going to be really hard. That’s the reality.

You say, "for the right price, you can get almost anything," but I guess what I am saying is, my experience so far is that this is not the case. I have called multiple staffing companies expressing my earnest desire to throw money at this problem, and they are not finding people leaping to take the job.

Do people go private, in terms of hiring private LPNs? How does one advertise--care.com seems to focus more on aides and we need more than that.

Agency. You need shifts. A live in aide is not a 24-7 on call person and will also be sick/absent sometimes. An agency is the most reliable option. Imo there’s not really any point to a live in aide unless you’re hoping to exploit them somehow.

When the agency sends some one good, who you really like, you can try to poach them to hire them directly. You need to take care because this may/will blow up your relationship with the agency.

For 24/7 care we’ve averaged around 6-8 people including a few really anchor people who work a ton of hours. This is mostly nursing aides but also someone who can drive/shop/cook. It costs north of $300k/year.

It should be possible to hire a local consultant who deals with assessing and arranging care for seniors. That person would hire and coordinate care for your parents. Sounds like it would be worth it for you to go that route since your parents can afford it and your dad's case is complicated.

Anonymous wrote:The aides? He has a feeding tube.

I see. I think your best bet is to connect with people in the medical field, share the situation, and be clear you’ll pay well, whatever it takes. Years ago, I knew a family with a live-in LPN M-F, and another weekend LPN. So if the average pay is 30-35/hr., you need to be clear upfront you’ll pay 40/hr. For the right price, you can get almost anything. You want top-notch continuity of care.

The aides? He has a feeding tube.

What’s the scope of care your dad needs that they don’t want to deal with?

I’m in the “crisis” phase of arranging in home care for parents who have lived in denial for years. Dad is now severely debilitated; mom more capable but *cannot* care for him at the level he needs. They are significantly lucky in that they/we have assets/money.

I live far away and my main goal is to get something stable in place. What is the most reliable way to get consistent care in the home?

There are agencies, but one aide company has so far failed to find us a live-in aide, I think because my dad needs more care than they really want to deal with. I called a private nursing place, but they are cobbling together shifts of various people and it seems like, for the long term, this may not be the best, plus what if the nurse fails to show?

Are there live-in LP nurses? Or any home services that, if someone can’t come, they send a replacement? I know we are lucky to have money to have this be an option, but so far care at home seems very difficult to arrange even if they money is there. I want to respect my parents’ desire for at home care but is this even feasible? How do people arrange it?