Long-Term Care: Home Care Aides
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Compared to nurses or physical therapists, home care aides typically will spend more time with you or your parent or other relative. To help make the arrangement more comfortable, plan to spend some time on the aide's first visit just getting to know each other and the physical space in which she (and it's almost always a woman) will be working.
When you go to a doctor's office, outpatient clinic, or hospital, you enter someone else's space and give up some control. Your home, however, is your private space, and the strangers who come in and out to help are essentially your guests.
Still, it's a different kind of relationship because the person comes to provide a service, not to chat. Bringing someone into your home or your relative's home can ease your responsibilities, but it should not add stress to your life.
The United Hospital Fund's guide, Working with Home Health Aides, offers some suggestions on establishing a good working relationship that can make your situation more comfortable. Here are some key points (and you can find the full guide at www.nextstepincare.org/Caregiver_Home/Home_Health_Aides:
Be clear about what services you expect. Write these things down in a simple agreement. Clarify what the aide cannot do, whether because of regulations, competence, or willingness.
Also include in writing the terms of employment: the hours and pay you have agreed on, whether or not meals and travel costs are included, and how much vacation time you offer.
Have a backup plan in case the aide cannot arrive in time or has to cancel.
Discuss how to handle emergencies. Leave a list of emergency phone numbers, including the doctor's office. Develop an emergency plan, and make sure the aide knows what it is.
Talk about whether and when to call 911. If you or your parent has an in-home DNR (do not resuscitate), signed by a doctor, then the aide should not call 911 in an emergency. You should discuss with the aide what you mean by emergency and whom to call if it is not 911.
Be clear that aides are not allowed to have visitors. You should also set limits on texting, phone calls, and other potential distractions from the job.
Respect and tolerance for individual and cultural differences is essential for both you and the aide. Ask the aide whether she prefers to be called by her first name or full name. And make sure she knows how you and your parent prefers to be addressed. Some older adults don't like to be called by their first name or Sweetie or other nicknames that are not meant to be offensive but may seem so.
Food and religious differences are areas in which conflict can arise. If you or your parent follows certain religious practices that are new to the aide, explain what they are and why they are important. Just as important are the aide's food preferences and religious practices. Aides should feel that they can observe their personal choices but they should not impose them on others.