How to Write Instructions for your Home Health Aide

Home Health Aide Daily Care Plan & Instructions

When we first had a home health aide for my daughter the job seemed obvious to me. Not so to the various care workers who were assigned to her. Truthfully a home health care aide or companion typically has very little to do. A live-in aide can retire to his/her room and read or watch TV until you need their help. A part-time aide is in an awkward position because there isn't much to fill the time. I don't mind if the aides read, text or use their laptops - provided they meet my daughter's basic needs in a timely manner.

Do your homework when you hire an aide. It turns out that most people will only do exactly what is asked of them - no more, no less. For instance, with an elderly parent if you ask the caregiver to make a pot of coffee it is very possible that they will only make coffee on the day that you make that request. If your parent wants a pot of coffee made every morning with breakfast that needs to be specified. You need to prepare your home when you have someone working in it so they can find the things they need.

Review the instructions on equipment and procedures. Make sure that the aide has the written instructions available for any unique equipment like a lift. WATCH them perform complex tasks at least once to make sure that they are being thorough and safe. Don't trust that "showering" means the same thing to everyone. Some people may spray your family member down quickly, others may sit them in the shower and walk away for 10 minutes. Be specific about your expectations.

Review and provide instructions for all medications that the patient requires. Don't forget non-routine medications. For instance, if the person has an Epi Pen make sure the aide knows where it is and how to use it.

If you expect the person to prepare meals or snacks, make sure that they know where the ingredients are as well as what food preferences or allergies the person may have. When in doubt, provide a printed recipe including the location of all ingredients. Decide if the person will be eating with your family member and provide adequate quantities of food (obviously live-ins expect meals).

While it seemed ridiculous at first, I learned to provide a detailed list of each task that I wanted done every day.  Each task is described including the timing (after school, at dinner),  tools to be used (special cup, broom, etc.)  and the frequency (daily, weekly, etc.). I also include check boxes so the person can keep track of what has been completed each day.

The last section of my daily list includes safety instructions. Make sure that you have your address written down in the event of an emergency. You'd be amazed at how many people simply follow their GPS and have no idea where they are. If you are not going to be there at all times include your contact information on this page as well.

Here is an example of a daily care plan for a 4-hour after school shift for our daughter. Your plan may be more detailed depending on medical needs and the extent of home care tasks you expect.


Daily Home Care Plan for __________________      Date:  _____________

Tasks include, but are not limited to:

Personal Care

         Meet & get her off school bus using wheelchair

         Change clothing if wet or dirty immediately after school

         Toilet or/change Depends every 2 hours   

o   Completed  at     time _____________       time _____________   

o    Check  Depends immediately after school. Change after shower & before bed

o   Thrown wet/dirty Depend in kitchen trash can

         Provide afternoon snack (prepared in frig) Complete at time _____________   

         Assist with ambulation around house (maintain contact guard at all times)

         Assist with TV remote, computer, etc.

         Shower daily    Completed at time _____________   

         Brush hair daily after shower

         Wash hair on Wednesdays   Completed date _____________   

         Assist with feeding during meals & snacks

o   Cut food into bite sized pieces for finger feeding

o   Assist with use of spoon or fork (may need to feed her)

o   Place dirty dishes, cups and utensils in the sink

         Provide companionship & supervision at all times

     Maintain safe environment while parents are away or otherwise occupied.

Home Care

         Make bed daily    Completed at time _____________   

         Fold & put away laundry as needed (2-3 times a week)

         Dust & vacuum bedroom on Mondays (weekly)  Date _____________   

o   Use Swiffer dusters and Shark carpet sweeper

         Clean bathroom on Fridays (weekly)    Date _____________   

o   Use disinfecting wipes to wipe down toilet & bathtub

o   Lift no slip mat and place on shower chair to air dry

Safety    I can be reached at 555-555-1234

Never allow her to walk around the house alone – be with her at all times.

Watch for choking while eating and drinking.

In the event of a clonic/tonic seizure (grand mal):

1.    Ensure her safety - roll her to her side, if possible

2.    Call 911 The address here is 123 Main Street Anywhere,ST

3.    Administer medication per instructions on label (outer pocket of blue backpack)

For insights on the aide's perspective please go to http://newoldage.blogs.nytimes.com/2009/01/21/advice-from-a-home-health-aide/

Questions to Consider Asking a Home Health Care Agency

Questions to Ask a Home Health Care Agency

DISCLAIMER: I am NOT a lawyer or insurance professional. Please check the local laws and regulations in your state.

We've had a home health care aide for my child with special needs for roughly 10 months. We located an agency through a list of state -approved providers. However, some of the caregivers they sent were completely unsatisfactory. For instance, one casually mentioned during a family dinner that her own family had called child protective services on her several times.

Another time an frail woman who appeared to be about 70 showed up. I was afraid she'd fall and break a hip! I ended up making her tea and letting her watch TV until the end of her shift. In my opinion, she couldn't handle the physical challenge of working with a 125 pound, autistic and mobility impaired person.

I finally discovered that the agency (which was approved by my state Medicaid) hired through Craigslist. Applicants were required to pay for their own background checks, but were allowed to start assignments before providing the agency with the results.

The agency was hiring them as independent contractors. These individuals had no worker's compensation insurance. Several told me that they had no personal health insurance. What would have happened if they were hurt on the job in my house? Most likely we would have been sued.

When I contacted the home health care agency I asked about these issues (none of which they refuted.) I also asked if they had any general liability insurance in case my child was injured by one of the people they sent to our home. The answer was that the business was insured, but the coverage only extended to their physical place of business (the office.) If my child was hurt or abused by someone they sent over I would be free to sue the individual involved!

These practices put both my family and the caregiver at risk. I had to ask the state to help me locate a more suitable agency. Rest assured that I asked A LOT of questions before I agreed to a new agency!

So, as a precaution to others I've compiled the following list of questions.

If you have a home health care or home care worker in your home, consider asking the agency* the following questions:

Are the workers you send to my home employees or independent contractors? This is important because the agency isn’t paying payroll taxes on independent contractors – including worker’s compensation insurance.

If an independent contractor is hurt on the job in your home or driving on your business you can be sued for medical costs and lost wages. Do not rely on Homeowners Insurance coverage to protect you, unless the insurance carrier has confirmed coverage for this risk. Many insurance companies have specific riders that can be added – at a cost- to cover in-home caregivers

Does the agency have general liability insurance?
In the event that your child or family member is injured while being cared for by an employee of the agency does the agency have coverage to pay for related medical expenses? Ask to see the documentation.

Does the agency have theft insurance?
Have employees been bonded? In the unfortunate case of theft by a caregiver is there insurance coverage to help you recover financially?  Ask to see the documentation.

Has the applicant had a criminal background check, drug screen and employment (not personal) references contacted?
Just because caregiver is provided by an agency or registry doesn’t mean that adequate screening has occurred. A number of smaller agencies recruit though Craigslist. Applicants may or not have been interviewed in person. 

Is the worker First Aid/CPR certified?
Tell the agency what your specific needs are. Don't assume that the worker will know how to operate your equipment, assist with transfers, etc.

Ask things such as: Has the caregiver had any specialized training (familiarity with equipment/supplies, received training in a specific illness, etc.)?  Are they capable of meeting any lifting requirements?

Does the caregiver have adequate auto insurance coverage?
If not, and the caregiver gets in a car accident in the course of running errands on your behalf, then you may be held liable for the damages caused by the caregiver.

 *If you hire an in-home caregiver yourself ensure that you have similar coverage!

If you hire a home care worker privately, you are not required to provide workers compensation (unless they are being paid through a funded program such as CCSP/PSS in Georgia.)

Like any employer, you must abide by the applicable disclosure and authorization provisions if you elect to perform a background check. You should only have a background check conducted by a professional third party. Do not attempt to do it yourself. If you elect to have a background check done be sure to adhere to all legal requirements regarding privacy and disclosure.

If you are hiring the worker privately be sure to have clear job guidelines including specific lifting requirements and safety precautions.

If the worker is injured lifting your family member, slips in a wet bathroom, etc. are you prepared for the financial costs of covering their lost wages and medical costs? What if they sue you – do you have an umbrella policy on your homeowners insurance that will protect you?

What if you are robbed by them? Will your insurance cover the damages?

If they injure your family member are you equipped to handle the related medical costs?

Be sure the worker knows what is expected of them while on the job in your home and that you have made your home safe for both the caregiver and your family member.

DISCLAIMER: I am NOT a lawyer or insurance professional. Please check the local laws and regulations in your state.

Minor Miracles

Minor Miracles - Adaptive Softball League

This article first appeared on the Exceptional Parent website in April, 2008. We owe special thanks to so many of Amanda's teachers and paraprofessionals who volunteer their time to Miracle League!

We are very fortunate to have an adaptive softball league near our home. The North Metro Miracle League (NMML) provides inclusive adapted sports for children and adults of all abilities. As their website states, “Each of the NMML players has an on field Buddy to assist with the things the player’s disability makes difficult or impossible. The resulting interaction between buddy and player is an essential part of our mission. We want to remove the barriers to inclusion, accommodation and friendship that often arise just because a person has a disability.”

Amanda has been playing softball with NMML for six seasons now. The environment at the games is relaxed and supportive. During the first season she spent most of the game crying and trying to escape the field. Amanda rarely expresses emotion. It is as unusual for her to cry as it is for her to laugh or smile. My husband and I had to reassure ourselves on every drive home that we were doing a good thing.

During Amanda’s second season, another dad called out, “Way not to cry, Amanda!” There couldn’t be a nicer group of people involved in children’s sports. Everyone cheers as each player walks, rolls or is carried into home plate. There is no score. Still, we felt awful taking her.

We told each other that Miracle League was a good form of exercise for a child who has difficulty walking. We discussed the value of fresh air and socialization with her peers. We’d quote Tom Hanks from the movie A League of Their Own, and remind Amanda, “There’s no crying in baseball.” But mainly, we felt terrible that every Saturday morning we forced our little girl to do something that made her cry in the name of “fun”.

Of course, Saturday morning softball wasn’t the only time that we’ve had to force Amanda to do things she doesn’t want to do. We made her go to therapy several times a week for years. We’ve taken her to have multiple surgeries. In a way, going to baseball toughened us up for all of the other things we had to do for Amanda's benefit.

The most surprising outcome of our participation in North Metro Miracle League has been Amanda’s friendship with Erin. A typical teenager, Erin is Amanda’s first and best friend. For the past three years, Erin has been spending her Saturday mornings acting as Amanda’s Miracle League buddy.

With Erin’s gentle guidance, Amanda stopped crying during games. She even began to cooperate. Now she looks forward to going every Saturday morning. At the beginning of this fall season Erin called to let Amanda know that she was going to be her buddy again. Amanda was so happy that she made a card for Erin. Amanda never draws or colors voluntarily. That in itself was a minor miracle.

Erin’s friendship has expanded beyond the baseball field. She has helped us out at home - she even came to Amanda’s birthday party! Due to her disabilities, Amanda finds social interactions difficult. However, Erin never makes Amanda feel different. They enjoy each other’s company and smile when they are together. Just as the website promised, playing softball really did remove a barrier to friendship for Amanda. As far as we’re concerned, more than exercise or fresh air that has been the biggest miracle to come out of the North Metro Miracle League.

The Stuff Kids Lose

I love this time of year. The winter is coming to an end, the flowers are starting to bloom and there is so much to look forward to!

First we get to pick summer camps and plan vacations. Danielle is already signed up for a day camp at Out of The Box Art Studio. She'll need to bring a painting shirt or smock and her lunch box every day.

I'm not sure whether Amanda will be going to summer school or camp this year, but either way she is likely to be spending time with people who don't know her well. I'm not going to risk a repeat of last year when she was sent to the wrong school and no one knew who she was.With a nonverbal, autistic child labelling every item is a necessity. I even have one on Amanda's IPad. 

In addition to camps, next year Danielle will be attending a school that requires she wear a uniform. I'm thrilled because it means no more early morning battles or weird outfits (today she wore a striped dress with striped tights!) It also means that a lost coat is probably really lost. You can't exactly call the school and say, "Ours is the navy fleece jacket with the monogram" when that's what everyone has to wear.

So - naturally that means we need labels. I never have to think twice about where to buy my girls' labels. I'm a Mabel's Labels BuzzMama because they are really the best labels I've ever tried. They stick to anything and everything. With summer fast approaching  its time to order more.  They have a camp combo that comes in great colors with cute camping icons like a campfire or a canoe.

I love the color choices and fun icons. My favorites are the dolphin and the flower. However, Danielle has already chosen her icon - a tiara! How typical of her- the more glamour, the better. I think I'll order Danielle a Basic Combo Kit that comes with metal bag tags as well as stickers for her shoes.  And for Amanda, a set of skinny minis with a heart since her name means "beloved".


Disclaimer: As a Mabel’s Labels Buzzmama I'm acting as a volunteer ambassador spreading the word about products and company. I may receive free products in exchange for my involvement in the program.