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.

Wallpapering War Stories

or as a friend subtitled it, "The Glue always wins."

When we were looking for a house I kept describing this as "the house with the palm tree wallpaper." The owners were from Savannah and apparently quite homesick. Maybe plastering the house with palm trees made them feel more at home. There were palm trees in the master bathroom, palm trees in the hall bathroom, lots and lots of palm trees in the dining room...

And there still are.

I am the least girly of girls. My mother reupholstered furniture and sewed new pillows for each season. The decorating (and the do-it-yourself) gene skipped a generation. I don't decorate rooms; I inhabit them. I am more interested in comfort than style.

However, I hate wallpaper in general and the red palm tree wallpaper in the hall bathroom in particular. I've heard so many horror stories about wallpaper over the years that here I am, seven years later, still living in a house with wallpaper in 3 bathrooms, 2 bedrooms and the dining room.

Amanda is about to turn 13. I've decided that it is unfair to keep a teenage girl (in a wheelchair) in a room where roller skates, baseballs and footballs circle the ceiling. So, the other day I grabbed a corner of the hideous border and pulled. Ooh! Success.  A long, ugly strip of wall paper curled away from the wall. I pulled again... an even longer strip ripped off this time. I was in paper stripping Heaven. I pulled and ripped for half an hour until all of the ugly stuff was down.

Well, almost all.

I was so proud that I dragged one of Danielle's friend's mothers into the room to show off my handiwork. I didn't realize that I had to get the white paper backing off as well until she calmly offered me her steamer to remove the rest. Oh crud.

I made a pilgrimage to local Lowe's where the clerk cheerfully informed me that I would need a scoring tool, Piranha wallpaper remover spray, a wallpaper shaver and a special sponge with a paste scrubber.  Total cost: approximately $25.00.  Okay, I had the tools. Time to go attack that ugly off-white paper.

It was fun. I made a few mistakes the first time (note to self: next time start in a corner that you can't see from the rest of the room.) Rolling the scoring tool around made a wonderful noise. I felt empowered as I watched it punch rows and swirls of tiny holes in that persistent paper backing. I sprayed the spray until the paper turned brown and the liquid ran down the walls. Then, my personal favorite, I shaved it off. It peeled off in pieces like wet felt. They fell to the floor in clumps at the base of my 6 foot ladder. I was back in Heaven.

Four hours and a few gouges later the silly white paper was lying in damp piles on the floor. Next horrifying revelation: the paint under the border doesn't  match the rest of the walls.

Crap. Now I'm going to have to paint.

I am NOT a Housewife



My Mom,
 quintessential 1950s

I'm not a housewife. I married a man, not a house. Good thing, too, since I've been through four houses but only one husband.

Last summer I took out one of my many mops to clean the tile floors in the basement. Danielle looked at it and asked, "What's that?"

 "A mop," I replied.

She thought for a moment then said,"Oh! like they have on TV."





I Hate to Iron

The First installment of My Saga of Domestic Ineptitude

Some of my friends grew up at the knees of domestic divas, the unsung Martha Stewarts of their generation. I did not. Other moms baked their own bread and sewed their own clothes before anyone realized that being a homemaker could be marketed.  My mother routinely burned food and passed it off as our “Minimum Daily Requirement of Charcoal”, just like we had a MDR for vitamins. My brother once wrote a school essay entitled, “Morning at My House.” Apparently it started with “I come downstairs and smell the burnt toast…”

Mom didn’t wash dirty dishes immediately; she hid them in the oven. Needless to say, she didn’t bake. She hated to vacuum. When we were in preschool she paid me or my brother 5 cents to vacuum the entire downstairs.  When I complained about the poor wages later in life she said “I got what I paid for.” I never saw her dust. I was 14 before I realized that other people dusted their homes.

My mother, however, DID do laundry. She was almost compulsive about it. When we were very young we had a washing machine but no dryer. I remember laundry hanging out on a square clothes line in the summer and from the rafters in the basement in the winter. And, she loved to iron. She ironed everything from our sheets to my father’s boxers.  She had a frosted glass spray bottled filled with scented water. She would spray the clothes and then roll them carefully. One by one she would unroll the damp item and iron it, then carefully fold or hang it with all of the buttons buttoned, the zippers zipped and the snaps snapped.

I toss clean laundry on the floor of the laundry room. Dirty laundry is typically on the bedroom floors, so we can tell it apart from the clean stuff.  One of the flaws with this “system” is that our clothes are always wrinkled. I once had a neighbor tell me that she’d rather send her kids to school without breakfast than wearing wrinkled clothes. I guess we all have different ideas of good parenting…

I own an iron and even an ironing board. I bought them for my mother when she came to visit.  Kevin gave up on the possibility of me actually ironing a long time ago and takes anything he wears to work to the drycleaners. As for me and the girls, well… I have a few tricks. Like my mother, I own a bottle of scented water. Unlike my mother I just spray the clothes and toss them a back into the dryer. If there isn’t time for that I spray them with Downy Wrinkle Releaser and hope. In really extreme situations I’ve been known to straighten hems using my flat iron. (Finally, a use for the beauty products I buy and never use!)

Sometimes I feel a tiny pang of guilt when I drop the girls off at school and see all of the other children neatly pressed.  And then I think smugly, “at least mine have had a good breakfast…”

DDIY ~ Don’t Do It Yourself

Hon,

You are a smart man.

You are a strong man.

You are a handsome man.

You aren’t a handyman.

Hire someone else to do this, please!

Kevin and I have a long history of semi-disastrous Do It Yourself projects.  I think it’s because we think we’re smart – or maybe we’re just cheap. Both of us, despite years of proof to the contrary, believe that we can do anything that we can read about.

Take this weekend, for instance. Our 23^rd anniversary started with an eerie smell emanating from the basement bathroom. Naturally, we both thought perhaps there was a clog in the toilet. Plunging resulted in sewage seeping up through the bathtub drain… eeeewww.

Our next logical thought was that the septic tank needed to be pumped. We’ve had a rainy spring and it’s been five years since we’d had it done. Mr. Router happily obliged us with a $400.00 house call. Goodbye, anniversary gifts, baby sitter & dinner at an upscale restaurant.

Then Mr. Router gave us the bad news. The septic tank wasn’t the problem – the ejector pump needed to be replaced. Estimate:  $1, 200.00 more… Goodbye, ever eating out again.

So, what do two smart people do in this situation? Look it up on the internet!  If someone can describe how to install a pump in four paragraphs how hard could it really be? All we needed was a wet/dry vacuum, tools and some time.

And rubber gloves… and old towels… and no sense of smell… Kevin gamely bought a shop vac and began to remove the foul smelling stuff from the mysterious hole in the basement floor.  Several hours later, with no end to the ooze in sight and no good way of handling the waste we came to the conclusion that $1,200.00 was a very fair price.

Some anniversaries are silver. Some are gold. This one was just plain sh*@.