The Limits of Empathy – NYTimes.com. “Other scholars have called empathy a “fragile flower,” easily crushed by self-concern.” I have many times considered the role of empathy since I’ve been working with seniors. Some people (and senior services organizations) seem to have lots of empathy and some have very little (that “crushed by self-concern” thing) IMHO. It is challenging to set boundaries balancing empathy and concern for the often unmet needs of the care recipient (patient, client or resident), while maintaining a professional and mentally healthy distance. Lay persons have little training in “dissociation” which healthcare and social services professionals seem to have in varying degrees. Learning how to care the right amount - without caring too much or too little – is a work in process in my personal experience with seniors.
Monthly Archives: September 2011
How to Put More Jobs in the American Jobs Act « News and Opinions « Direct Care Alliance. “If we invest in putting people to work delivering social care services—shoring up our crumbling social infrastructure by adding jobs in professions like direct care—we can begin to crawl our way back to full employment, while providing vitally needed services and doing more to help those who are least able to weather the current non-recovery recovery.”
FCA: Hiring In-Home Help. A fair-minded article covering options which seem “fact checked”. My Google search of ‘how to hire a caregiver” resulted in a number of hits on some caregiving sites with home care agency banner ads. So naturally, the articles on those sites favor using agencies. And/or some articles had distortions, such as stating there is an option to hire a caregiver as an independent contractor (legally, this is not correct). There are plusses and minuses using agencies and also with private hires.
A case I’m working on now has reminded me that unless the senior has an advocate such as a family member or a care/case manager, it is very hard for them to evaluate and comprehend all these choices. Their abilities are declining, and they don’t have Internet access or realize what is “out there”. Seniors by themselves are very vulnerable in the process of deciding whom to hire for home care. Sadly, because of the complex “supply chain” and distribution network in the home care field, many seniors don’t get the help they need until they face a crisis, or they are in terrible shape.
Family or patient advocates, these home care hiring choices are for your consideration – please become informed and let the buyer beware on all options!
Build an Old Girls Network. I have been thinking that there are so many semi-retired women in their 60′s out there who could be such wonderful caregivers. With the job market such as it is in this recession, jobs could be created for these women and worlds could be changed. Many “old girls” have family caregiving experience, and have had careers in other fields over the years. Older women are typically more stable and drama free. And being closer in age to the senior clients being served would be a plus on both sides of the equation.
Several years ago, I contacted an out-of-state home care agency with a wonderful sounding name, Seniors Helping Seniors. They offer franchises for sale. I set up a phone conference with the franchise marketing representative, whom I believe is the daughter of the founder of the business. She e-mailed me three simplistic articles on demographics and potential of senior care franchises, and acted as if they were top-secret material. I personally had written more thought-provoking pieces, never mind what I have read in years of research and training. She spoke to me from a script, and acted as if I was going to be joining a cult. I was totally put off by her strange approach, but I do love the concept of seniors helping seniors.
I agree with the article in the link above, how can we women be better networkers? I try to do this in my own sphere of influence, I give and ask for referrals. Agree with the author of the post in the link, it is not in many women’s nature to mix business and friendship, but we can learn! Matching up semi-retired women as caregivers with senior clients sounds like a goal I can commit to!
SHOCKING that someone working 4 hours a day, split shift, at $9.50 per hour, doing this kind of work, would have PERSONAL ISSUES that would prevent them from coming to work! What nerve! I note the family member has an out of town area code. Shame on them for not showing up to help their disabled family member themselves, and secondly for having such a degrading attitude toward the caregivers they are recruiting. Also as a side note, this client is IHSS In Home Supportive Services, paid by the State. Not much good to say about any of this, with the possible exception of the performance bonus offering.
“Care Provider(s) needed for disabled woman. Shifts are 8-10am and 8-10pm Mon-Sunday. Care to be provided in apartment home in La Mesa. We are looking for 2 caregivers starting immediately. Ideally, one person would work M-F and one person would work weekends.
1. Must pass Department of Justice Criminal Background check.
2. Must be able to lift and transfer TALL, average build woman to and from her wheelchair to the toilet and bed. THIS MEANS YOU MUST HAVE REASONABLE STRENGTH AND NO HISTORY OF BACK INJURY.
3. Must be okay with providing personal care such as showering, hair brushing, cleaning, etc.
4. Must have reliable transportation.
5. Must have good attendance.
Hourly rate is $9.50 per hour and is paid by the State of California (IHSS). You can check this website for more information: http://www.sdihsspa.com/payroll.htm
Bonuses- Performance Bonuses are given after the first 30 days and then each 60 days thereafter depending on performance and attendance.
We have had problems finding reliable workers in San Diego and would really like to find someone who enjoys working with the disabled and who does not have a lot of personal issues that prevent them from coming to work.”
Nanny Tax Forms and Procedures: Are They Worth It? – at Care.com. Thanks to Bob King of Legally Nanny for posting this link. This information also applies to families who hire in home caregivers “under the table”.
Let’s Not Let Home Instead Shut Down a Path to Justice « News and Opinions « Direct Care Alliance. There are a number of opinions on this issue, some say home care will become (even more) unaffordable if in home companion workers are paid as most other U.S. workers are paid. But there is also the point of view of the worker to consider. Agencies pay very little, and charge the client exorbitant rates. As a former client and employee of home care agencies, I can attest to the fact the low pay to the workers and the high rates to the clients create a revolving door on both sides, with little longevity and satisfaction on either side.
This issue parallels some of the culture wars and income inequality issues which are so prevalent in today’s economy and political scene. As with many of the issues we are facing in this country, there are no easy answers and the solution may lie within a compromise if such a thing is possible in today’s world. This is a political issue that will not attract much attention outside of the home care industry. Considering home care is one of the few growth industries in this country today, we should stay on top of this.
Rosalyn Carter said it best: “There are only four kinds of people in the world – those who have been caregivers, those who are currently caregivers, those who will be caregivers and those who will need caregivers”.
I see many posts on Craigslist from families who want to hire a caregiver to “live in”. Usually these postings are by adult children, looking for care for an elderly parent. Often the compensation is offered as “room & board” plus a small amount of money. I have to resist the temptation to write them and try to educate them that this is not how it works. As in all things relating to family caregiving, there is a big learning curve in hiring paid caregivers that is just not common knowledge.
The term “live in” must have been developed by the home care agencies. Agencies provide caregivers who sleep at the client’s home, but who actually live elsewhere in homes of their own. Rates for “live in” agency caregivers are upwards of $250 per day. Agencies also have requirements about caregiver accommodations and the amount of uninterrupted sleep time that the employee must have during their shift.
It seems that seniors, in the effort to maintain their ”independence” for as long as possible, often refuse to get help until they are quite sick and need round the clock care. This is not only cost prohibitive through a home care agency, but it also tends to be difficult to staff from the agency perspective.
You have to ask yourself, “just who would do this kind of work?” Agency pay for live in caregiving ranges from $110 – $150 per shift, with the majority of agencies paying at the low-end. The worker gets maybe half of the bill rate to the client, the rest is overhead and profit to the agency. Typically, an agency would staff with two caregivers, one for three and one for four days. There are classified ads online and in every publication from agencies who are constantly recruiting “live in” caregivers. Not many people are willing or able to do this kind of work, especially for the relatively low pay. With some exceptions, the people who do this kind of work at this rate of pay would be those on the lowest rung of the employment ladder - those with few other job options. There are wonderful, dedicated and capable agency caregivers and they are in great demand. WIth agencies, the best workers go to the best cases. With some agencies, even some big well-known ones, the “mirror test” applies, if a worker will fog up a mirror they will be sent out on a case so the client can be billed and revenue generated for the company. Their contract probably states you may not get your choice of a caregiver, and I’ve even seen an agreement that said, you may not get a caregiver at all!
However, privately hiring a true “live in” caregiver is also a very risky proposition. Again, ask yourself, “who would do this?” You might find yourself with a person who has just arrived in a new city, and has no place to live. Or perhaps a victim of domestic violence, mental health challenges or homelessness.
When I was a family caregiver, I twice tried to hire a true “live in” caregiver. One time I hired a woman who was relocating back to San Diego who had advertised on Craigslist. She and I had similar backgrounds in the travel industry. I checked two references, one of whom was a former business associate of mine. She lasted about two weeks and left the key on the counter one day when my Dad and I were out. She e-mailed me later, out of the blue, and told me she attempted suicide after leaving our house, her life was spiraling out of control. She told me bits and pieces of her past, she seemed like a nice woman whose life had been wrapped up in bad choices and bad men.
Later, I used a San Diego non-profit which matches people looking for housing (see above for “who…?”) and seniors needing some help. I interviewed a number of applicants and I was just not interested. I did eventually hire a woman who made a decent first impression. She turned out to be emotionally unstable, and after some acting out on her part, I gave her the required 30-days notice to vacate under our agreement. She became angry and verbally abusive to me, and I had to get an attorney to evict her.
A person who lives in a home and provides services in exchange for rent is a tenant in the eyes of the law, and subject to the landlord tenant code, which strongly favors tenants. So I could not change the locks on our home, I had this unstable woman with no options who had burned all her bridges living in our guest room. The placement agency was little help, they referred me to the paperwork I had signed, cautioning me about the legalities of the situation. One of the social workers told me she should not have been placed with us, since it was too soon for her to have recovered from her own issues. I was fortunate that she finally did move out, without doing any damage or retaliation beyond upsetting me and my Dad for days, and costing me attorney fees and the lock change that I did anyway after she left.
There are no easy answers when a frail elder needs care and/or supervision around the clock. It is challenging to find someone qualified who can do this kind of work, even at a decent salary. A carefully screened legal private hire (a household employee) can be a way to circumvent some of the pitfalls of high cost/low quality agency “live in” caregivers who are in high demand and short supply. And caring for a frail elder is challenging enough without a family going through a nightmare of having a “desperado” inadvertently becoming a tenant in the home.