Can we contract Mom's caregiver to be Dad's, too?

Ozzie asked...

My mother is currently under 24hr care with an agency. My father, who has a leukemia type disease, has recently deteriorated and also needs care. My mother's primary care giver has been a HUGE help and has helped my father with IADLs and more recently with some ADLs (without additional compensation.)

We would like to reimburse or hire her directly for his care while keeping her on contract with the agency, per the original agreement, with my mother.

Can anybody tell me if this will be a problem with the agency and if we are going to be obliged to pay the agency for her services?

PS I am not sure what to do about the days when she needs time off and both my parents require care?

PSS Are there any contracts on line for independent care givers?

Expert Answer

Kay Paggi, GCM, LPC, CGC, MA, is in private practice as a geriatric care manager and is on the advisory board for the Emeritus Program at Richland College. She has worked with seniors for nearly 20 years as a licensed professional counselor, certified gerontological counselor, and certified geriatric care manager.

Hiring a caregiver is a complex issue, particularly so if you want to hire one caregiver for two parents. I am not clear about your question; I think you are asking if you will have to pay the agency for your father's care if it is given by the same caregiver who is assisting your mother. You state that your mother is receiving 24 hour care and imply that her care is coming from one person only. Let me give some general guidelines.

If a single caregiver is expected to stay in the home for 24 hours for several days at a time, you cannot expect the best care after the first day or two. This is especially true when there is more than one person who requires care. This is because 24 hour care is intended to assist the care receiver throughout the night as well as during the day. If the care receiver did not need nighttime care, the agency would have contracted for 18 hour shifts. After the caregiver has been awaken at night for more than a few nights in a row, he/she cannot be as alert and responsive as she was on the first day. The care receiver may be able to nap during the day but this is not usually the case for the caregiver.

One solution is to have 2 caregivers, one for your mother and one for your father. Another suggestion is to have 2 caregivers who alternate, so there is always one there and one resting off duty.

I believe most agencies would require additional payment if the caregiver is expected to provide assistance for more than one care receiver.

The next part of your question has to do with days off. Again, I recommend more than one caregiver alternating days or several-day shifts. Four days on and four days off works well in many situations. This eliminates the need for off days becasue they are built into the arrangement.

You asked about independent caregivers, those who do not work for an agency. I discourage you from hiring independents on a long term basis. Agencies do thorough background checks, and assign caregivers who have training and/or experience to give the type of assistance needed for the particular client. Most private individuals (or families) such as yourself do not have expertise to check the background and references of a stranger applying for the position. This is an area where documented abuses are abundant. Even honest, well-meaning caregivers may not realize that they do no have the skills to provide necessary assistance until it is too late.

Independent caregivers are good for running errands, making social visits, helping the care receiver choose what to wear, and perhaps taking them on outings. These types of activities are very different from helping a care receiver with impaired balance take a bath or get to the toilet.

Another item about hiring a caregiver who has been assigned by an agency is that there is probably a contract with the agency not to accept a job as a private pay caregiver in the same home where the agency placed them. When the agency has gone to the expense of checking the background and references and training the caregiver, it is a violation of the contract between the agency and the caregiver for the caregiver to accept the position and be privately paid. The caregiver would never be employable by an agency again.