Home health agency contracted to provide in home care for disabled, elderly parent. Between August 20th, 2011 and September 15, 2011, this agency failed to provide caretakers for at least 6 shifts without notice or did not send caretakers in a timely fashion, meaning that there were gaps with no caretaker present. The family specified that no caretaker should leave the home unless the next had arrived. When management was contacted by family members, their expectation was for the family to provide fill-in care, at times requiring an immediate response, ie: called at 8:00am saying 8:00am nurse's aide would not be coming. Reasons given for caretakers absences were school registration for child, providing transportation to husband for work, children getting to school. On more than one occasion, the caretaker sent to the home did not have the knowledge, skills, training, or ability to properly care for the patient (unable to transfer the patient from bed to commode to wheelchair). On more than one occasion, the caretaker assigned to the evening shift contacted the agency supervisor with complaints about poor care given during the previous shift. On more than one occasion, medications sorted by family for administration by paid caretakers were found in the medication box the following day, not administered. Poor management and lack of accountability by agency's administration, and their failure to provide staff that arrives as scheduled and is able to perform the necessary care as discussed and agreed upon by the agency's RN evaluation and written care plan required the family to provide, manage, and micromanage the care of the patient, both from an organizational and a physical stand point. The family was for all intents and purposes, "on call" 24 hours a day, 7 days a week due to the unreliability of service and lack of skill.