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Feels shady. My parents have live-in care. Both are in wheelchairs but can walk with walkers. Mom sleeps in a pull-up, Dad is catheterized. HHC agency is saying the aide is not getting enough sleep and is pushing for an additional aide at night. Our current aide is not complaining and I feel the agency is just trying to get more money out of us. My sister visits 1-2 hours daily (the aide takes that time to herself) and both parents say they rarely get up at night. They are also pleasant and grateful (our current aide says they are very nice people). Any advice on how to push back with the agency? We're NOT shelling out for a second aide.

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If you don't want to shell out for another aide I suggest you care for your parents over a weekend or more in order to assess the situation.
I think you'll find the suggestion of your HHC is not only realistic but in the best interest of your parents.A tired caregiver makes mistakes.
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Thank you for the reply. I will spend the next four days with them and their caretaker, so will better be able to assess the situation. My concern is that it is the agency, not the live-in aide (who has repeatedly told me and my sister how much she likes my parents) who is raising these concerns. When directly questioned, the aide says she's fine. This leads me to wonder whether the agency is just seeing my very involved/concerned, family--who are clearly capable of spending $100K per year--is preying on us. I feel this is a legitimate worry and would love feedback from others who have negotiated this really terrible balance of wanting the best for these loved ones and not wanting to be taken advantage of when we are in a vulnerable position. I've read--and first-hand experienced--how ALFs nickel and dime clients after charging them a fortune for basically a bed and some cheaply prepared meals. I want what is best for my parents, but for their sake and mine, I need to protect their assets.
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It will be good for you to see whether they do get up at night a lot, or whether they make noises that need to be investigated, etc.

As a 24/7 caregiver for my husband for 10 years, and a week-end caregiver for my mother, I can tell you that not getting enough sleep is unpleasant and dangerous. If your parents really do sleep through the night, then all may be well. But that would be kind of unusual in the world of people who need caregivers.

Needing breaks and needing sleep has nothing to do with how nice people are. I loved my husband (and mother) with all my heart. I was nice. He was nice. But I still needed uninterrupted sleep.

Certainly you have a duty to protect your parents' assets. I don't blame you for being cautious. See how you feel after 4 days on site. But if your parents need night care ... or when they do in the future ... it would be penny-wise and dollar-foolish not to provide them with that extra care, since they can clearly afford it.
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DCT, it is a great idea for you to spend the four days there. Also keep in mind that your parents behavior will be different with you there. Perhaps you should think about installing some sort of electronic device that will monitor and record what is actually occurring. Or maybe there is a way for you to hide so parents do not know you are there? You also might want to consider doing four days alone without assistance. In my area home care for two people is about $144,000.00 a year so $100,000.00 does not sound too out of line.
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My MIL is in an ALF. Her base rent is $2195 and includes meals, entertainment & transportation, laundry, exercise classes and day trips twice a week. $73.33 a day is a cheap and permanent vacation.
Level II care is $475/month. That works out to $15.83 a day. She has nurses 24/7 and aides to help get her up and put her to bed. No way I can do that cheaper for her at home. No nickel and dime adders either.
The only extra is her cut & color once a month for $50. It's all good.
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Checking further, I see that in 2010 the Federal government passed laws that require an 8 hour rest period each day. New York also requires one full day off per week. Check your state for new laws regarding live-ins, overtime payments and rest periods. Things are changing rapidly and violations are sanctioned.
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There are new laws at the federal level going into effect for 2015. Haven't seen them yet and have tried looking for them.
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I ran a Home Care agency for 7 years and would often hear concerns, feedback from the staff that they were reluctant to share with the family they were working with. Companies (i.e. the office team) more often than not are the "middle man" that keep the peace between the staff and client.

It was a great suggestion to work with your parents and staff during the time the agency feels there are issues so you can gain first hand knowledge. Remember, you're all working as a team to ensure your parents are well taken care of and remain as happy and healthy as possible.
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Home care agencies vary widely in both quality of care and communication with their client families. I had a very bad experience with the private-pay agency that looked after my husband for a bit over a year. We paid them faithfully and on time and then in October of last year, the day before the day-shift 12 hour caregiver was supposed to come in, I got a notice from the principal of the agency that they were dropping us immediately for reasons she did not specify. I had to miss a day of work because of this and my ability to earn a living depends on coverage. We had an outstanding bill for the final week, so I responded, both via email and certified mail, just tell me the reason for this and I'll pay the bill. No response, so they didn't get paid. Additionally, just before all that happened, the HC aide approached me about working privately for us and I was fairly sure that this aide had been poking around on my home desk and saw an invoice citing the agency's fee for the aide's services. Yes, I should have filed that invoice away... warning to all of you out there... and it was not long after that that the agency dropped us. We are fortunate now to have better coverage through a PACE program... please look it up -- hopefully you are in a state/region that has one of these.
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California has new laws on live-ins, too regarding, among other things, overtime, rest, breaks, etc.
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We're in Massachusetts. But California seems to be trying to set standards, which is all to the good. I just posted something on Facebook about a live-in kids' nanny in California who is causing her client family a world of grief. It's enough!
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The live-in nanny situation is scary. There need to be better rules going both ways (treatment of in-house care and protection of families who have live-in care).
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I am a nurse with a HHC agency and we have "resting shifts" and "non-resting" shifts. The fees for these are different.

A resting shift is where the caregiver gets at least 6 hours of uninterrupted sleep overnight.

A non-resting shift is an overnight shift where the caregiver doesn't sleep.

It's good that you'll be able to assess the situation first hand. If your parents are up and down during the night some changes might need to be made. If you're there for several nights in a row and your parents sleep through the night you'll have to have a talk with the agency. The agency isn't going to want to lose your business so I don't know why they'd be pushing this issue unless their caregiver--YOUR caregiver--has mentioned something to them. And when asked by you she may not have felt comfortable being forthcoming if there is a problem.

I see different patients all the time and the families always want to speak with me and I always compliment their loved one. Some patients may be old grouches in which case I tone down the compliment but even the grouches get a compliment. Your aide may be just being polite. If there's no problem with your parents overnight I can't understand why the agency would risk pushing you to spend more money thus risking you going somewhere else. It doesn't make sense. When we get an aide on a case and everyone gets along and the schedule works for everyone we move heaven and earth to keep that client happy.
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Following Jessie's lead, perhaps you could have a relaxing talk with your live-in caregivers, say you're assessing the situation for now and the future, and ask if they have any suggestions, and if they were in your situation, what changes would they make? If you use the word "changes", you open the door to a more open dialogue and may be able to find out whether they have made comments to their employer or whether the employer is just pushing without trying to reveal private communications.
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I would investigate the situation. However, I had 2 aides the last year my father lived. His live in aide slept while the day time aide was there. It wasn't a perfect arrangement but I also helped with the direct care when I was not at work. 2 parents is a lot to care for even if they can walk in walkers. Supervising them, giving them baths, dressing them, toileting them, doing lots of laundry, it probably is exhausting.

Good luck.
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Ok I hear you saying the aide is not complaining And that wonderful but the real question is asking the aide if she like to have a day off every now and then.? It good to have a break it can become a mental thing and not physical because you have to place yourself in the aide shoes would you want to work day in and day out without some kinda life outside care taking. sure you would. It not
healthly for people not to take a break a person could go crazy insane. So I would matter of fact insist on the aide having a day off. I don't think it so much about the money it mental abuse.
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Marketwatch has a blog that addresses elder care and caregiving that is worthwhile reading. Google:
"Elder-care aides stuck without wage hike"

a good place to start.
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We were also dropped from an agency without a reason and no notice. The caretaker didn't show up for work. I didn't call to find out why because we weren't satisfied with the company anyway. I did call to ask for the $400 deposit back. They said we dropped them without notice and refused to give the deposit back. We have been caring for my father-in-law 24/7 for many years now and believe me caretakers need a break even if they don't complain. My husband is an only child so we don't have any relatives to help. We hired another healthcare agency and then fired them because the caretaker was telling the agency lies about us. Like the agency that dropped us they didn't deliver the care that was promised. Agencies give a list of what they do. The list usually includes vacuuming and dusting the living room and one bedroom, cleaning the kitchen and bathroom, showering, dressing, preparing meals, changing the bed and doing the laundry. The caretaker only had to vacuum the bedroom with a sitting area, clean the bathroom, change the bed, shower and dress my mother-in-law and feed them lunch. My father-in-law said the caretaker would sit and talk on the phone and he would have to make lunch. He was 88 and his wife was 89 and both using walkers. The caretaker was not vacuuming but she said she was. If she was, why were me and my husband having to do it? I do not require things to be immaculate but I don't like seeing pieces of food and lint all over the floor.
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Good point the Nurse has if you being talking in front of the aide and talking about money she might now want to say anything cause she don't want to lose her job. so the agency is talking on her behalf. before they lose her and she has to find another job cause this one is killing her.
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I care for my mother who is fully ambulatory. She is a little off - senile and has visual artifacts due to macular degeneration partial blindness. She sometimes has night terrors and she wears a c-pap at night, refusing to use the potty chair beside the bed, it must be refitted each time she goes to the bathroom, usually a couple of times per night. I am sleep deprived! Your caregiver may be also.
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Very important topic, seems to me - I find it very distressing that agencies often want to be the spokesperson to the family, and do this without the direct care aide present for any meeting. When I hired helpers for my brother, I called while they were there and listened to them, so that when I later spoke with the agency, I gave them the dilemmas, and had solutions in mind. But that's because I did a lot of care for my brother myself, and knew his pace and needs. Yes, stay there yourself, or videotape - and ask the aide to document her shift - how often does the elder ask her to get up? Or ask the agency to ask her to document - or ask that she come to the next meeting. Don't be afraid to tell the agency that you feel OK with a different plan. Yes, sometimes aides are glad to have an agency speak for them, but often the agency has multiple goals - like scheduling others for instance, using this aide elsewhere, avoiding overtime pay hours. That is normal, so try to find out what are their concerns. Maybe temporarily, they need an extra aide? If so, get the current one on board, and make sure you stand up for her remaining there, when temporary is gone.
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Many health care agencies don't have enough staff to fill the need. It sounds like the aide is in the home 24/7--you didn't indicate. The aide sleeps at night and she is rarely called upon. If the aide isn't complaining and she receives adequate breaks/time for herself then I don't see a problem. It wouldn't hurt to introduce a second aide to offer some relief for your current caregiver, however I know it's sometimes difficult to find the 'right' person that is able to get along well with your parents and your family. I think it's good you will be spending some time there to access the caregiving duties and the possible 'burden' on your current caregiver.
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Its a great suggestion to spend time to make the determination yourself. My current situation with an HHA . I agree that it is often the management trying to get their billing up especially since they are providing care for two. Push back since if they knew what they were accepting or find a new agency or private hire. Our private hire does twice the work that the HHA staff does. Good luck this stuff is never easy.
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Thanks all for your input! I stayed with my parents and my mom slept through the night. My dad asked for help at 5 AM. Considering he was put to bed at 8:30, that doesn't seem unreasonable. He can't move around on his own, so so many hours in one position can get uncomfortable. It seems, though, that our aide--who is live-in, but does not bathe my parents and is spelled by another aide every 12 days--is frightened by the buzzer we have hooked up by Dad's bed. Apparently, her brother died of a heart attack and she fears the same for herself? I know you have to trust the people who are caring for your aged parents, but she ( the main aide) seems a little off?? Any advice on how to handle THIS situation?
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Daughterct, Is it the buzzer noise, or is it an overall fear? You need to cover this with her and use progressive discipline. A verbal warning if she cannot respond. A written warning for the second failure. A final warning with notice of termination for a third failure. Timestamped video is strongly recommended. Without hard evidence of progressive discipline, she will file for unemployment and probably get it.
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Emphasis on "FOR PROFIT CARE". If this agency can convince you they need to "add more services" then it is more money in their pockets. There is a multitude of criminals in this field and I suspect they often "cause" a need for additional services. Beware.
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