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In-home care agency's high turnover is upsetting to older adult

Columnist Carol Bradley Bursack says lack of consistency can be hard for older adults who rely on strangers to come into their home to help them shower or do other daily tasks.

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Carol Bradley Bursack, "Minding Our Elders" columnist.
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Dear Carol: My mom needs help while bathing and with some daily tasks, so we hired an agency to provide four hours of in-home care per day. Our problem is constant staff turnover. Most of the new people are fine, but each new caregiver needs to be trained for Mom’s preferences and needs. From Mom's perspective, another stranger in her home is upsetting. Are some agencies more likely to retain caregivers than others? How about hiring privately? This turnover is hard on both of us since I need to take time away from work to cover missing caregivers. — CE.

Dear CE: Lack of consistency is understandably hard for older adults. Who wants strangers to come into their home to help them shower? Unfortunately, low staffing has been an issue for years, and of course, after our intense COVID challenges this problem has intensified.

You could, as you suggested, change agencies, and that might be a good option. Do consider this carefully, though, if you are otherwise happy with them. Since most agencies are struggling to stay staffed, you could find it difficult to get started with another one, and you don’t want to be left stranded.

Read more columns from Carol Bradley Bursack
This week, Carol Bradley Bursack explains ways to assess if an older relative's cognitive abilities are starting to decline or staying strong.

It’s true, though, that if an agency pays well or provides better training, they retain more employees. For that reason, I’m not discouraging you from changing agencies, but, if possible, contract with a new agency before discontinuing your mom’s current care.

Regarding hiring privately: Understand that you’d be taking on extra work, as well as risk. You’d need to do your own background checks, screening and interviewing. Also, depending on where you live, you’d most likely have to pay the employer’s part of the caregivers’ taxes as well as issue tax forms. Even if the person you hire is an independent contractor which could change how you handle taxes, you’d be smart to buy liability insurance. This would protect you in case they are injured in your home, or while caring for your mom.


My last thought on this is to remind you that since bona fide agencies are having a tough time hiring, hiring independently won’t be an easy task. I’m not trying to discourage you from hiring on your own since, with the right caregiver, this option can be a dream come true. However, if you consider a private hire, do it with your eyes open. Begin the process by conducting research into the state laws of your mom’s residence.

You could also use this opportunity to discuss with your mom the pros and cons of an assisted living facility (ALF). Since either choice means changing caregivers, you might at least plant the seed, and even schedule some tours if she’s willing to look around. If your mom enjoys socializing, highlight that aspect of an ALF.

Assure your mom that you'll do everything you can to honor her preferences. Gently remind her, though, that reliable care is what will help her live as independently as she realistically can, and options are limited.

Carol Bradley Bursack is a veteran family caregiver and a nationally-recognized presence in caregiver support. She's the author of “Minding Our Elders: Caregivers Share Their Personal Stories,” a longtime newspaper columnist and host of her blog at mindingoureldersblog.com. Carol's an introverted book nerd, so you won't see her mugging in viral videos, but you can easily reach her using the contact form at mindingourelders.com.
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