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I recently hired an agency caregiver to help my husband who survived a serious stroke 3 years ago. My husband has been medically assessed and would qualify for living in a skilled nursing facility, but I want to keep him at home as long as possible. Husband is paralyzed on entire left side of body. He can transfer from bed to wheelchair and back with the help of one person. He needs help with all the ADL's. He is generally mentally sound. I have been his sole caregiver for 3 years and it's (beyond) time for me to get some help.


Last month I hired an "experienced" caregiver through a reputable agency who didn't train him. Giving the new caregiver the benefit of the doubt, I've been training him myself for the past 3 weeks (30 hours per week).


It's become apparent to my husband and me that this caregiver has very real challenges both physical and mental. He's a very odd and gentle person who constantly needs quite a bit of reassurance from us that he's doing okay... When we offer the most gentle constructive criticism that we can, he looks wounded but he tries to hide it. We feel sorry for him. We suspect that the caregiver is genuinely disabled, and that this is his first caregiver job. We've learned that he's in his late 40's, lives alone, has never been married, has no partner, no kids, no outside activities, and his only interest is collecting reptiles. He's never travelled, he can't cook, or do math. He literally has trouble distinguishing left from right. After 90 hours of caregiving my husband, he still can't remember which side of my husband's body is paralyzed. He can't figure out which shoe goes on which foot when he dresses my husband. Yesterday he put on my husband's pants backwards. Sigh.


We've come to the conclusion that this caregiver needs to be replaced as soon as the holidays are over.


What is the most gentle and kind way to fire our caregiver? Do I say nothing at all to the caregiver and simply phone the agency to ask for a replacement? That just seems so abrupt and cold.


Do I level with the agency about this caregiver, or do I simply tell the agency that the caregiver chemistry isn't right?


I'd like to avoid causing hurt feelings to this caregiver as much as possible. I think being fired is going to traumatize him.


Does anyone know a kinder way to do this?

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You contact the agency and explain that this particular caregiver is not working out and that you would like another,
You can explain that the level of care your husband requires needs a more experienced caregiver.
The will reassign the current one and assign another.
If you want to terminate the contract with the agency all together you will have to look at the contract and see what provisions are for that. Do you have to give notice? If so how far in advance? Is there a time on the contract (is it a 6 month contract, 12 month?)
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Just tell the agency you don't need their service anymore, you don't have to protect someone's feelings, he still is in the agency and they will send him to someone else :)
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It is hard to fire anyone but your husband’s care is of most concern. What if your husband was choking and this caregiver didn’t know what to do? He is jeopardizing your husband’s health. You must contact his agency ASAP.
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LostinPlace: I did see your STELLAR update of December 27.
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Communication with the agency will keep everything objective. You and your husband certainly have the right to change caregivers; " pt rights". You can simply call the agency and, speak with the clinical supervisor ( whoever, whatever title is responsible for the caregiver assignments etc), explain the issues and, tell them you want to interview , consider others who will be able to serve your husband best . Simply tell the agency that you do not want the current caregiver to return; let the agency be the one to share the decision and reasons; this will avoid emotional, subjective reactions etc from either the caregiver or you and avoid unpleasant experiences in the home. Your husband's care needs are the priority; not the caregiver's personal life etc. do not let the agency try to talk you into giving him another chance etc.; simply tell the agency that the caregiver is not competent for your husband's needs. Period.
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You need(ed) to discuss this with the owner / manager of the agency.
This is inexcusable (that they do not train / properly) and/or hire people emotionally and/or psychologically unstable /'unfit' to do this extremely important work.

* This agency needs to be reported to the Better Business Bureau and the Attorney General - check and see about their licensing. Are they licensed to function as an agency? a business?

Your error in thinking is taking responsibility for this caregiver vs putting your husband('s needs) first.

This is 'serious' business. Not a time for you to be concerned with hurting a caregiver's feelings. Your husband needs the proper care with someone trained and the maturity to handle what comes up - at the very least - know to NOT take behaviors / words personally. And, have the experience and maturity to know to discuss situations that he feels he needs help in how to manage. Clearly, he can't do that. YOU ARE PUTTING YOUR HUSBAND AT RISK by putting this person's 'feelings' ahead of your husband's needs. WHY?

This caregiver could snap at any time.
Since you already has a sense that he might be traumatized is a major RED FLAG that he needs to leave / not return ASAP.

Contact the agency; put your concerns in writing.
Track everything by date, time, situation.

It is the responsibility of the agency to tell the caregiver they placed to NOT GO BACK TO THAT ASSIGNMENT - it is not your place to 'baby-sit' emotionally unstable, untrained caregivers.

I sense you and your husband would greatly benefit working with a professional social worker - or someone who can help you mange your / your husband's medical / caregiving needs.

If you do not contact the agency and let them handle their employees, you are waiting for something unfortunate to happen, plus you are paying for (?) inadequate care. WHY are you thinking this way?

This provider shouldn't be 'helping' / placed or caring for anyone. Period.
He is a possible health risk / safety risk to anyone he is chared to care for as a 'caregiver.'

Do not make this your problem. Or release yourself from making this your problem. Find another agency immediately.

Gena / Touch Matters
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LostinPlace Dec 29, 2023
Touch,

I find your comment off base, unhelpful and actually quite offensive. To suggest that I put a caregiver needs above that of my husband's is breathtakingly incorrect. To accuse that I'm putting my husband at risk (in capital letters) reveals to me that you have no idea about how to communicate in a supportive manner. You especially, given your line of work, should realize that your wording is harsh and accusatory. For shame.
Please note that I contacted the caregiver agency days ago. I covered this already in a prior post, which it sounds like you didn't read. I pulled the trigger to replace the caregiver quickly after getting many helpful comments from this forum which helped me "reality check" that it was the right step to take.
Meanwhile, our family friends who work in healthcare kept assuring me that our caregiver experience was pretty typical of what's available, and that a replacement might be even worse.

The NY Times recently ran a series of articles titled; "Dying Broke" about the alarming scarcity of finding affordable and available skilled in-home caregivers currently in the United States due to their low wages, poor working conditions, and general burnout from the pandemic. Did you know that most caregivers can make more money working at McDonalds than as a caregiver? According to the NY Times, because of this situation, there aren't many people applying for caregiver jobs at agencies. Exceptions are "special needs" applicants or inexperienced caregivers who plan to use agencies as career stepping stones to the end of hanging out their own shingle for customers. Given these circumstances, it's no wonder I've been hesitant to "fire" the agency caregiver.

About social workers: Yes, I've met with three different social workers, in person, since my husband's stroke. Maybe the social workers in California are better than the social workers here in Florida, but here they were stunningly useless. They had no suggestions for us other than to hand me a list of governmental agencies to contact by myself (I had already contacted all of them myself anyway). The social workers would not provide recommendations or referrals regarding medical care, in-home health programs, transportation for disabled people, emergency evacuation processes for the disabled, mental health professionals, or how to arrange covid vaccinations for the bedridden. They would not recommend any in-home caregiver agencies. They would not recommend any PT, OT, or Speech Therapists. I was told that they could no longer make any recommendations due to new guidelines that they had to follow. Although they did suggest a local senior daycare program, which I explained was not possible for us, as we lived on the second floor of a low rise condo that had no elevator, only stairs. There was no way to get my husband up and down the exterior stairway - and the social workers had no solutions about that, either. They suggested that we move to a one story residence, but had no suggestions about how to handle a move safely during the height of the pandemic. Oh wait, I forgot, one social worker said he could get my husband a hospital bed.

On my own steam and moxie I've found and we've worked with Elder Care Attorneys, Psychologists, Financial Advisors, Movers, Handymen, Maids, Transport Services, Medical Specialists, Visiting Nurses, Real Estate Agents, Rehab Facilities. I've purchased an untold amount of equipment that Medicare wouldn't cover. I've been my husband's 24/7 sole caregiver without a single day off in over three years. I've transferred him, I've cooked and cleaned for him, I've done the ADL's with him every single day. I've done his laundry, bought him a special computer, fought with insurance companies as an advocate for him, I handled his daily meds, ran errands for him, cleaned the house for him, protected him from covid and the flu, while meanwhile grappling with the VA for veteran benefits.

You owe me an apology.
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Update: I called the agency yesterday to stop the current caregiver visits and to discuss this caregiver's shortcomings. I explained in detail why he wasn't providing the level of care that my husband requires as well as why I consider him a real safety risk to my husband.

The agency manager I spoke with sounded genuinely surprised, shocked, and even appalled as I continued to describe our caregiver experiences. She kept apologizing for how the caregiver continually mishandled things despite the training he was given. She apologized for her agency's misjudgement regarding selecting this caregiver for our needs. She sounded increasingly embarrassed as I gave her more and more examples about the caregiver's performance. I hope I'm not imagining that she sounded a little ashamed about the agency she's working for.

I stated that I want a state certified aide from a reputable 40+ hour training program. (Factoid: In our state (FL) aide certification requires only 12 hours of training but the more reputable 40+ hour certification aide programs are also available. Guess which certification program most Florida caregiver agencies use!)

The agency manager promised to send us a replacement caregiver who has much much more relevant experience and skills. I'm a bit skeptical at this point, but I'm willing to see if the agency actually comes through this time. I plan on switching to another agency very quickly if I'm not satisfied with the replacement caregiver.

So thank you, everyone - for all your helpful advice and support regarding how to handle the sub-par caregiver. situation. I have to say I'm very impressed and pleased with this forum and the caregiver wisdom of the people who participate in it. Thanks again!
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AlvaDeer Dec 27, 2023
Thank you so much for your response and your update. So few come back to do this for us. You are your own EXPERT now and can help others here, and I hope if you have time you will do this. As you will see we are none of us alone in our problems on AC.
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Here is a situation where being nice is not kind.

You seem a very nice and kind person. I think if you can view the 'special needs' caregiver as an employee of the agency and not a lost puppy to be rescued, you will be on your way to having the agency reassign him in a timely manner, like by the 28th.

Often, Special Needs persons do have a very sweet nature. It is not a kindness to treat him any different than any other employee. imo.
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LostinPlace Dec 27, 2023
Very astute comment - much appreciated. I liked your metaphor about the puppy - very appropriate. You're right, this is not a puppy rescue! :-)
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It’s not your job to let him go. Call agency and tell them you need a more experienced caregiver with transferring skills, etc. Basically, a caregiver who worked with similar type patients previously. He won’t show up as soon as you tell agency. You can choose to use a different agency as well. So no worries..it’s not your job to let him go. In addition, his personal life or anything other than pertaining to the job of taking care of your husband shouldn’t even be discussed! Good luck in finding an experienced caregiver. They’re out there…just keep trying. Hugs 🤗
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PeggySue2020 Dec 26, 2023
There’s a bunch of posts missing from this thread including the op telling us that they got rid of him via the agency,
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Dyslexic has to do with being able to read. This man may be a high level Autistic. Burnt has worked as an aide so knows what she is talking about. Line up a different agency. Make it clear what DHs needs are and you want a State certified aide. This means the person has completed a course and the Nursing Board, in my State anyway, has certified they passed it.

I would not tell this person ur not happy with him. Just call the agency and tell them he is not capable to care for your husband. That you do wonder if he has some challenges that they may not be aware of. He also came to you, it seems, untrained and seems unsuited for this type of work. You feel be is not cerified.

If a certified aide is like the nurses I worked for, he should be able to show you certification when requested. The nurses had to have their licence posted at their desk.
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BurntCaregiver Dec 29, 2023
@JoAnn

In my state a CNA has to complete several months of training both classroom and practical.
I don't know what rules other states have. Here a person can become an APCNA which is cheaper than going to nursing school. That's a whole other story.
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I guarantee you that man is dyslexic. I certainly hope he's been diagnosed, because it's terrible if he's never been given any tools to help him deal with it.

At the very least, tell him in a roundabout way about the trick to tell left from right. Hold your hands out in front of you making an L with your thumb and forefinger on each hand. The one with the L facing the correct way is your left hand.

Poor guy -- he needs help to work with his issues, but your house probably isn't the place.
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First of all, you do not do the firing of this caregiver. The agency he works for does.

You call the agency and tell them that he is a very nice person but is an incompetent and ineffective caregiver and you will not allow him into your home again.

Caregiving for someone with a serious condition like your husband is serious work. There is no room for indulgence to a caregiver that is special "needs". The agency should never have even hired someone like this. I would not be surprised to hear that the state is paying most of his wages. Businesses will hire a person with disabilities because they don't even have to pay them minimum. The state pays most of their wages then thanks the company for hiring them. That is fine, but mentally disabled people should not be providing care for people with serious conditions.

If I were you and I say this as the owner of a homecare agency, you would be wise to start using a different homecare agency.
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LostinPlace Dec 21, 2023
Well, thanks for your reply which caused all the pieces to fall into place for me. Your scenario totally makes sense - - That the agency knowingly provided me with a subpar, unskilled caregiver because the state would pay most of the caregiver's wages. The agency put their own profits above any consideration for the level of care my husband required.
I agree with your advice to switch to a different agency for the next caregiver.
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You phone the agency and you tell them JUST EXACTLY what you wrote us here.
In fact, read it to them; give them a copy of it.
You have been nothing but kind here, and very understanding.
That this gentleman isn't up to the job may have to do with training, or it may have to do simply with him, as you suggested. In all truth it isn't on you to guess about that. You are paying decent wages and must have an adequate caregiver.

This is very sad and you are very kind and I can imagine your anquish, but this is not your fault. Nor, seemingly is it the job of this caregiver. He may be just fine in an in-facility caregiving job where he can be assigned where he works best and can do best, and slowly gets trained and acclimated.

So sorry.
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The agency will handle this situation for you. They will assign another caregiver for you if you request one and inform the former caregiver that they are no longer needed in your home.
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BurntCaregiver Dec 21, 2023
@Need

They should use a different agency altogether.
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Be honest and nice at the same time. No point hiding the truth. Also, you want to protect other elderly people from him. You would also have benefitted if he hadn’t come into your life in the first place. The caregiver almost sounds like he has dementia or is retarded. It sounds dangerous having him as a caregiver. He could make serious medical mistakes.
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BurntCaregiver Dec 21, 2023
It is dangerous. I don't know why a caregiving agency hired someone like this unless they are getting an incentive fromt he state to hire special needs employees.
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Don't say anything to the caregiver. Instead you give the agency an earful about how dare they send out someone who can't do the most basic things like remember left from right. You let the agency do the firing and replacing with an actual experienced aid. Immediately. The agency needs to know in no uncertain terms that caregiving is not an appropriate job for this person.
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olddude Dec 21, 2023
Apparently the interview process at the agency is simply checking for a heartbeat.
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I think you need to level with this caregiver that he's not able to meet your husband's needs and give him specific examples, as you've given us, with putting pants on backwards and shoes on the wrong feet etc. It's nothing personal, he simply does not have the experience required to care for a man who's paralyzed on one side of his body. You need a CG with THAT SPECIFIC EXPERIENCE. You like him very much, thank him for his service thus far and wish him the best of luck moving forward.

Then I'd get on the horn and give this agency a piece of my mind! They hired a disabled person who's unable to do even BASIC caregiving functions for petesake, when they KNEW the situation they were putting him into and hubbies needs! Plus the CG is demanding his favorite foods be available, puts clothing on backwards, shoes on the wrong feet and has NO SHORT TERM MEMORY. This level of caregiver is unacceptable to send to any client period. Either they send you a truly EXPERIENCED caregiver with a proven track record and references you can check, or you'll have to leave them a negative Google review and find a more reputable agency to deal with. Don't mince words. Don't try to be sweet and nice. This is business and you've been ripped off, plain and simple.

Wishing you the best of luck with all of this.
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