How can I get nighttime/overnight care?

Donna, for night service what I used was a professional caregiving Agency who was licensed, bonded, insured, and had workman's comp for their employees. The Rep from the Agency came over to see my Dad's house and interview us, to which I was also interviewing her with a lot of questions. I would pay the Agency and the Agency would pay the caregiver.

What I liked about this one Agency is that their "night caregivers" were to stay awake throughout the whole night. That was the only scheduled shift these gals would do, thus they would go home after the shift to sleep. I rarely got to see the night shift as it was late in the evening, but Dad said he liked the caregivers, were there quickly when ever they heard his feet hit the floor, so they could help Dad to the bathroom.

Make sure the caregiver has a comfortable place to sit with plenty of lighting, and maybe a TV or if your parents have WiFi the caregiver could use a device to get movies or TV shows. A good caregiver can quickly hear their clients even if the TV is on. There isn't much the caregiver can do at night except sit and wait.

To find the Agencies, first I would call your county Agency on Aging to see if they had a list. For myself, I got a list from the hospital when my Dad was a patient.

Depending on where you live, the cost per hour could be anywhere from $20 to $30/hour for a licensed Agency. If you decide not to use an Agency, make sure the caregiver has had a flu shot and a clear TB test, along with a good back ground check.

I understand your frustration. I'm undertaking the same project, along with others. It's very difficult to find in home help, in part b/c there are so many agencies, so much hype about what they allegedly will do, and unless I'm really missing something, not much you can do to vet them.

I view this project as somewhat akin to walking through a field with hidden quicksand pools.

This is what I've done; it might be somewhat helpful:

1. I've gotten lists from the Alzheimer's Assn. and Area Agency on Aging for our zip code. The AA lists are better and longer. But these are just lists, not necessarily endorsements. I've also searched online, trying to vet the agencies, but they're all the best thing since sliced bread, and all their clients are happily smiling, well groomed, cheerful elders. And, interestingly enough, it's curious how many of them are owned by people who allegedly have been caregivers themselves.

2. I've made checklists of what I'm looking for: approximate duration, x times per week, and a more detailed work scope with both non medical, somewhat medical and medical tasks (I use the same list with agencies to scope out what they will do, as I've been mislead by at least one.)

I've also started e-mailing the work scope to candidates and discussing it before any meetings, so neither of us waste our time if they're not going to perform some of the critical tasks, or at least I have a good idea whether what they will do is worth an interview.

This happened after a rep told me a particular task (not common for home care) could easily be done, but at the assessment interview, the interviewer said they'd need some instruction from me before the tasks could be performed by the workers. I don't mind the instruction part, but I didn't appreciate being told this was something they could handle when the workers hadn't even done it before. Just be honest, please.

3. Then I start calling. First ones I eliminate are those that won't take charge cards. I won't pay by check or cash b/c there's literally no recourse once paid, and if I discover something missing later.

Besides, they're in business; they need to perform competitively like businesses do, and that means extending charge to clients who want to pay that way.

4. I ask if they're a franchise, how long that particular franchise or company has been in business, whether they have their own staff, how many, and how they're trained (one agency even admitted at the interview that they don't train their staff! - and this is a very prominent agency). Also, what are backup arrangements, how they match to a client's needs, cancellation policy, whether they hire independent contractors, whether they subcontract and hire from other agencies, how much experience a potential home care worker has, and, very importantly, if they schedule the same person or make assignments the night before.

I've been through the night before issue and don't like it. A different worker every time is too disruptive for an older person, and it's disruptive to me as well. Besides, the learning curve is basically reset to zero for every new worker.

5. What I've learned is that some keep their staff to a minimum, hiring independent contractors, or subcontracting with other agencies. I was able to learn that one particular agency actually subs with another which I had rejected for lack of timely response (I called the marketing rep 3 times - not even a voice mail answering service; called the office number the 4th time and left word but my call was never returned.

This was after a long hard sell pitch the day before, and at that time I was very enthused and interested in the company, and the rep seemed to be quite enthused as well. Now I wouldn't hire that agency directly; I certainly don't want it providing workers through another agency.

6. What I do now is e-mail the proposed work scope before even meeting with a rep so I don't waste my time. The last one I interviewed confided in me that they don't do any of the semi-medical tasks, but might do something such as cleaning the oxygen concentrator, and that most of their staff are homemakers and housewives who want work in the afternoons but want to be home when their kids come home from school during the school year. The interviewer even tried to get us to set a time that was more conducive to workers being able to leave earlier once school started.

7. I've also discovered that affiliations, apparently on a business to business relationship, are occurring and seem to be fairly standard, with medic alerts being the primary service/device being pushed. This also occurs with home health care staff. Visiting physician affiliation is another service being hawked.

On the medic alert situation, the agency which hired homemakers and housewives initially praised our medic alert service, but then began to badmouth the service, which I considered the best of all those I researched. She tried twice to sell medic alert services during a 1.5 hour meeting.

Then the rep began pushing other services. Having been told they did only light housekeeping, I was surprised when the rep began hinting that she felt the house needed more heavy duty work (which had already been done by 2 other contractors I hired), and guess what? They had a contractor on staff who could do this for us!

It was only after I told her I suspected this was the same contractor I had already interviewed for an outdoor project and learned that he had trouble agreeing to a work scope; he wanted to expand what could be a few hours of work to an all day job at about 4x what I paid for it last year. (I also knew that one aspect of his proposal couldn't possibly be done in the time he estimated.)

8. They don't do any semi or medical work, yet they wanted HIPAA authorization. (For what, pray tell?)

9. Outrageous terms and conditions, especially on the liability issue. The egregious agency had a liability limitation - despite claiming that they had proper liability insurance, the limitation clause put a cap on any damages of $1K COLLECTIVELY for the company. If they broke anything, injured my parent, stole things, whatever...the total liability for ALL SUCH INCIDENTS was limited to $1,000. No way!

Some of the oxygen equipment is worth a few thousand dollars alone.

It's not that I expected incidents to occur, but I would still never limit them to $1,000, collectively, for all the representatives (especially when they're pushing other companies' products and staff, and/or subcontracting from other agencies.

10. I also ask for copies of the agreements now before we meet so that I can negotiate egregious clauses before wasting time on a meeting. In one case, a agency recommended by (I believe, if I remember correctly) a hospital, really overreached - it wanted a deposit equivalent to 2 weeks of workers' wages ($2500 in this case), which it held w/o interest in a bank account. It was returnable, when the services were terminated, but in the meantime, we lost use of that $2500. We might even have gotten $.05 in interest had it been in a bank account!

In addition, the contract required the "patient representative" (me) to sign ALL documents as well as my parent. This was mandatory. I suspected the company was trying to extend responsibility and liability for payment to me. It was in some senses a guarantee.

11. I found a few really good agencies, recommended by people in facilities offering palliative care, but as luck would have it, their jurisdiction doesn't extend to my father's area. This has been a major problem.

12. I even called hospitals, figuring that some of them would have their own agencies. Some did. Some didn't, and recommended agencies, some of which sounded decent. I'm following up with those.

I'm thinking if we were closer to one of the larger cities with the big teaching hospitals, there would be more agencies, and of higher caliber.

13. I did find one agency that I thought was the answer to everything. It was an agency through one of the top, most progressive hospital, but after much discussion, they felt we were too far outside their range. They preferred areas of higher population density - workers can cover more ground, see more clients, and the company can make more money in those areas rather than suburbs where driving time from one client to another is greater.

I share all this this not to be negative, but rather to alert you to what might take place as you struggle to find someone. I wish this was a much easier task, not b/c of the work but because I want to be able to have confidence in the agency I choose, as i'm sure you do as well.

I feel your pain; this is a difficult project. Buying a car is a lot easier, and I don't like buying cars.

All I can suggest in the end is that you interview, ask questions, re-interview if you have to, and present a clear work scope, in writing, of what you want. The task is made all the harder when the need is urgent, so if you do have to settle for less than what you'd like, make sure the contract includes a reasonable termination clause.

But I would try teaching hospitals and large hospital conglomerates if you have any in your area. They often are more progressive and offer more of a variety of services.

And, good luck and good wishes for success in your search.