A year ago we added agency service to my mother's care, 2 days a week. My thought at the time was to provide my bro with an emergency plan if I decided to run away and join the circus. (I do think I will be a very good clown)enough of that.

Here's the thing. The protocal that this agency (maybe all agencies) has for employees to follow doesn't suit me. I have worked with the primary contact to fine tune Mom's folder.

This weekend, They ticked me off big time again. Monday I reread the riot act to the agency contact.

Haa, I am not even dealing with thieves or abuses. (Lucky me and Mom). Still, I tell them, you work for me and my Mom only by following these guidlines. They screwed it up again this weekend.

It is very interesting to hear what the protocal for their employees happens to be. I recommend that all of you, (if you hire an agency) specifically request a copy of agency protocal. Especially for emergencies.

I hope that this person was confused, but the agency CG told me that if Mom had an emergency, she was supposed to call the agency and wait for instructions, rather than call 911 (on the house phone) then Me (on the cell phone).


EXCUSE ME. Any one taking care of my Mom better be ready to use MY protocal.

In my experience, no agency has a good enough communication system to see to it that your LO's wishes are followed.

quote:

thru

Hi all, you all have provided very nice information about this. this all posts are grate to understand something new or to getting some knowledge..

AnnaS, in part I was letting off some steam, something I seem to have plenty of lately. A big part of the issue boils down to the 1,000 questions you don't ask because you never knew such a question existed in the first place. (What do you do if Mom falls out of bed and may have a broken bone..? Call the agency and wait for instructions to call 911?)

What started my rant was that they agreed to do this my way (call me immediately if there was a need to send a sub). It didn't happen.

Now the questions come up, one on top of another. I do think an agency can be of use. Many of their employees will work with you in a wonderful way. I wanted to start with one (this one was highly recommended by a friend whose parents were in AL and needed transport to appointments and sitters in the hospital.)

Yes, there are problems to work out, and I think it is very important to look into this BEFORE you are in a bind. Having friends and neighbors that are supportive means the world. Finding ADC that is social and entertaining and active is an under rated gold mine.

It is still worth while to check out resources. Actually the Day Care facility would be a great place to start. Some of their people might want a weekend side job, or know someone who is working part time. While your mother can still interact and tell you what is going on, has "reactions" that you can "read" is far better than if you have to go into emergency mode.

This links to a similar thread where I posted an article that talks about the good points of using an agency. I highly recommend reading the comments. It may help with any decisions you may face later.

http://eldercare.infopop.cc/eve/forums/a/tpc/f/55060160...621092006#5621092006

Very informative posting and it is going to make me think twice about going to an agency in the future. I’m with you, I want someone following my instructions. I guess the only alternative is to hire your own caregiver which I guess has its own issues.

BC, you know I have been through all of this. What I do have to say is, you may have to keep calling agencies to find one that will work with your protocol. As everyone else has said, and we all know, the agencies have to have some form of guidelines. When I was working with an agency for my Mil, the front of the fridge was covered in our protocol on flouresent papers. I had typed in large font "New and fill in CG's PLEASE READ", that was also in case we had an emergency replacement on a night shift and we may or may not be at home to talk to them, they would at least have all info for Mil and phone numbers to reach all of us. Also, our day shift was great about going through every aspect of the day, meds, nights, and whatever they may need to know. I also was blessed with having a professional contact at the agency who was on top of every situation. I can't count how many times I called to tell him a certain cg was not to ever show up at our door again. Many of them were fired immediately. I really have no patience for someone who looses their job after blatantly breaking every rule, or request, specially after I made myself easy to reach for any question or problem that may have cropped up.

I know you love your Mom so much and expect anyone taking care of her to work as hard as you do, I always did. Just keep on keeping on, you know how you want it done, and expect nothing less.

Just a quick note, my Mil was on hospice, the day cg was with her when I had to take my Dad to a hospital 1 1/2 hours away for surgery. Mil had aspirated on the feeding tube, the cg called Hospice, they told her to suction and wait that she would be ok. I happened to call right after the cg was told this, I could hear the panic in her voice and hear my Mil gasping for air. I told her to call 911 immediately, it was too late, her lungs were full of the supplement, the Dr's did everything they could and could not clear it out, she had COPD which complicated matters. She ended up coming home form intensive care after 5 days and lived 24 hours. We are not bitter, we know this cg was very attached to her, we also know how she had suffered in pain for years and was ready to go. We miss her, but also know she is with her husband, son and other family members and with her Lord.

Sorry to carry on about myself, but I did not let Hospice make this last decision, I made it. They were not happy with me for doing that and I told them I did not care, I was not going to let that woman drown with out trying to help her. We have to be our own advocates, no one else will be.

big hugs bc!

quote:

Perhaps they have to call because they need to know whether your mom is a "no code," a "slow code," has a DNR or what...

Thats quite possible MB & BC I know where to look for this info at least here there is always a file where we put a copy of our daily notes and in that folder it has notes from the office if they are a full code or DNR BUT if its a new patient someone who has yet to get a file folder then its up to me to ask specifically if they are a FC or DNR they sometimes dont furnish that info.

Now those hearing aides ugh...Iv had one so far an lemme tell you BC I hear you! If you dont know how the heck to work them and get them in you might as well throw up your hands in frustration.
This one pair I had to deal with OMG how the heck they pop those things in I couldnt figure out I swear they should have picture instructions posted somewhere for us and I sure as heck didnt want to hurt that poor thing or break the dang things so I took a REALLY big deep breath studied the dang things for a moment REALLY looked at the ears on my guy and pop pop waalaaa they were in
As for the agency not callin you....Uh yup guilty of that here too. You've heard my own gripes about them and most times they are aware hours before that the regular cant show up for some reason.
Now sometimes it is scheduling when they send a stranger in (schedules are done month by month)so someone you like is probably scheduled somewhere else but why they dont call is something I dont understand.
Its plain a$$ rude so I say to this try another agency if they cant find a way to inform you of changes

Because the CNA called me at 9AM I had already made my secondary plans. I had to wait and see what the agency did, because the CNA is not supposed to contact the client directly, and I couldn't put her on the spot when she was doing the right thing.

At 12:30PM, I still hadn't heard from the agency so called the CNA and asked if she felt up to calling them back to see what they had done and to remind them that this particular client (ME) was very peculiar about fill ins.. in 15 minutes, the sub was on the phone to me.

I asked her when she had been given notice and she said 8AM. Then, "Why am I only hearing about this now?" " I didn't want to call untill I had some one lined up" "So who is coming?" "A new lady, she is terrific." "I'm sure she is, and would love to meet her another tim, but she isn't coming tonight. Did you read my Mother's file?" "Uh, no, I mean yes, what do you mean?" "I mean "K" was supposed to have it in her file that I am notified as soon as you are notified. Are you saying "K" didn't put it in the file or that you didn't read the file?" "Uh, I don't see it here" " I see, never mind. I will make my own arrangements for tonight and I will speak to "K" on Monday, Thank you for trying, but I do not need your CG tonight. I will do it myself."

And that is what I did. If I have to drive an hour round trip, spend at least an hour showing someone around and teaching them how to handle Mom's ears, I may as well just stay for the night and do it myself. Then on Monday I did call "K". Told her "Either my instructions aren't in Mom's file like you said you would do or this weekend person did not read the file. I am not happy. Get it straight. There are other agencies. I would rather not start over, but I certainly can if it happens again."

Hmmm, now we will see. I also mentioned that I was told that the scheduled CNA was ill and that she had done the right thing by calling in sick. I tell everyone on their first day with Mom that no one should come with a fever, diarrhea or vomiting.

MB, I never got out the guns, but I was tempted.

quote:

Originally posted by Bobcat:
I called the CG who called in sick, her son came home from school sick, then she began feeling puky. It is one of the schools that has had an outbreak of norovirus.

The agency wanted her to come anyway, but I had told her like I tell every one, don't come if you have a fever, diarhea, or vomiting. She called me back this evening. Her doc says it is noro.

Uh huh - I suspected as much... She did the right thing - too bad the folks at the agency didn't notify YOU... Some of the nurses Mom had were so GOOD - unless it was a dire emergency, they'd call me (knowing the office might not) and I'd wait for a bit to see IF the agency would call; if not, I'd call them and they'd "suddenly" remember to tell me there had been a change... And some of the nurses were BUTTHEADS... someone just wouldn't show up or someone I'd never seen would appear. They generally were not greeted well by me... I'd ask them why they were there, who sent them, wasn't I supposed to be called? THen I'd call the agency with them standing there and give the person in charge a hard time for putting that employee in a bad position by not doing the job the agency was supposed to do!! At least the nursies knew I wasn't mad at them - I knew who had dropped the ball!

Perhaps they have to call because they need to know whether your mom is a "no code," a "slow code," has a DNR or what... The employees don't carry your mom's full case file with them nor any of the legal papers, etc., so they may not even be aware and need to call the agency for instructions. I'm sure it IS some kind of "cover their butts" situation. There may also be paperwork they have to fill out for the state to report a 911 call - who knows? Did you ASK them why this is their policy?

So this wasn't about a 911 situation - it was about a substitution with no call to you? I don't blame you for being hot - I certainly would have been, especially since this is someone coming to work a shift, not just make a HH appointment!

But in the end - that's agencies for ya. It's BUSINESS to them and PERSONAL to us - apples and zucchini, KWIM?!!! A LOT depends on who is in charge at an agency. I always made it a point to get to know the DoN and that made things go a lot smoother - until I came across one who was crazy! She made trouble for me, but in the end, she screwed herself and lost our business for her agency. I HOPE she lost her job, too! DoNs have emergencies, families, get sick and take vacations, too, and people who sub in for them may not be aware of your particular requests (as IF they are gonna READ the chart - NOT!!! ).

Stuff happens, BC. It's HARD to get the system to work in a home environment - even tougher in a facility or hospital! Such is the stuff that caregivers come unglued about...

If you are unhappy with the agency and how your mom's case is being handled, get on the phone and interview others... Sometimes it IS the agency; other times, it's whomever is in charge there at a particular time. Don't take it lying down, but don't let it get you all stirred up too much either... it's the HOLIDAYS, dear.

Take a deep breath and put down that gun!!!

I called the CG who called in sick, her son came home from school sick, then she began feeling pucky. It is one of the schools that has had an outbreak of norovirus.

The agency wanted her to come anyway, but I had told her like I tell every one, don't come if you have a fever, diarhea, or vomiting. She called me back this evening. Her doc says it is noro.

quote:

agency CG told me that if Mom had an emergency, she was supposed to call the agency and wait for instructions, rather than call 911 (on the house phone) then Me (on the cell phone).

The agency CG is supposed to call the agency and wait for instructions. That is the protocol. NOT call 911, unless instructed by the agency. I know they don't get back to you for an hour or more. The CGs have the same number I do.

Calling 911 first, rather than calling them first, duh, no brainer. I have asked the CGs, yes that is by the book, don't call 911 until further instructions. Also....

I went thru this with them before...Me being the last to know if a stranger was to be sent to my mother's house. Mom has custom fitted adjustable behind the ear(BTE) hearing aids. NOT ONCE have they sent someone who is able to give her assistance with her aids. Twice they have had to be repaired because they haven't been handled correctly (still under warrenty, no cost, but Mom had to do without her 'ears'.

They agreed to let me know as soon as they know if there are any changes in the list... a stranger coming in... I have to be there to introduce her and instruct them about the hearing aids. It takes me 30 minutes to get there.

They got the message that 'T' was ill at 8 AM and didn't let me know until 1PM. If I had known at 8AM I could have made other arrangements and been able to have dinner at home with H.

"K" swore to me that it would be in Mom's file to call me instantly in case of a switch. Either she didn't put it in the file or the weekend person didn't read the file. Either way, they messed up, and were wrong.


I understand that they can't fill Mom's pill box, but can't call 911???

[QUOTE]Calling a family member first in a 911 situation puts a professional in jeopardy if things go wrong... Even calling the agency first in a 911 emergency gets sticky [/QUOTE

I don't won't them to call me first, I never said that. I want them to call 911, but the CGs tell me they are supposed to call the agency first and wait for a call back before calling 911. Nuts and crapola. Call 911, then me, then them.

This message has been edited. Last edited by: Bobcat,

See I can only guess why they require this, they always say things to me like "we have to cover our butts" or "they have seen it all" which tells me they have dealt with families who may not be so nice and have made a stink about these things.
If thats the case I pretty much know and have dealt with families like this in the past.
These are usually the cases I excuse myself from before it gets to this point because I know all too well their not on the same page as me.
I try every trick I can if its called for before I make that decision to call 911, but if its IMHO something I cant handle that call is made first. Im not going to waste precious time and call someone who will tell me "give them a back rub" and they pretty much know by now I dont just whistle dixie.
I think the problem is these agencies rely too much on "aides" who have no medical knowledge and couldnt take Vitals to save their own life or access a patient that may be in distress.
Just remember one thing sweetie and pass it on to your CG's if they feel the need to write down in their notes that a 911 call was made by them then add that it was at your insistence. No harm no foul they cant get into trouble if it was ordered by you whether it was by phone or in person.
The agency on the other hand their only following the rules set forth by their superiors.
As long as they are aware your the one that made this rule they cant do a thing they HAVE TO honor your wishes, personally I dig families that whip out the ole "I can ALWAYS go to another agency" routine it means they will fight for their LO and thats all that matters to me

quote:

Any one taking care of my Mom better be ready to use MY protocol.

I understand how you feel, but that dog won't hunt in this scenario any more than it would at a hospital or other facility.

The specifics of agency vs employer (ie. YOU) protocol is a tricky wicket. Remember, even though you may subcontract some of a LO's care to an agency, they are not LICENSED by you - they are licensed by the state! Professionals have laws and guidelines they must follow. There is an official chain of command that pro's are expected to follow. Asking them to circumvent that command chain puts them in a very tough situation... They do not work directly for you - they work for the Agency. It is the Agency with whom you subcontract.

Calling a family member first in a 911 situation puts a professional in jeopardy if things go wrong... Even calling the agency first in a 911 emergency gets sticky... It's all about how one defines an emergency...

About the only way around all this who does what to whom first rigamarole is to PRIVATELY employ caregivers. Then, YOU can call the shots so long as it doesn't violate any laws or licensing.

You can make REQUESTS of the Agency and its employees, but there is no guarantee that they will FOLLOW your requests, particularly when it concerns something like emergency medical situations...

quote:

Insist on full disclosure about the protocol for their employees.

They may or may not disclose this to you. I am not aware that they are under any obligation to do so. Employees of an agency also have licensing laws that they have to know that override the directions from their agency! If an agency directs their employees to follow a procedure that causes delay to someone's care and causes harm to the patient, it's the employee who will be losing their license for not following the law FIRST before anyone else's directives.


What exactly happened that caused the ruckus, anyway?

First, I apologise. PROTOCOL not protocal. Sorry. I have had a previous problem and after that gave specific instructions to the agency...

Not much I can say here. I must be protective of the CGs that put Mom before the agency. Mom seems to have a special "whammy" on those who meet her. Credos to the agency CG that gave me a call to tell me she was ill and had called the agency to say so.

If you go with an agency??? Insist on full disclosure about the protocol for their employees. If you disagree, say so. Test it. Make sure they know you mean it. If they won't play it your way, tell them you will find an agency who will.

I am not feeling nice right now. I have chewed a new one for the agency contact, and it is a bitter taste. A small price to pay.

HAH! Boy BC Im tellin ya right now thats the protocol here too! If I hear ONE MORE TIME from an On call "give um 2 tylenol and rub their back" Im gonna puke, crawl thru that daggum phone an wring someones neck!
Heres what I do:
I assess my patient right away take vitals and judge from my everyday experience with my patient, if I feel they merit a 911 call THATS EXACTLY WHAT I DO.
THEN I call the agency and tell them what Iv done.
Now this only applies when I have "Full code" orders, if their on hospice then I can only call Hospice and my agency to update, no 911 call unless theres something specific about the case that can be solved with paramedics showing up like for instance an issue with blood sugar levels (I had such a case in the past with a patient on hospice going into a coma for low BS levels) paramedics came in and set up an IV an stuck around till she regained consciousness. *I warned them to stop giving those dam diabetes meds*
anyhoo....
If these are new hires you got for mom I can understand their hesitation, they feel their going to get in trouble if they sidestep their rules I on the other hand dont give a rats a$$ WTH my agency thinks.
If my patients family says to me (and its one question I ask) if at anytime you feel they need to go to the ER get them there, then thats exactly the orders I follow.
Agency rules are secondary to the families wishes IMHO, THEY pay the bills and afford me my paycheck.
So far *knock on wood* I have never got a chew out for this issue and an occasional call from the primary family member to the office on what a good job I do doesnt hurt either
Talk to your cg's and tell them how you feel and that your willing to back up that decision to call 911 if the need arises, in fact tell the agancy your the one that made the call if that will help
So:
Have them call you first to report if theres time, give permission for them to call 911, THEN call the agency after your cg has called in the future
Hope this helps
Oh and make sure if this happens cg's write in their notes you are the one that made the call to 911
We really have to "fudge" in order for no one to get into trouble so make sure your cg's are on the 'same page"