I'm not angry here - just frustrated with trying to shove a square peg into a round hole...

Today, I discharged the home health bathing/changing aide who has been coming for the past couple of months 3-5X a week. I TRIED to make this work - I really did - but in the end, it was causing me more hassle than not having the "help." Here's the dilemma:

In a facility, there are different workers who do different jobs. The patient is at the hub of the whole operation. The custodial workers gather their mops and sprays and stuff on a cart and go from room to room, cleaning, taking away trash, putting new liners in the cans, removing dirty linen and replacing it with fresh linen. The changing aides come around with their wipes, remove soiled linen, etc. then they go on to the next room. And so forth. The changing aide's job is finished and set up by the custodian who carries away the trash and laundry to places where other people dispose of the trash and do the laundry. That job is set up for the next shift by replacing the dirty stuff with clean stuff. When supplies dwindle, the purchasing agent orders new stuff and has it delivered to the facility where it is distributed to the various locations for the custodian to get their liners, sprays, etc. and where the changing aides grab their wet wipes, soap, shampoo, towels, underpads, etc. The whole machine works because every separate job supports the other jobs that other workers have to do for the patient's care.

At home, it's different because, even though the patient is tis still the hub of the operation, the entire rest of the staff is Y O U! When a changing/bathing aide arrives at your home at a certain time (regardless of how YOUR day has gone thus far), they expect their supplies, etc. will be stocked and available to them. When they leave, you put on your custodial hat and remove the trash, replace the can liner and drag the soiled linens and clothing to the laundry. The trash is placed into the receptacle that YOU take out on garbage day. At some point, you then start the washing machine and wash the laundry, put it into the dryer, then remove it, fold it and replace it in the patient's room or linen closet to set up for the next go 'round. You inventory the supplies and write the ones that need replenishing on your shopping list to purchase, bring home, unpack and restock so that they will be there the next day when the aide arrives again.

THIS is the problem! Everything has to be "ready" for the aide to arrive and do their job, then leave again. The "hands on" patient care is the LEAST of the work! It is the setting up, supervising, purchasing, restocking, etc. that comprises the lion's share of the work!! I don't mean to sound ungrateful for small favors, but that's NOT what I call "help."

So, with no ill feelings, I discharged the aide today as it's more trouble than it is worth for me to have everything ready for HER arrival at a certain time each day to do 15-30 minutes worth of changing and bathing. She goes on to the next person, or home for the day, and I am left with miles to go before I sleep so that things will be ready for her half hour appearance the following day... I am not getting a "break" - I am working to support her on her schedule! This is commonly called, "the tail wagging the dog."

What I NEED is assistance with some of the "background" support work to free me up to do other things (or NOTHING) that truly help support ME in caring for my mom. Unfortunately, that's the "invisible" part of patient care that medicare does not pay for...

NOW, if a changing and bathing aide brought supplies WITH them and took away the dirty stuff and returned it the next day all clean and ready for the next round - now THAT would truly be valuable assistance!

It ain't a perfect world, I guess. Thanks for letting me spew...

MomsBuddy, forgive me for laughing .I just went through a big argument with the home care agency.I have had the same, weekly aide for my husband that I had for my aunt.They were going to take her and give me a newly , what they call trained aide.This aide knows where everything is in my home.She and I have things organized so they are at her finger tips.I also have a downstairs closet where I keep supplies .I was not going to give up one that was so helpful to me and get one that was possibly second rate .After much rangling I got to keep her.When I get fill ins I have to be in the same room , show them everything and make sure they wash him, change the water as need and do all that is required to keep his skin from breaking down.Some of the newer and younger I have to show how to do a colostomy bag, and the texas catherator.Have to make sure they straighten the bed as I like.I HAD ONE, A VERY NICE PERSON , BUT , WHEN SHE WAS DONE I HAD MORE WORK THEN HER PRESENCE WAS WORTH SO I TOLD THEM NEVER TO SEND HER BACK.I even took pictures of her mess incase I needed to prove my point.The one I have 5 days a week is excellent.She has been doing the job for 30 years and is excellent.She does not need to be supervised and does an excellent job because she has a good work ethic.She asks me if I want the clothes in the washer, will fold the clothes , even fills my roll of toilet tissue when needed.She will go to the supply closet and get what she needs when items are low.Never leaves a mess.She knows how to deal with hubby when he is agitated and becomes physical.To think they were going to give me someone new was not an option for me and I let them know I had other options.
The VA pays for my husband daily care.So I contacted my case manager and told him what was about to happen and what were my options.I continue with this gal but on her days off I hold my breath wondering who will come to the house.The more mature ladies are great.The younger ones , too me , put in their time .I have told the nurses I am making a big poster , hang it over hubbies bed with a list of things that have to be done.When you have to be there all the time it does not serve you well.
I have to say I do want to be there when hubby becomes agitated because I do not want him to sucker punch or kick anyone.Some times on the weekend I wonder if it is worth it when I have to constantly tell someone what to do and be the teacher..They do seem to have a problem with the younger help.They do not take their job seriously.They are not prepared for the task that are involved.The turnover with younger aides are great.The older ones are more devoted and truly care. I HAVE REMINDED THE AGENCY FOR THE MONEY THEY RECEIVED FOR MY HUSBAND I WANT TOP NOTCH SERVICE.