By Rona S. Bartelstone, LCSW, BCD, CMC
In situations in which there are personality
issues because of cognitive changes or a history of
challenging relationships, the agency supervisor is
available to provide guidance and support to both
staff and care recipient. This can be very fragile,
especially if there is a lack of trust or behaviors
that are strange to the home health aide. The
support of a supervisor can help the aide understand
that this is part of the disease process and cope
with behaviors so that the aide and the client can
have a successful relationship. Often, supportive
supervision is the key to making a challenging
situation work.
Case Example: Mr. B lost his wife who had cared
for him for over 60 years. He needed help with
shopping, meal preparation, transportation and an
appropriate selection of clothing. His family had
hired many aides on his behalf. It seemed that Mr. B
would fire every aide after only a few days, always
stating that they didn't know how to do anything
right. When Mr. B came to us, the home health
supervising nurse spent time talking with him about
his needs and expectations.
She learned that Mr. B was unhappy because none
of the aides did things the way his wife had done
them and this made him feel uncomfortable in his own
home. The nurse supervisor explained that everyone
had different ways of keeping house. Mr. B was
amazed because he thought that all women learned the
same routines. Having realized this, the nurse spent
more time with Mr. B to find out what was happening
that was different from what his wife had done.
Amazingly, small things like letting dishes air dry
on the counter, versus drying them and putting them
away, were distressing to him. By going through the
daily routine and learning about Mr. B's
expectations, the supervisor was able to provide
clarification to the aide and the first one placed
in the home was able to be successful and have a
multi-year relationship with Mr. B.
The employer, whether it is a private individual
or an agency, has a great deal of responsibility in
hiring and managing a home health aide. This
includes responsibilities that are financial, legal
and involve governmental regulations. When a family
is ready to hire home health aide services, they
need to make a basic decision about the source of
such assistance. This decision needs to take into
consideration the type of help needed, the financial
and tax implications, the need for supervision and
the relative vulnerability of the person receiving
the care.
If the family is unwilling or unable to assume
the full range of responsibilities, they would be
better off working through an agency. If the family
chooses to hire privately, they need to consult a
lawyer and an accountant to assure that they make
proper arrangements for all of their obligations. In
addition, they need to stay involved in the
relationship to assure proper care and a mutually
supportive relationship.
