Starting Services

Most people value their independence. You may find that it is hard for the person who needs the care to accept help from others. A confused older adult may have difficulty understanding why a worker is needed and may be afraid of being harmed or robbed. Including the person in planning for home care services is a sign of respect and may help that person accept care. The more the person receiving care is involved in the decision-making process, the better. It gives him or her the opportunity to discuss concerns, feelings and hopes for the future.

Plan Ahead
Planning ahead may lessen the older person’s resistance. If the person does not agree with the plan for home care services, he or she may unexpectedly cancel the service. You may find it useful to develop a plan, in advance, with the worker on how to manage this issue. It may be helpful to also include the older person in this problem-solving process.
Good communication is critical to the success of your relationship with the home care worker. A thorough orientation is extremely important in order to get the relationship off to a good start. The better the employee understands what is to be done, in what way, and how often, the better he or she can do the job. Be CLEAR and SPECIFIC in your explanations. Take the time to discuss details and really listen to the worker (concerns, questions, and suggestions).
If you are working with an agency, listen carefully to the guidelines and boundaries it has established. There are many tasks that your worker can do for you and there are others that he or she may be unable to do because of the agency’s policies. Don’t put the worker in the uncomfortable position of performing tasks that are not allowed by the agency or cannot realistically be done.
Discuss problems or concerns as they occur. The sooner an uncomfortable situation is resolved, the better off for all involved. Often people are hesitant to discuss a problem because they fear the worker will leave. If you are not satisfied with a situation, it is important to discuss it with the worker as soon as possible. Don’t expect perfection. The home care worker cannot do everything the way you would. Be open to renegotiation in order to maintain a good working relationship.
Cultural Diversity
Be aware that people from different backgrounds often have different styles of communication. Cultures differ in terms of what is considered acceptable behavior. Behavior that appears rude may simply reflect cultural differences. To develop sensitivity for one another’s backgrounds, it is a good idea to discuss early on in your relationship topics such as communication styles, attitudes towards family, touching, and asking personal questions. Try to understand an employee’s culture by asking questions and then demonstrating respect for his or her culture.
Employer Checklist
The following are key issues to discuss on the first day:
Days needed
Hours needed
Rate of pay or method of payment
Car fare, gas reimbursement, or mileage
Vacation/Paid or unpaid?
Emergencies/Hospitalization of client
Make-up time
Meals/Food provided?
What to do in an emergency
Supervision procedures
Record keeping
Social Security
Disability/Worker’s Compensation
Managing client’s money
Notification of termination
Emergency Procedures
Be prepared for emergencies. In a convenient, visible location post important telephone numbers, including those of family members and physicians. Make sure Medicare, other insurance information, lists of medications, and identification cards are accessible in case hospitalization is required.
Important Telephone Numbers:
NAME: _________________________________________
ADDRESS: __________________   PHONE #: ____________
MEDICARE #: _______________   
OTHER INSURANCE #:_____________________________
DIAGNOSIS: ____________________________________ 
MEDICATION ALLERGIES: __________________________
To Be Notified:
Home Phone Number
Work/Cell Number
Other Contact Names:
Phone Number
Social Worker:
Home Care Worker:
Home Care Supervisor:
Hospital Preference:
It is important to review safety procedures for both inside and outside the home. For example, discuss potential hazards in the bathroom and kitchen. Talk about home security including locking doors, key arrangements, and use of indoor and outdoor lighting.
Most people find it helpful to make arrangements, in advance, for shopping and other activities that require cash handling. The worker may not be able to use his or her own money; therefore, funds should be available for anticipated expenses. Be sure to ask for receipts for all expenditures.
You may want to discuss how to handle transportation costs. As the employer, you can choose whether or not to reimburse travel expense incurred during working hours. Items for discussion can include travel to and from work, use of worker’s car on the job, car insurance coverage and other travel arrangements.
Cancellations and Absences
Come to an agreement about absences or cancellations for both the worker and the person receiving the care. Who should be contacted and when? Discuss payment procedures if a hospitalization occurs. Be aware that the worker may seek other employment if he or she is not paid during a hospitalization.
Dietary Likes and Dislikes or Dietary Restrictions
Because food often seems to relate directly to one’s sense of happiness, this topic deserves attention. Sharing family recipes may be a big help in creating a positive atmosphere. The worker may enjoy the challenge of creating something new and the older person may appreciate the opportunity to show off one of his or her specialties. Dietary restrictions should be discussed to avoid mistakes, problems or health hazards.
A home care nurse is trained to give medication. Some home care workers are able to monitor medication usage and provide reminders for the older person. The attached medication chart will come in handy.
Medication Card For : ________________________________
Name of Medication & Dosage
# of Times Per Day
Times of Day
House Rules
Every home has its own unwritten rules about such issues as smoking, TV and radio playing, use of the phone, house temperature, acceptable eating areas, guests, pets, etc. Talk with your worker about your house rules.
The Person Receiving Care
The worker will want to get to know the person needing care. Introduce them. Discussing the following topics may help break the ice: hobbies and interests, profession or trade at retirement, relationship with family and friends, bathing and dressing habits, and feelings about needing a home care worker
Routine and structure help create a sense of security. Everyone will benefit from knowing what happens when. Acquaint the worker with daily routines. Discuss what occurs during a typical day.
The following sections may assist you in finding help for your loved ones: