Originally posted to Quora 29 November 2017
The first thing to be said – great caregivers don’t do this job for the money, the appreciation or the respect. The best ones do it out of a sense of duty and conscience for their fellow person.
Home caregiving in particular is a job with a lot of moving pieces that are constantly changing. There is a constant scramble between homes in different locations, gaps in schedule and rushed distances. Client conditions ranging from frailty to mental illness to brain injuries to developmental disabilities. There are a lot of areas where something can go wrong. Caregivers with a deep and visceral need for routine are probably better looking at facility or hospital work. Given the state of the home care industry currently, the ability to cope and adjust to change on short notice with a degree of grace goes a long way to ensuring long-term sanity.
Home caregivers will at some point be emotionally overwhelmed and question the sanity of their job choice. They may work excessively long hours, frequent split shifts and have gaps of unpaid time during the day. They are rarely appreciated half as much as they deserve. The most challenging clients that require the most patience and attention are often the most hurt and insecure. Often unable to appreciate or to see past themselves to what others are doing for them. Many clients will refuse or resent their own need for care. Caregivers see people in some of the most intimate and vulnerable positions they ever experience. They build trust, sometimes inches at a time, in order to gain acceptance and access someone’s vulnerability in order to provide for that person’s needs. They often do what needs to be done even when everything else in their day goes wrong. Tired, rushed all day, working late, it’s someone else’s fault and the last client needs a little extra too. Some caregivers meet the need, some have been pushed past the point of being able to meet the need and some have already left.
People & Work
Over the course of years home caregivers see most aspects of humanity. People give them secrets, wishes, tears, anger and unpredictability; often seen through the lens of an illness or cognitive issue. They can be adored in one hour and reviled the next, repeatedly, within the same day. Excellent personal and emotional boundaries are required. The work is often physically demanding and the rates of injury are among the highest of all service professions. People facing eventual loss of communication ability and movement, such as those with a motor neuron disease, requires caregivers with a highly detailed, patient and intuitive capacity in order to communicate in the later stages of the disease.. Some people you would adopt, some you would murder. You care for all.
Good or bad there will be one. Look up the local providers in the area and read the job reviews on ratemyemployer or glassdoor. Standards of operation tend to vary wildly even within a single employer who has different locations. Culture can shift dramatically with the departure of that one scheduler who always made sure people were looked after. Smaller operations in particular can go through manic shifts due to scheduler or manager turnover. Livable employment is hard to come by in home care these days. Be your own advocate, practice self-care and document your interactions if you aren’t being heard.
Even if home caregivers never communicate with admin employees they still get a schedule. Their scheduling will be the primary reason they stay or leave. Unreasonable travel times and frequent gaps between client may mean they’re often working for free. Or it means less time with a client. Or more rushing. Due to scheduling errors they may be sent to the wrong place at the wrong time and often deal with an unhappy client who sees them as the responsible party. Many cope with a lack of consistent income or high needs clients too frequently. It’s easy to understand how burnout occurs.
Schedulers are find the least bad way through an emotionally charged landscape of constantly changing client needs. For unfilled visits that have no available caregivers, someone will generally be asked to work on their day off or outside their availability. The asking is often a source of pain to both caregiver and scheduler for various reasons and time may be a factor in deciding the order of priority for calls. Schedulers should be calling the best choice in the order of least harm. In the end, it still means choosing someone to be pushed further than their preference.
There is a serious lack of operational comprehension across the home care industry in regards to scheduling. It drives the bulk of client and caregiver complaints and many work related injuries. Rush is the killer of care and emotions are infectious. Giving caregivers enough time to get from A to B with consistent livable pay and humane scheduling allows them the time and security to focus on their client.
Great home health aides are not always valued for the skilled, intuitive, compassionate individuals that they are. In the private industry, wages generally reflect this lack of appreciation for what is required. The question I always encourage clients to ask when they are looking for home care is “Are the employees paid a living wage?” If they are not then it’s fair to expect high staff turnover, a less skilled workforce and more frequent absenteeism. All of which destroy client continuity. Government home support workers in Canada tend to be slightly above a living wage with good extended health benefits and an ok pension. Private home support workers tend to be paid moderately less than a living wage with scant benefits and no pension. Combined with the constant inconsistency of hours; job security is often a concern. A large discrepancy between home care and facility or hospital pay drives turnover as well.
Intuition is essential. Being able to know what someone needs without being told reflects a level of attention to detail that is essential for many complex care clients who are unable to speak or communicate clearly. Going into someone else’s home for the first time, knowing how to approach, when to ask questions, what events are triggers for agitation or anxiety. That attention to detail and other-focus reflects deep seated empathy and compassion.
Reliability – First about effective communication and second about frequency. Last minute absences and change are generally the most emotionally charged and create the most turmoil for all involved. Policies or cultures that discourage or disallow caregivers to ask taking time off when they need it increase these absences. Caregivers with frequent absences, more than once a month, who provide the advance notice possible should be supported but avoid training with complex or high needs clients. Unlike many jobs, caregivers are often contacted at all times of day, perhaps many times a day which can lead to burnout and feeling a lack of privacy. The admin should be trying to accomodate the constraints the person’s life requires.
Self-awareness – Caregivers ability to understand their own limitations and capacity. This usually leads to better self-care and personal boundaries. Skills caregivers develop for themselves they extend to their clients. Insightful self-care oriented caregivers are looking forward to assess risk for themselves and others. They are more likely to be self reliant, to innovate and often work well with dementia clients.
I’ve personally worked as a caregiver, scheduler, operations manager and agency owner in Canadian home care, government and private sector. A caregiver for a period of months and then moving into the bowels of scheduling for many years before owning and managing my own agency.
TLDR – Do it because you want to do it, not to have a job or a career. Practice self-care, protect yourself and have good boundaries. Be consistent in your assessments before lifting and other risky activities. Injury rates are high, often back, neck or shoulders. Scheduling is a huge problem, be nice to the good admin and don’t tolerate the bullies. Compensation & job security for caregivers in Canada is good in government and poor in private sector. The work can be very rewarding for those that can change with the changing requirements of their clients. Do the due diligence on specific employer locations, consider a second employer and don’t be afraid to jump ship. Good caregivers leave and clients follow.