Appeared in Hospital News, Volume 13, No. 6, June 2000
Imagine that you have recently had a catastrophic injury. You completed the acute phase of your rehabilitation, which means that you are medically stable; however, you will never walk again. This may also mean that you are unable to feed or dress yourself, depending on the extent of your injuries. All of the hospital staff have been very supportive, including teaching you techniques on how to develop life skills. You have attempted to "deal" with all of the psychological stressors with your situation, and now arrangements must be made to secure equipment and services within the community. It is logical to rely on the professionals' advice; however, the professionals have never "lived" with a disability. They have probably recommended a few nursing agencies within your community to facilitate your care. This may include your occupational and physiotherapy.
The following information will discuss the pros and cons of different ways of receiving home care.
Using an agency
As with any service, there may be some potential problems in using an agency. My 20 years of experience in using attendant care has shown that most agencies do not adequately prepare or inform their staff regarding the client's situation. They may be working with an elderly patient with Parkinson's disease one day, and someone who is young and who has a spinal cord injury the next. The needs of each individual are varied, and it would be unrealistic for an agency to train all of their staff to meet each individual's needs.
If an agency happens to retain a competent, caring and reliable individual, they can be exploited. It is usually these "good" employees who are expected to work too many hours per week because all of their clients request them. The agency will probably send their best employees to nursing homes for an eight-hour shift, rather than to someone's home for a few hours. This only makes sense from a business standpoint.
In order to make a profit, agencies charge a premium to recruit, train and administer the necessary paperwork, such as payroll for their employees. Depending on the agency and the geographic location, attendant care may cost as much as $16 per hour; however, their employees may only earn between $9 and $11 per hour. Agency staff are usually compartmentalized in what they can do. In some cases, they are not allowed to perform certain tasks, such as providing medications, or they may not be able to drive their clients to appointments and errands. I have always worked since my accident and I need to get up early. I have found that agency staff are not prepared to come early, which does not provide sufficient time to get ready and go to work.
The positives of using an agency is that they handle all of the administrative functions such as recruiting, training and payroll. They are also good backup attendants for those you hire. If one of your attendant is sick, or is unavailable, using an agency for a few days can provide assistance in the meantime. Agencies are also a great source of securing attendants when you're away from home.
Hiring your own help
There are some logistical problems in hiring your own attendants; however, it has been my experience that this is the best way to ensure that your needs are being met long term, while creating a positive atmosphere for the attendants.
If you live in a metropolitan area, it is a lot easier to recruit attendants. Living in a rural community decreases your chances of finding appropriate attendant care. I find that individuals who have not worked in the health care industry usually make better employees. They can be instructed as to how you want things done, and they will not battle with you over techniques and methodologies.
Advertising for attendants in the General Help Wanted section of the local newspaper has given me the best results. When I lived in Toronto, I received hundreds of responses per day from an ad I placed in a paper with a more general audience, compared to ones geared toward professionals. Now that I live in the smaller city of Burlington, it is more difficult to find the appropriate help, but persistence pays off. Once you have refined where and how you will advertise, it is important to develop a "script" for what questions to ask potential attendants to eliminate people who may not meet your needs. This should ensure that only individuals who fit your lifestyle and philosophies come for an interview. It is important that references are provided from people who had to rely on these potential attendants.
It may also be a good idea to try the individual out. It is one thing to discuss the job during an interview, it is another to actually perform the work. You could have them come in during your care and shadow an existing attendant, or you may feel more comfortable teaching them yourself. Most people learn from seeing what others do, and so it may be beneficial to have an existing attendant show them the routine. Regardless of whether you hire your own attendants or use an agency, you still have to direct your own care. It only makes sense to hire someone yourself, whose allegiance is to you and not to a third party. Most of the duties are not that difficult, and it is not that hard to train your own attendants. You may find drafting a "letter of expectation" clearly states your wishes and wants, and may minimize the frustration of explaining the duties over and over to numerous employees. I clearly state in my letter of expectation that attendants may assist with anything that I am unable to do as a result of my physical limitations. This means they may be assisting with my company's paperwork, driving me to appointments or performing personal care. This provides me and them with more diversity and flexibility.
If you hire your own attendants, you can pay them more money, and still save on your overall costs. Why wouldn't an attendant want to make $12 per hour for the same work? You pay the attendant an extra $3 per hour and eliminate paying the agency the extra $3 per hour for their administrative functions.
A good attendant will probably stay with you between six months and two years. After that, they usually become complacent. I joke with my attendants that the position is not upwardly mobile. They cannot become me! If a good relationship is established, each party can provide the other with sufficient notice to recruit a new attendant.
