By Pat Irwin
Got Mom or Dad to agree to accepting care—check. Found a caregiver with good references—check. Disciplining or firing a caregiver—help!
Finding the right caregiver for your parents or loved one can be your saving grace, your best friend, the linchpin that makes your caregiving experience a success. But when that relationship goes sideways— what then?
Some families don’t understand that they need so much more than a warm body to show up and provide care and support to their aging relatives. They also don’t understand that there are employment laws that still apply to in-home workers.
Take it from someone who has been there, to enjoy a successful caregiving experience it’s important to recognize that caregiving is a two-way street. From the person being cared for and the family members to the paid carer themselves, everyone has rights. Respecting and constantly striving to adhere to provincial and federal guidelines and reasonable responsibilities is essential in the caregiving relationship. These apply whether care is being delivered in the family home, in a retirement home or in long-term care.
Starting off on the right foot
A caregiver is part of your family and, for many, an essential part of their day-to-day lives. However, it’s a uniquely personal relationship so disciplining or even firing a family member is something no one wants to tackle without adequate preparation. The solution, as I see it,
is to put the caregiving relationship on a professional footing from the outset. After all, the key to any successful business relationship is a clear understanding of scope, responsibilities, and tasks—a caregiving relationship is no different.
What to expect
In the last few years, a number of provinces adopted a Bill of Rights for both caregivers and their clients. For example, let’s look closely at what clients and patients in Ontario should be prepared for:
As a client, you have the right to the following treatment by caregivers:
• Be free of mental, physical and financial abuse.
• Be treated in a manner that respects your privacy and independence.
• Professional care regardless of your ethnic, spiritual, language, lifestyle and cultural preferences.
• Take part in determining, and agreeing to, your care services.
• A clear explanation of the services you will receive and who will provide them.
• Express concerns about your service and decisions affecting your care without fear of retribution.
• The ability to appeal these decisions.
• Confidentiality and the privacy of your personal health information.
As a client, you have the following responsibility to caregivers:
• Treat caregivers with courtesy and respect, free from discrimination or harassment.
• Provide all information required for effective treatment.
• Help develop your care plan.
• Follow the agreed-upon care plan.
• Provide a safe working environment, including securing pets during visits if requested; not smoking during visits; and managing household hazards such as snow and ice.
Do your homework
So, can you just pick up the phone and “order” a caregiver? Think again! You’ll need to do a careful search. The key to success is the hiring family’s commitment to reviewing the patient’s day and clearly defining the required roles and responsibilities. If you’re doing the hiring, be sure to figure out:
1) What is needed, where, when, and how—a companion, a personal support worker, any special equipment.
2) What does the parent really need, what do they want and who will they accept? These elements may not necessarily align.
3) What does the adult in charge need help with and what will they be able to accept and pay for. Don’t be surprised if these differ from what the parents say! If there is a significant gap, it’s essential to sort things out before proceeding further.
4) What skills are needed?
5) What type of person is needed—quiet or outgoing?
6) What other attributes are ideal, such as language or culture?
Your objective is to create a safe, well-run home that anticipates and meets your parent’s needs and expectations now and into the coming months.
Due diligence and employment contract
Be cautious and undertake a comprehensive review of the applicant’s resume and qualifications that includes their health, police and professional references, willingness to follow special requirements such as pandemic protocols, etc. and their specific experience as it relates to the position you have in mind. It’s expected that a reputable agency will have already checked these items for any candidate they put forward. If you are hiring a caregiver privately, you should attempt to check these yourself from the information the candidate provides.
An Employment Contract for senior care is much like any other work contract. It states what the family or individual requires from a caregiver. It defines the place, hours of work (keeping labour laws in mind) and a description of duties. It should also outline the hourly rate, scheduled breaks, vacation, or missed work policies, use of cellphones during working hours, and other details specific to the role. It should clearly state escalation process for emergencies, causes for dismissal, and procedures for termination of the contract. This contract must be signed by both the client and the caregiver and may be updated or amended over time as requirements change. A probationary period of three months is recommended.
In a caregiving scenario, cause for immediate dismissal would include abandonment (leaving the client unattended while on duty), theft, being impaired by alcohol or drugs, illegal activity of any kind, or abuse of any kind—physical, emotional, or financial.
However, most issues that occur aren’t as clear-cut and will require discussion or investigation. Steps to understanding and resolution include asking your parents about the issue and how it affects them. Be mindful—if there is dementia, consider the hallmarks of the disease when a parent is worried about or suspects theft.
“Has Mom or Dad’s behaviour changed? Are they angry, fearful, more reserved? ” Remember back to when you chose this caregiver—what did you like about them? Has any of that changed, and if so,
how and why?
Also, ask the caregiver how they are feeling about their position and encourage them to speak freely. Is the workload too heavy—or too light? Are there any personal issues? Is the caregiver uncomfortable in some way? Ask the agency client manager what they can discover. The
agency should replace a caregiver with no questions asked, since they too want the best fit for everyone. And, last but not least, keep detailed records of all activities and discussions.
When you aren’t happy with a caregiver’s performance, it’s wise to issue a formal warning and clearly state your timelines and objectives. This is the role of the agency if they are working with you within the probationary period.
Firing a caregiver means needing to hire someone else to care for your parent. Use what you’ve learned from this experience to decide which qualities you want—and don’t want—in your new caregiver and try again.
How much do you really know about this caregiver, the person who helps your family’s life work? Be sure you get to know your caregiver, show interest in what they’re doing, check in on how things are going for them and say “thank you.” As Gertrude Stein said, “Silent gratitude isn’t much good to anyone.”
Pat M. Irwin, BA, AICB, CPCA, is the president of ElderCareCanada and a professor of distance learning at Centennial College.
Hiring someone is a business arrangement that requires a legal agreement to govern a working relationship.
Include in the contract:
• Schedules, including days, hours, and location the caregiver will be working.
• Compensation, including salaried or hourly rates, overtime, and holiday pay.
• Reimbursements for shopping, travel, medication purchase, etc.
• Pay schedule and type—cash, cheque.
• Taxes and deductions— what and who will make them.
• Vacation, time off and sick days (note, an agency will back-up their workers).
• Termination clauses and notice period.
Description of duties:
• Meal preparation— who plans, prepares, shops.
• Housekeeping, including laundry, cleaning, maintenance.
• Personal care, including bathing, dressing, toileting, personal care.
• Physical therapy, exercise, appointments, social activities.
• Privacy agreements on personal information and social media ban.
• Provision of supplies and adaptive tools such as walkers or wheelchairs.
• Contact information for all family members and health professionals.
• Escalation procedures in the event of a health emergency.