The Challenges of Hiring Home Health Aides

When my first husband had metastatic bladder cancer, our needs for help and support shifted frequently. One week, pain management would be our primary challenge. The next week it would be lymphedema in his legs.

It felt like we were constantly scurrying to address the latest challenge. As a caregiver, other people often advised me: “take care of yourself” and “get some help.”

Those are well-meaning, oft-repeated lines to any caregiver. And they are true and well-intentioned. You can’t care for someone else if you’re not sleeping well and eating well yourself. And most caregivers, especially for a patient who is seriously ill, cannot carry the burden by themselves.

Hiring help isn't always easy to do

But when it comes to hiring help, it is not so easy to do. America faces a caregiver crisis, both because of the burden placed on family caregivers and the challenge of hiring qualified help.

Here is my story about trying to hire help. We lived in downtown San Francisco. So, we were not in a rural or remote location, and there are a number of agencies and services available. Theoretically, that should have worked to our advantage. I initially thought that it would be nice to hire an off-duty nurse to help us. However, I quickly learned that is far too expensive and we really didn’t need a nurse.

Home health aides

Most agencies provide home health aides. At that time in San Francisco, a home health aide cost $25 an hour and we had to hire them for at least four hours at a time. Who are the home health aides? They were typically recent immigrants (which I am appreciative a willing immigrant labor force can and does assume this work) who received five or six weeks of training from the agency. Even though we were paying $25, the aide was receiving only about half of that per hour.

This was a highly reputable agency and that much training may be exceptional. Still, it is just five or six weeks of training to care for a very sick patient.

On the appointed first day, Sally was supposed to arrive at 9 a.m. At 9:30 we got a call from the agency that Sally was having trouble finding our building. She had taken the wrong bus and ended up on a different part of our very long street. At 10:15, another call told us that she was still challenged to find us.

Last-minute cancellations and other problems

Remember, we were in downtown San Francisco. I know any city can be confusing but should it be that difficult to find a downtown building? I then had to spend time on the phone trying to explain the directions. We ended up canceling the whole meeting that day because it would simply take her too long to arrive.

The agency decided to send someone else the next day. But then that person got sick at the last minute and couldn’t make it.

By the time we finally connected with someone a few days later, I was skeptical about how much help it would really be. But Marie was friendly and kind and seemed to pick up on details quickly.

I soon realized, though, that she was almost too friendly and happy for the severity of what we were facing. Not that I would want someone depressed, but she was relentlessly cheerful in the face of Ahmad’s pain and my frustration with trying to calibrate his pain medicine appropriately.

Can you complain about a competent aide being too happy? I wished she would just mellow a little bit. But how do I request that from her or the agency?

The complexity of bringing someone into your home

I realized just how complex it is to hire a stranger and bring them into your home. We dealt with a number of aides and most of them were very competent. But each had their own manner and approach. I sometimes felt like it was more incumbent upon us to adapt to them than them to adapt to us.

And while I understood the need for a minimum of four hours, I found that on many days, there was a 45-minute window where I needed a lot of help (helping him dress, getting to the car, taking medicines if he was confused or sleepy) and then a two-hour window in which I didn’t much help at all. I learned, during those times, to outsource routine tasks like laundry or dishes.

I will never again casually tell someone to “just hire some help,” as if that will immediately simplify their life. It will help but it isn’t necessarily as easy as we might assume.