The quality of service from home care providers and their staff can vary greatly. This article lists potential problems encountered when receiving home care services.
Patient: The individual receiving care.
Client: The patient, or someone such as a family member acting on their behalf to maintain the relationship with an HCP or caregiver.
Home Care Provider (HCP): An organization that coordinates and manages in-home care services by maintaining a roster of caregivers. The provider is responsible for scheduling and dispatching caregivers to clients based on their needs.
Caregiver: An individual who provides in-home support services such as assistance with daily living activities and companionship. Caregivers may work independently or be employed by an HCP.
- Omitting travel time between patients, making it impossible to visit every patient per the schedule.
- Overlapping patients; placing a bet that multiple patients can be visited in the allotted time.
- Scheduling a visit mere hours or minutes before the visit is to start.
- Calling the caregiver during the work shift.
- Requiring the caregiver to do tasks during the work shift that are not of interest to the client, such as maintaining timesheets or filling out forms.
- Assigning a large rotation of care staff, all of whom need to be brought up to speed each time by the client.
- Assigning staff to patients who lack the necessary qualifications to provide required care, such as operating ventilators or lift equipment.
- Deliberately avoiding accepting information about the patient's needs, such as the need for their staff to understand how to operate critical equipment, so as to avoid responsibility for its misuse.
- Reassigning problematic staff to other patients instead of disciplining them or terminating them.
- Ignoring complaints, or avoiding addressing them in a meaningful way.
- Blaming the patient for personnel issues, citing a lack of clear instruction, inadequate care supplies in the home, personality issues, etc.
- Showing up late consistently, but staying barely within the HCP's tardiness policies.
- Showing up late, but leaving on time, thus shortening the shift.
- Skipping a shift and claiming that the client cancelled it.
- Making their own schedules; the client may not have a way to know what the real schedule is, so they unknowingly accept whatever is presented, no matter how inconvenient.
- Checking in with their employer's scheduling platform, but not from within the client's home.
- Leaving the client's home to take phone calls or sit in their car during a portion of the shift.
- Leaving the client's home early without confirming with the client that all necessary tasks have been completed.
Example: Caregiver conspiring to avoid a shift
Background: A home care visit was scheduled for early in the morning.
- The caregiver calls about half an hour in advance of the shift, and hangs up after only a couple rings. The call is missed by the client.
- The caregiver repeats this action again a couple minutes later.
- With the caregiver nowhere to be found, the patient gets help from others in the home instead.
- Much later in the day, the caregiver calls back and offers to do a visit.
- The patient declines as they have already received care from others.
- The caregiver informs the HCP that the patient has declined the visit for the day.
The caregiver would still be paid in such a circumstance, as most HCPs have policies about late cancellations not affecting pay for staff.
- Claiming that a given task is not within their scope of work, sometimes adding that their supervisor would not allow the task to be performed if they were to find out.
- Claiming that a given task is unsafe, such as needing to use a sharp knife to open a package.
- Claiming that there is not enough work to do, and that they should be able to leave early.
- Doing an undesirable task poorly, to prevent being asked to do it ever again.
- Leaving tasks incomplete, placing the burden on family members or caregivers that live with the patient.
- Treating the patient in a way that silences their voice and disregards their opinions.
- Engaging in inappropriate conversation topics.
- Engaging in inappropriate touching, such as massages with inappropriate boundaries, or sexual touching.
- Altering the patient's diet unilaterally, possibly ignoring important considerations such as allergies.
- Giving unsolicited medical advice.
- Giving unsolicited opinions on family dynamics or other household affairs.
- Making changes to the layout of the home, such as where supplies are kept.
- Stealing supplies, such as gloves or masks.
- Using resources in the home without permission, such as phone chargers, or coffee makers.
Poor quality care unfortunately is quite common because the clientele are often dependent on receiving the care, and have a low risk tolerance. Still, there are ways to maintain a higher standard of care.
- Ask for a copy of the schedule. This makes it harder for caregivers to unilaterally change it.
- Use a smart doorbell or security system to maintain a log of when the caregiver enters or exits the home. Report problems to the HCP, or if applicable, to the government.
- Promptly report bad behavior before it has a chance to become normalized.