When Problems Arise During In Home Care:
Warning Signs and Coping Strategies

By Robert F. Bornstein, PhD and Mary A. Languirand, PhD

In some earlier blogs we talked about caregiver stress and how to manage it, and also about strategies for finding good in-home care….another way of easing the burden and reducing stress. In this blog we discuss what to do when problems arise during in-home care.

Make no mistake: The majority of caregivers are good and compassionate people, devoted to their patients' well-being. Some, however, are not. No matter how carefully you evaluate things ahead of time, it is impossible to predict with 100 percent accuracy how someone will perform in the future. So here's what you need to know….

Important Warning Signs of a Poor Home-Care Worker

These include:
  • Unanswered phone calls or a constant busy signal
  • Television or radio remaining on throughout the day
  • Late arrivals, early departures, last-minute cancellations
  • Health care equipment (needles, swabs, etc.) in the trash, instead of properly disposed
  • Significant decline in the cleanliness of the home
  • Evidence of illegal drugs in the home (for example, lingering odor of marijuana)
  • Signs that the caregiver has been drinking alcohol while on the job or before arriving for work (for example, alcohol on the caregiver's breath)
  • Presence of other people in the home (for example, unexplained visitors, the home-care worker's children)
  • Frequent complaints on the part of the care receiver
  • A troubling change in the care receiver's behavior (for example, increased depression, agitation, or confusion)
  • Reports from neighbors that something is awry
  • Any sign-no matter how "minor"-that abuse, neglect, or exploitation has taken place (these signs are described in detail below)

Confronting a Poor Caregiver

It is important that you confront a caregiver promptly when you suspect something's wrong, but the way you confront the caregiver is critical. Be tactful but firm. Try not to sound accusatory or blaming, but express your concerns clearly and directly. Ask specific questions about the care receiver's concerns, as well as your own. Don't mince words. Ask questions until you're completely satisfied with the answers. If something needs to be changed, continue the discussion until you've developed a mutually agreed-upon plan of action. Set a follow-up meeting to assess how well the changes are working. And if, after you've pressed the issue, you conclude that something is wrong and it can't be fixed, do three things:

  • Document the problem-take detailed notes describing the problem, photographs if necessary.
  • Terminate the service, and begin the process of obtaining replacement service.
  • Report your suspicions to the home health care agency if the caregiver is an agency employee, or the appropriate state licensure/certification board if the caregiver is an independent provider.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here's the link: