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Thread: Son's insurance is offering us Self Directed Option for services -- advice?

  1. #1

    Son's insurance is offering us Self Directed Option for services -- advice?

    Hi folks!

    We have had some horrific caregivers over the last 12 months, from perishable food left out on the counter all day then fed to him, to 2nd degree burns, to people who don't show up leaving him alone for 20 hours while we were away.

    They have not been all bad, and most of the horror was from the first agency and when we switched to a second agency there was an improvement. But there are still some scary ones.

    My son's insurance case manager has set up a meeting with us and wants us to consider self directed option for care. She said we can hire his caregivers directly and/or we can provide some of the services. We do not want to take over his care giving, I work and I am already doing his bowel routine, managing his meds, and re-doing what the caregivers do badly.

    As a past employer of many types and skill levels I can imagine what headaches this might entail.

    But the prospect of hiring on a caregiver, by caregiver basis is attractive. The agency has not been able to replace a few people we really don't want unless they have done something horrible (like the one that is with him 20 hours a week that won't speak to him AT ALL because she says she's moody -- that's not a reason for replacement so he is stuck with her. She is suppose to provide companion care services. Yeah.)

    Any advise? Is it a nightmare? Should I just continue to lean on the agency to provide better service?


  2. #2
    You can probably do better on your own. Learn how to properly interview and screen. Read back in this forum for tips from others who hire non-agency help for recruiting, interviewing, contracting, hiring, and, when necessary firing. There are also some good books out there on attendant management that can be a big help. Ones I can recommend include these:


  3. #3
    Junior Member
    Join Date
    Mar 2014
    Washington State
    I am brand new to this side, but have been an incomplete quadriplegic since 1976. So, this is my first post, so pardon me for what I don’t know.

    Anyway, I do both. I have care provided by an agency, in addition to hiring my own care. I live in the state of Washington, and direct hires are called individual providers (IP’s). There are pluses and minuses to both.

    Receiving care from agencies means that caregivers are replaced, either permanently or temporarily if they become ill. I’m really surprised to hear about the “moody” caregiver. I know with the agency I work with I have the right to ask for a caregiver change whenever I like. One just needs to be careful because one can be labeled as “difficult”. And, if that starts to happen in might be hard to get in with different agencies if that reputation begins.

    For myself, I have found it helpful to know exactly what the agency’s policy said about caregiver replacement. And remember, just because their policy states that, doesn’t mean it’s a legal. I have found that knowing what the laws state in Washington concerning long-term care and Medicaid funding goes a long way. Or in your case, what your insurance company's policies are concerning long-term care. And always remember, just because they say it doesn’t make it so. And what I mean by that is that those social services individuals providing service often do not know what the laws say, and give inaccurate feedback. One of the best forms of self advocacy is to be able to educate service providers concerning the law, so you have to know what the law says!

    My one big piece of advice I have when a hiring a caregiver is to start off with a really good job posting description. And you wanna be able to sell the desirable parts of the job, state what your expectations are upfront, and do a facebook “stalking” of people that apply. Below is one that I got off of craig’s list to use as a prototype to formulate my own.

    Home Health Care Aide (Paid Training)

    HIRING IMMEDIATELY with PAID TRAINING - On Bus line - Make a difference in the life of a young man with developmental disabilities. Implement daily living program. - Provide emotional support, intensive behavior modeling and instructive companionship. - Maintain knowledge of clients to ensure needs and goals are being met using individualized software for accurate documentation - Respect the rights of clients. - Maintain positive communications. - Instruct, support, assist and encourage client toward independence while ensuring their health and safety. - Participate in staff meetings and required trainings - Additional duties as assigned.

    APPLICATION PROCESS- Communications: E- mails and phone calls with questions about the position will not be answered. Only those sending completed applications will receive an interview.

    PLEASE GO TO Website: xxxxxxx apply. Note: Application file must be saved after completion and then e-mailed.

    Benefits: Excellent Opportunity for applying skills in the fields of special education, psychology and human services. Share and learn from others providing intensive in- home care and support to a client with developmental disabilities. This position offers a chance to be paid while learning and putting into practice the skills needed to be successful in the human service field of developmental disabilities - Learning respectful communication, positive behavior, and attention to detail. - We are a state certified DSHS agency, instruction and support are key components of the service we provide. -Work scheduling around classes and other personal needs are taken into consideration. - We consider each staff person a valuable asset to our success of providing quality care. -Our team of care providers and supervisors seek to provide a respectful working environment -Experience through this job will be beneficial and can be applied to many other professional situations.

    Qualifications: Washington State Driver\'s license and insurance. - Satisfactory criminal background check.(Agency will conduct) - First Aid, CPR & Bloodborne pathogens certification within 30 days of hire. (training provided if needed) - Authorization to work in United States. - 9 month minimum commitment!

    Knowledge and Critical Skills: Patience, emotional fortitude, strong moral character, excellent communication skills, dependable, motivated, self- directed individuals who have a demonstrated ability to work independently as well as part of a team in a stressful environment are required. -

    Physical Requirements: Sufficient strength to lift a maximum of 75 lbs; the ability to communicate verbally at a level sufficient to perform the essential functions of the position is required. - Ability to work in an environment with service dog in training. “

    Once you have a good job description you can use it over and over again when looking for new caregivers.
    I recruit caregivers off of craig's list, and the local colleges that provide education in nursing and social services.

    The other thing that is super helpful is the utilization of a “caregiver notebook” . In the notebook, I have daily and weekly monthly, and every three months task sheets that need to be signed off each day with the caregivers initials, so I know who’s doing what. Additionally, they sign in and out every day with how many hours they worked that day and ad to a monthly running total. Here is a link a with a template or prototype of one. ("caregiver manual templet" in orange letters on of bottom right pg)

    It can be super intimidating and scary getting caregivers in that are competent and want to stay on for an extended period of time. But, once you get the hang of it, it gets to be a lot easier. You get a system in place that you can use over and over again. I also keep a list of all the caregivers I interviewed over the years, and notes so I don’t need to repeat the process again with the same individual when I get to the point were I need to hire a new caregiver.

    I use speech recognition, so there may be a ton of typos above, I did not want to edit!

    Good luck!

  4. #4
    Senior Member elarson's Avatar
    Join Date
    Mar 2012
    The Netherlands
    We also hire care directly. I agree with everything that So-n-So wrote. For advertisements, the more explicit the better, to make sure there are no mis-communicated expectations.

    We live in the Netherlands, and receiving a Personal Care Budget to hire our own care is a lot of work administratively. Formerly we hired through agencies, but found it more work overall, especially with administration, and it was harder to replace them if they did not work out. By hiring directly we can require them to do administration in a way that works for us and we can be very firm about what we require.

    We have Excel spreadsheet invoices that they fill out that I link to for the needed administration provided to the government, which saves a lot of time. Our contracts reference current care requirements, which are well defined in writing and updated as-needed, and we train them using the requirements.

    Although it all takes longer to setup at the beginning, if you invest the time you can save a lot of work and problems with not getting the type of care you want, or having bad care that you can not get rid of. Labour laws are strict here, so our contracts only list variable hours with a 30 day cancellation. In reality, this means if they are not working out, we just won't schedule them.

    Because I need to sometimes travel for work, I've setup everything so that I can be managing and administrating remotely if needed. We use Google calendar for scheduling, and have a blog with all the important "Crew" information that we keep up-to-date.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  5. #5
    I was hiring my own care before I moved into this facility. Caregivers got scarce where I was living in North Scottsdale. It's kind of the "yuppie" part of town, especially considering I lived in the guesthouse on my parents property. I was having lots of issues going through companies here when I lived in an apartment more in the city. A couple of times the company sent out a girl that only spoke Spanish. I speak very little Spanish so you can imagine how difficult that was. I came up with a great ad that I would post on craigslist. Caregivers usually lasted anywhere from 6 to 9 months although my last day time caregiver I had was with me for over three years. We had lots of fun together and she had no problem hanging out after her shift was over occasionally just to do stuff. Here's the ad I would place:
    Caregiver needed for a 34 year old C-5/6 male quadriplegic. Job duties would include cooking, cleaning, helping me with my daily living activities, the occasional wound care,, driving, and basically being my fingers when I need things done. I try to keep things simple and little bit fun.
    Requirements would be dependability, dependability, and a general good nature, and oh yeah, did I mention dependability. Also, dependable transportation and fluent English are a must. Experience would help but is not necessary. I have no problem training people for a relatively simple job. I am looking for someone in their 20s to 40s considering we'd be spending a large amount of time together, but that's not set in stone. I do have a dog so if that's a problem let me know.
    The hours I'm looking to fill would be Weekend days from 9:30 AM until roughly 12:30 PM at $9/hour and Weekend nights from 8 PM until 10 PM at $20 a night. I'm looking for a separate caregiver for each shift.
    If this job interests you send me an e-mail with your phone number. If you have any experience, please note that also
    I'm located in North Scottsdale around Scottsdale and cactus roads.
    C-5/6, 7-9-2000
    Scottsdale, AZ

    Make the best out of today because yesterday is gone and tomorrow may never come. Nobody knows that better than those of us that have almost died from spinal cord injury.

  6. #6
    Thanks guys!

    "And always remember, just because they say it doesn’t make it so." Is so true.

    I have had agencies blow so much smoke up my butt it should be coming out of my ears. I ordered the books, and your ads are really helpful. We are going to go on the pay our own way plan. The insurance plan finger prints them, does a level 2 back ground check and pays them. But if they fail to show, we have to stand in. But that's what's been happening all along anyway. Neither of the two agencies he's had have put in a substitute when he's had a no-show anyway. They use us as their substitute!

  7. #7
    Senior Member forestranger52's Avatar
    Join Date
    Feb 2007
    From a small cabin in the big woods of The Allegheny National Forest, PA
    I have had agency supplied attendants for almost 10 years. Community Resources for Independence in PA always supplied an ON-CALL one when the scheduled one went missing.

    My 2 year old agency, Voices For Independence is a terrible joke. Now they say I need a back-up plan. Never told before or I would never have bought and remodeled my Camp here in the forest. Not everyone has family or friends that can be depended on.

    Must now sell and move to a big city.

    Good luck, hope the hired help works out for you.
    C 5/6 Comp.
    No Tri's or hand function.

    Far better it is to try mighty things, to win glorious triumphs, even though checkered by failure. Than to take rank with those poor spirits who neither enjoy much or suffer much, because they live in the grey twilight that knows neither victory or defeat.

    Teddy Roosevelt

  8. #8
    When you are recruiting and interviewing, ask if anyone you like but do not choose would be willing to be available for back-up/emergency on-call. Even if you have to spend your own money to train them, and do a background check, it may be worth it for the peace of mind. Attendents have family problems and need occasional sick days just like any other employee. I always told my mother's attendants that I did not want them working when they had an URI (even with a mask) for fear she would catch it and it would turn into pneumonia.


  9. #9
    Senior Member elarson's Avatar
    Join Date
    Mar 2012
    The Netherlands
    We did what KLD suggested, except we specifically recruited for "backups". We have a primary care person, who has been with us for 4 years, in the mornings on weekdays and I do the evenings and weekends. We recruited for people for vacations, sick days, and occasional help on nights and in the weekends when needed. We hired 2 "backups" and trained them at the same time. Although it cost more, we really wanted to build a "crew" so we also had our primary care person part of the training. Because we want to keep the "backups" up-to-date, we have them come about once a month for care, even if the primary care person is available.

    When the primary care person needs time off she will put it in our Google Calendar and then I will invite the backups, who then let me know if they are available to fill in. Although Google Calendar does not work great for scheduling, most other options require a monthly fee and were more than we needed. If you do a Google search "employee scheduling software" you will find a lot of them, and some can also be used for time tracking and billing.

    I would never go back to working with agencies if we can avoid it. They are a rip-off and add more work in my view.
    Partner of an incredible stroke survivor. Limitations: hemiparesis and neglect (functional paralysis and complete lack of awareness on one side). Equipment: TiLite ZRA 2 and 2GX, Spinergy ZX-1, RioMobility Firefly. Knowledge: relative newbie for high-level equipment (2012), but willing to try to help others who are new with similar limitations (definitely not a guru, but inquisitive).

  10. #10
    Thanks guys. His insurance does a level 2 background check and as for experience, we've seen what that's worth. I would take a friendly good natured person with no experience and train them vs some of the experienced people we've had. We are getting 4 people, two of which are willing to switch off as able.

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