Working with paid carers

When paid help arrives, families expect coordination to get easier. Frequently it gets harder for a period, because there is now a second system, a rota the family does not control, and a set of people who change without notice.

Why the two sides cannot see each other

It is structural rather than anybody’s fault. An agency records against its own obligations: visits completed, tasks in the care plan, incidents. A family holds appointments, family visits, preferences, and the hundred small things that are not in anybody’s plan. Neither record contains the other, and neither party thinks to mention what to them is routine.

Carers also rotate. The person who learned that your father will not accept help before his coffee may not be back next week, and that knowledge leaves with them unless somebody wrote it down.

What consistently falls in the gap

• Anything outside the care plan. A form that needs signing, a call that needs returning. Not in the plan, so not the carer’s job, and the family assumed somebody there would notice.
• Changes made by one side. A family rearranges a Tuesday and the visit still arrives. An agency changes its timing and nobody tells the daughter who booked the appointment around it.
• Observations that never travel. A carer notices somebody eating less. It is not an incident, so it is not reported, and the family finds out at the next review.
• What the person actually prefers. Learned repeatedly by successive carers, written down by none.

The habits that close it

• One shared list of what needs doing that is not the care plan. The care plan is the agency’s document with a specific purpose. The family’s coordination is a different thing and needs its own place.
• Write down the preferences, once, where a new carer will see them. This is the single highest-value thing a family can do for paid help and it takes twenty minutes.
• Name one contact on each side. Not five family members ringing the office. One, both ways.
• Ask specific questions at reviews. "Is everything fine?" produces "yes". "What has changed in the last month?" produces information.

The first two weeks decide it

When paid help starts, families tend to stand back to avoid seeming to supervise, and that instinct sets the pattern badly. The first fortnight is when the carer is learning what normal looks like, and it is the cheapest time to correct anything. Being present, asking what they are finding, and writing down what they learn is not supervision, it is the handover that otherwise never happens. Families who do this get a materially better arrangement than families who do it at the three month review.

Respect the boundary in both directions

Paid carers have a defined scope, and asking them to work outside it puts them in a difficult position with their employer. Equally, an agency is not responsible for coordinating a family. Both sides do their own job better when the seam is explicit rather than assumed.

Family Observatory sits on the family side of that seam deliberately. It holds what the family is coordinating and makes the unowned items visible, including the ones the agency was never going to pick up because they were never theirs.

Where this does not apply

If the agency is not delivering what was agreed, that is a contract and quality problem, not a coordination one. Better shared records make it easier to evidence, and the conversation to have is with the agency manager or, where it is serious, the regulator. Coordinating around a service that is failing is a way of absorbing the failure.

Related

• Who is in charge
• When siblings disagree
• The long-distance sibling
• What the category means