When a Private Duty Caregiver Steps Over the Line

Are private duty aides guests of the facility in which they work?  I recently went to see a client who’s in a rehab facility and was stopped by the Assistant Director of nursing (ADON), the Unit Manager, and the Director of Nursing (D.O.N.) about a private duty caregiver presently caring for a client of ours.  It seems the private duty aide hired by the family on my recommendation has interfered with the operations of the unit and has alienated staff with constant interventions, accusations, and mistrust of the facility’s caregivers.  Although an exceptional caregiver in a private home setting, she doesn’t understand how a nursing facility operates and is a bit too compulsive when it comes to the facility’s staff.  In her defense, she has been wonderful about keeping me abreast of the client’s condition, lets me know when the doctor visits, how the client reacts after physical therapy, etc.  She has not only sent long emails describing every person who has entered the patient’s room and what was done, but all too often these emails are peppered with, “they don’t know how to do this”, or “they did that”.  I have been good about listening and not reacting but when I was told she had been visited by an administrative person, I decided to see for myself what the problem was.  Having been trained as a nursing home administrator I understand the numerous regulations imposed on facilities and the fact that extensive documentation is done by the nursing staff.  I was right, the moment I approached the A.D.O.N., I was informed that this caregiver’s excessive watchfulness of the facility's staff and not the patient has been documented “ad nauseum” in their records.  

Private duty Caregivers need to be aware of the scope of their duties when in a nursing home facility or rehab facility.  These facilities are “nursing” centers for a reason.  Patients are moved to these facilities because they need nursing care.  No matter who the administrator is, the Director of Nursing has the overall responsibility for patients in her building and takes her position very seriously.  Not only responsible for the care of the individual patient, she is responsible for employee training and ongoing monitoring; interacting with the professional staff (individual therapy modalities), doctors, family members, geriatric care managers, administration; scheduling staff and switching personnel when she or he has personnel calling-off; is knowledgeable with Agency for Health Care Administrations numerous regulations; is responsible for grievance procedures, and takes risk management seriously so everything has to be document.  Anyone who has worked in a nursing home realizes, “if it isn’t documented, it didn’t happen.” 

In this case, the Unit Manager knew me personally so the issues were resolved amicably, the caregiver was admonished to pay closer attention to her patient and not to be so involved with subjective observations of the facility’s nursing staff.  The family has paid her to do a job and not be a “house monitor”.  

In her defense, I was a personal caregiver to my mother when in decline from Alzheimer’s disease.  I finally realized what a pain I was to the staff.  I was riddled with guilt for placing her in a home which created the “nothing is good at this facility” mentality and "nobody can care for her like I can".  I even attempted to do the caregiver’s job once and dropped my mother accidentally on the floor as I was untrained.  The outcome was that it prompted me to pursue Nursing Home Administration as a career choice.  Once I realized what was involved in obtaining and maintaining the license for the building and the scope of responsibilities that nurses and nursing assistants are challenged with, I sang a different tune.  Next time I need a private duty caregiver in a nursing home setting, I will staff from an agency with personnel familiar with nursing home procedures or perhaps start my own agency.  I think it's time.  If you have comments, please feel free to post them below or contact me at: olga@agooddaughter.com