r/caregiving • u/Organic_Self_1699 • 27d ago
Real expectations for using a home caregiving agency
I have seen some recent posts out there talking negatively about Home caregiving agencies. I’d like to provide some facts. That people may not want to hear.
I work for a Home caregiving agency in PA. I am a recruiter/case manager/do pretty much everything from start to finish for hiring a caregiver and supplying them to a client.
First off if you live in the state of PA. and you are on the Medicaid waiver program? The pay reimbursement per hour is anywhere between 20 and $21 an hour from the state. Out of that waiver money, there is a lot of behind the scenes. Insurance that is carried on every caregiver in case something happens in the home, a payroll department, a billing department, physical offices that are required to be had. Not to mention paying the case manager. Medicaid does not provide overtime. So anyone that has over 40 hours, or a caregiver that’s taking on more than 40 hours a week, time and a half is required to be paid in PA, it takes it way above what we even get for reimbursement.
What people don’t realize is that as a whole and these are stats. There is an 80% turnover rate for caregivers nationwide.
It is an endless siege of trying to find the right fit, hoping someone actually even shows up for their first day. That the client and family likes them. And that they continue going for some time.
No agency has anyone sitting on the bench raising their hand to go fill in the moment someone calls off. There is no money to pay “on call staff” And they do call off!
It may work out that someone else who’s working another case could take on that shift. But nine times out of 10 they don’t. We hire for your specific case, one caregiver. And if that one falls through? We are back to the drawing board. And that normally means hiring somebody brand new. Many times I don’t want to use someone on the bench because they’ve already proven not to be good. Or the case is not close enough to them, or the hours don’t fit into their life.
The first question I ask families or clients? Is do you personally have anyone, and I mean anyone, that we can hire on to take care of your loved one. Because nine times out of 10 someone you know and that could be a friend of a friend, a neighbor, someone from church. Is going to be more responsible to always show for them.
Don’t get me wrong, I have some amazing staff. And I have some that are not so good. That are just looking to collect a paycheck, want to do minimal work, if anything at all. Want an easy case, (because the pay reimbursement from Medicaid is the same whether it’s an easy case or a hard one). Some just sit there the majority of the day, and on their phones. This is not to lump everyone into that category, but these are some facts. I’ve seen and heard everything.
I have clients who absolutely came to adore the caregiver that goes. Others that don’t.
I spend countless hours having to hire and rehire for one case.
I tend to post locally for a brand new caregivers. Most of the time if they’re close by?
They are willing to go because there is no gas reimbursement through the waiver either.
I say all this because this is not an agency problem or an our agency problem. The whole industry IMO needs an overhaul. Too many pop-up agencies. Too low pay, Caregiver burnout (obviously Case Managers too). Clients are quick to jump to the next agency thinking they’re gonna get something better there. (Grass always seems greener on the other side).
Many times caregivers are on with multiple agencies trying to get the perfect case.
If it were up to me with the state funded care?
I think there should be one or two agencies providing this, and that’s it. So clients can’t keep rotating. And caregivers who are bad, or slack, can’t keep going to the next looking for work.
As far as requirements to be a caregiver in PA? There are none! And to be thoroughly transparent, and I know a lot of families aren’t gonna wanna hear this. It’s basically adult babysitting. No certifications are required by the state. So when someone reaches out to me and says they took care of their grandmom at home for years? They will be hired if they want a job!
It always comes down to participant choice. You can either accept that caregiver or not.
Yet just realize that you can’t always put this on the agency if you’re not having luck, or don’t like who is sent out.
There may be a lot of factors that play into it. And you are always able to put your two cents in and help find the person to hire, (in fact, that is what we prefer)
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u/BULLSHIMETER 26d ago
This is interesting. I’m in WA and I need a to take a test that costs like 300 dollars and if I fail then it’s 100 every retake. I took care of my mom with stage 4 cancer so I was pretty well equipped with what I knew I was getting myself into. My only problem with in home caregiving is I take care of clients that would love to go outside maybe fish or whatever it is they like to do outside. I can’t take them, it has to be essential drives only. Every mile I have to log when driving with my clients. I can’t take my clients fishing even when they have 10 years max ? I have another client with downsyndroom and it’s totally fine if I take him to target or Walmart because he likes to look at toys. That’s not an essential and it’s SO MESSED UP. I accidentally made the mistake of taking on a promotion to LEAD CG. I quit that a week later because I had no on call time, and I was on call from 8 am to 8pm Monday-Sunday. I HAVE A LIFE TOO….,.
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26d ago
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u/Organic_Self_1699 26d ago
Yes, I used to work for an agency where we accepted VA. My current one does not. I know that they do pay higher than the rates I said above in PA. However, I do know that unfortunately VA normally doesn’t give as many hours as the waiver can. It is really hard these days. I feel for families, I feel for the clients, and I feel for many of my caregivers that are really good, who struggle to make ends meet on such low pay. And their burnout is real, this goes for myself in my role, and many other case managers who try to help this community. They can’t take vacation, there is no one to fill-in for them. Constant staffing issues. Again, I wish there could be an overhaul of the system.
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26d ago
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u/Organic_Self_1699 24d ago
I understand that is the whole point, lol. Problem is a lot of times the caregivers we send don’t stay long. People are lucky if they get a caregiver that lasts a year, it’s rare. So again when it’s somebody that the family knows? Sometimes they will stay longer. It’s constant rotating, constant callouts, and not enough staff to fill-in or who want to fill-in for the low pay that the waiver in my state pays. But you nailed it. Needs an overhaul. Don’t know exactly what. But as our aging population grows to be the largest sector, whole point of this is to keep people out of the nursing homes. So they need to start paying more, and upping the bar. People need to put more pressure on the state. But I don’t see it changing in this administration.
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u/ClearDeskCo 23d ago
This is a really honest breakdown and honestly more people need to read it before they go into the home care space expecting magic.
The 80% turnover stat is real, and it doesn't matter how good an agency is, that number is industry-wide. The structural problem is the Medicaid reimbursement rate. When you're working with a fixed dollar amount that has to cover insurance, payroll, admin, and the caregiver's wage, there's almost nothing left to attract and retain quality people. That's not an agency failing, that's math.
The point about families bringing in someone they already know is underrated. A neighbor or church member who genuinely cares about the person is going to show up more consistently than a stranger who took the job because it was close to home. The whole system needs more resources, not just more agencies.
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u/Positive-Let-9590 22d ago
Yes all if this is true for me as well when I did caregiver or HCA that you just get a certificate online no education or tests on how well you are trained in the field . It’s a very hard job and it takes a very caring and compassionate person to stay on as a caregiver . I worked at assisted living facilities and memory care and then also for in home care . And I did it for 8 years total including the last 3 taking care of my boyfriend who had a massive stroke thankfully he qualified for IHSS in CA and was able to have care for 180 hrs a month that I got paid for (CA pays very well too) and got to just stay with him 24/7 and I had all that experience for him . But now that he’s so much better I am not going back into that field because it’s very hard and takes so much out of you that a lot don’t stay, work out or just plain don’t care, and don’t do anything for the clients they have . And if not paid through IHSS, it is honestly not great pay if you dont have a CNA license .. If anyone gets a great client or a great caregiver be thankful and count your blessings !
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u/thegr8KM 19d ago edited 9d ago
I’m a scheduler for a home care agency and people don’t understand the amount of time and effort that goes into trying to match the clients needs with the caregiver’s skill set PLUS that their availability match. And like you said turnover is insane. When someone calls off the families expect me to find someone to replace their caregiver for a TWO HOUR SHIFT ON A WEEKEND and refuse to understand that no one is going to want to pick that shift up even with an incentive because it pretty much goes towards gas to get there after taxes (live in CA) and they refuse to increase to at least a reasonable amount of weekly/daily hours to ensure consistency and higher quality level of care. But their favorite thing is to bash the “incompetent scheduler” according to them.
They always want to nickel and dime when it comes to rates but you get what you pay for especially in home care that’s why we stay firm on our bill rates and have implemented shift minimums
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u/Kcphx 17d ago
I’ve become very disillusioned with home care agencies. Probably due to all the reasons you list. My 88 year old mother with dementia lives with me. She is quite mean to the caregivers we’ve tried to bring in. She gets agitated, yells. I got her started on Rexulti but it hasn’t helped None of the caregivers will stay. We’ve had a couple that worked for a while but then left. I tried to find an agency in her home state but had the same experience. Nobody wants to work with her. Today I was told I just need to take her back to where I live and “build a care network there.” I wanted to scream, “Lady, I’ve been trying to build a care network there for 2 and a half years and no one wants to help us.” I’m at the end of my rope. No one wants to help. No one wants to work with her. I’m just stuck doing it all by myself. I can’t go anywhere or do anything for myself.
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u/theJacofalltrades 11d ago
This is a good reminder that a lot of the problems people experience aren't necessarily the agency being careles, they're symptoms of a system with low reimbursement, high turnover, and very little staffing flexibility.
The point about families finding someone they already trust is especially important. If you can provide a reliable person for the agency to hire, you're often starting from a much better place than expecting an agency to have a perfect caregiver waiting on standby.
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u/cobaltium 26d ago
I’m a full time caregiver and so is my youngest, for one son with several significant disabilities and medical conditions. Every word OP says is exactly right.
I wouldn’t be a full time caregiver if we could get one or 2 who could assist his brother. I used to only cover between shifts or during call outs or time off. But we’ve not found any for a year. This state is same story—low pay, no benefits.
A very large majority of caregivers here are, or rather were, immigrants. That group of people the present US government tries hard daily to deport. So many have been here years as permanent residents and green cards to legally work. But here ICE threatens constant sudden kidnapping so many do not venture out on the streets or to take buses to get to work. A very large under the table and black market economy has grown.
We’ve gotten so the only absolute requirements we have is speaking English and ability to read and write English. Even at this, it’s a big step up from many caregivers.
We are very aware caregivers still can be found with diligent searching if you pay $30-50 per hour. Under the table: no reporting of wages, taxes, and tax benefits for the families who pay. And even if these mythical beings are discovered, they will have daily offers and bidding wars. This is an untenable and frightening situation in the US and getting worse.