Should You Trust Home Caregivers Who Work Fast?

Can you trust health care workers to do their job? What happens when you do not trust a health-care-giver who is very nice and get the work done very fast?

Only in a perfect world can you trust a stranger. No employee is perfect- not even me. 

When a family with a disabled person needs extra ordinary care-taking life is stressful enough – then hire a kind acting stranger who  seem to have all the necessary skills to help out – but, they are only there for the pay check and all the extras they can rip off.

This  post will address some issues with health-care  employees that willfully cross the line of neglect and fraud, from my per-spective.

Trust in God, but lock your door…

For the last 6 1/2 years we have had some very good people in and out of our home to care for my adult son who – BAM! – got hit hard with Progressive Multiple Sclerosis.

We have also have a number of home health who care-givers who crossed the legal lines. With all of my years of experience as an RN that including doing home-health care, I have let my guard down. It is exhausting living with a disabled person, no matter how much you love them. We family members needs a break on a regular basis, extra outside care-givers are hired by what ever funds we can get to help do daily cares or even the more heavy lifting tasks.

Examples: Transferring from bed to wheelchair and back : do Range of Motion and strengthening exercises: bathing; dressing; assist with toileting….and more.

Unfortunately we live-in caregivers can not stand over the top of every hired out side employee every minute- it’s CRAZY to assume we can or even should have to. We feel relief when we sleep deprived parents or spouces can grab an extra few minutes of sleep or go out to have lunch with friends because the care-giver is at home doing what they were hired to do….

I let my guard down…

– all caregivers let their guard down. We are exhausted. There is nothing romantic about caring for an ailing loved one day after day – week after week- year after year.

In retrospect I should-a would-a could-a have done things differently when employees proudly proclaimed to be ‘very fast and very good.‘ – According to whom are they very good when they are very fast?

RED FLAG! Could “I work FAST” means they may cut too many corners in care-giving?

A former caregiver snapped one day when they were reprimanded for not recording* the time it took to do what task.

The reply was, ” I’m the only one who does anything around here. I should not be penalized for being much more efficient than you. No one needs to know that I do my worker faster than anyone else.”

Upon further investigation as the mother of the client being cared for it was discovered that the employee was telling the employer of record that they worked 8 hours a day instead of the actual 1.5 to 2 hours total they may have been in the home.

There had been sneaky excuses without making up the not just the time but the health care tasks that were needed to maintain the patients; skin integrity; the joints and muscles to prevent damage as the disease progressed….and more. it was not about being FAST. The prescribed duties to prevent complications were being neglected and act  of omission.

When is a line crossed that does harm to the patient when he/she consistently is not getting the care that is being paid for?

That fine line of neglect and or fraud can be crossed right under the noses of family members of a disabled or elderly patient…one…step…at…a…time…and with charming sweetness…it becomes..easier…and easier… to…get robbed…of…services…your…care-giver…is being…paid…to…do…causing your loved one…or…yourself…to be irreparably..harmed.

For your information:

Who ends up being responsible for a subordinate in the “nursing chain” of task delegation?

In our home care-situation with my disabled adult son, we employees do not work under a licence as would happen in a facility. We still have a “pecking order” in our home. My son is the ’employer’ who hires and fires his employees.

When an employee in your home is not doing what they should; makes decisions to do something against established protocol; does not communicate in writing or even verbally; leaves early within out doing the job and charges for it – guess who is also responsibly for neglect?

As the mother, father or wife in home of a disabled child or spouse, you are responsible for the employees neglect or fraud if you do not act soon enough to correct the employees action- even tho’ you are the case manager or the social worker supervising nor are the not the employee who is committing a crime- as a mandatory reporter you are held legally responsible for not acting on the patient behalf in a timely manner…no matter how many cries 

for help take days and weeks to get a response from the legal managers who don;t get back to you for days on end- they are on 

overload. The Hot-line for Medicaid fraud takes weeks to get a reply from. Even the Adult Protective Services don’t get out to see the victim for weeks.

Sure, call the police who can no nothing because your don;t have an evidence – the offender has the right to be innocent until proven guilty.

I do not sanction wrong-doings of any care-giver – in my home or in a facility work place EVER and I try various appropriate ways to correct the other employee I am stuck between a rock and hard place to legally prove there is a problem and how legally handle the problem with out legal black-lash from the employee even if they are dead wrong.

You can not just up and fire someone. There are steps to go through which protect the job of the employee…sneaky and manipulative as they may be…

a bad employee ripping you off has more rights than you do. it is your word against theirs and your responsibility to show the evidence. Sounds like a stressed our person – all law enforcement; social workers and doctors are so overworked will the make sense of your desperate cries for help? Probably not- exact why the elderly and disabled are getting neglected and dishonest health care-providers are getting awy with “murder”. ( My opinion.)

It’s complicated.

( My son has fired me about 15 times in 10 years, but, he never would fire a care-giver who had be-friend him. Huge RED FLAG! Do NOT cross the line of employees becoming personal friends. Keep it professional.)

Let it go? Forget the Forgive and Forget?

Every time a patient: the clients the family members; or manager of a facility or nursing agency Let it Go, for what ever reason, the perpetrator gets bolder and bolder and more sophisticated in crossing the line. 

These people share with others who will validate their faulty reason for  bending the rules or even breaking the law.

I think the hardest part of dealing with care-givers who break the law in little steps is to start is convincing the lonely home-bound patient who is capable of making their own decisions – up to this point that the very kind care-giver is doing them an injustice.

Strong Statements Must Be Made!

We all must stop allowing care-givers to choose to do neglectful acts; stop theft; stopping fraud is way past due.

We MUST SPEAK OUT to protect our most vulnerable citizens. Life will turn on a dime making you or a loved one a vulnerable person just ripe for some sociopath to be taken advantage of.

But, with so many chains of command especially when the funding like Medicare or Medicaid has to go past so many desks – waiting for a phone call or a written reply – from whom ever covers that area – some one gets SCREWED! There is never one phone to be made that fixes neglect or fraud in the health care setting.

Yes, it is a time consuming inconvenience to make legal stink. That is exactly WHY people who have no other skills can get certified as nursing assistants with the sole purpose of de-frauding the weak and vulnerable.

Before the good people who work hard in nursing homes and elderly or disabled home-care get your panties in a defensive wad consider this:

The only thing necessary for the triumph of evil is for good men to do nothing. Edmund Burke

When your co-workers are stealing from your employer; sleeping on the job; cutting too many corners with patients and you say NOTHING you are participating in your co-worker’s crimes as an accessory to a crime. if that is the case- SHAME on you!

And if you CNA’s do speak up and suffer from it – your life is miserable – I know. You have bills to pay – you don;t want to lose your job for making waves. In the long run because of budget over spends you will not get a raise and you may still get laid off due to loss of accreditation for the department you work in.

People who chose to steal from the work place; claim to do the job but don’t become pros at lying and manipulating so much that you can feel like the CRAZY one. They have you chasing your tail feeling like  the bad guy. We all suffer for the action of sociopaths.

  • You feel guilty when the make there excuses.

For examples:

An employee or a co-worker sneaks off early or spends too much time on the phone. The excuse might be, ” cover for me. My kids has a school project they need help with.” Well, no, I don’t want any child to fail in school because the parent wasn’t there to help them

….wait – who agreed to come into work on a certain schedule? The kid’s project is NOT the employers nor a co-workers problem to cover for.

“I have to leave early. the family is celebrating my mother’s birthday. We are meeting at 5 to eat dinner.”
” It’s my dad’s birthday… I have a school conference at 6. I’m leaving early.”

Hold the birthday cake! When did you parents suddenly have a birthday? Who agreed to work at a certain time on a certain date?

“Disruptive people can be anywhere and everywhere at any time we interact,” Foster says. “When we don’t approach difficult topics, they take root and they grow like viruses.

” My other job called me in to work. gotta go.” …and who has the responsibility to cover your in home patients care that was agreed upon 2 weeks ago?

No employee can bill Medicaid for hours they have clocked in at another job for the same time.

Yet, this is a SCAM we have seen in the city we lived in too many times….they get by with it by playing on the sympathy of the vulnerable patient who longs for people supposedly cares about them.

A bad coworker isn’t just annoying, they can actually be detrimental to your career. His or her behavior can make you feel constantly stressed, which decreases your productivity and can even lead to long-term health problems.

This quote is from an article titled: The 3 most common types of terrible coworkers and how to deal with them.

This article above is worth reading tho’ not exactly focusing on a care-giver thief or one who bills for work they leave 4 hours early, but is very insightful on dealing with people who don’t do their job for what ever reason they seem to justify.

It is easy to say, “Your FIRED!” Donald Trump is so very good at uttering those 2 words. But, firing an employee is more complicated that saying those 2 words.

Those rule breaking stinkers end up seeming to have more rights to not be fired than the loss you or a loved one are suffering in the aftermath of being taken advantage of. all too often co-workers know that something is Rotten in Denmark, but do not want to get involved. they say nothing. How will the boss ever know if they do not have eye-witness facts?

I am going to address some of these stinking hazards of having employees you really need to get kicked to the curb– they have rights under the law and they know it. As an employer or in my case, the live-in mother- my gut feeling is not concrete evidence of wrong-doing.

Yes, once again, we have had issues with caregivers before who were hired to do certain health care tasks, but, chose to cut corners – ‘because’everyone else does…we are  entitled to extra compensation for doing all the work.’ 

From my experience when a home caregivers states, “I’m very fast and very good,” I think we family members of the elderly and disabled must proceed with caution about that employee or even a family member…no matter how sweet and helpful an employee seems to be. When the opportunity presents itself – you don’t know who will cross the line of committing a crime under your nose – yes- a CRIME – an your hands may be tied that hampers you from taking appropriate action.

Some people may be efficient, but, caring for an aging adult or a disabled person is not a race to be won. Careful attention to detail is a key factor in preventing secondary health issues that ultimately will harm the patient. I have a big gripe about negligence from omission once again by a charming and trusted care-giver in our home. And, I am NOT alone in anguish over omitted health care tasks and fraudulent over-billing when I expected to a loved one was being cared for as instructed.

If you have followed No Non-cents Nanna’s blog any length of time you may have read that my ‘full-time job’ has been to care for my once athletic- never been sick adult son who got-BOOM- hit hard with progressive MS.

Yes, I do know that you can hire an agency or some family members can get paid to help care for him. Back ground checks are done on employees.

But, there will only be a legal record if a person has caught nor reported. all too often the small omissions are not on the record. 

Please, no unsolicited advice on MS cures. Our realistic goal is to maintain quality of life. 
Getting good care-giver help and or the funds to care for a loved one is not THAT easy. There are a lot of hoops to jump thru' but 
that's another blog.

That fact that I was an RN should give me an edge,  one would think. But, all having oodles of experience as an RN only allowed me to perform higher level of skill that my son would have gotten from an agency sending out an unsupervised CNA ( certified nursing assistant)  who lacked the knowledge base to understand WHY it really mattered that cutting corners to be very fast and very good, really do matter. Our medical facilities and nursing homes are filled with entitled CNA’s doing the grunt work for minimum wage or a tad above under the supervision of a stretched too-thin RN.

In fact being paid to do certain tasks, like assisting to eat; incontinence clean up: doctor prescribed tasks such as Range of Motion – but cutting corners in order to get done faster then billing for it is FRAUD. 

I'm not even addressing the issues of selling the patients medication or jewelry.

All too many CNA’s are not doing what they are paid to do and the patient  suffers. Yet, the crime, yes, a crime, is over looked or swept under the rug leaving a bad care-giver to go on to the next patient and the next with out so much as a written report on the record.

I am picking on the Certified Nursing Assistant because is seems all to clear to me that the not-so-highly-trained people get the idea that they “do all the hard work” without the benefits the more highly skilled under management enjoy. This skewed thinking is shared encouraging co-workers to fell entitled to rip off their employers.

What did your Grandma used to say, " Just because all your friends are jumping off the Brooklyn Bridge doe NOT mean you should, too."

I don’t care if everyone else is doing it, it is fraud and neglect by omission! Neglect is a punishable CRIME – no one is entitled to be paid for a medically necessary task that was not done.

  • YOU are an accomplice to a crime if you do nothing or say nothing.
  • Theft is Theft no matter how under-paid you feel you are…so go get more education and get a better job.
  • Not speaking up about wastage; mis-appropriation or point – blank theft or co-workers fudging about assisted tasks is one of the many things that hamper you from getting a pay raise.
  • It’s not the “lazy welfare people”  mis-using our tax-payers dollars, in my opinion. It is the care-givers who use 6 papers towels to dry theirs hands – if they properly wash their hands in the first place thus practicing good infection control – it’s the taking home 10 ink pens every week so you don;t have to buy them for the kids. It’s the taking home toilet paper and garbage bags for your personal use that raises the over all expense in facility health care and keeps you from getting that raise because you are so fast and very good….
  • …and it’s YOU who don’t want to get involved by snitching or upsetting your co-worker friends.
8 Sure Signs That Your Co-Workers Are Toxic
Should you rat out your co-worker?

Any act or failure to act performed intentionally or recklessly that causes or is likely to cause harm, including: infliction of physical or mental injury; sexual abuse; unreasonable use of physical or chemical restraint, isolation, or medication; threat or menacing conduct; fiduciary abuse; or omission or deprivation by a caretaker or another person of goods or services which are necessary to a avoid physical or mental harm or illness..

No matter how distressing any allegations, failure to respect an employee’s rights, including the right to procedural fairness, during an investigation into an allegation of elder abuse may result in an unfair dismissal claim. If an employee who has been unfairly dismissed is unable or unlikely to find alternative work, there is a greater risk of reinstatement being ordered.

Care providers owe a range of duties to consumers at both common law and under aged care legislation, including protecting the consumers’ health and safety. These duties tend to imply that where an allegation of elder abuse has been made, the employer should err on the side of caution for the consumer’s protection. But providers must also ensure that they do not breach their obligations as an employer under the Commonwealth Fair Work Act 2009.

Difficulty Detecting and Distinguishing Abuse and Neglect from Effects of Chronic Disease Among the Aging

One of the factors that complicates the task of generating accurate estimates of the prevalence of abuse and neglect is that it is often difficult to distinguish abuse from the effects of the chronic diseases found among many elderly, particularly those at risk for abuse and neglect because of their functional limitations. Signs that may indicate abuse or neglect tend to be attributed to either the normal processes of aging or to the chronic diseases and disabilities experienced by many frail elders (Wolf, 1988)

Elder Mistreatment: Abuse, Neglect, and Exploitation in an Aging America.

Dealing with Employees who Steal- it’s Complicated!

Employees that take home more than a pen in their pocket on occasion may very well be controlling the boss’s actions by the balls– excuse me- but, employers, managers etc are placed in a vulnerable legal situation to prove wrong doing. You’d better have good evidence or you will end up with having to pay through the nose even if the employee is proven a thief.

Employee Theft.

Employee theft actually accounts for eight times more losses to companies than shoplifting.

 I am not alleging that theft occurred by employees in our home, recently, but it has in the past:  new Gold toes socks; nice new bath towels; toilet paper; paper towels; computer cord exchanged with one that was bitten by the employees dog; new man’s hat- never worn…leaves you chasing your tail when things are missing.

But, I do know that I have found items in our home that

  • we did not purchase
  • did not come in our medical supply orders
  •  I would not order these items for very specific reasons.

What disturbs me to the hilt is that I specifically made clear statements to an employee as he/ she stated, ” When we leave work, my co-workers leave my full-time job will ask, ‘W’hat did you get today?’ I can bring you anything you want; garbage bags; toilet paper…”

  • NO! That is theft – do not participate in it at all.
  • Report that activity to your supervisor
  • If you have anything stolen from that facility DO NOT under any circumstance bring any thing from your other job into our home. (I listed some valid reasons and I will write about that later.)

Employee theft is an issue besetting retailers every day. A 2005 survey by the University of Florida puts the cost at $17.6 billion, and concludes that employee theft accounts for 47% of inventory shrinkage.

What are some reasons to fire a home care employee?

You’d better have good cause that you can prove or you are in trouble. You may have to pay Work Man’s Comp out of a very small salary budget.

Examples to fire for Just Cause when your operate a business

These 3 examples can apply to a home-care-giver job. Either way, an employer or a home care client is screwed when a care-giver employee chooses to cross the line deliberately.

  • There is a huge difference between making a dumb mistake and given the opportunity to make On-Course-Correction and willful neglect; theft or even fraud.

Willful Misconduct:

In the past we have had a rubber stamp to use to sign checks or sign off on care-givers time sheets.

RED FLAG! to say the least in my very long post. 

Think about what can go wrong.

I have seen co-workers and home health employees documenting that they did things they never ever did. So WRONG – so not legal!

Recently I encountered a care-giver who only pretended to record his tasks – but never did. I called this person on the lack of proper and vital communication. We needed thing documented in order to tell the doctor. We needed things documented in order to prepare for the next funding review.They attempted to gaslight their way out of the issue.

So why would I expect my son’s caregiver to record personal things like BM’s; the color of his urine; or how many minutes ROM and strength exercises were to done?

If the care-giver said they wrote it down in the book that was neatly stored a way but never was… I failed my job as mother of a disabled child by not doing what? I believed that the records were kept. When I found that nothing was written down I approached the employee -We needed those records for continuity of care.

I was met with excuses; distractions; diversions. After the fact I discovered WHY? Now we have another issue that when proven will lead to fines; loss of licence and maybe jail time for the employee. And, as an adult, a mandatory reporter in the home watching over the disabled individual, I will also be held legally responsible for not acting fast enough.

Below is a partial quote about CNA documentation to support my “bitchiness” about recording the job done.

Documentation has other important functions:
It creates a permanent record of the patient’s health care.
It serves as proof of care and services for billing the insurance company.
It can be used as evidence in a court of law.

From CNA Duties: Eleven Golden Rules of Documention

I really want to tell the true story about a caregiver in our home who would not document a word. There is no evidence the person was even in our home at all let alone when they worked or what they did. But, since I can’t tell all, now, below are valid reasons why I insisted the “qualified” care-giver, tho’ not hired as a CNA for this job – and I was NOT making it up to make their life miserable. ( Gaslighting)

If you didn’t write it down, it didn’t happen

Date, time, and sign every entry

Chart care as soon as possible after you give it

Write legibly every time

Be systematic

Be accurate

You absolutely must be objective

If you notify the nurse of something important, include it in your entry

Use only abbreviations approved by your facility

Never change what you have charted

Don’t chart for someone else or let anyone else chart for you

The above quote taken from CNA Duties: 11 rules of Documentation

Got any idea why an employee would not want to document?

Big mistake HUGE!

But, now as the family member of a disabled person who is supposed to be getting X cares from a care-giver – what do you do to resolve the poor choices of the home health care-giver?

I have mind set at this time to say, “Get rid of the CNA. Only hire more highly trained people to care for patients. There is too much of a knowledge dedicate to trust unskilled people to tell the truth.”

If my statement offend you CNA’s and medical assistants, then I must ask you, “Why in Hell are you not speaking up about your co-workers?”

Support articles on firing an employee: it’s complicated:

These are the five main laws and requirements you need to double (and triple!) check before firing an employee:

Wrongful termination: Make sure you’re not firing someone for an illegal reason.

At-will employment: Check if your state has any exceptions to at-will employment laws.

Last paycheck: Make sure you give their last paycheck when and how your state mandates.

COBRA Insurance: Provide your employee with COBRA insurance information.

Unemployment Insurance: Offer unemployment insurance to employees who qualify.

How to Fire an Employee the Legal Way

10 Things to Never Do When firing an Employee

There are 2 sides to every story:

Sometimes it is a matter of not knowing all the facts. Who’s responsibility is it to know how to perform your job or who is qualified to do the job?

There can be miscommunication.

There can be stress that we can or can not control.

Then there are people who look for opportunities to take advantage; to control others; to get ahead…at your expense.

What if the employee did not know better? Ignorance of the law is no excuse. There are some things you just do not do.

Here is the worse case scenario facts when you hire a Gas – lighter….no one ever seems to be prepared for. I have found my self a victim of Gaslighing far too many times- why? Because I am nice and polite – only to point – don’t make me angry by hurting my family. I will go after you legally, morally and ethically. But, few people want to reveal their shame of being taken advantage of. So they forgive and try to forget least they not look like a good Christian to their peers, to say the least.

How to Know Whether Someone is Gaslighting You

Gaslighters use a variety of subtle techniques to undermine your reality and portray you as the disturbed and messed up one.  These include, for example:

  • Discrediting you by making other people think that you’re crazy, irrational or unstable.
  • Using a mask of confidence, assertiveness, and/or fake compassion to make you believe that you “have it all wrong.” Therefore, eventually, you begin to doubt yourself and believe their version of past events.
  • Changing the subject. The gaslighter may divert the topic by asking another question
  • Credit to gaslighting

To wrap up my post about Home-health Caregiver being Very Fast – there are no easy answers nor solutions to having a loved one being the victim of a caregiver – no matter their justification.

Fraud and neglect are happening all over – yet – few witness ever bother to speak up. Yes, we will “get into trouble” for the shiitakes of others. But, we MUST do something. I hope my ramblings gave you some insight in to the “low level ” of care many of us senior citizens or suddenly disabled children may experiencing, unfortunate, because there are people who seek to prey on others, our friends, family co-workers – good people- who chose to not be bothered to speak up.

I am Malika Bourne the No Non-cents Nanna saying,

Make good choices.

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