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When you hire in-home help, either through an agency or on your own, you automatically become an employer and a supervisor. These may be roles you are comfortable with, but for many people, managing the relationship with in-home service providers is unfamiliar territory. The people who assist you are integral members of your health care team, so you want to do everything you can to ensure that they are able to do their jobs effectively. You already took the first step to achieving a good long-­‐term working relationship when you took care to hire the agency or person you felt was right for the job. Now you just need to establish and maintain an effective working relationship by:

• Giving the person the training and information he or she needs to succeed in the position.
• Establishing clear, realistic expectations.
• Keeping the lines of communication open.

Orienting the person to the job

Even though the person will have formal training, experience, or both that qualifies him or her for the job, it is important for you to bring the person up to speed on your specific needs, preferences, and routines. You may also need to give the person some basic information about ALS, because the person may never have cared for or known someone with the condition before.

Familiarize the person with the layout of your home, pointing out the location of equipment and supplies the person needs to do his or her job. Also make sure the person knows how to access equipment that might be needed in an emergency, such as the first aid kit, a list of emergency contact numbers, and the fire extinguisher. If necessary, show the person how to use appliances or other pieces of equipment.

Review the tasks you expect the person to perform, and the schedule for performing them. If you are working with an agency, a case manager may be assigned to work with you and other members of the health care team to develop your care plan. Keep in mind that a caregiver who is working through an agency can only do the tasks listed on the care plan, so if there is a discrepancy between the tasks you expected the caregiver to perform and what is listed on the care plan, call the agency for clarification. If you hired a caregiver independently, you will have more leeway with regard to what tasks you can ask the person to do. Review the job description carefully with the person to make sure he or she is willing and able to perform the duties as listed. Do not ask the person to do tasks other than those listed on the care plan or in the job description.

Show the person step-by-step how you want tasks done. If the task is a caregiving task, be sure to let the person know which steps of the task you can do independently, and which ones you need help with. If there is a reason you prefer something to be done a certain way, explain this to the person as you are demonstrating the task. After explaining the task and showing the person how you do it, have the person do it. Provide feedback as necessary to help the person learn how to perform the task the way you want it done.

Make sure the person knows what to do in case of an emergency. If the person works for an agency, the agency should have emergency response protocols in place. Find out what these are. Prepare an “In Case of Emergency” document that includes your home address, phone numbers for key family members and members of your health care team, and the numbers to call in the event of a medical, fire, or police emergency. Post the list near the phone or in another logical place. If you have a do not resuscitate (DNR) order, show the person where this document is kept.

Communicating effectively

Good communication is an essential part of any successful relationship. Check in with the person regularly. Ask questions such as “How are you finding the work?” and “Do you have any concerns?” Listen to what the person has to say, and work with the person to find satisfactory solutions as needed.

Giving meaningful feedback in a timely fashion helps the person do his or her best job for you. Be sure to recognize a job well done by thanking the person and commenting specifically on what you appreciated about his or her work. Everyone responds well to praise. If you need to correct a problem with the person’s work, do so immediately, using positive and corrective feedback. Tell the person what he or she is doing well first, then give specific instructions regarding how to correct the issue, demonstrating if necessary. Remember to focus on what is wrong, not who is wrong. If the person works for an agency, it may become necessary to involve the agency in rectifying the problem (for example, if the person’s work does not improve despite your coaching). Describe the problem objectively, ask for the agency’s help in resolving the matter, and follow up in writing, if necessary.

Respecting boundaries

Over time, you may come to regard the person who helps you as part of your family. While you certainly want to create an environment where the person feels comfortable and appreciated, it is important to establish and maintain professional boundaries. If you are working through an agency, the agency may have policies in place to help its employees maintain a professional relationship with clients. For example, employees may not be permitted to share meals with clients, or to accept gifts or tips. If you hired the person without going through an agency, you can establish your own policies. Just make sure that the policies you put in place support a cordial professional relationship, not an overly familiar one. Blurring the lines between professional and personal relationships can result in uncomfortable situations for both the employer and the employee.

Terminating employment

Sometimes it may be necessary to let an employee go. If you are working with an agency, the agency should have a procedure in place for replacing an employee who is not working out. To end your arrangement with a non-­‐agency employee:

• Give the person notice of the termination (e.g., 2 weeks), unless you are concerned for your safety. (If you are concerned for your safety, make the termination effective immediately.)
• State your reasons for terminating the person’s employment clearly. If necessary, refer to the person’s job description and employment contract.
• If circumstances permit, end on a positive note by expressing gratitude for the positive contributions the person made during the course of his or her employment.