Elder Care Company “Home Instead” Transfers Reported Thief to Another Client; Endangers Client Welfare and Violates Own Contract

Do not ever use the home care aide agency Home Instead. One of their aides stole from my 93 year old physically frail but cognitively fit mother and another put her in the emergency room.

Strange as it may seem, we didn’t terminate the relationship because we thought it as salvageable. We had an incentive to keep the one remaining aide we had through Home Instead because she had been doing a good job for a while, was willing to be coached and trained, and was very careful about Covid risks. The second incident, the emergency room trip, which did take place on this last aide’s watch, resulted from what should have been an easily solvable lapse: failing to give my mother enough fluids.1

Yet the local agency was uninterested in this health and safety risk and another recent service failure. They dumped my mother instead, in violation of their own agreement, putting her at even more risk due to the difficulty of finding a replacement with virtually no warning.

We are embedding their agreement at the end of the post because the very document is a monster red flag, screaming of intent to operate in bad faith, which they have done.

We used Home Instead only for one aide, SC, who we liked and had historically performed her tasks well, for two seven-hour shifts a week. In addition with the peculiar lapses in keeping my mother hydrated, SC was also increasingly having difficulty transferring my mother in and out of her wheelchair. This is a health issue because my mother’s wheelchair, like most, isn’t designed for protracted sitting. It hurts her back to be in it for more than a half hour; longer use produces swollen feet.

A similar age and sized aide who’d been partly paralyzed herself for three years and now has a rod in her lower back is able to perform the task. In other words, SC’s second shortcoming was of technique, not of strength, and she was willing to be coached by an occupational therapist, and even wrote a note to make that clear.

Home Instead tried to depict her as having chosen to quit abruptly on us, when SC as a pro (she previously worked in the back office of a local bank) would never have left us in the lurch (she was the responsible sort who would have stayed on until we found a replacement had she really thought the situation was no longer tenable).

When I challenged Home Instead, “SC very much wanted to continue and it appears she changed her mind only as a result of your company’s influence,” they did not deny it.

More important, they did not offer to provide substitute even though their contract effectively obligates them to do so, jeopardizing my mother’s safety.

It’s bad enough to be introducing a new person into a home care situation with Covid very much out and about in Alabama, but even worse to leave a wheelchair-bound woman with no care. They gave only three day’s notice, which is completely unrealistic in terms of the time it takes to find a new aide.

We’ll show how they breached their own agreement and their various indemnifications and waivers are defective. As a result, they’ve just painted a big liability target on their back due to their abandonment of my mother should anything happen to her.

We had previously held back from reporting the local Home Instead franchise, Pahos, Inc. to the State of Alabama for elder abuse. They refused to terminate or even discipline an aide who had charged over $200 of clothes to my mother’s credit card card. We will now do so, along with their contract-violating termination of service and other client endangement.

Instead, the director of client services, Susie McClanahan,2 depicted the theft3 as a “misunderstanding,” and assigned her to another client.

Ms. McClanahan did not check with us after she had spoken with the aide, merely cheerily informing us of the “misunderstanding” take and that she was being transferred rather than let go. Ms. McClanahan was clearly uninterested in hearing anything more from us on this topic, even though we could easily have shown her the aide’s misconduct was studied.

As Lambert said:

What are they, the Catholic Church, just moving the pedophile priest to another parish?


Home Instead presents itself as providing services to enable elderly or mobility-limited individuals to remain in their own dwelling rather than an institution. Home Instead will submit documentation to long-term health insurance plans for clients to be reimbursed, meaning they hold themselves out as providing assistance with “activities of daily living” (inability to perform enough “activities of daily living” is the basis for the insurance coverage to be activated).

Different insurers and government agencies sometimes break them out into finer categories, but they include:

1. Personal hygiene – bathing/showering, grooming, nail care, and oral care.
2. Dressing – being able to make appropriate clothing decisions and physically dress and undress oneself.
3. Eating3 – the ability to feed oneself, though not necessarily the capability to prepare food.
4. Maintaining continence – being able to mentally and physically use a restroom. This includes the ability to get on and off the toilet and cleaning oneself.
5. Transferring/Mobility- being able to stand from a sitting position, as well as get in and out of bed. The ability to walk independently from one location to another.

In other words, these home health agencies provide services both to those who might need an aide once or twice a week to drive their car, help with errands, tidy up the house and do some meal preparation, as well to as clients who are getting “assisted living” levels of hand-on care in their homes on a daily basis. Some also target Alzheimers and hospice patients.

My mother is 93. She is cognitively fine but doesn’t always seem to be so because her hearing is spotty even with a very fancy hearing aid. However, she can no longer walk and needs an aide to help her to and from her wheelchair, off and on the toilet, and to give her sponge baths and change her clothes. We have aides 13 hours a day.

And in case you wondered, our dealings with Home Instead had been cordial, even with my description of the need to address SC’s lapses in making sure my mother got enough fluids (even on the days they ran lots of errands, the other aides got this done) and the need for more training, which would have been paid for by my mother’s policy. Given the seriousness of what had happened, one would assume the agency would be concerned and want to make sure SC again got on top of the hands-on care part of her job. Instead, we got chipper brush-offs, forcing us to become clearer that these issues were not going away on their own (Home Instead refused to provide any help in finding an occupational therapist, when given the size of their agency, a mere internal e-mail would almost certainly have provided leads).

The Home Instead Red Flags: Low Standards, Bad Faith Contract

We were so foolish as to engage Home Instead years back because my mother got a referral for them from a friend. She hired them when she was unable to get out of bed for a few days after a bad flu and got 24 hour care.

When she finally felt well enough to get up to take her first shower, which occurred on the overnight shift, the aide left her alone in the bathroom, naked with the water running, and went to the other bathroom across the house. My mother hadn’t eaten properly for days, could well have been dehydrated, and thus was at real risk of passing out or getting dizzy. This was utterly irresponsible. She never wanted to do business with them again.

Unfortunately, when my mother started to need daily care, the first agency we used provided competent aides but was unable to staff Sundays and had trouble with Saturdays. We wound up back at Home Instead.

Our main contact was an official face of this franchise, Client Care Coordinator Susie McClanahan, whose picture and brief bio are posted on their site. She assured us that all the managers were either nurses or had had hands-on care experience and said that in the last few years, they’d been able to get better aides and now she’d feel comfortable sending any of them to handle a family member.

The agreement told quite another story. As you can see:

Deliberate creation of a virtually unreadable document. The contract, if you can charitably call it that, is in microtype, in a grey font, and provided to clients only as a paper copy or a scanned image, which means it’s difficult to work with and read. Of course, it can be OCR’d, but how many older prospects will do that?

Or if the intent isn’t to impede proper consideration of the agreement, the only other plausible reason is still an awfully bad look: they are so cheap that they are seeking to save money by having a single page document.

Lambert graciously used another tool to generate a larger, more readable version, which we have embedded.

Egregious and unenforceable indemnification provisions. The fact that anyone would ask for these terms is a warning to run the other way. First is the indemnification section:

Each party agrees to indemnify, defend, and hold harmless the other, its officers, agents and employees, from and against any third party claims or suits that arise out of negligence or willful misconduct by such party in connection with or arising out of the activity which is the subject of this agreement.

You might say, “How could a third party claim come about?” For starters, I live her and am not party to the agreement or a legal agent of mother. If an aide were to steal from me or wreck one of my computers, that would give rise to a third party claim. I am sure the lawyers in the readership can come up with more examples.

You might also say, “Why didn’t you object to this clause”? Because it’s so over-reaching that it’s void in Alabama.

There is a limit to Alabama’s acceptance of broad indemnity agreements…In Alabama, agreements that purport to indemnify another for one’s intentional conduct are void as a matter of public policy.

This provision also appears to be unenforceable:

Client, within sixty (60) days, must notify Provider in writing, Provider of any loss Client alleges to have been caused by Provider or their employees/contractors. Client, within sixty (60) days of any such alleged loss, may proceed with criminal or other charges allegedly caused Provider or their employees/contractors. In the event Client fails to take such action with respect to a loss allegedly caused by Provider or their employees/contractors, Client hereby waives any claims, civil or criminal, against Provider and its employee/contractors.

Home Instead cannot use a contract to restrict a citizen’s right to make a criminal complaint. Home Instead is literally attempting to put itself above the law.

Any lawyer will tell you delay is not helpful to a plaintiff in a criminal or civil matter, yet there are often good reasons to look before you leap legally. What if a client were hospitalized and the family thought it best not to stress them with possible litigation until they felt better? My mother literally cannot see what is happening in the house. What if I weren’t living with her and a theft were discovered only when a relative or old friend visited, which could easily be well after the incident (even more so now with Covid-induced isolation)? We actually had a close relative pilfer many items nearly two years ago and I am still discovering that certain valuables departed in that haul (the latest, a Lalique figure my mother sometimes displayed at Christmas).

What if it takes time for the client or the client’s family to nail down facts firmly enough that they want to proceed, or to obtain valuations of lost or damaged property to determine if the amount at issue is worth the brain damage? What if the client wants to make sure they know what the likely legal costs will be and needs to shop for counsel?

And what about physical abuse? It’s hardly news that victims of abuse often protect their abusers, plus (particularly with a client with some cognitive impairment), it might take some doing for concerned relatives to be sure what happened.

No shrewd client would want to send in the initial “You are in trouble” missive without consulting a lawyer first; they might weaken their case by saying too much or too little.

The statute of limitations for Alabama for most contractual matters is six years. I sincerely doubt that a sloppy agreement that doesn’t even stipulate what notice amounts to would hold up to challenge given its multiple breaches of statute. Put it another way: if Alabama isn’t on board with indemnifying against willful negligence, it’s hard to see that it would give a free pass to a company trying to give itself a “Get out of jail free” card.

Lack of termination provision for Home Instead. The agreement does contemplate termination by the client and calls for 14 day calendar notice. But there’s no provision for termination by Pahos, Inc.

The “RATES AND SERVICES” section begins with an unqualified commitment to provide services. The “may remove any employee” language does not relieve Home Instead of the overarching service obligation. And the “change the level service” (which is not at all well defined but in the home care context generally refers to the agency determining a client needs a higher level of care based on a home visit) clearly is not what was intended here.

Moreover, Home Instead made clear the intent was to terminate service, even though their own contract does not permit that, and not simply “replace” an employee. They offered to refund our deposit…which they did not do even after the incident of many years ago when the overnight aide abandoned my mother in the shower!

Other glaring deficiencies. It’s either cheeky or lame for Home Instead to depict their napkin-doodle document as the “Entire Agreement” when it’s not even close to being a complete contract. What’s is the term? Where is the evidence of consideration? Where’s the notice provision? How about a few definitions? There’s not even a mention of governing law, or the normal more specific nailing down of where a case is to be lodged.

To give an idea of what a joke this “contract” is, another agency in town has an agreement that actually is a proper agreement, on normal paper in normal sized type with standard margins. It’s over 15 pages.

Home Instead does not appear to appreciate that a document that is not and legally cannot be a complete agreement works against them. As the drafter of the form, they were in the position to get exactly what they wanted and force a prospective client to negotiate any changes in terms. Any incompleteness or ambiguity of the agreement, like the failure to specify how to provide notice (as in how exactly to send legally significant communications), will be interpreted to their disfavor in court. The lack of a termination provision? They require the client to provide Home Instead a 14 calendar day notice when aged individuals are clearly more inconvenienced and potentially harmed by a termination than a professional firm. It would be a no-brainer to tell a judge that a client was entitled to at least symmetrical treatment, as in 14 calendar days, in the absence of any evidence of harm to the agency or its staff (which has never been alleged here; it’s my mother who has been getting the short end of the stick).

Phony Reviews

The reviews in the home health care agency game are completely corrupt. For instance, one site, Consumer Affairs, rates home health care agencies. Home Instead gets less than 2 stars out of five:

On the one hand, Consumer Affairs has an “affiliates program” where companies pay a fee to get accredited, and mirable dictu, on average have vastly better scores. However, there’s no reason to think that the reviews of the companies that don’t pony up are artificially low. I read the reviews and quite a few described practices and even contractual terms that are specific to Home Instead.

But more important, what matters is the caliber of the local franchise, and particularly in a low cost area like Birmingham, it’s conceivable that a local franchise could outperform the national standard. And the reasonably-sized local agencies do get high marks.

But many reviews are too obviously planted. Have a look at Caring.com, where the review of employees working at Caring.com make clear that they are always under pressure to be closing, as in sign up facilities and agencies. The Home Instead reviews there are mainly thin but curiously uniformly positive. At Google, 4 of the 34 reviews with text were from employees, all 5 star glowing, when the more reliable GlassDoor gives Home Instead 2.4 out of five. That suggests a haircut is in order for the Google reviews.

* * *

Our remaining aides are completely mystified by the difficulties we have had with Home Instead. One worked in nursing home, where she was responsible for the full-time care of 18 (and sometimes as many as 22) patients: feeding, bathing, bathroom trips and bum wiping, getting them in and out of wheelchairs or minding them as they walked, making sure they got their medications, changing their clothes. She said caring for my mother is ridiculously easy and she fails to understand why anyone would have difficulty with the job.

As we’ve said before, the home health care service business is a lemon market. With aides who work for agencies getting only $10 an hour for less than full time employment (no health insurance!), it’s not hard to see why.

The best I can infer is that despite needing to take on clients who need assisted-living levels of care, the agencies would much rather be in the business of providing easy-peasy services like driving clients to the doctor and at most doing light housework if they could only drum up enough clients like that to support a business. But it is also hard to figure out why no one has found a way to offer a higher-caliber service at a premium rate so as to be able to pay employees enough to want to keep the job.

The other problem here, particularly in the South, is that these agencies often get hired because there are no close relatives nearby. That means there’s little or no supervision of the caliber of care being offered. And even if the client isn’t always happy, in most cases they will probably tolerate it out of not wanting to cause friction with the caregiver or burden their relatives. These agencies don’t like having someone on site who will keep tabs on what is actually going on, since they might well be caught out.

So be warned: if you have to hire one of these services for an aging parent, install cameras. They need all the protection you can provide.


1 The emergency room visit was the direct result of SC failing to make sure my mother had gotten enough to drink. My mother was leaning to one side in her wheelchair like a rag doll when being transported to her couch, unable even to sit up straight; SC could not get her out of the chair because my mother was too weak to provide any help.

Seven hours later (taking Covid risk in going to a Birmingham hospital in November), the staff did a workup, declared her EKG to be perfect and everything else to be fine. They determined she’d had a blood pressure crash due to being dehydrated. She perked back up as soon as she got some IV fluids and a snack.

However, it was distressing to have a repeat a few weeks later with SC, with my mother again so weak she wanted to go to bed in the late afternoon, which is not at all normal for her. We got the aide on the next shift to come in early. The second aide insisted my mother drink and have some food, and she was fine again in a bit more than an hour. I have been having to press SC to make sure my mother was getting enough fluids, and she continued to be the only aide that had difficulty with that.

2 Ms. McClanahan has no expectation of privacy since her employer publicizes her name and position on its website. She does have a manager above her, Jeanelle Huggins, Director of Client Services, whose photo and bio are also on the local Home Instead site. My impression from our e-mail correspondence is that Ms. McClanahan has a great deal of autonomy in her dealings with clients. She did mention Ms. Huggins in context of the theft, so more senior management bears responsibility for keeping a thief as an employee. However, my impression is that Ms. McClanahan was responsible for pushing our aide SJ off my mother’s account when she knew she had no substitute, as in she is culpable for the contract breach.

Readers may be bothered at calling out a company manager, but Ms. McClanahan is making recommendations and decisions that are clearly not in the interest of clients, most of whom are in a vastly more vulnerable position than my mother, and she needs to be held accountable.

3 By sheer happenstance, I opened and reviewed the credit card statement on which the aide’s fraudulent charge appeared in front of my mother when that aide was on duty. I read out the name of the vendor and the dollar amount to my mother and asked her if she recognized them, since I didn’t. The aide confessed immediately, unprompted.

Notice how damning an immediate confession is. Had she somehow “mistakenly” made the charge by putting my mother’s card number into her phone to order takeout food and then somehow had that number pop up for her clothes order by virtue of an error, she would have been surprised and confused, and presumably next alarmed when she realized she’d somehow put the charge on my mother’s card. But there was no sign of cognitive wheels spinning. She knew she’d made the charge, but didn’t ‘fess up until she was caught out. Someone who’d made an honest mistake would have gone to my mother immediately and offered to make her whole. This aide instead tried to get away with it.

Worse, she actually did get away with it.

Because the charge was made on a credit and not a debit card, the loss to my mother was covered by the credit card theft protection provisions. However, this was a theft in the sense that I am certain that the aide did not make restitution to my mother’s credit card company and hence ultimately to the merchant, so she did succeed in getting >$200 of clothing for free. Tellingly, she wasn’t even using her real name with us (she went as Anna but we learned later via an e-mail from the agency that her real first name was La Dexia).

4 Eating in the ADL context really does mean needing to be fed, like a baby, but agencies like Home Instead include food preparation and shopping as part of their services.

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  1. Katy

    God bless you Yves.

    You have helped turned the internet from a mere communication device into something that can lead to justice and a better world. This isn’t just your story, it’s that of tens of millions of us and eventually, all of us, if things keep eroding in our civil society.

    If you have Netflix, “I Care A Lot” is a new movie about scam artists ripping off elderly people with the collusion of the medical care and legal establishment.

    Moral of the story~don’t F* with a lady with an internet forum.

    p.s. You might want to blank out your mother’s address on the contract, lest she be showered with gifts and unwanted attention.

    1. Eyan Nemus

      re: the name and address. Yeah, I noticed that as well. It’s easily readable by humans, so I’m not sure that’s a good idea.

  2. Gregorio

    Is it not possible to skip the middleman and seek a qualified person that you hire directly, by offering an attractive salary above the wages typically paid by an agency? It seems to me that it would be an attractive opportunity for a qualified and caring person in a low wage industry.

    1. Yves Smith Post author

      In theory, that is an excellent idea and likely a big contributor to the “lemon market”: good aides get hired directly by clients.

      But if you read the microtype agreement, you see Home Instead and other agencies contemplate that and provide for $10,000 of damages if someone hires an aide they’ve worked with within two years.

      And the aging client typically won’t know people young enough to act as aides, and the out of town relatives are unlikely to know people in the right circles either. As someone new to Birmingham who works all the time, I don’t being to have useful contacts.

      1. coboarts

        Just a heads up if you are hiring directly, don’t get into a ‘cash’ relationship. Run it full 1099, checks, contracts. There are a lot of people out there playing a lot of games on your aging parents.

          1. NotTimothyGeithner

            Petty theft is far down the list of potential problems in these arrangements. Coverage on an individual healthcare worker is a problem. “Susan the other” suggests a state agency, and this would help with the insurance problem.

          2. Yves Smith Post author

            I don’t see how that possibly applies. Any homeowner has liability coverage and all sorts of casual home workers provide services, like cleaners and baby sitters, yet don’t go about trying to sue their customers on bogus grounds. On top of that, insurers are savvy about fraud and I imagine have no hesitancy about pursuing those who try to submit fabricated claims.

    2. vlade

      Above what Yves says, to provide 7×8 care you really need at least two people, in the sense that you need a backup for illness/vacations/emergencies etc., never mind not wanting to work one person >50 hours/week (exception might be a live-in help, but even there you need a readily available cover).

      For 7×13 as Yves writes, you’d almost need three.

      So the problem of going outside agency is really two to three times as bad as Yves describes.

      1. Sue inSoCal

        Lambert, a co-op for this sure sounds like a good idea. (Also for child care centers!)

        Yves, lawyer here, disabled with MS. I recall your first horrendous rodeo with your mom left freezing in the tub. This sh*t storm of boilerplate is the quintessential adhesion contract, in my opinion. It’s unintelligible and contradictory. To wit, Provider has little to no liability to speak of and even decides its own statutes of limitations. Good golly. (I wondered if I’d find mandatory arbitration somewhere and, ta da! There it was at the end.)

        This is very typical. I looked at many of these agencies for myself for assistance a few times per week in Southern CA. Background checks? Oh please! I had a woman I thought was great! Then – wait for it- she wanted to move in with me because someone “shot up” the house she was staying in. (With bullets.) So, I ran my own on background check and found that, not only was she a slick liar, she had 4 AKAs, felonies, and appeared to be money laundering (I won’t bore you!). Suffice it to say, it scared the hell out of me because I lived alone.

        I have someone in the family who worked in drug rehab. A salient warning was “lock up anything of value. So many of these people who have not had much sobriety go directly into home health. Be prepared to lose stuff.”

        If you feel you have a case, you can seek a legal opinion (someone mentioned an elder care lawyer) or use small claims court. Depending on your state, small claims can go up to thousands of dollars without a bunch of hoopla.

        Something to consider: I have a disabled colleague who had good luck, believe it or not, hiring from Craig’s List. Did a short interview over the phone, background checked them so she didn’t waste her time, then met the person (accompanied by a friend, of course) at a public location armed with a checklist of questions. I think that’s what I’ll try when I need help again. (This is difficult during Covid, I know.) In short, I absolutely empathize.

        (I’m a member of the CA state Bar, but retired inactive, so this is not a legal opinion. Just my thoughts.)

  3. Carla

    Yves, sorry to say your experience is similar to so many I have heard from friends and relatives who have used home health care agencies, including Home Instead. With my mother, we were fortunate to have one privately referred, privately hired part-time aide who was just excellent. However, when we needed someone to live in, we had to privately engage another aide who was problematic. Fortunately, no disaster occurred during the few months she lived with and worked for my mother, but the experience convinced Mom and the family that assisted living was a better alternative. I’m not certain that was the case, but that was the choice we made at the time.

    Increasingly, in this crazy world we inhabit, there are few good choices; sometimes none. Yves, you and your mother have not just my empathy, but I’m sure that of a legion of other readers as well.

  4. CJ

    So I ask this, not as a critique, but as someone that is struggling as you to manage my own parents’ care: why not report the credit card fraud to the police? Is it because you were trying to salvage the relationship or because the police would likely not pursue it? Or a mix or?

    1. PeterfromGeorgia

      Different state, different issue – I spent 6 months talking with a DA in a very large county trying to get it to prosecute a low six figure embezzlement case. The DA refused as it wasn’t big enough to be worth their time and told us to deal with it in civil court. Even if it is reported it can be difficult to get a DA to prosecute.

      1. Yves Smith Post author

        The state agency is a much better route. They actually do investigate any report, so a caseworker will appear in person and make Home Instead ‘splain itself.

  5. PlutoniumKun

    I’m very sorry to hear this Yves, it sounds a nightmare. Best wishes to you and your mother.

    Your mother is fortunate to have you to look after these details, so many people don’t have the ability or knowledge to stop these terrible practices, which is presumably how they get away with it.

  6. David

    Sometimes (quite often, actually) I despair of this world, until I meet people or hear stories about people who are doing their best to clean up their own small corner of it, which is all, in the end, any of us can do, no matter what poses we strike and no matter how many Tweets we send. So Bravo, Yves, and bless you for your humanity and your resilience.

  7. flora

    So sorry your mom and you are dealing with this stubborn agency. From the ratings, it sounds like others have similar problems with that outfit. There are lots of questionable outfits waiting to “help” the aging person, unfortunately.

    You mentioned law and lawyers: There is a legal specialization called Elder Law which lawyers can apply for certification in in addition to their regular practice. Some lawyers have their whole practice in the specialty. Elder Law specialists usually have more in-depth knowledge of elder related legal matters in finance, wills and trusts, elders and contracts, govt programs like Medicare and VA benefits, elder abuse law, etc. Alabama might have some good Elder Law specialist attys. (I am not a lawyer.)

  8. Shonde

    I have no idea if it is still available, but in 2007 one of the best things I found for my spouse was a Lazyboy lift chair recliner. It provided a full lift to standing position in addition to a full recline for resting, Healthcare individuals who came to our house said they had never seen one like we had. It also has back and seat heat if you want that.

    The chair made transfers to a wheelchair for bathroom needs much easier and of course provided the comfort a wheelchair would not.

    I could trade horror stories for hours about the 7 years of using agency care even if it was only for 4 hours a day. One agency refused to provide another caretaker after I complained about two and asked they be replaced even though one of those caretakers hit my spouse leaving big bruises in the kidney area which he admitted but said he only did it when my feeble spouse hit him. The other one kept bringing her family to our house without my permission when I was not home. Oh, the stories! When I was packing to move to Minnesota, I discovered even more items somehow missing from our home.

    Yves, you have a tough job but considering the alternatives, a worthwhile job. In a nursing home in southern California, I do believe my spouse would only have lived one year and that would not have been a good year. Your care shows your love of your mother.

    By the way, reading Naked Capitalism when I had time kept my mind active during those 8 grueling years. So thank you Naked Capitalism.

    1. savedbyirony

      The lift chairs are still available and come in all sorts of sizes and a range of price points. Our mother used one as well. Over time she even decided to sleep in hers. The adjustable recline was much more comfortable for her than a bed and she liked that she could raise herself to a sitting position to read anytime, day or night, that she wanted. Her insurance also helped pay for hers.

      Our family had varying experiences with in home aids, but we were able to work things out so that the aids were never there alone helping either of our parents. When our mother’s health issues just became too much to deal with in her house, she moved to an assisted/nursing home were she lived/survived for close to 16 years. “Survived” for the last 8 years of it is the key word. When she moved in the place had wonderful ownership, great aids to resident ratios and good tasting healthy food so she was quite happy there and we did not have to worry much. Unfortunately, when the founder/owner died the new ownership adopted all the terrible practices often found in nursing homes. We always had a family member stop in to see her daily. At first it was just to keep tabs and visit; overtime it became to act as an aid for her, as well as to clean. (In Ohio, and this is all pre-covid, the neglect that nursing homes could get away with was terrible, and the ombudsman was a joke. We were coming close to hiring a lawyer before our mother took a turn for the worse and died.)

      There are some good assisted living/nursing homes out there but they have long waiting lists, at least where I live. If one is found, if possible put an elderly relatives name on it. Those places are precious and can actually improve some people’s lives.

      1. John Rose

        When my sister’s Alzheimers got too serious, we moved her into a church-owned assisted living facility and was cared for wonderfully until she died after forty months or so. Other church-owned facilities in the area also have high satisfaction rates as far as I can tell. All the for-profit ones are suspect.
        The cost for my sister, though, all out of pocket from the family, approached a quarter million dollars.

        1. savedbyirony

          Yes, i agree. The two best nursing homes in our nearby area are both affiliated with churches. The Catholic run is easier to get into because they do not prioritize members of the local parish, while an Apostolic run home has limited rooms for non-members. Both have waiting lists.

          The cost! Even with a good pension, social security and a very good long term care insurance policy from MetLife (they do not sell those anymore) our mother’s care nearly drained all her savings as well. We live in an awful country. Best i can tell, the vision is arrange it so as many as possible die destitute and suffering in one way or another.

  9. Susan the other

    This is a problem that will get bigger much faster than before Covid. Rest/nursing homes are not only extremely expensive, they are now unsafe like never before. I’m sure private daycare centers for children are equally at risk. So you’d think that good home health and child care professionals would see the opportunities and provide the services. But what seems to happen is that the worker and the client are virtually blocked from direct interaction and engagement. And call me cynical, but I think there is only one reason for that – profit taking. If there were a way for the workers to be screened by a state agency it would be better. And their services subsidized because profit taking by privateers is in such bad faith that home care workers cop that same attitude for themselves, imo. No matter how qualified and dedicated they are they are always screwed by their employer. Hard work, low pay, no benefits. Nobody is winning here.

  10. LAS

    Oh, Yves, hang in there. This is the best and worst of times. On the one hand, so much is out of our control. Yet I’m sure your mother is completely proud of you and grateful for your company, including your going to bat for her needs. In the end, your companionship and sharing is what will matter most. To be with her is more important than overcoming all the problems.

    You are always going to be disappointed by our really poor health care systems in the USA. There certainly are some good people, but that’s unreliable. The systemic aspects effectively guarantee terrible service will frequently prevail, followed by cover-up.

    My family used a regular maid service for a number of years. Then, after a health crisis, I consulted with a few doctors about assisted living. We tried 4 different places before finding one that was very nice, if not totally perfect. Each time we tried a place as a respite type situation and after a few weeks my parent made the decision for themselves whether they wanted to stay on or come home. The winner was not only the best of the lot but the most open … I could hang out there as much as we wanted, even bringing the dog over for the weekend, having meals together, etc. That worked then, before covid-19. I don’t think since covid-19, the same approach will work.

    Have the two of you gotten vaccinated for covid yet?

  11. Elizabeth

    I can only imagine the nightmare you are dealing with, Yves. I had a similar situation with my Mother years ago. My mom needed 24-hr. care because she fell in her home. Nothing was broken, but she was 99 (and very independent) at the time, and one doesn’t recover from something like that. Anyway, I had to find a home care health agency pronto. The one I found was not a franchise, but the head of the company (with whom I spoke in person) assured me that their aides are trained for this kind of care. One day I noticed some items missing from my mom’s bedroom, and had a very strong suspicion of who was the guilty party. I called the agency and told her what happened, and the agency head confronted this aide (who admitted it) and was promptly fired. To make a long story short, I felt that I had to be at my mom’s home as much as possible, because I really didn’t trust the other aides.(I really hated feeling that way) Only one aide was an RN (she was excellent) – the others had 1-2 weeks of training. After my experience, I would never trust any home health care agency unless I could be there in the home to see what was going on. I refused to put my mom in a nursing home. Hang in there Yves, and thank you for sharing your experience with us NCers. Maybe some positive change will come about because of it.

  12. Nce

    I am so sorry to hear this happened to your mother. I don’t know if it applies in your state, but in CA there is a difference between certified Home Health Aides and senior care workers. I was a CNA some time ago at a rural hospital with a SNF unit, but would have needed additional training to administer medications to work as a HHA. How does your state certify these workers? Any HHA that neglected a patient in the ways you described would have had their certification revoked here in CA, let alone theft… This truly is criminal.

    1. Yves Smith Post author

      As you can see from their contract, the Home Instead aides are not certified and Home Instead is not licensed and disavows that it is providing any health-related service. Once in a while you do get assigned a CNA by these services.

      One local agency hires only CNAs and markets itself as having better aides. Even though it aspires to operate more professionally than Home Instead (the management said it wanted to hear about and solve problems, although as you’ll see when we get to the chair incident, not really), the aides got the same pay as at Home Instead and weren’t on average any more motivated. We had one literally abandon my mother. She walked off my mother’s nearly 1 acre property, out of voice range when I called for her. I had to ring the agency to call her on her cell to get her to return.

      Another aide from this agency announced that she was one month pregnant and acted like that meant I should wait on her. She’d look daggers at me when I had to remind her to perform tasks agreed with the agency as part of the basic duties, like wiping the kitchen counter and emptying the dishwasher.

      Yet another aide broke the chair used only by the aides. She tried to fix it (I found her having flipped it over, pretending to clean underneath it) and she denied breaking it even though the yardman and the aide from Home Instead had seen/used it the day before, and along with my mother, corroborated that it had been fine prior to her shift. The agency removed her from our account. Her refusal to admit to what she had done and her status as the agency as one of their better aides led her to complain about us to other aides (as in getting a de facto rebuke didn’t fit her self image, so we had to be the bad guys), making it almost impossible to get staffing.

  13. John

    The deliberate cruelty embedded in predatory neoliberal capitalism is the heart of this story. Abuse of the elderly in need of long term care is exceeded only by abuse of the mentally ill in neoliberal America. It sounds like you at least have a few of the angels who work in this hell realm system. And the institutions can be worse. Luck of the draw. My sympathies to you and your mom.

  14. lobelia

    At John, March 2, 2021 at 5:01 pm, regarding:

    … Abuse of the elderly in need of long term care is exceeded only by abuse of the mentally ill in neoliberal America.

    Truer words never spoken, I would lengthen that (as you likely would, had you the time), thusly:

    … Abuse of the elderly in need of long term care is exceeded only by abuse of the mentally ill, and those proclaimed to be mentally ill, in neoliberal America – and then, criminally: overly medicated to the point of dystonia, brutal addiction, or suicidal thoughts not previously experienced ; electroshocked; etcetera …accordingly™

  15. David in Santa Cruz

    My wife and brother-in-law have been trading alternating weeks to drive the 300 miles to keep their 95-year old mother in her home during the pandemic, after their ne’er-do-well brother who lived in her garage up and suddenly died. They both can work remotely, but their spouses are getting tired of being neglected.

    A civilized society would provide dignified and private assisted-living with stable, well-trained, and adequately compensated aides. Instead we encourage rent-extraction through the “privatization” Race-to-the-Bottom. A recent study of smart phone metadata published by the National Academy of Sciences showed that staff move between multiple facilities. Why? Most likely because they are only offered part-time employment so that they can be kept precarious and so that benefits and insurance can be dodged by the employers.

    These “non-compete” clauses are abusive. Is helping some frail old person to get on the toilet a trade secret? Freedom of contract for me, but not for thee seems to be a prime tenet of libertarianism.

  16. herman_sampson

    I guess we have been lucky: we (my wife, really) have used Home Instead for several years here in Indianapolis. Two aides were not very good and were replaced after my wife got too frustrated with their laziness and inattentivness. My wife is mostly physically disabled so she can monitors her aides actions. She depends on them mostly for a meal, light housework and transport to medical appointments and personal errands. Her current aide has been very good.
    Like most franchises in all businesses, I guess, YMMV.
    We contacted Home Instead as the top of the list provided by the local area agency on aging, but I don’t know its vetting process.

  17. Kfish

    Thank you for this information. Our family almost did use Home Instead here in Australia. The agency that we did go with had a similar $10,000 fee for ‘poaching’ a carer but the way that the agency charges, that money will quickly repay itself. The agency takes half of the charge-out rate over here.

    1. Yves Smith Post author

      The situation could be completely different in Oz. Notice in the contract they make clear they are unregulated/unlicensed. If they are licensed in Australia, it would be much lower risk to use any agency.

  18. Another Anon

    Does anyone know of any good agencies in New York City ? It sounds that Yves’s mom is in similar shape to mine. I think someone also mentioned that there is an agency run like a coop. Thanks

  19. Bawb the Revelator

    I feel for you, Yves, and any of you who don’t have my extraordinary great serial good luck. I’m 82, a retired psychologist and mediator who was born with cerebral palsy before it had a medically agreed upon name.

    In 2018 I was TKO’d by a BMW and broke my neck in two places. Once repaired with minor paralysis I was transferred to a “so-so” LA Rehab Hospital cum Old Folks Home for six months. My lone daughter bailed me out Against Medical Advice. Her family lives in my house The care I get but never required much less demanded is “Concierge Level” available only to the “Disgustingly Well Off.”

    My “Powerball Winner’s” good luck is unique if not off the chart. A Biden Administration that dismisses M4A and UBI to train the unemployed for homecare on a national basis is heartbreaking and sadly expected.

    You’re the best, Yves, but that’s what I tell #1 Daughter as well.

  20. Bawb the Revelator

    I’m 82 at the other end of Elder Care. In 2018 while crossing a street I was TKO’d by a BMW. My broken neck in two places was repaired at UCLA’s CA Rehabilitation Institute. With residual paralysis added to Cerebral Palsy at birth I was transferred to a “so-so” rebab hospital and elder care center.
    After six months my daughter brought me home Against Medical Advice.

    My “Powerball Winner’s luck” is unique. Her family lives in my home and the care I get is Concierge Level – now available to the Disgustingly Well Off, something I never was or am. OTOH the Biden administration predictably shies away from M4A and/or UBI during COVID times.

    A national retraining program designed for the under and unemployed 20 million might offset the same old same old. But that requires imagination. Something that’s lacking in Our Only Party among much else.

  21. Sarah Henry

    Wow. I may have dropped out of law school, but I learned enough to know if I submitted anything like this travesty as a written assignment to my contracts professor (a former Alabama supreme court justice), I would have failed the course.

    The “non-solicitation” section strikes me as odd too. Are they really trying to make the customer liable for $10k in damages for actions taken after the “contractual” relationship ends? Even assuming the agency has valid non-compete agreements with its employees, wouldn’t liability for violating those provisions fall on the ex-employee, not the customer engaging his/her services?

    I’m so sorry to hear you’re going through this, Yves. Sounds like a total nightmare to me.

  22. BarkingTribe

    Saw the headline..’Home Instead’ and ‘Thief’. Short story. Mother, by herself, own home, early 90’s, healthy, central AL., hired HI, 12K in silver goes missing. County sheriff, investigation, arrest and conviction. No recovery but minimal compensation. Thought folks should know.

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