En español | Until two years ago, Estelle Chandler, age 101, lived independently in Austin, Indiana. Chandler drove her minivan around town to visit friends, run errands and shop for groceries. At home she prepared her own meals. But in 2019, she fell and broke both femurs and crushed a knee. Now Chandler needs a walker and paid caregivers to help her out of bed and up from the couch, to cook, and to drive her to doctor's appointments and stores, says grandson Jon Hendren.
An agency provides a caregiver every weekday from 6:00 a.m. to 3:00 p.m. A next-door neighbor, who is a nurse, helps Chandler into bed each evening and fixes meals on the weekend.
"Mentally, she is all there,” says Hendren, who lives in Indianapolis and coordinates Chandler's care. At times, it can be a stressful responsibility. “It's a very scary feeling knowing that her network can break down any time and her immediate needs not be met,” Hendren says.
When such breakdowns occur, the agency is not always able to provide a backup caregiver, and the neighbor is not always available to cover. Once Chandler called an 86-year-old friend to help. Other times, Hendren has had to make the two-hour drive to Austin.
Unexpected no-shows happen all the time, say eldercare experts. They strongly advise families to prepare for them in advance to avoid having to scramble at the last minute to fill gaps in caregiving.
Review an agency's backup plan
If they're hiring through an agency, families should review with the agency its ability to provide substitutes for employees who unexpectedly need to take time off, says Sam Tatel, president of Companions for Seniors, a home care agency in Chicago that employs 35 trained, bonded and insured caregivers.
"We have backup caregivers ready to go, people who we would say are on call,” Tatel says. His backup personnel get plenty of work filling in for caregivers who have personal emergencies or simply need a break from a demanding assignment.
Hire more than one caregiver
Preparing for gaps in paid caregiving is especially important for families that hire caregivers directly — through word of mouth, for example — and do not have an agency to rely on. Amy Goyer, AARP's family and caregiving expert, suggests that such families consider hiring two caregivers to split the weekly hours.
"That way there is always another person as a backup that you can contact, if they are available,” and that person is familiar with the loved one's routine, says Goyer.
Tap into caregiver networks
Sara Sadin, a New York-based geriatric care manager who consults with corporations and families across the country, advises families that hire directly to discuss backup plans during the interview. Many applicants will say they have a cousin or friend who can fill in. Sadin recommends not stopping there. Ask for more information “and perhaps conduct an interview, even if it's by phone,” she says.
Sadin also suggests that families reach out in advance to neighbors who employ caregivers. “For example, the lady across the street has a caregiver. Maybe that caregiver can give you two hours in her day … in an emergency,” and perhaps the family's caregiver can do the same for the neighbor, says Sadin.
Substitutes do not have to be professionals, says Goyer, author of Juggling Life, Work, and Caregiving. She recommends asking willing neighbors and family members to divide up a list of tasks — from doing laundry to preparing dinner — in case the paid caregiver has to miss a shift.
Post backup plan and instructions
The backup plan is in place. A network of substitutes has been created. Now what?
Both Goyer and Sadin strongly recommend that families find a visible place to post contact information for the people who can be called to cover for a missing caregiver, along with instructions about medicines and meals and other care. These can be tacked to the kitchen and bedroom walls or kept in a binder on the kitchen counter.
It is crucial that everyone involved knows what to do when the caregiver for the next shift cannot show up, and that substitutes who have never previously worked in the home understand what must be done, they say.
The power of kindness
Nancy Schulman employs four caregivers through an agency to provide round-the-clock care for her 96-year-old mother, Blanche Benjamin, who has Lewy body dementia and lives in her apartment about a mile from Schulman in Manhattan. Several of the caregivers have worked for Benjamin for years. If one needs to skip a shift, another will cover.
"They will work it out amongst themselves,” says Schulman. “The caregivers stay if they can't get help. It's an amazing operation."
Schulman has only one recommendation for other families. “Take the best care that you can of [caregivers]. Be kind, be generous, be loving to them,” Schulman says. “It is a very difficult job being responsible for somebody else's physical well-being."