A caregiver and nurse at home after surgery: selection by diagnosis, a trial day and the first week
The clinic discharges the patient and says: "needs constant supervision". The family, meanwhile, goes to work, cannot sleep at night and looks for a caregiver through a friend of a friend, whose experience nobody has been able to check. This page describes how we find someone with experience of exactly this diagnosis, how a caregiver differs from a nurse and what a caregiver must never do, what a trial day means, who pays whom and what happens on the morning the caregiver does not turn up.
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Experience with this diagnosisStroke, cancer, transplantation and orthopaedics each call for different skills
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A trial day and a back-upBoth sides can say no; nobody is left without a caregiver
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No percentage of their payThe caregiver names their own rate; our fee is fixed
Caregiver, nurse, physiotherapist: who does what and what they should not do
The two most common mistakes: asking a caregiver to do a nurse's job, or paying a nurse to be a caregiver 24 hours a day. The table shows where the boundaries lie.
| Role | What they do | What they do not do | Typical schedule |
|---|---|---|---|
| Caregiver | Hygiene, feeding, repositioning, mobility, tablets as prescribed, recording oxygen saturation and blood pressure, accompanying to appointments | Injections, drips, catheter, stoma, wounds, changing a dose | Day, night, 24-hour, in rotation |
| Nurse, licensed | Injections and infusions, wound and stoma care, catheter, treating pressure sores, tube feeding, communication with the doctor | Everyday care around the clock, unless agreed separately | Visits once or twice a day, in severe cases full time |
| Physiotherapist | A rehabilitation programme based on the discharge recommendations, exercises, getting the patient upright, training the family and the caregiver | Care and medicines | 2-5 visits a week, according to the programme |
We work out which combination the patient needs from the treating doctor's discharge recommendations; if the discharge notes do not say, we ask the doctor rather than leave the family to guess.
From selection to the first week
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Describing the needs from the discharge notes
Diagnosis, level of mobility, procedures, schedule and conditions in the home. At this stage we also decide whether a separate nurse is needed and what equipment must be in place before the caregiver arrives.
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Checking candidates
Experience with a similar diagnosis, references from previous families, whom we call, a health certificate, and for a nurse a diploma and certificate. The family receives 2-3 candidates with their CV and rate.
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Trial day
A paid day with a family member present. The family sees how the caregiver works, the caregiver sees the real workload. Either side is free to say no.
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Contract and the first week
A contract between the family and the caregiver on our template: hours, duties, termination, confidentiality. During the first week we call each of them separately every day; the back-up is known from the start.
Rehabilitation at home and the handover from clinic to caregiver
On the first day the caregiver reads the clinic's discharge recommendations, not the family's recollection of what the doctor said. So on the day of discharge we do three things: we obtain the discharge sheet with the prescriptions and the care regime, we contact the treating doctor or the ward nurse with questions the sheet does not answer, and we leave the caregiver a written daily schedule: medicines by the hour, repositioning, what to record and when to call the doctor.
- Physiotherapist at home: a programme based on the discharge recommendations, 2-5 visits a week, training for the family and the caregiver so that exercises continue between visits.
- Diary: every day the caregiver records oxygen saturation, blood pressure, temperature, food intake, bowel movements and mood. This diary is the key document at the doctor's next visit.
- When to call the doctor: a written list of red flags that the caregiver keeps: fever, difficulty breathing, a change in the wound, a change in consciousness. If in doubt, 112 first and only then the family.
- Reviewing the schedule: every two weeks we check whether the patient still needs 24-hour care or whether a day schedule is now enough, so that the family does not pay more than necessary.
Frequently asked questions about caregivers and nurses
Caregiver or nurse: who does what, and what can a caregiver not do?
A caregiver provides everyday care: hygiene, feeding, repositioning to prevent pressure sores, help with moving around, giving tablets as prescribed by the doctor, measuring and recording oxygen saturation and blood pressure, accompanying the patient to doctor's appointments, keeping the family informed. What a caregiver cannot and must not do: injections, IV drips, catheter and stoma care, professional wound care, changing a dose. That is the job of a licensed nurse, who comes once or twice a day or, in severe cases, is present all the time. Often the best combination is a caregiver full time and a nurse on visits, which spares the family a double 24-hour rate. We work out which combination the patient needs from the treating doctor's discharge recommendations, and if the discharge notes do not say, we ask the doctor.
How do you check a caregiver, and what does a trial day mean?
We check three things before introducing a candidate to the family: experience with a similar diagnosis, not just care in general, because a post-stroke patient and a cancer patient need different skills; references from previous families, whom we call ourselves; and a health certificate, because a sick caregiver is a risk to an immunocompromised patient. For a nurse, a diploma and a state certificate are added. The trial day is a paid day on which the caregiver works with a family member present: the family sees how they talk to the patient, how they reposition them and how they record the readings, and the caregiver sees the real workload. After the trial day either side is free to say no, and in that case we find the next candidate at no extra charge.
Who is the employer, and who pays the caregiver?
The family. The contract is made between the family and the caregiver, and the family pays the caregiver directly at the daily or monthly rate the caregiver names, which we do not set and on which we take no percentage. Our fee is fixed and covers selection, checks, the trial day and coordination of the first week. We provide a contract template: working hours, days off, what is and is not included in the duties, termination, confidentiality. This model gives the family the right to change the caregiver at any time and gives the caregiver transparent terms. What we do not do: we are not the employer, we do not pay the caregiver and we are not responsible for the medical outcome of the care; the treating doctor and, for nursing, the licensed nurse are responsible for that.
What happens if the caregiver falls ill, does not turn up or the family is no longer happy with them?
From the moment of selection every patient has a back-up candidate who knows the case and whom the family has met on the trial day or knows from a photo and CV. If the caregiver falls ill or does not turn up, the family calls us rather than searching for a caregiver: the back-up comes the same day or the next morning, and within a few hours for 24-hour care. If the family is no longer happy with the caregiver, no reason is needed: they end it under the terms of the contract and we find a new candidate, the first two changes at no extra charge. During the first week we call the family and the caregiver separately every day, because that is exactly when problems arise, and most of them are settled in a single conversation before the family even thinks of a change.
What needs to be in place at home before the caregiver arrives
- Medical equipment An adjustable bed, a pressure-relief mattress and an oxygen concentrator, operated by the caregiver.
- Clinical cleaning Disinfecting the room before the patient comes home, and daily instructions for the caregiver to follow.
- Guardianship and support When the patient can no longer make decisions and a family member signs the contract with the caregiver too.
The right person from day one, a back-up from day two
Give the diagnosis, the schedule and the date. Within 2-3 days you will receive vetted candidates with references and rates, and you decide yourself on the trial day.