The “Triple Witch Hour” at a Home Care Agency
The Triple Witching Hour
Borrowed from the stock market, the term “triple witch hour” became part of our vernacular at the Agency; and unlike the stock market, which had a triple witch hour on one Friday afternoon every three months (a point at which futures and options contracts expired, bringing about heightened volatility and excitement), we had a triple witch hour –several hours really- every Friday afternoon. Thus we prepared all week for the dreaded hours on Friday afternoons.
The Agency’s “responsibility”
Mrs. Mullen lives on her own, cared for by our live-in caregiver, Juanita. She is wheelchair-ridden, paralyzed from the waist down as a result of a stroke she had almost a year back. She has a loving and capable daughter, Linda, who is an attorney. Linda would have been the perfect person for Mrs. Mullen to live with, except that Linda lives in Delaware, miles and miles away.
We’ve had this relation with Mrs. Mullen ever since she came out of the hospital following her stroke. A short time later, Juanita became the primary caregiver, and every time Juanita wanted to take the weekend off, usually every other week, we would send another caregiver to fill-in, also as a live-in. We thus provided services at the Mullen residence on a continuous basis, without interruption.
Relieving the primary caregivers
On Friday afternoons, our weekenders would be showing up to replace weekday caregivers at client homes throughout the area. Since most of our clients were like Mrs. Mullen in the “may-not-be-left-unattended” category, we were thus assigned to provide uninterrupted services at many of our clients’ homes. We therefore had many “Juanitas” who had worked day and night from Sunday to Friday and who were, on Friday afternoons, looking for their fill-in relief caregivers to arrive and take over for the weekend.
Not only were we to provide for the safety and wellbeing of our clients, but we also had to –simply had to- relieve the weekday primary caregivers who, having worked hard all week, would have made rigid plans for the Friday night –plans that we better not upset. For if the relief worker didn’t show, they would have to stay on the job until we could find someone else to relieve them, and that might take several hours at best.
That set the tone for the “witching” factor: caregivers calling in late at the last minute or, worse, no shows on the part of the weekend relief caregivers.
Care Coordinators on their knees
The task of scheduling caregivers to be at certain homes by no later than set time falls on the Care Coordinators, or Care Managers as they are at times referred to. At our agency, we had three Coordinators, and it wasn’t rare that we overheard a Coordinator “begging” a caregiver to drop what she had and rush to a certain patient’s home. And that wasn’t because the Coordinator didn’t have other caregivers who could go to that patient, it was because only that particular caregiver had the requisite knowhow to meet the needs of a certain patient. Besides, she would have typically been to that patient before, with good knowledge of how to get to the patient’s home and how to provide good care and companionship once she is there.
Thus if wheelchair-ridden Mrs. Mullen was also say over 200 lbs in weight, we couldn’t just send any caregiver there. It had to be someone who could execute smart transfers for a person of that weight, apart from the patient’s other needs. To relieve Juanita at Mrs. Mullen, of the dozens of caregivers we had, perhaps only a handful a) lived within commuting distance from the Mullen residence, b) could do that kind of lifting, and c) happened to be available at the last minute for a 48-hour live-in assignment.
Our clients’ needs
Short term forgetfulness, cognitive impairments, Alzheimer’s, paraplegics, advanced Parkinson’s, and people who were very frail, those were some of the folks in our charge, their sons and daughters at work and living separately, frequently in other states. They represented the ultimate in responsibility to all of us the agency -care recipients who could not be left unattended –not even for 10 minutes. Thus by Friday afternoon of every week we worried mostly about them and, in particular, about those whose next of kin, or “responsible party” as we referred to them, were out of town. And even among those, there were always a handful who could not be staffed by just any caregiver –they required attention by the very special only.
We prepared all week for the witching afternoon
Over time, we learned how to “attack” the Friday witches: we prepared well. We prepared all week, and we had contingency plans for all eventualities. Most weeks, we were able to go home on Friday evenings by 7 or 8 PM, having tucked in everyone with their rightful caregiver. Lisa would be squarely booked for Ms. Francis who loved her and who would throw a tantrum –at 92 years of age- if we sent anyone else. Mrs. Kulowski, who fussed and cussed whomever we sent for the weekend, would finally get exhausted and go to sleep, only to wake up altered and easy going the following morning. I remember one fateful Friday afternoon though when I felt like the Oxygen had been sucked out of my lungs –out of our whole office.
Because of a lot of flu going around, we had what came close to being a tsunami of call-outs: one caregiver after the other calling out sick. We worked our database, tapped our short lists, made a hundred calls and, after all that, we were left with two caregivers that we simply could not find reliefs for. We decided that people from the office staff would fill-in. Nothing else we could do. We would go ourselves because the caregivers in attendance there had both done two weeks in a row non-stop, so we simply had to relieve them. At the very last minute however, one of our Coordinators pulled the hare from the hat and produced first the one, then both of the needed caregivers. The point nevertheless was that if all else failed, and it never did, we, the office personnel, would have to fill the gap.