Personal Attendants: Avoiding the Bad Hires

Over 14 years of interviewing and hiring caregivers I’ve learned to expect the unexpected in terms of responses, appearances and caregiving philosophies. I hired a guy who couldn’t tell his twin sons apart. I worked with a grown man who made custom headdresses for Star Wars action figures and used soap scum to style his hair. I considered hiring a guy with subcutaneous, surgically implanted horns. I interviewed a woman for a live-in position who calmly told me her ex was trying to find her and kill her and that her son was in jail for trying to kill him. I didn’t hire her. Every once in a while something (or someone) will catch me off guard, but after 14 years of mistakes, successes and what I can only call “experiences” — as well as countless conversations with other people who deal with caregivers — surprises are  becoming rarer and rarer.

I liken hiring caregivers to Magic Eyes, those 3-D eye puzzles that were popular in the ’90s. You spend hours and hours staring at the poster and all you see is a farrago of colors and shapes. Then, when you’re about to give up — right after hiring that perfect caregiver who turned out to be bipolar — it all makes sense. The answers, habits and qualities that were right in front of you all begin to fit together, and instead of a confusing decision you are left with a series of simple choices.

As nice as it would be if there were a definitive guide to hiring caregivers, there isn’t. Yes, many people have written many tomes detailing the minutiae of every step of hiring caregivers, but the reality is the final decision is a highly personal one. My favorite caregiver might be your worst nightmare. That said, when it comes to the process of hiring caregivers, there are some universal lessons that may make searching easier.

Expect the Unexpected
The profession of caregiving attracts some of the most compassionate and generous people in the world. It also attracts some of the strangest. For Vini Portzline, a quad from Harrisburg, Pa., that reality struck home when a scrapbooking enthusiast she had hired as an attendant had to spend a night in jail for trying to kill her boyfriend. Mike Wilson, a quad from Redmond, Wash., also had an employee who got in trouble with the law for domestic violence. Portzline’s attendant disappeared, Wilson’s turned out to be highly reliable. Tk Small, who has spinal muscular atrophy, summed up the situation facing prospective hirers: “You never can really tell what you’re going to get.”

Unless you are independently wealthy or incredibly lucky, your chances of hiring nothing but people who exactly fit your desired profile is slim to none. Even if you have been able to find those “perfect” hires, working intimately with someone over a period of time can often force you to reevaluate what you thought was ideal. In short: be ready to work with and tolerate people you might not have ever interacted with if not for your disability.

A Brazilian soccer fanatic, a cross-dressing female impersonator, hard-working single moms, a Native American shaman — aside from being intro material for numerous bad jokes, the only thing they likely have in common is that they all worked for me. If there is one thing I’ve learned, it is that you can’t judge a caregiver by their appearance. Small perfectly illustrated this with the tales of two attendants he hired. One was a musician with a flexible schedule and a seemingly good attitude. The other was a recovering pothead who had no education beyond high school. The pothead became one of Small’s most reliable caregivers and a lifelong friend, while the musician never showed up after finishing training. “Sometimes you get lucky,” Small says. “Sometimes you don’t.”

Wilson, a C5-7 quad, has been hiring (and firing) caregivers for 24 years. He says he is still surprised by which hires work and which don’t. “I’ve been surprised by some hires who I thought would be exceptional, and they swore on their mothers’ graves that they wanted to be with me for the rest of their lives. Two or three days later they said they couldn’t afford the gas to drive and their second job required them to change their hours,” Wilson says. “It’s amazing how once people get these jobs, they find a reason they should be doing something else.”

Crazy vs. Eccentric
Looking back at the small number of caregivers I’ve hired that haven’t worked out, I find they can legitimately be broken down into three categories: incompetent, irresponsible and crazy. The first two are sure to cause problems and can be dangerous; the latter is sure to cause problems and most definitely will be dangerous. “When you’re in our situation, you’re always in physical jeopardy if you’re working with somebody who has an anger management issue, a short attention span or might be using drugs or alcohol,” Wilson says. Background checks and references can only tell you so much. You can ask all the right questions and still not get the answers you need. It took almost two months of working with one male caregiver for me to piece together his reliance on a series of anti-psychotic drugs. I woke up one morning with him peering into my eyes, his face a foot away from mine. That along with his boasts of rage-induced superhuman strength led me to fire him. In retrospect it’s funny, but the reality is I was lucky.

The hard part is separating crazy from eccentric. Interestingly, both Small and Wilson said they have had success with people that might seem shady. Small said he doesn’t mind hiring someone with a criminal record as long as the candidate is honest about the past and the charges were not too severe. Wilson employed a man with a court order against him regarding domestic violence, but said he never felt threatened. “Working with me he was polite and caring and gentle. I couldn’t begin to imagine how a person like that could get into a fight with anybody, never mind a spouse,” he says.

If someone makes you feel unsafe in even the slightest way, move on. “A lot of times I feel like I’m playing psychiatrist to the people I interview,” Portzline says. When someone tells you, “I’m a 6-foot-2, white, American male. I’m basically the most destructive force in the history of the planet,” — as someone recently told me — don’t waste time psychoanalyzing, just move on. Do a background check. Check all the references. Consider having a friend or someone you trust meet them and give you their perspective. You can’t be too careful.

Avoiding Know-It-Alls and Do-Nothings
Wilson says he has learned to trust his gut when it comes to deciding who to hire. His experiences have attuned him to the unique nature of caregiving and the sometimes hard to discern qualities of those who thrive at it. “This is a job that takes a unique kind of human nature. It takes somebody who is willing to set their own biases and their own needs aside,” he says. “These people come into our homes and have access to our private lives in ways others don’t. So we’ve got to have a real level of trust that goes two ways.”

Small has a theory. “I break it down into three types of people who end up doing this type of work: the people who like doing this type of work, the people who do this type of work because they are good at it, and the people who do it because they can’t do anything else.” You can find a good attendant in any of the three groups, but it’s going to be much easier if they enjoy what they are doing.

Portzline’s best tip for identifying those individuals is to focus on how they interview as much as what they say. If the candidate doesn’t communicate with you well in the interview, chances are they won’t on the job, either.  Is the candidate curious about you and your routine? Does he or she ask questions? Does he or she seem to have all the answers? I recently had a candidate explain to me that just by seeing my arms crossed he could infer that I was losing body heat, getting cold and would likely need to leave soon. He was right that I was ready to go, but it had nothing to do with being cold. My arms were crossed out of frustration over wasting time with someone who clearly had no idea what he was talking about. I could picture him lecturing me about how the way I’ve done my routine for 14 years just didn’t work, and I wanted to vomit. “Know-it-alls are almost always bad,” says Wilson. “Your overall chances of getting better care improve greatly with people who ask questions because they are willing to learn about you and what you need to make your life better.”

Small focuses on candidates’ body language during interviews and scopes out their hygiene. Long fingernails are a definite no-no. He works to be as explicit as possible in describing the job and what it entails. If someone cringes when you say “bowel,” you can guess how they’ll respond when it comes time for a bowel program. “I had a guy argue with me over the pay rate in relation to helping me go to the bathroom,” Small recalls. “He goes, ‘You want me to wipe your ass for $7.25?’”

The End Reward
All of these bad experiences pale in comparison to the countless tales of good attendants and caregivers who have made a positive impact. Last year, Small’s attendants stayed with him 24 hours a day during an extended hospitalization, helping and ensuring the staff didn’t screw up his routine. “If they hadn’t been there, I’d be dead,” he says. “The hospital would have killed me.”

Stories like that show why putting in the extra effort to try and find the best possible attendants is always a worthwhile investment. Thanks to the amazing people who have worked for me, I’ve traveled around the country, been exposed to countless cultures and learned enough about homemade tattoos, couponing, ferrets, Brazilian mixed drinks, boxing, dreadlocks and much more to compile my own encyclopedia of random caregiver knowledge.

All those memories, plus the passage of time, make the few “experiences” I’ve had with less-than-ideal attendants seem trivial.

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