How to Be a Good Employer and Keep Your PCAs Happy

what makes a caregiver relationship work

Illustration by Mark Weber

Over the course of our 30 years, NEW MOBILITY writers have interviewed hundreds of wheelchair users to unearth secrets to one of the most difficult disability-related tasks: hiring good caregivers. The thinking behind the majority of the stories was simple: Who knows what works better than the people doing the hiring?

The answer always seemed obvious until I found myself in a conversation with a friend’s caregiver this summer. She has worked for my friend for many years, and it became clear that she hasn’t stuck with the job out of need. She puts up with the early morning wake-ups and last-minute calls because working with my friend means something to her.

I realize that caregivers are like snowflakes, in that each one is unique, but I got to wondering what we could learn by talking to some who have been in successful long-term situations. What matters to them? What makes a good employer? How do they like to be managed?

With these and other questions in hand, I set out to talk with a diverse group of five caregivers, united by the fact that each has worked at least five years for a single client. I figured if you stay with someone for five years or more, something about that relationship is working.

I ended up speaking with four women and one man whose situations ran the gamut. They worked with one client from between six and 35 years. Three of them were paid by an agency or with Medicaid or state funds while two received private pay. All but one worked the equivalent of full-time; the other worked as a live-in.

Three Key Words

A number of common themes came up throughout the interviews, the most universal one being the importance of respect. “Mutual respect is a big thing,” says one. “We both understand that we’re both humans, and we’re gonna make mistakes. Everyone has bad days, and when they do, it’s important to remember that it’s just a bad day.”

“It works because my client and I respect each other,” says another. “I know I have responsibilities with my job, but she has responsibilities as my boss, too, and she has to be as respectful of those as I do of mine.”

For four of the five caregivers, that respect made them feel more like family than merely an employee. “His mom started talking to me right when I first started, and she said, ‘Anyone that stays with us should become family. You’re in our lives, you’re in our house, you’re at all of our dinner tables — why treat you like a stranger?’” recalls one caregiver.

“Her family is one of the greatest things,” says another of the woman she works with. “They keep in touch and support me — it’s like we’re working together, so if something happens we can talk about it.”

If “respect” and “family” were the two most commonly uttered words, “communication” was probably the third. Every caregiver I spoke with emphasized how essential being able to talk with their employer is. “I get a lot of anxiety and stressed out, and I feel like I’m overwhelmed a lot,” says one caregiver. “My client doesn’t necessarily feel it or she doesn’t feel it about the same things. So I’ll tell her, I need you to listen and let me talk this through. She will, and usually I’ll feel better just by having talked through all the steps.”

“We’re generally pretty good, as far as understanding each other,” says another about her client, “but he makes sure we have a formal sitdown every six months to air any problems or needs. It sounds awkward, but it’s been really helpful and led to a number of good talks and changes.”

All three themes — respect, family and communication — remind me of a comment one caregiver made about why so many caregiving relationships fail.

“I know a few people who have gone through caregiver after caregiver, and my boss actually asked me why I thought that was,” she says. “I told him, ‘I think it’s because they don’t treat their caregivers like people.’”

Troubleshooting

Spending inordinate amounts of time working together was the most cited way to develop those understandings, but too much time together can also lead to rifts. The important thing is knowing how to work through those tensions.

“If you’re mad with me, tell me why you are mad,” says one. “Then I can understand. But if you’re mad with me and you’re lashing out at me for nothing, that is a little hard.”

“I can tell when he is in a bad mood,” says another caregiver of her boss. “I’ll say, ‘Hey, do you need some time to yourself?’ And I’ll give him some privacy. Likewise, he’s pretty good about saying, ‘Hey, I’m gonna meditate and have some time to myself.’”

That same caregiver related the story of what she deemed the most difficult period of her employment, when her employer started dating another of his caregivers. The two eventually married, and all three are now close friends, but initially things weren’t easy. She credits him with going out of his way to talk through the situation with her and his other caregiver.

“He actually took us to dinner and talked to us to find out what we wanted to see and what we were willing to do and not do,” she says. “It helped us figure out a new dynamic and move forward.”

Sometimes the table is flipped, and changes to the caregiver’s life are responsible for helping or hurting the employee/employer bond. One caregiver mentioned how the end of a long-term relationship left him in a funk and short on resources. After weeks of what he later realized was probably perceived as moping, his boss pulled him aside and asked what was wrong and what he could do. A new schedule with more hours helped relieve the financial crunch and improve his attitude.

The story also shows how critical it is to be observant and pay attention to your hires’ wellbeing. A simple thank you or acknowledgment of a caregiver’s work can go a long way.

“He’s really appreciative, which is a big thing in my book,” says one caregiver. “When I leave, he’ll ask if I need anything from him. He’s always the first one to tell you that he appreciates everything that you do, and he goes above and beyond with birthdays and holidays. He makes a point to know his people.”

“He is constantly apologizing for asking me to do what are often really simple things. I appreciate the sentiment but I try to let him know I get it — this is a job,” says another. “Still, I’m glad he cares and doesn’t want to overburden me.”

A Great Opportunity

All of these insights will hopefully give you a foot up on hiring and working with future caregivers, but as many interviewees pointed out, there is only so much you can do if you aren’t compatible with someone. One caregiver suggested prioritizing compatibility above all else when hiring. “Skills can be learned and skills can be taught,” she says. “I would want to find somebody I could have fun with, not because I’m looking for a friend but because you’re going to spend so much time with this person and you want to be able to enjoy your company and not hate life.”

Also, it’s important to think beyond your own needs and consider what your caregiver is getting out of the relationship. “At the beginning I thought I’d just do it for a year, because that was what was asked of me,” says the same caregiver. “And then it really worked out. I got to do a lot of things I hadn’t done before, like drive across country and travel, and I was completely responsible for myself and another person. I think it was really good for me.”

“I’ve had so many crazy experiences thanks to this job,” says another. “I’ve learned new skills, tried new foods and been places I never would have gone on my own. Honestly, when I think about everything that’s happened over the years, the stuff people think of as ‘caregiving’ is such a small, small part of the job.”

One caregiver wondered why more people looking for work don’t give her field a try. “It can be a really worthwhile career choice. Everybody can give it a shot. Anybody can do it. Well … not anybody,” she says with a laugh. “It takes a certain personality.”

Hopefully this story will give you some insight into finding quality caregivers with the right personality and skills for you.

Random Tips From the Other Side

Below are a few comments and ideas the caregivers shared in their interviews.

On Helping New Employees: “A new hire will come in for two or three morning shifts and watch our morning routine before we let them work a shift by themselves. We call it shadowing. We give them the rundown and show them what to do. That way, if you don’t remember it all the first time, it’s not a big deal because somebody else will be there to help you.

Bonding Over a Pet: “We got a dog within the first two weeks of knowing each other and we definitely bonded over the dog.”

Write It Down: “Having my daily responsibilities written down was really helpful. I got a step-by-step list detailing how to do everything when I started. After eight years, I don’t need that anymore, but we started a white board where he can write random tasks and jobs, and that has been great.”

Money Matters: “She has always been really clear about how much I will make, and she has let me know when there are changes because of state policy or something. I can handle uncertainty with other topics, but not with money.”