Would you hire a retired (non-registered) RN, BscN? And for what?

February 17, 2022 11:38 AM

I need ideas for how to frame a home care business that doesn't include nursing duties. Please see below for what I see offering as services. Potential pitfalls would also be good to know.

I'm posing this question to better formulate how I might create a consulting business for home care that might include everything that my previous experiences had me doing, except for the actual nursing care - perhaps to check-in with an elderly loved one, do light housekeeping, meal prep, go for walks with a client or assist with motivation to do some routine exercise, be company and conversation, perhaps take a person out to help with groceries or to sit alongside and interpret doctor's appointments (to pass on to family or to assist in making further investigations or appointments)... and just basically do what family (if there is any) might not be able to do from a distance.

I don't want to have to renew my registration, as that would require much more mandatory recertifications and costs incurred. I also don't want to be responsible for nursing duties any longer - but I'm certain that I could assist in finding the resources needed, how to obtain funding for such resources through gov't programs, and possibly be retained in a slightly heavier capacity until those programs and assistance were to kick in. Or for a temporary illness/injury(?).

I just want to have a few clients (2-3) that I could assist regularly - but not so regularly that it would be mandatory that I showed up to get someone out of bed and on to their daily activities everyday. I could easily recognize when someone was declining or needed to eventually get set up with services that would do that, though. And of course, I would communicate with families about concerns, or contact EMS or primary care provider if there was a serious issue or emergency.

I suppose I might consider renewing my license if it meant that my insurance was better covered, but I wonder how much insurance I would need to just "check in" and "help out"? Also, if I am again licensed, then there is the risk of being asked or expected to do things I am no longer wishing to be responsible for - even though I know how to do these things, I haven't been doing them for a few years now, and empirical evidence changes best practice procedures over time. ***I am however, able to see things that others wouldn't, could prevent accident and injury from happening through safety measures that I could suggest and implement around the house, would be able to check to see if someone's been taking their medications or eating properly, handle a small skin tear and monitor for infection (etc), and have a problem solving mind that likes to help others continue to be independent.

I guess I'm just looking for ideas on how to frame this for my smaller city (about 20,000). There is already a volunteer group that covers similar things, like driving to doctor's appointments, but they don't include interpretations and solutions to individual's problems (say perhaps, finding an OT that can create ergonomical eating utensils (or even jerry-rigging some myself with a cloth and tape over a handle temporarily), or a contractor for a home modification for ease of mobility)... and they don't offer continuity of care and monitoring, from what I understand.

Let me know what YOU would want from what I'm describing so that I can propose what I will do for a client, and to create a mission statement.

Thanks hive mind!

posted by itsflyable to Work & Money (16 answers total)

I don't have very detailed advice except I've been vaguely researching available things for my own situation (possibly needing care of some kind in a nebulous fashion that doesn't fall into a nursing category) and there's a term I found called "companion care" that might be useful to you to research with if you didn't know it already that basically covers those sorts of activities. There's a website called Care.com where you can hire people to do that kind of work which might be useful for you to sign up for to look at what provider profiles look like maybe, even if it's not directly useful as a way to find clients in your smaller area.
posted by foxfirefey at 11:45 AM on February 17, 2022 [1 favorite]

Here are some pages framing similar(-ish) types of care, if that's a helpful resource: Companion Care, or eldercare doula.
posted by mosst at 11:53 AM on February 17, 2022 [3 favorites]

I've seen several people on Nextdoor in my area trying to hire someone for this type of work (companion care) and I think saying that you're a retired nurse would be a huge bonus. You might try posting on your local Nextdoor explaining what you can offer.
posted by pinochiette at 12:40 PM on February 17, 2022

I live in a town about a quarter of the size of where you live and my landlady is 96 and lives alone and has a person like this in her life. There are a number of things this person does for her that are not-nursing but also a little more professional. These include

- small errands including taking her to get her vaccinations (she does not drive) or lining up rides for her if she can't take her places.
- taking her out for walks and keeping an eye on her balance
- suggesting solutions for age-related problems (low vision, low hearing, keeping track of medications)
- occasional lift heavy boxes kinds of things
- helping with minor tech issues (very minor, I help with all the major stuff, but like getting the ipad to quit playing or helping her access a lab result in her medical portal)
- checking in with the family if something seemed "off"

I think you could say that you've been a nurse for X amount of time, are NOT currently a nurse but are very familiar with the medical and health care environments in Small Town and would be available for non-medical companion care. You could then decide if you wanted something like "daily except for weekends" "every day" "once a week" or what the range was. I know with my landlady it's daily except weekends.
posted by jessamyn at 12:43 PM on February 17, 2022 [1 favorite]

Response by poster: I should also say that this service could easily be applied to assisting younger people with mobility or chronic health issues... and would encompass more than simple companion care in terms of expertise.
posted by itsflyable at 12:45 PM on February 17, 2022 [1 favorite]

I would love to know there's a "private," so to speak, social worker I could hire to help consult on my mom's caregiving. Right now I'm flying by the seat of my pants trying to figure out how not to fill in all of the gaps with my own life if I don't have to. I'd like to have an expert available, maybe with periodic checkins, about whether and how to expand coverage, either with the current ones or by adding more, or to try hiring outside of the agency industry. Stuff like that. It's not complicated, but it's hard to do from inside the situation, the options available and best practices are not easy to find. "Domain expertise" in HR-speak, I guess.

As far as doing the work, the more trained and RNs of the caregivers we've had have been way more confident and professional without medicalizing the relationship, which is nice. Even with the regular "fix food, clean a little, chit-chat, sit around while Mom watches the news all day, and be there to call 911" caregivers have told me about bedridden clients that they take care of with the same exact skills, so I don't think the vast majority of non-hospital/SNIF/institutional caregiving is particularly intensive. What it is, though, is schedule-driven. I don't know what use I would have for a "pop-in" person. "Fill-in" is what the more flexibility-oriented CGs we've had tend to do. 4hrs here and there, maybe on same-day notice but also maybe further in advance. Again, as a client I don't even know how to plan my needs here, and every client has different levels of independence, abilities to be alone with themselves, regular visitors, that kind of thing.

From a client standpoint that's what I think about.
posted by rhizome at 12:56 PM on February 17, 2022 [1 favorite]

Answer based on my imagination/what I have read in other people’s asks and advice on dealing with aging parents, but not on personal experience: it seems to be often the case that people want help understanding what choices exist, or what choice will be *best* for them, especially how to make the best choice with limited resources. I work in a field where high-level strategic thinking is constantly invoked but actually in very short supply - while the vocab might not carry over, what about something on the order of [strategic care planning or advising]?

Client: help! I or my loved one is aging/dealing with new/chronic health issues, and I feel so overwhelmed. What kind of help is a good investment, and what isn’t? Can I trust reviews/ratings of facilities/companions? What do my medical providers’ results and recommendations mean? What do I need to do now, and what do I need to do in future?

(Former)RN to the rescue! YOU know how to navigate and improve the utility of medical systems - evaluate potential care assistants (AND how to take actions to cultivate/monitor interactions with caregivers to ensure it’s a good working relationship) - create schedules/reminders for health checks and/or home-care logistics - find creative solutions to what seem like intractable or completely unique problems (e.g. the McGuyvering of assistive technologies). You help people make good decisions, and make sure that they stay that way.

Give people 15 min of your time to describe their problem and prove they can’t stump you. Whatever personal branding you do, consider offering free tools or links to resources that already exist in your community, Miracle-On-34th-St-style - if people didn’t know about things like the volunteer group you mention, you mentioning it both helps the group help more people and shows potential clients that you are helpful.

Ha! Re-reading what I’ve written, this might be a pitch with more scale than you were intending (2-3 clients). That said, if you don’t expect to be able to keep clients for years at a time, finding a way to stay relevant and present in people’s minds even when you can’t take on new clients might be helpful. (Also, if you find anyone else doing the same work whose work quality you could vouch for, you’d be able to make referrals to each other that could be mutually beneficial.)
posted by rrrrrrrrrt at 1:05 PM on February 17, 2022 [4 favorites]

This type of person is often referred to as a Personal Care Assistant (PCS) in the disabled community. You can frame yourself as someone available for regular shifts, or for backup/substitute availability when regular PCAs fall through.

I'm not sure if Care.com is popular in Canada, but it's a common place to look for this type of work in the US.

If you're looking for referrals, good places to start are maybe at local churches where leaders might know of people who need assistance for themselves or their family. And talk to local social workers (hospital, government, etc.) - they'll often be in the place where their clients will need someone like you.

I think describing yourself as a retired nurse gets the point across that you've got the background knowledge, but aren't currently licensed.
posted by hydra77 at 1:08 PM on February 17, 2022 [2 favorites]

Putting yourself out there as a retired nurse just begs people to expect those duties from you.
You’re interested in the personal care aspect short of the medical/hygiene— is this correct?

Other related services might be helping families decide on care facilities, filing for aid and services, maybe accompanying patients to appointments and treatments. Getting my family member to dialysis was confusing and difficult- as was wading through new and competing dietary restrictions and treatments.
Maybe there is a way to market you as an ‘after care’ assistant or home health assistant.
posted by calgirl at 1:20 PM on February 17, 2022 [1 favorite]

It can be very hard for parents of developmentally disabled adults to find occasional care for them. People who do regular childcare may not understand what is needed. This has been especially difficult with the pandemic because facilities that normally provide activities have been closed. Taking people for walks or playing games could be a very useful service. There's a disabled adult near me that I periodically see out walking with his caregiver.
posted by FencingGal at 2:18 PM on February 17, 2022 [2 favorites]

There is a job some do out there, and bill quite a bit for. It IS useful. It's called "Nurse Advocate". It's a medical professional that aids individuals find the care they require from specialists. I had one briefly. She did me a GREAT turn in finding an appropriate Neurologist, but otherwise, was too flaky for me. (I have major issues with medical staff that talk down to me. I'm a nursing school drop-out and worked plenty in medical offices AND medical insurance offices, as well as writing software for the two to play nice together...way back at the dawn of time, before IBM and Bill Gates were a thing.)

LOTS of people need help just to navigate the insane medical system in the USA.
posted by Goofyy at 2:54 PM on February 17, 2022 [1 favorite]

Response by poster: Thank you to those who have responded so far. You are truly making me think about how to market this (or just exactly "what I would do" for clients). I knew my experience as a nurse would likely cause misunderstandings. I do however, think it is a valuable asset in what want to offer. I will have to think hard about how to present this. It's more like "Mom" services. Someone who shows compassion and will help you get the tough things done to get through the day/week/month (which can differ depending on how you feel), keep you motivated to live well/move independently, and be a compassionate ear/shoulder when you need one.

To be clear, I don't want to market myself as a care aide or nurse. I want to provide services that will allow someone to remain independent longer. I would like to help people get out and remain independent and to be active; to take them out to shop or pop out for them, help them do some gardening (but not dig their whole plot), make a nice meal or prep meals for the week (I love cooking!), do some laundry or housework (even organizing), get to an appointment (or decide when to book one and with what type of professional), to help with planning and decision making by providing perspective either for a fully capable person who is aware that health issues will crop up and make life difficult, or with their families who are concerned about such possibilities.

I suppose I'm thinking of a more housekeeping/homemaking with a lean towards "transitional" companion service that could provide continuity and knowledge of the client as a whole person BEFORE a major health event happens - to provide a baseline how that person had been living before getting caught up as a medical case number who arrived unable to walk or speak (when s/he would get out for regular walks, and coherently communicate in the weeks before)... and perhaps be able to get them home sooner (or into physical therapy in the hospital sooner) to have a better chance at a full recovery through client advocacy and knowing who to talk to / how to talk with them and where to find them / or the services available. The ability to fill in the gaps before home care service (or before a facility is found) might be set up would be the last level of my service, but I could still do all the homemaking and other things according to client preference, or to guide new gov't provided caregivers into an understanding of client preferences and needs. There would have to be a cutoff limit to possible caregiving needs in such an event.

Ok. I know not to comment and respond. Maybe I really just need to market as a homemaker / companion - as these people often end up doing similar things as I've described, once they've been with a client long enough and developed that bond of trust.
posted by itsflyable at 2:58 PM on February 17, 2022

Companion does seem to be the right moniker for what you describe, although I've mostly seen that used to describe live-in services, where the companion provides company and light housekeeping in exchange for room/board/small salary. I think there is a market for more ad hoc services, though, either as respite care for a spouse/child care-partner, or as ongoing scheduled care.

One thing to consider is however you market yourself, draw up a formal contract of services between you and the person you are providing service to (or their family member/POA). My great-aunt did not have such a contract with her equivalent of what you describe, and when my aunt died, the proverbial shit hit the fan.
posted by basalganglia at 6:28 PM on February 17, 2022

From a job description

The Home Support Worker will provide culturally appropriate home support to older people, and their carers.
The purpose of the role is to promote and maintain older peoples’ independence, enhance their quality of life
and prevent premature or inappropriate admission to long-term residential care

Glue on "freelance" and that seems to cover a fair bit of what you want to do.

Think about having an offsider/partner as otherwise holidays are not going to happen
posted by Barbara Spitzer at 9:56 PM on February 17, 2022

Your aspirations sound a bit like Country Cousins [without the living-in] which my [UK] mother talked about through her 90s. She liked the idea of having a younger fitter person in the house in case, but she also didn't want to negotiate any of her independence to accommodate the needs of this other person, so it never happened. When things got sketchy on the cleanliness front (she was registered blind with macular degeneration) she signed up with an agency that would do cleaning, cooking, lifting, [chatting] at an hourly rate. She was genuinely reassured that she would only be lying in a heap at the bottom of the stairs for max 23 hours. That agency was aware of mission creep and had nursing and hygiene options available in due course.
Could you become that agency by developing a network of fixers to do the bits you don't / can't / won't? Including gardeners, plumbers, drivers, bottom-wipers, bill/letter readers, de-clutterers.

My FiL [IE] could do with someone to tie up the many loose ends in the tapestry of his care which involves a) the district nurse b) chiropodist c) OT d) Alzheimer's Society e) the age related clinic at the nearest hospital f) the kit [crutches, zimmers, rollators, wheelchairs] warehouse g) meals on wheels h) elder drop-in centre i) get-out-of-bedders j)k)l)m). His daughters have had to work hard to access what's available; it's such a waste to be re-inventing the wheel for each family with elder care issues. Is that Goofyy's Nurse Advocate ?
posted by BobTheScientist at 11:33 PM on February 17, 2022 [2 favorites]

Something I'm looking for right now: Advice on how to set up the house for my mom should she eventually be able to live on her own again.

For example, when she first got her walker, she was told to remove all throw rugs, as they can be a trip hazard.

She's had various home therapists suggest things like a walk-in shower and a motion-activated nightlight for the bathroom. But it would be nice to have one expert walk through the whole house and give us a definitive list of what needs to change, based on my own mom and her current/future abilities. It would be awesome if this person is sensitive to the feelings of an elderly person, such as resistance to change or being treated like a child.

Someone who could do the actual heavy lifting involved in this process would be a lovely bonus.
posted by SuperSquirrel at 7:04 AM on February 19, 2022 [1 favorite]