Much of what we do in home care business is administrative: arranging schedules, handling call offs, following hiring protocols, assessing clients and documenting, documenting, documenting. The data entry and paperwork is endless.

But at heart our business is all about human beings interacting with one another, so in the long run our success relies on pure people skills. Nowhere is this more important than in finding the right “match” between caregiver and client. It’s definitely an art, not a science.

The first consideration is ensuring that the home health aide has the right skill set, experience and strength for the client, but the rest is about finding the right personality match. A skilled home health aide who is beloved by multiple past clients may nevertheless rub her new client the wrong way and there may be no “fixing” the situation short of changing the aide.

A complicating factor is that many of our clients are convinced they don’t need our help in the first place. It’s their pushy children who are forcing them to do this, they tell us. (Never mind that they are 95, legally blind and recovering from a broken hip. By golly, they’ve always done everything on their own and they don’t see why that should change now!)

In these cases, just getting in the door is success. Being permitted to stay for the entire shift is a major victory. Clients who are resistant from the get-go usually won’t help our cause by saying just what they would like to have done. We know we’ll be more likely to succeed if we send a home health aide who is creative and proactive about setting their own schedule of things to accomplish on the shift. They need to prove their value to the client.

Other clients love nothing more than giving directions, right down to the last detail of how they want things done. They need someone who is willing and compliant. If the client’s manner is gruff or even hostile, we need to match them with an aide who is mature, experienced and self-confident enough to know not to take things personally.

Patience and understanding are all the more critical with clients who have dementia. Dementia patients can lose their social inhibitions and say things they never would have dreamed of saying in their pre-dementia lives. Family members are often mortified to hear what comes out of a parent’s mouth, but caring, experienced home health aides are usually unfazed by this behavior. They understand the situation. It’s very important for us train employees for dementia care and to recognize ahead of time who does not have the right temperament to succeed with these clients.

There’s no way around it: some customers are just plain difficult. And rude, demanding behavior is tougher to put up with when there is no dementia involved. In those cases we have to remember—and remind the home health aides involved—that even difficult people need care. Maybe there are extenuating circumstances such as pain or frustration at being dependent that we need to keep in mind.

Regardless, we do our best to help everyone who needs it. One of the clients we have been providing around-the-clock care for over 6 years has “fired” rejected over 35 people. One aide carried too large a handbag, she said. Another one was a “moron,” and yet another (one of our sweetest and most skilled) “looks like a man; don’t send her back.”

As you can imagine, we had almost as many employees who didn’t want to work with her either. “I need money but not that bad,” was a common refrain. We don’t force the home health aides to take a client they aren’t happy with. The “match” has to work both ways.

With effort and creativity we’ve managed to provide this client uninterrupted care all these years. We have a pretty finely tuned sense of who will pass muster with her by now. And we make sure to thank the home health aides effusively and frequently so they know they are deeply appreciated by us, even if the client herself takes their efforts for granted.

On the bright side, there are times when we get the perfect fit right away, and that makes us really happy. Over ten years ago I signed up a client who needed a companion several days a week. When I dropped by toward the end of the first shift to see how they were doing I found the two of them sitting on lawn chairs and chatting like the oldest of friends. All these years later they are still inseparable pals and the client, now in her 90’s, is still living in her home.