For those of us whose children require in-home nursing, agencies are often the first resource suggested to us by hospital personnel and discharge nurses. Because they have access to multiple nurses, agencies can often respond to the need for care quickly. Many hospitals suggest that families use agencies instead of independent nurses because they assume that the quality of care is managed more closely in agency settings.

By contrast, most families who use home nursing have found that agency nurses are often less invested in the care of their patients, as they can simply quit and find another agency with little consequence. The way many agencies are managed contributes to the poor quality of care some families receive from agencies, since the nurses are bounced from one case to the next when families are dissatisfied with the care their child is receiving. We had this experience recently with an agency called Care Health in Ohio. I share the name of the agency as a customer review because I want families who are considering this agency to be aware of the potential for a negative experience with them.

Having recently moved to a new city, we enlisted the help of an agency that provides pediatric nursing. A family friend who is one of the Care Health’s employees referred us. After interviewing the case manager, we decided to give them a try. However, two months later, we decided to fire the agency, not just the nurses, for issues related to the consistency and quality of care. Here are three signs that you need to fire your agency.

The agency seems to have an abundance of nurses who lack professionalism or skill

In our recent experience, the nurses who worked with our son were moderately experienced with pediatric patients. However, their professionalism left much to be desired. Instead of giving appropriate notice for absences (of which there were many), the nurses called off within an hour of their scheduled start times or arrived more than thirty minutes late without calling or notifying us. No apologies or acknowledgements of the disruption caused by their attendance issues were ever given, which signifies both a lack of professionalism and a lack of compassion. One nurse, who obviously disliked working third shift, would rant aloud every morning about how she was “ready to get out of here” well before the time her shift was to end. Another nurse from the agency was regularly caught sleeping during her shift.

The employees of the agency seem unconcerned with the quality of care your child receives

If the agency you are working with sends a case manager who never asks about the care your child is receiving, this is a sign that the agency has little concern for quality. The case manager from Care Health who visited our home did not inquire about how the nurses were performing. Even when I told her that I had concerns, she did not seek additional information. To me, this lack of information seeking signified that the agency did not intend to address or discipline the nurses for their performance issues. Instead, they simply moved the unprofessional nurses to other cases so they could become someone else’s problem.

Agency employees do not respond to your concerns

When I discussed my concerns about the nurses and their behavior with the case manager and scheduler at Care Health, I was met with apathy. For example, instead of addressing the chronic tardiness of one nurse, the agency’s scheduler asked me to change our schedule to make it easier for the nurse to arrive on time. The idea that we should change our entire family’s schedule instead of addressing the nurse who showed up 30 minutes late for every shift was unbelievable, and it showed that our family’s needs were secondary to the agency.

After dealing with call-offs for three consecutive night shifts, we made the decision to reduce the number of hours Care Health’s nurses worked in our home. When I told the agency’s scheduler and case manager the reason for the reduction, they essentially shrugged their shoulders.

Breaking up is (sometimes) hard to do

The process of firing an agency isn’t always easy, especially if options for care are limited in your area. Our patience with Care Health was necessary for a time, while we searched for nurses to replace the hours they covered. The agency demonstrated a lack of commitment to quality and tone-deafness to the experiences of the patient and family, which told us there was no fixing the relationship.

The purpose of a home nursing agency is to provide relief to the family by caring for the medically complex patient. If your agency provides more stress than relief, it’s time to make a change.