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The relationship is different for someone present in a home, for many hours, on a regular basis, from professionals who arrive in many homes, briefly, to assess and treat.
I feel insulted if an agency steps in the middle - they fear individual aides making arrangements on their own, worry about upsetting families, but I think a family-caregiver bond and respect is irreplaceable, and they should encourage families with appreciation, to show their value of ongoing aides. Agencies do not offer career ladder training, just an hourly rate (relatively low) and only skills training sessions periodically.
If you tip the mailman, the trash man, a waitress, hotel personnel, etc, by all means tip the home health aides, and because most are scraping by, money is best as part of a thank you.
Most caregivers (no matter their education level or qualifications) don't make enough to justify the "nasty" parts of the jobs we do..out of love. (And if you don't come to love your client, then I feel sorry for you) Money was the reason I worked 2 jobs for several years and money was the most appreciated gift. My client's family HIRED me because they simply could not care for mom any more--they all knew the exhaustion and frustration of the endlessness of caring for her.
For me, it was my JOB and I did it with pride and respected my client. Being respected in turn just made me feel valued and want to do a better job. One of my saddest days of my life was the day we moved her into a NH. Broke my heart, I cried all the way home.
I also have private aides with her 12 hours a day - except for one or two steady ones it is a revolving door and some only do one shift a week - among the six I'm tipping, one gets $100, one gets $50 and the rest get $20 and all get a small box of See's candy
I see nothing demeaning about tipping a caregiver who is only getting $10 to $13 an hour. Maybe it's different for an RN or LPN. My thinking is that if the caregiver is good, they are saving your life and sanity, and keeping your loved one happier. Don't they deserve a nice gift of money more than your lazy, know-it-all sister-in-law?
If you can't afford much, then when you give it to him/her, say, "I wish it could be a million dollars!"
A tip to a health care professional seems demeaning, imo.
Presentation is everything, wrap it up nice, or put the gift in a pretty card.
Gifts during the year are nice too.
One of my Dad's caregivers use to cook from scratch, and she would bring him extras she had cooked. He loved her cooking. Her sisters would give her deserts for "Mr. Bob". So in her case, a grocery store coupon would work :)
Knowing how much the family spends on health care it does not compute.
However I would give cash not a gift card.
I see now. Thanks for the clarification. It's nice there are some decent medical people; too bad there are so few of the same in the Cleveland area.