Q. I am a low-level quadriplegic and I require assistance from attendants for my morning and evening care. Gina has worked as my sole attendant for two years and is intimately familiar with my routine. She talked to me about the importance of having a backup attendant and suggested her friend Susan, who recently received her certified nursing assistant certificate and wants extra work. Finding reliable and capable attendants is challenging and having a recommendation from Gina made the task easier. I interviewed Susan and outlined my care needs and the related light housekeeping associated with the position. Susan accepted the job and started working for me the following week. But I soon found out that having multiple attendants presents tricky personal dynamics.

I work from home, so my morning routine is set, except when I have an early meeting or a medical appointment. On those days, I wake up earlier, but the sheer volume and nature of my morning care routine requires a quick pace. The days when Susan was working and I had an early appointment, I was often late. On each occasion, I asked Susan to move faster, but she didn’t speed up enough. I was frustrated and stressed.

One such morning, while Susan was making my bed, I went to the other room and dictated a text to Gina stating that Susan was not responding to my requests that she move quickly to accommodate changes in my schedule. In the following weeks, it was clear that Susan was upset. While normally chatty and happy, she did her work quietly and seemed to avoid conversation with me. After many days of this, I asked Gina if there was anything wrong with Susan. Gina reluctantly told me that Susan had heard my text and was upset that I did not talk to her directly. I realize my mistake and want to correct it. Should I talk to Susan directly, even though Gina was the one that told me why she was upset? How do I apologize to Susan and work with her productively to find a solution to the problem of her not picking up the pace when needed?

A. Any good employer must recognize that employees’ skill sets differ. Each attendant has strengths and weaknesses, and you will want to assign duties accordingly, whenever possible. But you, as the individual receiving care, also play a critical role here. You must communicate a clear, consistent understanding of your expectations to your assistants so they can effectively meet your needs. Where problems do arise, it may be tempting to talk to your long-term attendant about another caregiver, but it is not a wise practice.

In this instance, texting Gina about Susan’s tardiness was unfair and put Gina in an awkward position. Even though attendants may know each other and interact regarding your care, it is important to deal with each person directly. Here, you could speak with Susan individually and apologize for talking to Gina about your frustration. Explain in detail why your timeliness is important and that there are mornings when you need to expedite your routine. Use this conversation with Susan to make clear that you were not trying to embarrass her. This is also an opportunity to hear from Susan. Maybe there is a reason that she didn’t rush, such as fearing she might compromise an aspect of your care.  This dialogue provides an opportunity to brainstorm with Susan about possible solutions. She may have valuable input on how best to meet a morning deadline. Also, this is an opportune time to promise her that there will be an open dialogue with her alone about any future issues.

If Susan understands that you are sorry for making her uncomfortable and that you value her as an attendant, the two of you will have a basis to move forward. It is also important to impart the same message to Gina — that you will not be talking to one attendant about the other. This will ensure that each attendant feels worthy, respected and not subject to comparison with her colleagues. These elements are key to an effective caregiver relationship and can go a long way toward avoiding the pitfalls of caregiver comparison.