What instruction should be left for hired caregivers? How detailed?

This is personal opinion from me as an RN, but were I caring for someone I would want instructions and thoughts and clues as COMPLETE as the family can make it for me. I cannot know all the idiosyncrasies of the patients, and they matter in my caring. I would love a 20 page letter if you are up to making me one. You can always head it by "I recognize this is overkill, and I don't want you to resent the length of it all, but just in case you are wondering about certain issues, I have made it as complete as I can in order to try to help with the matter. Please, if you have any questions, do give me a call. I am trying to be helpful, and hope I am not overdoing it".
I would love the info myself.

I want to add to Burnt's post considering responsibilities of an aide.

As I have said before I worked as a secretary for our local Visiting Nurses. We had a client who was bedridden and we were asked by his Dr to do a few things for him. His wife held down a full time job and there were middle school age kids. I knew the wife and she complained to me that the aide provided by the State did nothing. Nothing meaning washing the dishes left by her family and doing laundry for the family were two of the complaints. I asked my boss about this and this was her response.

The aide is there for the client. If a the client lives alone, then the aide should do a little light housekeeping and clean up any dishes left from feeding the client. Also, trash removal, bathroom clean up, and laundry.

Now, if there is family living there its different. The aide is only responsible for what she does for the client. If she prepares a meal, she cleans up. She cleans up after a shower and toileting. She makes any kind of mess caring for the client, she cleans it up. Strips the bed, she could wash the sheets. But, she is not responsible for the laundry of the family or cleaning the house. Keep the clients area clean, yes, but there is another adult that can keep the rest of the house clean.

This woman had children old enough to help her.

My mom has had in-home care at varying levels of support for the last 16 years, and I've tried it all the ways: in-person "training," posted handwritten notes, posted laminated notes, more notes, fewer notes, 3-ring binders, checklists, charts, daily sheets that have to be signed, PDFs to the agency, emails to the agency, you name it. At this point I've landed on a "happy medium" of 1) a binder with a big stop-sign logo on it that says "New Caregivers Must Read" that includes a list of tasks for each shift (morning, afternoon, evening); 2) a laminated "BEFORE LEAVING" sign on the inside of the front door that highlights safety-related instructions ("make sure space heater is turned off," "leave walker next to the bed," etc.); and 3) a few smaller laminated notes elsewhere for things that are less critical. No matter what you do, there will be times when your instructions aren't followed (for any number of reasons), so focus on health and safety concerns first and be prepared to let the smaller stuff go sometimes!

If I was doing this I would probably think about how to set it out. I’d use clear headings for each topic (eg Toileting). I’d put the most important thing under the heading (eg every 2-3 hours), then leave a gap. Then put a subheading ‘detail’, and list by number (1) all the things you set out in your post. That way the carers can see the main jobs, and don’t need to read the detail if they are already confident.

I’d print out several copies. If one of the details keeps getting forgotten, I’d use a highlighter to make it stand out.

This might be worth trying out. But then, I once had a boyfriend who told me I had written the only love letter he had ever received with numbered paragraphs. So it may not be your style!

For Aides in my area, English is a second language, so I think keeping notes as simple as possible may be better. Really someone with experience does not need a detailed description of everything they need to do. And if me, it would be insulting.

I was an in-home caregiver (mostly to elderly) for almost 25 years. I find that most of the time the written instructions left by the family member were usually pretty useless and often downright offensive.
You can tell the caregiver that they have to bring your mother to the bathroom every two hours and help her with cleaning up and changing. That will suffice.
If a client's family assumed that I would not have sense enough to dispose of a soiled pull-up or the commode bag the client just took a sh*t in without written instructions from them, I would walk off of that job. That would be an insult to me and I would not return.
Here's what you leave written instructions for.

-What time the client is supposed to take their medications and what those medications are.
-What foods the client likes for their meal (if you haven't left the meal prepared. Many families do this for their LO and the caregiver heats it up).
-What time do they usually nap during the day if they do.
-A listing of a few activities they enjoy doing

Most importantly is the family member in charge should be honest with the caregiver about what level of dementia their loved one has and how incontinent they really are. If a person is totally out of it, that is not 'a little forgetful and needs reminding'. If the client pees and craps themselves daily that's not the ocassional 'accident' so many families will claim it is. They should also be honest about whether or not their LO can actually do anything for themselves, and just how much housekeeping they expect from the caregiver.
We are not housekeepers, or a domestic servant there to do for the whole family. I'm not washing the dishes from the family's supper the night before. Or doing their laundry.
Caregivers do for the client. Not the family. We generally do light housekeeping for the client. Light housekeeping is not cleaning out grandma's filthy hoarded house. It's not scubbing floors on our hands and knees that have been down since the Civil War and not cleaned after it.

I have found over the last 25 years of service that families tend to skirt around discussing with the caregiver exactly what the situation is and what they expect from them.
Be honest with us about the things I've told you here. Don't micromanage and knit-pick about small things. If a caregiver does not have sense enough to dispose of a soiled diaper or pull-up properly, get a new caregiver.

Yes, be as specific as possible! Most caregivers appreciate the information. If you don’t, then don’t be surprised if the caregiver is on her phone looking at Facebook!

My mom & aunt have several caregivers and including family we all need to be on the same page. I have a one page list of
instructions for the day shift and one page on the back for the evening shift. When family takes a shift we also fill out what is accomplished, what was eaten etc.

You can find daily notes templates online to copy & edit. I also ask all caregivers to sign their notes. Our caregivers work for other clients so this printed reminder helps a lot. It is a good idea to keep these pages for documentation.

For example-If either client becomes ill or has an upset stomach we can look back to see what they have eaten.

Caregivers are encouraged to text or call if they have concerns.

If at all possible, spend part of their first shift with them, going through the routines with them, telling them the ins and outs of it. It takes more time, but gets across the 'gist' of what you expect from them, far more powerfully than anything you could ever write down.

Woah! #1 - we can't apply creams without a MAR chart in place. Is the barrier cream prescribed? Is there a body map? I don't know if the regulations are so strict where you are, but we require:
the cream to be prescribed by a qualified practitioner (doctor, nurse, PA);
a body map showing area of application;
application directions - frequency, quantity, anything else that's specified such as "allow to dry";
a MAR chart, (MAR = medications administration record).

No MAR, no cream. I keep rules, and have only once been driven to break them, when a lady was trying to apply ibuprofen gel to her shoulder blade and I could stand it no longer. My documentation for that visit read "worked with client to apply prescribed gel to shoulder blade" which I blush to say was at best stretching the truth. Some of my coworkers are more practical and gung-ho about it, leading to clients' oft-heard plaintive remark "everybody else just puts it on..." Well they shouldn't!!!

Anyway, so #1 - if there are creams or medications of any description, you'll need MAR charts. You can find easy to use templates online; but check their policy with your agency - they may supply their own. This should have been discussed at assessment.

Speaking of assessments, I have just been promoted (and, story of my life, taken a pay cut - don't ask). It is now part of my job to Write The Support Plan for my team's workers to carry out. I am trying not to make them all hate me. I know that they are good people who know very well how to make a client safe and comfortable and will immediately report any concerns; so what I am trying to do is design a format that is what I would have wanted to see when I was doing their job. It isn't easy!

Try this:

One page profile. This is quite fun to do, and you should do it with your mother. It can be decorative, it is for everyone who visits her to see, and it tells people a little bit about her as a person. It goes on one single page, and should include:
what she likes to be called
what's important to her
what sort of help she needs - verbal prompting, physical support, reminders, e.g.
her likes and dislikes
a paragraph about her life, such as you'd find on a book cover 'about the author.'

Key data page - this includes anything the caregiver might need for ready reference in an emergency:
Allergies
Any DNR or similar directives
Any health alerts (e.g. pacemaker, diabetes, Apixaban, splenectomy)
Her Covid status, including dates of vaccinations
Her medications
Her doctor's telephone number
Her emergency contact's details
Her date of birth
Her address (yes I know we're standing right there in the house, but you'd be amazed how hard it is to recall an address when you're speaking to the emergency services).

Next, schedule. I recommend you divide it into four sections:
a.m.
midday/lunch
p.m.
evening/bed

Each section has its own page. On this you list the scheduled tasks, e.g.:
a.m. -
support to get out of bed, prompt use of Zimmer frame
transfer to commode/toilet
support with continence care including skin integrity check and barrier cream
support with personal care, including oral hygiene [full body wash daily except shower and hair wash Tues/Fri]
support with dressing and grooming/make up
support with mobilising to kitchen
support with breakfast, fluids and medications
support with toileting
support with mobilising to living room chair.

Because we are a Reablement service our support plan is written in the first person, with the client's active participation, so it reads more like "please support me to get out of bed, allowing time for me to mobilise. Please prompt me to use my frame to walk to the bathroom." You might feel that's friendlier.

Things that seem obvious but then turn out not to be... It isn't so much the instructions that count as the ergonomics. Where's the bin? The pull ups? The clean towels? The trick is to make it all work for people who don't already know your house.