Au Pairs With Manageable Health Issues – Would you match with them?

by cv harquail on February 17, 2016

Two different young women — potential au pairs — write with the same question:

How do Host Parents feel about matching with Au Pairs who have manageable health issues?

2634188382_c251883db9_zBy “manageable”, we mean — well understood, medicated or controlled successfully for a long time, not likely to interfere with caregiving, and not likely to flare up and become debilitating.  This could be diabetes, lymphoedema, Crohn’s disease, lactose intolerance, moderate hearing loss, and other reasonably “common” medical issues.   

Writer #1:  I am an prospective au pair with concerns about one thing. I have had a medical condition called lymphoedema since birth which is like a water retention. It does not affect my abilities in any way but I am concerned families wouldn’t consider me for them as I’m not ‘perfect’. I also received a kind of counseling for this condition…I will have to tick the box on my form saying that I’ve had counseling even though I did not receive it for anxiety or depression it was simply to do with my doctor wanting to ensure I was comfortable with having a long term incurable condition.

Writer #2: I’ve just found your website and find it great! I want to be an au pair in the USA for next year and I need an advice from host parents. I suffer from Crohn’s disease. This is not really known here in France but I realized Americans know this disease much better than we do. Do you think I have any chance with a family? I feel like no one will want to deal with a “sick” au pair even if I really want to do be part of a US family.

What information do you need from Au Pair applicants with “manageable health issues” to feel confident matching with them? 

Would it help to have an additional doctor’s report or recommendation?

Would you match with them? Why or why not?


Image by Ann Larie Valentine on Flickr


Another DC HM February 17, 2016 at 1:18 pm

This is such a hard one. To both prospective APs, I am sure you could both be excellent au pairs. The issue is not that you aren’t “perfect;” the issue is one of health care. As you both probably know, health care in America is very expensive and insurance can be minimal. This is particularly true of the insurance au pairs have- you will have a very hard time getting appropriate medical care for chronic conditions such as these (I don’t know if the agencies will even approve your application?). A previous au pair of mine developed ovarian cysts and struggled to get appropriate care. She wound up suffering through it until she got back home and back to her own doctors.

To AP #1, I don’t think a host parent will care that you had counseling for your chronic condition, but I do think most host parents are simply not going to want to take a chance with an AP who may have to be sent home to get well if she has a flare up or an episode. I’m sorry that if feels like a critique of you– it’s not. It’s really just the reality of the messed-up US health care system.

NoVA Twin Mom February 17, 2016 at 3:36 pm

As a follow up to Another DC HM’s excellent comments about our broken healthcare system, I echo that you really need to understand what your au pair health insurance will and will not cover. I’ve seen it compared to travel health insurance, which it is – it’s enough to patch you up to get you home, but not to manage a chronic condition.

Two suggestions if you get to the point that families will see your profile, or for discussion with au pair companies before that point:

1. Will you be able to get a year’s worth of any medication you need to treat yourself in advance to bring with you? That would show families (and au pair companies) that you’re thinking ahead about how to take care of yourself and to “work around” some of the difficulties with our health care system. It may also eliminate many of the insurance issues, as if the chronic issues can be treated “from home” your US insurance would only have to come into play for flare ups. THAT BEING SAID be sure to read carefully any language in the au pair insurance regarding coverage for “preexisting conditions” – which is what these would be.

2. Be upfront about what a flare up means. I’m not familiar enough with either condition to know if hospitalization would be a potential issue, or “simply” a great deal of discomfort that can be treated at home.

A third possibility would be to research if better health insurance is available for purchase (probably expensive health insurance, potentially an American plan that you would buy on your own rather than relying on the au pair coverage?) that WOULD provide the kind of coverage that you would need for treatment here rather than “patching you up to send you home”. If you find one at a reasonable price, please let us know!!

Good luck, it sounds like either of you would be a great match if you can get through the screening process, if for no other reason than you are thinking ahead about this kind of thing.

HRHM February 17, 2016 at 4:31 pm

As a long time HM and a physician, it depends a lot on a) the disease b) the host parents’ comfort and c) the AP’s other qualifications.

I have had an AP with an autoimmune disorder that require daily immunosuppression. It didn’t effect her ability to do her job although she had a flare during the year despite taking her meds religiously. However, it was a salivary gland thing, so while uncomfortable, not life altering. I would say no to a Crohn’s patient as a flare can land you in the hospital, on iv steroids, pooping blood etc. This would definitely not be covered by the crappy AP insurance and could result in a prolonged work absence.

My other issue is that medical care in other countries can be spotty or not. Lymphedema as described above, is a symptom, not a disease. It can have a variety of causes, some that come with other issues and may need (at least in the US) additional testing, surgery or other treatments. It can also be related to parasitic infection. Without getting into the weeds, it can be pretty hard to really know what is going on with an AP who is coming from a country with a vastly different medical system than what we are used to (Thailand vs Canada)

I have a list in my head of diseases I’d be ok with my AP having as long as she had been stable and was a grown up about self care. Any HP that isn’t familiar or comfortable should just say no to APs with chronic conditions. There are plenty of medical HPs out there and some may actually benefit from an AP with particular chronic disease (for instance, if I had a kiddo with type I diabetes, I’d be excited to host an AP with the same disease who has had it under good control for a number of years as she would understand how to deal with it in my kiddo plus be a good role model for self-care and living a normal life with the disease.)

Lid for every pot…

spanishaupair February 17, 2016 at 5:27 pm

I like your point about families with kids that would benefit of having an aupair with similar health problem. I have a more or less similar experience, i went to a family with a HK with chronical problems who refused to take the pills he needed and as i need to take pills too, different chronic problem, we would sit together and take our pills at the same time which encouraged him to take his..

About the topic i was an aupair with chronical problem, hypithyroidism, and wasnt a problem, i was in europe but i once searched and contacted an agency and did most of paperwork before deciding to extend with my european family and become to old to go to USA, and the agency said that i wouldnt have a problem finding a family because it was under controll and have lots of experience.

Another DC HM February 17, 2016 at 6:36 pm

As a previous poster said, it’s going to depend a lot on the illness at hand. This is a great example. Hypothyroidism is easy to control with medication and unlikely to “flare up” or cause any serious issues. I would have no problem with an AP who had such a disorder. Chrone’s disease, Lupus, diabetes or a mood disporder, however, is a whole different matter.

American Host Mom in Europe February 18, 2016 at 8:02 am

I will second the point about looking for host family / kids with similar needs. My oldest child has celiac disease (and hypothyroidism), and I actually search on GAP for “gluten” or “celiac” because when I have gluten-free au pairs, they are far more conscious about cross-contamination, and frankly, it is easier to cook for two than one when we have to make different foods (e.g., pasta). I’ve had two gluten-free au pairs, and love that it shows my 7-year old that her life can be normal too. But, like the others, I’d be much more cautious about diseases that are harder to control or have more serious (and child-care affecting) impacts if there is a flare-up.

WarmStateMomma February 17, 2016 at 6:13 pm

If you anticipate needing ANY medical care during the AP year, I would advise you not to be an AP in the US unless your own country’s medical care is really bad. Our medical care is too complicated, expensive and fractured to even be considered an organized “system.” We have some of the best physicians in the world, but they operate within this crappy, inadequate patchwork that really places a lot of limits on their ability to provide comprehensive care.

For an AP that has a situation that doesn’t require ongoing or even sporadic care – say hearing loss – it’s worth applying and being upfront about your condition. That would stand out to me when reviewing applications (honesty on a medical form?!?!?!) since all the applications I see just say they’re in perfect health, no previous diagnoses of anything, etc.

For any box you have to check that makes you uncomfortable – explain it in your host family letter. Explain the counseling was just related to XYZ condition and not depression. If the HF has to guess, they may move on to the next candidate.

Completely agreed with the response above that a family whose child has a condition similar to the AP’s would probably give more attention to that AP’s application. It’s so hard to bring an AP up to speed on medical stuff, especially if she comes from a country that prefers traditional remedies to science and medicine.

Look up your condition on WebMD. That’s the kind of info HFs (who are not in the medical field) would likely check when they try to figure out what your condition entails.

WarmStateMomma February 17, 2016 at 6:21 pm

Also, please not that APs in the US do not typically receive “health insurance.” They get “travel insurance.” For European APs, your own country’s insurance may give you better coverage in the US than travel insurance.

Even with “health insurance,” you can be billed several thousand dollars for medical care that’s not even major enough to land you in the hospital overnight. Don’t underestimate the cost of American health care. I remember my French friends (dad a physician, mom a physical therapist) being shocked that their son’s medical bills for a twisted ankle in Atlanta exceeded $2k. That was 17 years ago.

Taking a Computer Lunch February 17, 2016 at 6:52 pm

As the parent of a child with an autoimmune disorder, plus enough other medical conditions to scare most APs away (but somehow almost always manage to match with the perfect AP for us), I would consider an AP with a chronic health condition. I’d like to see candidates who had been able to manage their care on their own (e.g. they lived in an apartment, went away to university, or somehow lived a distance from their parent(s) home(s) without an incapacitating flare-up. I would want to see that they have been pro-active, and have sought medical advice about how to manage their health away from home for a year. I would ask questions about how stress affects them (because one of the most stressful things you can do is move – much less to another country!). Nevertheless, I’d probably choose an AP from a European country whose parents could afford the cost of prohibitive medical care should their child require hospitalization over a nice working class or middle class candidate from Africa, Latin America or China whose family had pooled their resources in order to help a child apply to become an AP.

I will echo everything said above. Do not underestimate how expensive medical care is in the United States! While every American hospital is required to have a fund for people who cannot afford their care (and an AP, as a legal resident may be eligible to apply should she be hospitalized as the result of a flare-up), I would not count on it covering the costs of care that could add up to thousands of dollars.

Finally, should you make a great match and head to the U.S., come prepared. Make up paperwork – in English – with all of your medications, down to the mg. of the dosage, how often you take it. Have your medical history written out – the times you have been hospitalized, the tests you have undergone, and your routine bloodwork and its results. This is something I do for The Camel. The idea is that if I need to rush to the hospital, then I can hand doctors several pages of notes – it makes it easier for them to translate what dosage to give my child via IV when they know exactly what The Camel takes in pill form. They know when to give the medication. They know what is “normal” for her – which is atypical of most people. When you arrive in the U.S. carry that paperwork around with you everywhere. Give a copy to your HF in case the worst happens and you’re unable to communicate. Don’t make anyone guess! (And I can tell you right now – one of the hardest things to do in an emergency situation is communicate effectively and remember everything!)

Oh, and you’re more likely to match with parents of special needs kids, quite frankly (and that includes parents who have children with chronic conditions – not necessarily children like The Camel who are mentally retarded and medically fragile). The more experience you have caring for a variety of children who are different will increase HF’s interest in you. (Just saying from my experience, where I take the already limited “special needs willing” pool and reduce it further by only considering candidates with actual special needs experience longer than 2 weeks duration.)

AspieMom November 21, 2016 at 3:33 pm

Do you have tips on how to match with an au pair when you have a special needs kid? Our son was only recently diagnosed as autistic (what used to be called Aspergers) and we are finding many au pairs are just not interested in talking with us. We are very fortunate to have matched with an au pair who suits our kids very well before he was diagnosed.

Taking a Computer Lunch November 21, 2016 at 9:43 pm

There’s at least one thread on this very topic. Use the categories on the right of the screen to locate relevant threads. Personally, I’ve used Extraordinnaire au pairs from Au Pair America 7 of the 12 au pairs I’ve hosted. In general, they have worked better than other au pairs, but some of the regular au pairs have been fantastic, too. It helps if your current AP lets candidates speak/Skype/email etc her to confirm “it’s not that hard” and “they’re a good host family.”

FirstTimeHM February 18, 2016 at 5:38 am

If you’re thinking about becoming an au pair more than becoming an au pair in Americe, you could consider northern Europe. In our country you would be added to our medical insurance and you would be insured as a resident. That means going to the GP without co-pay, any presciptive medication with very limited co-pay. Co-pay when you need to see a specialist or if you’re admitted to the hospital max 200 euro per year.
The northern European health care systems are easier to navigate than the American, the quality is just as good and the insurance here covers a lot more.

Personally I wouldn’t have any doubts matching with someone with very manageable health problems like astma, hay fever, lactose intolerance, etc.
I would be very carefull with diabetes, Crohn’s disease, lupus, etc. since the stress of adjusting to another lifestyle can cause major discomfort for you and perhaps even hospitalisation.

Quirky February 18, 2016 at 11:22 am

The previous posters have all given excellent and on-target advice. I am just chiming in to echo the caution about the cost of the U.S. healthcare “system” and the difficulties APs may have in negotiating it with their travel insurance. The insurance system is so complicated that it is a career in and of itself to go into medical billing.

A critical factor to understand is that usually everything is separately billed and covered (or not) by insurance: 1) doctors and any related providers like physical therapists, counselors, etc. 2) hospitals 3) labwork and other medical tests like xrays and MRIs 4) prescriptions and perhaps 5) other categories I am not thinking of. You have to be aware of what *your* insurance will and will not cover for any of these categories. The providers (doctors, labs, etc.) will not know this upfront because there are literally thousands of insurance programs out there.

So to give a concrete example based on my first AP: she had several problems and went to a doctor who was listed as taking the AP insurance. The doctor ordered multiple blood tests and performed a medical procedure related to a birth control method. The doctor also prescribed medication for a medical issue and prescribed birth control pills for birth control. My AP ended up with upwards of $3000 in medical bills — for everything birth-control related, for all of the blood tests, and for the birth control pills. My AP mistakenly assumed that because the doctor herself took the AP insurance, therefore everything the doctor ordered would be covered. Not true — the doctor, the lab, and the pharmacy are all separate providers and are treated differently by insurance. Also, AP insurance pretty much does not cover anything related to birth control or sexual health.

The AP insurance is really meant to cover travel-related accidents, not ongoing health issues. To give an example from the same AP — she broke a bone in an accident. The AP insurance (the enhanced version) did cover the ER visit, the x-rays, the follow-up with an orthopedic surgeon, and a flight home accompanied by a nurse door-to-door. My AP didn’t have to pay anything.

As a PP said, for a candidate who has a chronic health condition, I would really advise looking hard at other countries that may have much better health care coverage for foreign workers. I have no idea what the systems are like for foreign workers in countries like the UK, Canada, Australia, and New Zealand — or what AP programs in those countries would be like — but do not underestimate the nightmare that the US healthcare system can be for an uninsured person.

And circling back to the original question — as others have said, as a host parent my decision would very much depend on the medical condition in question — but I would be highly unlikely to match with anyone with a serious medical condition that might require medical treatment, both for her sake and for my family’s.

Another DC HM February 18, 2016 at 12:05 pm

You’ve hit on one of the third-rail issues in AP’s insurance plan- Birth Control. Birth control and any dermatology is excluded from coverage, something to keep in mind. Our AP with the ovarian cysts was able to get coverage for birth control but only after her doctor made repeated calls to the insurance company arguing this wasn’t about pregnancy protection but about a gynecological issue. She still could get no medical help for the corresponding skin problems her cysts produced.

Pre-existing conditions are also not covered, so should an AP wind up needing care for a flare up or episode related to their chronic condition, they would have to pay for it themselves.

dorsi February 18, 2016 at 12:24 pm

I was super impressed when the new LCC showed up for our post arrival visit with a list of urgent cares that take the I.E. AP insurance, as well as contact information for planned parenthood – and was explicit that sexual health needs are not covered by insurance.

AspieMom November 21, 2016 at 3:50 pm

Wow. Why isn’t this highlighted in any of the information?! This post is prompting me to add a section to our family handbook on medical issues and birth control.

Taking a Computer Lunch February 18, 2016 at 9:51 pm

I have two words for APs who want birth control (IMO a perfectly reasonable desire for an 18-26 year=old woman) – Planned Parenthood. The sliding scale makes it more affordable for APs than an OB/GYN visit + American pharmacy. (Used it myself as a buffer between university clinic and full-time employment with health insurance.)

Pregnancy is definitely not covered by AP health insurance!

Mimi February 18, 2016 at 9:59 pm

And is usually a guaranteed trip home…

Quirky February 18, 2016 at 12:30 pm

And sorry for the add-on post, but I just remembered to add that dental care is not covered by medical insurance. My current AP had to get four (4!!!) cavities filled something like a month after she’d arrived. I really don’t understand it — she had supposedly gone to a dentist before she left home, and we don’t drink soda or juice or buy much in the way of sweets or junk food, so it’s hard to see how her “American diet” could have caused four cavities in a month…but I digress. APs need to know that dental care is also not covered by AP medical insurance. My AP was able to find a low-cost dentist through our LCC, but it still cost a couple hundred dollars.

Ex European Au Pair February 18, 2016 at 12:33 pm

Be upfront and you may well find a family who would be glad to have you. I have a chronic illness, I’ve lived with it for years, I’ve held down jobs, etc.. When a family (with four children, 11, 10, 5 and 3) offered to match, I explained what it would mean in daily life : most days it won’t change anything, I can take care of the kids, be active with them, run around at the playground, etc… but there may be some days where I’m more tired and I’d have to spend a bit more time watching the kids play or doing quieter activities with them rather than playing catch for hours on end. They were fine with this, answering that they were okay with me having a few off days as long as it wasn’t all time.

So most of the time I was very active with the kids but there were a few days when I told the kids that I wasn’t up to trampolining or chasing them around the garden. On those days I’d spend some time watching them dashing about with a cup of tea in the rocking chair, we’d read more stories, colour more pictures, . It worked with my host family where it probably wouldn’t have worked with others, at the end of my year they asked me to stay longer. For me it was possible to make an au pair year work.

That said, I was in Europe so was working shorter hours and didn’t have insurance worries. Be honest, know yourself, what your capable of and what you need to thrive and stay well.

New to This February 19, 2016 at 7:00 pm

What you describe actually sounds similar to me to the ways I’d expect most people’s work performance to vary day-to-day just based on ordinary fluctuations in energy level, focus, etc. Some days you’re really “on,” some days you’re slogging through what you have to and tabling what you can for later. And parents, in my observation, are this way with our own kids — most kids are sometimes going to hear some variation on “Sorry, no trip to the park today; mommy’s exhausted.” (Of course, sometimes WE’RE exhausted because THEY wouldn’t fall asleep half the night, but they still wake up bright and early wanting to PLAY!) Even though the variation in how you’re actually feeling day-to-day is probably much greater than what the average person experiences, it sounds like you made up for a lot of that with self-awareness and well-planned coping strategies, plus, I’m guessing, an extra dose of sheer determination…

AuPair Paris February 18, 2016 at 4:42 pm

I have nothing productive to add really, but this conversation makes me so sad about the American healthcare system. I would say that, if the AP candidate is going to the US for other reasons than “this is *the* place I’ve dreamed of and have always wanted to be” or “this experience has to be in the US to have a positive impact on my future career”, there are lots of places in Europe with fantastic healthcare, and where the Host Parents are not actually allowed to ask about health issues (meaning not that you shouldn’t disclose them, but that you can wait until you’ve demonstrated that you’re aware and responsible to do so – after a skype or a few emails – which I think gives a fairer representation of what they might mean for you and the family and diminishes the probability of a kneejerk “that sounds too complicated” response).

In the UK, for example, we have free healthcare for everyone. Mostly. Prescriptions are a standing charge of about £8 ($12), for every drug, unless you can prove you can’t pay, in which case they are free. Surgery is free, appointments are free, hospital treatment is free – for everyone, not just citizens… And here it is illegal for employers to refuse to hire people due to health conditions (it’s required by law to provide “reasonable adjustment”, meaning that a wheelchair user is unlikely to be hired to be hired to haul bricks around, but if they’re a teacher, the school is required to put ramps in, if they are the best candidate for a job). This is not always followed to the letter (look at the former example – you’re not allowed to ask, but wheelchair use is visible…), and wouldn’t apply to HPs anyway, I wouldn’t have thought, but it has at least influenced the culture to the point that most moral people will hesitate before dismissing someone due to ill health.

In conclusion, you can learn really good English in the UK too, healthcare is free, and the NHS is one of our proudest accomplishments ever, so people should come here and take advantage of it before our government decides we’ve been sufficiently lulled into apathy and inattention to wipe it out completely.

(Give us your sick, your handicapped masses yearning for equality?!)

WarmStateMomma February 18, 2016 at 8:16 pm

In the US, medical problems lead to personal bankruptcy more than any other problem. Our situation is probably unthinkable to many APs.

Bklyn_hf February 20, 2016 at 4:40 pm

Really basic question: I realize that it’s a very good idea for an AP to disclose conditions that could affect their ability to perform childcare duties, but are they required to? Can a host family rematch over chronic health conditions that impact performance?

AuPair Paris February 21, 2016 at 7:31 am

In the UK? Well, I haven’t actually au paired here, though I *know* some aupairs here. But I’m not sure we have agency protection in the same way that there is in the US. Our employment laws are basically what I just said about “reasonable adjustment” – and that’s enforced by unions. Jobs with particular needs often have exemptions to be allowed to ask – not so much about medical issues themselves, but certainly “is there any physical or mental reason that you would not be able to fulfill the requirements of this position”. You’re not allowed to ask about how many sick days a potential employee has had in the last year, hospital stays, chronic conditions etc – but you’re allowed to ask if a potential employee is fit for work. In this way, the assessment relies upon what the individual knows about their own health, as well as what advice they have been given by their doctor, rather than an employer’s assumption that they’ve maybe heard about a particular illness, and think they might avoid it in their employees… Unfortunately, our terrible government, wanting people off benefits, has created a “fit for work” assessment, to get people off of disability benefits, and force them into work they’re not actually capable of doing – so now, rather than the doctor’s word and the patient’s self-assessment, as it has always been before, often these questions and assessments are answered by a government going “well, who cares if they can do the job? We don’t want to pay for their food any more”.

SO, anyway au pairs don’t have a union, and they’re not really protected by our employment laws, being in a weird place between guests with pocket money and employees. As such, I reckon an AP who couldn’t work as needed would find herself sacked, and end up either going home, or finding herself another family – probably on au pair world. And the family would rematch in the same way.

However, our culture of workers’ rights and the rights of handicapped people does seem to mean that most people (in my circles, and admittedly, they lean liberal) would think twice before hiring or firing based on conditions that could be worked around. I think there’s much less of a sense of “well that *could* be a problem, so we won’t hire based on that” – it’s more “that’s an immediate problem that can’t be fixed, so unfortunately, we’ll have to find someone new”. If an AP is ill, they will take a sick day and see a doctor if necessary (for free), and that’s not going to be a drama, any more than it would be if an HK was sick and needed a parent to stay home. A friend of mine developed what was eventually diagnosed as chronic fatigue syndrome while au pairing in London and her host family was fantastic – kept her on a long time, took a few days off their high pressure jobs etc – but eventually the three of them agreed together that my friend was simply too ill to do the work, and they mutually agreed that she should go home – and the family rematched with an extremely glowing reference. Of course for that illness, there were no warning signs.

Bklyn_hf February 21, 2016 at 12:47 pm

Thanks. I was asking about the US not UK but I think what you’re saying makes sense. As a person who has a rare disease and never discloses it to my employers until after I’m hired, I feel bad for any aupairs who feel they must even if it is not necessary. If your condition doesn’t require hospitalization or an enormous number of sick days I don’t see why anyone has to say anything.

I do agree that if a health condition puts you out of commission a lot then I think it’s only fair it be disclosed….

AuPair Paris February 21, 2016 at 1:01 pm

Pretty sure you’re required to disclose illness on the agency forms in the US. Haven’t experienced it, but that seems to be the gist. I’ve never disclosed my chronic illness on any job application ever – I knew it wouldn’t be an issue for my jobs, and it never has been. But I’ve never lived anywhere that it’s required to disclose.

HRHM February 21, 2016 at 2:58 pm

In the US, a HF (and also an AP) needs NO reason to rematch. They can choose to let an AP go for any reason (don’t like the way she does her job, drives, lives in her free time).

Being an AP in the US is not a job, it’s a cultural exchange and as such is not protected by any of the US Department of Labor laws. The relationship can be severed at any time by either side for any reason.

Taking a Computer Lunch February 22, 2016 at 7:51 am

Bklyn_hf, it works both ways. While HF may choose to rematch over an undisclosed medical condition that affects the AP’s ability to work, an AP may choose to do that as well. In my experience, it pays to be up front about your children. “X has asthma, but only uses his inhaler once or twice a year. It’s really under control and he’s never been hospitalized.” “Y has an anxiety disorder, which means that he might ask you to stay upstairs while he falls asleep when we go out on date night.” “X has Aspergers. He’s not violent, but he really needs a routine. We’re going to need you to help him follow it.” (I had a friend who had warned an AP about a peanut allergy but not asthma. It turned out that the AP had experienced the death of a child in a classroom who had had an asthma attack. She saw the inhaler in a closet and chose to rematch.

As someone with food quirks, I’m pretty up front with APs, too. I eat a wide variety of foods, like to experiment with different cuisines, but I don’t cook with anything that comes from a cow (inherited family allergy) and do not eat meat. Of the three vegetarians with whom I matched, two were “white food eaters” who were shocked at the variety in our diet and did not want to hear me talking about the need to mix plant proteins. The current AP and I are very alike in diet. Even child #2, who prefers to eat meat, will go out of his way to make something everyone can eat.

Just like I would want to know if I were hosting a woman with a medical condition that could impact her ability to work in the United States. I’ve been flexible about APs with food allergies (it’s only a year). However, as the parent of a medically fragile child with multiple life-threatening medical conditions, I want APs to enter our household with their eyes wide open.

TexasHM February 18, 2016 at 5:12 pm

Ditto to pretty much everything said above. To give the OPs a little bit more insight into perhaps the rationale of HFs in interviewing I will add this. If I was reading a profile and saw a condition I was not familiar with I would absolutely google it or go to WebMD as was mentioned with this in mind – how will this impact 1) the AP, 2) the kids, 3) me.

It’s one thing to say that if you have a seizure it is ok because it’s not going to be life threatening to you, it would be another to ask me to leave my 3 kids 5 and under with you knowing that could be a possibility or allowing you to drive them (mine are older now but that was our situation when we started hosting).

While I am sure most of us on this page would love to say “Sure! We can accept any AP!” the truth is in practice, that is impossible. As a lifelong asthmatic I would not hesitate for a minute to hire an asthmatic AP but I would also know what questions to ask. IE – When were you diagnosed? How is it triggered? (allergies, exercise, illness, etc) Have you ever been hospitalized? How do you manage? Can you bring a year’s worth of meds (if needed)? Could you get a second year’s worth (in case they decided to extend) if needed? Etc

I will stress again too that ALL preexisting conditions ARE NOT COVERED. 3/4 of our APs have come with history. AP1 had all kinds of eye and GI problems. She says she put the GI problems on the application and the agency advised her that HFs wouldn’t match with her so they took them off (thanks APIA). I was new so thought if the app said “no health problems” that I could believe it. Now I know better and that poor AP had to pay hundreds for just a couple of regular doctors visits.

AP2 app said no health problems and echoed in interview. A couple months after arrival she started having health issues and then admitted that she occasionally had horrible debilitating headaches at home but they were rare. Luckily I had a HM friend that was a doctor, AP was friends with her AP so she did me a favor and checked her out and diagnosed her with migraines and told her to quit drinking Coke and eating cheesecake everyday. That plus over the counter migraine meds allowed her to eat her cake and work her full term too! ;) If she had gone to the doctors office it would not have been covered. She was about to go to the CVS minute clinic which would have been around $100 and then they would have pointed to the migraine meds 10 feet away. She was thrilled she dodged the bullet/costs on that.

Current AP did not have health problems until we matched. Weeks later she was diagnosed with an impacted wisdom tooth and cyst. She had two surgeries, lost teeth, big deal. We talked about if it still made sense for her to come (risk of recurring, doctors input, etc). She is actually due for a third surgery once she returns (she came here against doctors orders) to close a hole in her pallet/rebuild her sinus and now that she is extending 6 more months she is trying to get an MRI to send back to her country’s doctor to calm him and her parents down (showing them nothing has grown back and that she is clear). Shopping around to pay cash for an MRI is $450-550. That is almost 3 weeks worth of pay for an AP here. (Sidenote if any HMs know how she can get a cheaper MRI or a better idea I would LOVE to hear it!!)

To flip the switch for the OPs I would say that any HF that would be hesitant to match with you due to a minor/manageable condition is not the family for you anyway! You would want someone that not only knows about your condition but ideally is familiar with it/accepting etc because you wouldn’t want a flare up to trigger a rematch conversation.

There is no perfect AP just like there is no perfect HF. Honestly is always the best policy and there is a lid for every pot but also do not underestimate the amount of stress you will be under moving halfway around the world to a place that only speaks a foreign language, has completely different food and customs, where you have no friends/family/support structure, where you cannot get affordable healthcare, have to deal with kids full time and you live with your boss! ;)

NewAPMom February 19, 2016 at 1:44 pm

As others have said I would not match with an AP who has a medical condition that may require treatment, I.e. Crohn’s, lupus, depression/anxiety (since that will likely get worse). Something like hypothyroidism that requires a med every day and shouldn’t affect their work is fine. I’m in the medical field so I have a good grasp of what can affect work and what shouldn’t. I wouldn’t even match with someone with lactose intolerance though only bc our last AP told us she had lactose intolerance. I told her no big deal, can get you lactaid. Well when she got here that became a “dairy free” diet which ended up being a huge pain and very expensive. So unless you plan to go dairy free, I would avoid lactose intolerance. My AP would not even try the lactaid tablets.

AuPair Paris February 19, 2016 at 2:11 pm

Lactaid helps an awful lot if you still eat dairy in very small amounts. This seems to vary person to person – some lactose-intolerant people note no difference whatsoever, and if you overload yourself with it (for example using it every day or for every meal) it loses effectiveness.

I would suggest that someone telling you they’re lactose intolerant does rather imply that they will be avoiding lactose…

Old China Hand February 19, 2016 at 7:16 pm

The problem is, avoiding lactose and avoiding dairy are different. Both my kids were milk soy protein intolerant as infants, so I had to eat totally dairy free. That means no hard cheese, butter, or yogurt, all of which generally don’t bother lactose intolerant people. Our current ap hates dairy (which i sort of knew, but didn’t realize how extreme it was – she just said she doesn’t like strong cheese), but with our experience of two years dairy free, we make it work. We don’t stop using butter, but use oil when we can. It’s not a huge issue with our diet and she is in the preference category rather than an allergy issue. It is mildly annoying, but mostly we just leave the cheese on the side. As with our previous aps, she isn’t in the habit of eating with us too often.

AuPair Paris February 20, 2016 at 7:38 am

Well fair enough. I mean, it’s a live and learn situation about what you can and can’t handle. I still think it’s sort of fair warning though. The lactose free people I know avoid all dairy. (But then the whole relationship with dairy in the US seems really different from the way it is here…)

In any case, I’m useless at cooking without a million different kinds of cheese and crème fraîche, so I doubt I’d be any good at catering for a lactose free person. Or in the US come to that, given the unpasteurised cheese sitch.

AuPair Paris February 20, 2016 at 7:41 am

Though “hates strong cheese” to mean “avoids all dairy” is *definitely* not fair warning. I hated all cheese before I moved to France. I was then required to suck it up and accustom myself to it, (or else be really rude and make food demands!) and now, like I say, I can’t cook without it. I haven’t much patience for picky eaters past the age of about fourteen!

New to This February 20, 2016 at 9:11 pm

One thing that may be different in the US than in other places is that a lot of our packaged foods have small amounts of non-lactose dairy ingredients — added whey protein is a common offender, for example. That enlarges the gulf between a lactose-free diet and a dairy-free diet quite a bit. But if the AP came from somewhere where packaged foods were less common, and/or dairy ingredients were a less common additive, she may not really have understood just how much extra hassle and expense the insistence on strictly dairy-free food entailed, and may have just seen it as a simple way of being sure to avoid lactose.

NewAPMom February 20, 2016 at 10:28 am

Well, I was briefly lactose intolerant (the gene seems to have switched back on), and had no issue with using lactaid. In true lactose intolerance using lactase enzyme to break down the lactose should be sufficient. You don’t need to avoid dairy. Anyway, my point was that we eat everything, so I now avoid APs who have any sort of dietary restrictions. Somewhere there is a gluten free, lactose free, vegan, low carb family for them. :)

Quirky February 19, 2016 at 2:20 pm

On the food choices/tolerances note — I skip right past candidates who are vegetarian, have any food allergies or sensitivities, keep kosher or halal, or otherwise can’t or choose not to eat categories of food. I’m sure I’m thereby missing a ton of great candidates, but with two working parents and three busy kids who have the usual Venn diagram of what they will or will not eat, it’s just too hard to deal with either a) shopping and cooking for two different ways of eating or b) considering eliminating categories of food (nuts, pork or meat in general, dairy) that play a significant role in our diet. And I say this as someone who was a vegetarian for 20+ years and am now omnivorous again, so I have plenty of experience on both sides of the food-avoiding coin. Since in my extended family I have vegetarians, kosher-keeping Jewish people, and dairy allergies, I am all too familiar with the problems of finding meals that everyone can eat, and I’m not signing up for that day in and day out for a year.

FirstTimeHM February 19, 2016 at 6:59 pm

For us I would welcome a lactose intolerant AP! We’ve got two kids with dairy allergies (one quite severe) and it wouldn’t be any trouble to include her in all our meals. The plus is I would have an AP that would be used to being very carefull and reading all the labels.

Old China Hand February 19, 2016 at 7:17 pm

I am a recovered vegetarian as well, quirky. :)

Old China Hand February 19, 2016 at 7:18 pm

I forgot to add, also for >20 years.

WestMom February 19, 2016 at 9:59 pm

Amen! DH is gluten intolerant and DD1 is lactose intolerant. Add to the mix some age-appropriate pickiness and I am about done with making exceptions for dinner!

2 kids and a cat February 20, 2016 at 1:53 pm

Indeed! Dh is gluten-free and our current au pair is a vegetarian — we all have family dinner every night and it’s been too much work, especially since she doesn’t actually like vegetables or pasta. I’m skipping all dietary restrictions this matching round.

WestMom February 20, 2016 at 2:12 pm

So what does a vegetarian eat if she doesn’t like vegetables? Sounds like a picky eater disguised as a ‘vegetarian’.

Quirky February 20, 2016 at 2:17 pm

Oh, it’s totally easy to be a “white-a-tarian.” Pasta, chips, pretzels, rice — heck, you can be vegan and not eat vegetables! I do think a lot of picky eaters/those with orthorexia describe themselves as vegetarians to cover eating issues.

2 kids and a cat February 21, 2016 at 9:06 am

I think she make herself a big lunch to tide her through dinner. Potatoes, eggs, cheese, and Mexican food – and tons of fruit. If I make a special ake, it’s gone in two days. I don’t want her to be hungry, but with our kids they can have the dinner I make and/or a piece of fruit, so the same rule applies to her. I did tell her privately that she was welcome to her preferences but to never mention not liking broccoli/other veggies in front of my kids.

New to This February 19, 2016 at 3:04 pm

I would be okay with some risks of condition “flare-ups,” depending on things like the likelihood of a flare and the impact it would have on the AP’s work. There are no guarantees that ANY au pair will be in perfect shape to work for the full year, and I figure I can cope with a higher-than-average risk level if the AP is otherwise a good fit. I would want to see that they had a plan in place for how they’d deal with a medical crisis (including being aware of and prepared for the medical expenses they might incur), but I suspect even perfectly healthy APs should be encouraged to think about this more about this than it sounds like most do.

A history of well-managed mental illness would also be a non-issue for us. If anything, my experience with young adults suggests that someone in that situation might well be MORE stable than the average member of their age group — so many people at that point in their lives end up being vulnerable to undiagnosed or still-developing psychological issues (whether full-blown mental illnesses, or just “growing pains”), and someone who’s been in treatment is likely to be more self-aware and already have a good toolkit for caring for themselves — and to take self-care seriously before they end up in crisis.

On the other hand, I’m with those who would find a special diet a huge challenge to manage — getting regular healthy meals on the table for our family is already a struggle for me (combination of some special needs of our own, my lack of organizational skills, and general unpredictability of our daily schedule), so having to learn to cook to a whole new set of requirements — and not being able to fall back on our usual takeout options — would probably be too much for us. It’s possible we could accommodate someone just by stocking separate food for them, but meal-sharing is important enough to us both as a component of family life in general and as part of our childcare/healthy-feeding approach that I’d be really reluctant to go that route.

CV’s example of a hearing impairment is another interesting one for me, mainly because I’m not sure how it would affect ability to function in a second language — dealing with less familiar phonemes and vocabulary would be extra-challenging, I’d think, when you also can’t hear people as well. But this is presumably something that anyone with a hearing impairment who has studied a second language has already encountered and considered, so I’d want to hear their perspective on whether they anticipated extra difficulties, what accommodations they might need, and so on — I certainly wouldn’t rule it out without a discussion of the issue.

AuPair Paris February 19, 2016 at 3:31 pm

Wrt mental illness – as someone who has recovered from serious anxiety and depression, the experiences I went through in recovering from those problems helped me massively when it came to helping the kids deal with their extreme emotions (and what is a tantrum if not a little kid absolutely lost on how to deal with anger/unhappiness/disappointment?!).

Having also worked in mental health (was on the older edge of au pairing) which I am now doing again, a lot of the younger APs I knew had fairly blatant symptoms of similar mental illness, with no awareness or diagnosis. Obviously a lot of it gets written off as teen angst and man, do a lot of people suffer from it. So honestly someone who has been through treatment is likely to be a lot better at recognising and dealing with it than someone who hasn’t – and it’s not as though you’re going to be able to diagnose on a brief skype chat and a series of emails when people are trying to be positive and proactive!

Then again, if people won’t be able to get their meds without paying through the nose… :\

WestMom February 19, 2016 at 10:02 pm

Metal health issues are still stigmatized in many countries. I completely agree with the fact that someone aware and well treated for mental health issues is likely a safer bet than the random candidate who claims not to have any mental health problems at all. Blame me for living in NY city, but I do think we could ALL benefit from seeing a therapist at some point in our lives!

Mimi February 24, 2016 at 6:02 pm

I’ve been struggling with an answer to these questions. As a HM with an auto immune disorder, a chronic condition, AND a food allergy I’d like to think that I’d be willing to work with an AP with health issues, but I’m not sure and maybe it would depend on the health issue. I think like HRHM I have a list in my head of diseases I’d be ok with my AP having but anything vulnerable to stress is a no-go for me because I think the program can be stressful for even well-adjusted APs. I’m also one who avoids APs with food allergies because food is often a big source of cultural issues and it’s too much work (again with a big hectic HH) for me…and stressful which I need to avoid for my own health.

The biggest factor I think potential APs with health conditions need to be aware of is the health care/insurance issue. Our current AP is out quite a bit of money for an infected ingrown toenail because it was not covered by her insurance (the premium, more expensive version of the two plans offered) and she had a hard time finding a podiatrist that would even see her with the insurance offered. If you have a condition that is going to require treatment here or could require hospitalization, you are taking a chance. If this is something you and your HF can live with, then it works for all involved. Lying about/omitting information about an undisclosed health issue would be cause for rematch IMO.

NoVA Twin Mom February 25, 2016 at 10:02 am

To prove how different host families are – we’ve had an au pair with food allergies. It wasn’t a big deal – and we DON’T have food allergies. What definitely helped is that her allergies were to certain fruits and seeds (not nuts or milk), so the allergens were easier to identify and avoid. She also had asthma, which my daughter was diagnosed with while she was here, and that was actually great because she already knew how a nebulizer and inhaler worked! :)

But because of the insurance issues, I too have a hesitation about matching with someone with a chronic health condition. Years ago I knew an au pair (how I was introduced to the program!) who became diabetic during her extension year. Her host family was willing to keep her (she was REALLY good) but the company encouraged her to go home. I think insurance issues were a large part of it.

potentialAP March 18, 2016 at 11:41 pm

I’ve been preparing myself to become AP in USA, I have a chronic health condition that maybe scares when you heard, but it’s totally controlled. And I have my med for one entire year.
I totally understand when HP say that don’t want to have a AP with health problems, but I don’t wanna just stop living because of this problem, I want to live my dreams like any other girl.
I always dreamed about USA, and doing what I do the best (taking care of kids), that’s just amazing, I’m very excited to be AP.
I’m not online yet, but I’m wondering if I’ll be chosen. I don’t know, maybe some HP don’t care about it.
It’s sad for me to think that potential HP can read my apply, than love me, and when they see my health despise me for it. (And I don’t blame them) .
Deep down, I just wanted to be AP like any other.
P.S: Sorry for my english, I’m still learning.

S June 18, 2016 at 7:04 pm

I have been wanting to apply for aupair in USA for a while now! I love taking care of children, they are a blessing and teach us a thing or two about life itself. Yes, children can be a handful but they’re so innocent and full of life.. all you want to do is protect, love and groom them to be emotionally healthy, successful individuals with core values such as respect, honesty, humility, and ability to believe in themselves in this competitive world. This would also be a wonderful opportunity to discover new places and cultures. My only problem is, two years ago I was diagnosed with HIV (scary, you’re probably thinking..uh-oh) it was first boyfriend, shortly after HS but actually I have accepted that this disease, it is my fate and part of my life now. It does not define me, my work ethic, personality, values etc. I have never been sick or hospitalized. I have been on meds ever since- which I take daily, they have no side effect on me. I’m healthy with an undetectable viral load. I have no food allergies, I only suffered depression early on upon my diagnosis but after that I began to really love and appreciate life. I realised how short life is and how drastically things could change in a short period of time, at just age 19. Here I am now, 21 years old studying towards my LLB degree and ready to pursue my dreams. I do, however understand that chances of having the the opportunity to aupair (or possibly even get a J1-visa) are very slim or almost non-existed for me considering my disease. I hold nothing against anyone as I think looking back if I were to put myself in HFs shoes I too, would’ve gracefully rejected an aupair with this of this kind for the protection of the kids and due to misinformation regarding the disease. The information provided above is very useful and I shall pass it on to other prospective aupairs. Thank you so much everyone.

experinced host mom July 29, 2016 at 11:47 am

Well after three month of great au pair care it hit the wall. Our AP diet and sleep habits indicated a medical problem. Thyroid? Hypothyroid…like two others. No it was much worse. MD ordered test and they came back with wild results. Tow concentration camp Vitamin deficiencies, an indication of Hyperthyroidism and probable hypoglycemia. Luckily we have one child and do not allow the au pair to drive (in her case very dangerous thing to do) and an easy schedule. Now our girl is in $4000 debt for lab work and can not afford any more MD visits. She wants to stay and says she is better…while taking no meds. IF there was not a strong bond with the child it would have been goodbye. But we are not sure we are doing the right thing. Her parents do not care and want her to send back $$$. We are not MDs and have no clue as to the extent of physical deterioration going on…she could be diabetic for all we know. Eats sugar like a drug….So much for being in excellent health as she stated on the application. The discovery of these illnesses impacted her badly and she nearly got herself deported doing a very stupid thing, forget rematch it was a serious legal violation that resulted in a $1500 loss to us and compromised other important diplomatic things. She had been warned not to do this in writing and verbally over 10 X. We have her on a short leash now and try and guide her. The child loves her and she him. We are hopeful she stays competent physically and legally. We like her a lot but she has no more chances left.

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