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Allison, I work for a Local Workforce Investment Agency in Bakersfield. One of the things we do is set up on-the-job training opportunities for our clients. The client would work for you and we would pay most of the wage for a set period of time. I'm not sure where you are but there is definitely a "LWIA" which serves your county and could provide a similar service to you. Maybe if you could get a person under this arrangement for three or six months, it would allow you more free time even if the assistant doesn't show, and you could figure out a plan. Could your assistant go on disability? That type of person always seems to figure something out to scrape by even if it means moving in with other family they don't like!
I've considered something like that. I also have my MIL that can come in on a pinch and help out if needed--especially when I'm on vacation. My FIL works for us and has already said he'll be there all week long (he usually works only 3 days a week) to help with phones if our estimator has to be out of the office (which will happen since DH won't be there).
I've decided that I need to have a talk with my assistant and let her know that she cannot continue to tell me she's coming in and then change her mind. When I know she's coming in, I schedule other things and it really messes things up when she doesn't show.