As a geriatric care manager, I am often called in when families are in a state of crisis. From my experience, there is often a common pattern that leads to such moments, so I wanted to share my observations over the years to help families avoid as many of the caregiver pitfalls as possible.
For elders, having a ‘stranger’ in their home and answering a bunch of questions about their personal life, medical and financial status is not easy. Especially if you are in pain or dealing with a host of aging issues. There is money involved. But it’s health care. The whole thing is challenging. Finding the time for an adult child to help with securing a caregiver between working and raising kids can be nearly impossible. Navigating how to do it well is another story altogether.
This often results in horror stories from elder abuse to untimely report of health symptoms that results in the spread of disease. The art of privately hiring a caregiver legally is enough to make any adult child move their parent in with them, which can lead to a loss of income and a last minute move to a facility when things get rough.
Is there a silver lining to this whole elder care thing?
Yes. Here are my Top 10 Tips to Avoid Caregiver Pitfalls.
When an elder shows signs of not being able to live alone any more (i.e. needs assistance with eating, bathing, dressing, toiling, transferring, or incontinence care), look to your friends, doctor, people you trust, and online resources to provide you with the names of local home care agencies they have used or heard are good. Or call a Geriatric Care Manager or Placement Specialist for a good referral.
Check out their websites. Call them to compare services, prices, caregiver screenings, philosophies. Make sure the caregivers are fully screened, licensed and bonded, covered by the company’s liability insurance and experienced.
Make sure you and the elder meet the caregiver before they are sent out to work a shift. And that you are clear on all the terms of the agency/caregiver, set up billing in a reliable way, and make the agency/caregiver aware of your elder’s needs and tasks you would like accomplished per shift. Ask them who to call and when at the agency, confirm back up caregiver coverage for when their caregiver is sick, and make sure they know who to call in an emergency. Confirm your elder’s code status (i.e. whether they want CPR, care wishes) with the agency and provide a copy to the agency and caregiver to enact in case of emergency.
It’s important you and your elder like and trust the home care team you will be entrusting your elder’s care with and ask them/caregiver to provide you with frequent reports of care.
Ensure the agency has properly assessed your elder’s caregiver needs. Check in with the elder as the care proceeds to ensure they are happy with the care. Discover any unmet needs. See to it that your elder’s care needs are being met with the help of their care team: doctor(s), agency, caregiver, family, neighbors, whomever is involved. Give someone outside the home has a copy of the house keys. Set up a medical device alert to protect the elder at all times, especially when the caregiver isn’t there.
Drop in on the elder unannounced while the caregiver is there, at a time of day you know is best for the elder. It helps to infrequently drop in to survey the setting organically. If the caregiver completes daily care notes or uses a mobile app to record the activities of the shift that is emailed to you, track changes with your elder and tweak the process with the caregiver directly to make sure the care continues to best serve them. Or hire a Geriatric Care Manager to do this most efficiently and allow them to help you. See how the home care agency/caregiver can help with this is if you can’t afford a Geriatric Care Manager.
Thank caregivers, providers for providing great care to your elder as often as you can as this will only reinforce the care. Remind your elder to show gratitude for the caregiver and their care team although it is difficult for them to do while grappling with what is often rapid loss of function and independence. This results in less turnover and sets the tone for respecting the care team that works tirelessly for the elder and their family.
Express gratitude for your elder who has done so much for you and continues to teach you how to still crack jokes in the face of adversity. Make the most of the time you have left with them.
Someday we will all be that elder and we will appreciate our caregivers because we have been on the other side. We are paying it forward. This type of attitude makes us appreciate all of the care team members, including the elder who has so much to teach us. Great caregivers know how to assign value to the elder who often feels that they have nothing valuable to contribute any more.
Keep monitoring the care and making sure your elder has what they need. Value fun and their quality of life as much as their quality of care. Have tough conversations with them that will bring both of you peace and acceptance to make the process easier. Your care of them is what truly keeps them alive. The fact that someone truly cares is huge. Never underestimate the value of your kindness.
Creating a comprehensive process where you know what to ask an agency, caregiver or care team member from a doctor to an RN, greatly improves your elder’s care. We would all like to think that every doctor will cover everything a patient needs but that is often not the case. It’s important to go with your elder to doctor’s appointments if they are not able to accurately report symptoms or the caregiver is not able to either. You can also ask that visit summaries be sent home with the elder and emailed to you if you can’t make it to the appointments to follow and supervise the care. A lot can go wrong with care in the home so it’s important to supervise this as well, as most agencies do not manage doctor’s appointments and more complicated tasks for elders. If not managed well, this can result in everything from emergency room visits to mismanagement of medications.
Elders often associate their dependence on caregivers with loss of purpose. We can turn that around into gratitude for great care when the care is provided in a way that is dignified and respectful. Wherein the elder is part of the care team and given the respect of making as many decisions as they safely and competently are able to. The most common complaint I hear from my elderly patients when I start working with them is that they feel like no one listens to them, that they don’t exist. They stop saying this when they are included. Wouldn’t you want a say in your life?