Caregiver training essential to delivery of quality care

You need to hire a caregiver for a loved one. Perhaps you have a niece or nephew who needs a job, and who would love to help you. Maybe someone you know has recommended a good private caregiver they have used.

Hiring a private caregiver is a solution that many, many families use to assist in providing care to a loved one. Privately hired caregivers may be less expensive per hour than agency caregivers – and that makes sense when you realize that hiring an agency caregiver involves paying a portion of the wages of a supervisor and other support staff. For many families, the extra price is worthwhile because of the extra support they receive.

But for many families today, hiring a relative, neighbor, church friend or other private caregiver is simply the best solution to a challenging situation.

If this situation describes your current needs, here are some things to carefully consider:

1) Selecting a caregiver: Just because someone is available isn’t quite enough to qualify him as a good caregiver – although sometimes, out of desperation, that’s a major consideration. A good caregiver will have some personality traits that are more important than experience; traits like patience and caring, warmth and a sense of humor. The best caregivers are also creative problem-solvers – that skill allows them to provide care even when they don’t know exactly what they’re supposed to be doing or have never done the task before. How do you know whether the person you’re considering has these traits? The best way is to look at the person’s history. If you don’t personally know this individual, talk to 2-3 people who have known the person for at least a few years. Ask about these traits, and try to determine if this is a part of the individual’s personality. Here’s the key when interviewing candidates: Past behavior is the best determinant of future behavior. This is not, unfortunately, the job to see if your nephew’s rehabilitation for anger management was successful!

2) Caregiver Training. There are no national requirements for training of in-home caregivers. There are some basic parameters for home health aides and nursing assistants, and some states that have specific requirements, but in general, for caregivers, on-the-job training is often the only training they may receive. That’s not enough for you and your loved one. Demand at least a certificate level of training – it’s now easily available, and affordable, too, through a variety of classes as well as fully online through web-based training professionals.

Caregiver training is essential for in-home, privately hired caregivers. They have no support or supervisor to call when they run into questions about best care. Unlike a nursing assistant, there is no nurse down the hall they can contact for nursing or medical questions.

They may have no one to relieve them if the stress of caregiving becomes too great on a particular day, evening or night. That, and the fact that in-home private caregivers often spend hours alone with the person in their care, makes them vulnerable to stepping over the line from caregiving to abuse or neglect. This can be unintentional, as when the caregiver simply snaps and slaps at the hands of a person who won’t stop grabbing at him. It can be refusing to answer a call for help, if it’s been one of those nights and the caregiver simply can’t go assist one more time.

Any of these scenarios can happen, and happen without your awareness. Training – high quality, thorough skills building – can help prevent abuse and neglect while it builds stronger skills for coping with caregiving tasks and with caregiver stress.

Finally, consider training that provides the caregiver with an opportunity for career advancement, or with the ability to get their services covered by long-term care insurance policies. Courses that are provided by valid training organization, especially Certificate programs, will help you and your caregiver receive additional benefits beyond improved skills.

3) Stay in touch with the caregiver. Ask the private caregiver to keep track each day with notes about what he did that day, and what the person in his care required. You can use something as basic as a spiral notebook and a pen. Review his notes at least weekly, and talk to the caregiver about events he records. Give the caregiver your cell phone number and the number of at least one or two other people he can call in case of an emergency. Let the caregiver know that you understand that caregiving can be stressful, and give him permission to call you if he ever feels overwhelmed by the job.

Private in-home caregivers work today for many families all over the U.S. With some good planning, training and support, you can make it work for your family, too.

The family caregiver: should you feel guilty about moving mom or dad out of their home?

It’s been a cold, snowy week here in Oregon. The schools are closed and people are being advised to stay inside and off the roads if at all possible.

I called my mom first things to see how she was doing. She moved into a retirement center about a year ago – not entirely of her own free will. From time to time I wonder how much she misses her old home, set far out in the country surrounded by acres of pasture and woods.

She began our conversation this morning by telling me how no one wanted to walk outside in her village. The risks from a fall are simply too great at their age to take the chance.

My mom, of course, gets restless and starts calling her neighbors. “I have to get out to do laundry anyway,” she says. Her cottage is right next door to the laundry room; her closest neighbor is just one door further down.

By the end of the day yesterday she had joined one friend across the lawn for lunch (“she had made enough soup for an army!”) and spent the rest of the afternoon at her nearest neighbor’s place playing a 3-D version of Scrabble that’s her current favorite game.

I was, at that moment, so very thankful that my mom had moved into a close community of seniors. She’s not at home, alone, trying to stay warm and occupied.

She’s active, healthy and happy. Her mind and her heart are filled with activity and companionship.

We have much to be thankful for this holiday season!

Caregivers Need a Break

Family caregivers, especially adult children caring for aging parents, need a break.

We've known for years that caregivers have a higher rate of illness - even death - than the person in their care. We know that caregiving is stressful physically, emotionally and psychologically.

We know that high blood pressure, sleepless nights, colds and depression are common problems among caregivers.

Now, another study of baby boomer adults caring for parents reaffirms these impressions, finding that "helping a parent results in a downward trajectory of health and well-being for the child." ("Routine Caregiver Duties Create Overload," Times of the Internet, Sept. 26, 2008)

Among the issues are the challenges of balancing many roles. Most baby boomer generation family caregivers are also working, managing their own household and caring for kids or even grandkids. They have parent-teacher conferences with their children, and then rush to their parent's home for caregiver meetings.

They are sandwich generation people, pressed down and put on the grill.

Giving caregivers a break may be as simple as giving them access to tools to help them cope. It may be offering support in terms of training for their role, so that as they face caregiving issues with their aging parents they know how to respond.

Knowledge, after all, can be one of the greatest stress relievers of all. And providing support in the form of access to training is something that can be done by anyone, from anywhere.

If you know of family caregivers that need a break, consider ways to help them gain access to caregiver training and resources. Contact us - we'll help.

What's Happening to Mom? - Taking the First Step

Carrie has a full-time job and two kids still at home. When her dad became ill and passed away unexpectedly, Carrie spent a lot of time with her mother, talking to her about what she would be doing with her life now.

Carrie worried about depression becoming a problem for her mom, and her mother being alone, but what she discovered was that her mother seemed unable to manage even the simplest daily tasks. Cooking seemed to be completely beyond her; even daily dressing, bathing and grooming tasks seemed overwhelming.

In just a few days, Carrie began to suspect that her mother had been experiencing a decline in mental functioning for a long time – her father had been “filling in the blanks,” and no one in the family had even noticed her mother’s failing. Carrie needs to figure out what to do to be the most helpful to her mother right now – at the same time she’s coping with the loss of her father, as well as her own full-time work and family demands.


Figuring out how to face this challenge in addition to your own life demands is the first step you’ll need to take. Learning to cope with your loved one’s needs without losing your mind is your biggest challenge, however!

The First Step

Get a diagnosis. This is the first step you need to take, and the sooner you take it the better. You may wish to go directly to a research center that specializes in Alzheimer’s disease (most university hospitals have these kinds of programs). Or, you may need to start with a family doctor, and go from there for further tests, if necessary.

A visit to the doctor for a thorough check-up is the first important step.

You may hear, “There’s nothing wrong with me – I’m not going to the doctor.” Right off the mark, you need to learn some new skills.

Start with this one: Reassurance. “Dad, I’ll go with you, and I’ll stay with you the whole time – it’s no big deal.”

If that doesn’t work, try bargaining. “Mom, if you’ll just do this for me, we can go to lunch together afterward and have a nice, long chat at your favorite restaurant.”

If that still doesn’t work, try diversion: “Honey, I need you to go to the doctor so the kids will stop nagging me. I’m getting sick and tired of the nagging – it’s up to you to get those kids off my back.”

These are skills you’ll develop and learn to use like a pro over time. You’ll find that you need a whole new set of skills to be most helpful to your loved one, and keep your own sanity intact.

The least useful approach both now and in the future is argument. You might also call this debate, persuasion, or explanation. Whatever you call it, it won’t work! When the brain functioning is impaired, even slightly, a factual presentation is likely to be futile. Logic is frequently one of the first brain functions to diminish, so no matter how grounded in facts your arguments may be, you just won’t win. Try some of the other “tools” for accomplishing necessary goals.

Janice had tried every logical approach she could think of to get her husband Mac to agree to go to the doctor for testing. Each time she brought it up, Mac simply refused to go. “I’m perfectly fine,” he’d say.

Finally, at her wits end, Janice said, “I promised the kids that we’d both get to the doctor for a check-up. I’ll go first if you’ll go after me.” Reluctantly, Mac agreed to go. Janice got a same day appointment, and took Mac in before he was able to change his mind and refuse again.

Once you get an agreement to go to the doctor, you’ll want to consider the following things:

• Accompany your loved one to the doctor – all the way in. Don’t send him or her into the examining room alone.

• Make notes about what you’ve observed – details and facts, suspicions and observations. Take your notes with you, and don’t hesitate to read them to the doctor, or simply give them to the doctor. Can you do this in front of your loved one? Try it – you may be surprised how accepting your loved one is with the facts you present, especially if you word them as facts. For example, “Dad got lost coming home from the store last week. It was kind of scary for us both.” If you just can’t read your notes in front of your loved one, simply hand them to the doctor or nurse to read. Be prepared for your loved one to become suspicious about what you might have to say “behind my back,” and make an effort to include your loved one in your discussions with the doctor if at all possible. Most individuals with early stage memory loss are keenly aware of what they are losing, and this is distressing to them as well. Talking about it openly can actually be very freeing for both of you. Whispering about things tends to reinforce our society’s stigmatizing of diseases causing dementia. Choosing to openly discuss all of the facets of memory loss and dementia can help both you and your loved one face this disease rather than feel that it needs to stay “hidden.”

• Ask for tests. If your loved one has just suffered a significant loss – from a spouse to a beloved pet – be aware that depression could be the problem. Untreated, lingering depression can cause a person to act like they have dementia or another brain impairment. With appropriate medication and perhaps a “friendly visitor” program or brief talking therapy, your loved one may be able to work through the depression and re-gain complete mental functioning. Other physical problems like bladder infections, pneumonia, or vision or hearing losses can look on the surface like Alzheimer’s disease. These problems are generally completely treatable, and what looks like dementia can be totally reversed if the underlying health problems are addressed. Be aware that simple things like drug interactions, dehydration and malnutrition – fairly common problems for the elderly person living home alone – can cause the appearance of dementia. Ask the doctor to test for these and similar treatable physical ailments before you both assume that your loved one has dementia.
  

• Expect your loved one to be much more lucid at the doctor’s office than what you’ve observed. This can drive you nuts, especially if the doctor is not experienced in diagnosing dementia, and looks at you like you’re the one with the problem! This is so common that, fortunately, the medical community is beginning to catch on, and educate doctors to look beyond the “perfectly normal” presentation in the office. Be prepared that your loved one may even be able to ace the “mental status exam” that a physician can complete in 2 minutes during an office visit. If this happens, ask for a referral to a neurologist, or seek out an Alzheimer’s diagnostic center at a nearby University or teaching hospital. Don’t let this distress you. Take a deep breath, and know that what you’re going through is very common and normal. Keep at it until you find a doctor who is really able to see what you’ve been seeing, and help you find an appropriate treatment plan.

• Ask about medications. Once the physician has ruled out treatable problems, and has determined that your loved one likely has a disease like Alzheimer’s, ask about medications. The drugs currently available to “treat” Alzheimer’s disease and other dementias work best during the earliest stages of the disease. During this time, medications can be truly helpful, and can help your loved one regain some functioning, and, barring that, can delay significantly the progression of the disease. Imagine giving your loved one a year or two of extra independence, and what a difference that can make to him or her, both personally and financially. Ask about those medications!