Elder Care: Caregivers-choosing what's right for you

One of the ways to alleviate stress is to find a caregiver to give you a break. The break can be a physical one, as in "I can go out because I have someone to stay with Mom while I'm away." Or it can be mental one, as in "I don't worry as much because I know Mrs. Smith is with my Dad at night." And of course, if you're lucky enough to find the right sort of caregiver, it can be both.

There are many types and classes of caregivers. To start I can separate them into the following general categories:
Personal aide: does light housework such as laundry, making the bed, vacuuming, dishes. Assists with food shopping and other light errands. Drives client to doctor appointments and other outings. Provides companionship.
Caregiver: does all the activities of a personal aide, plus assists with any of the activities of daily living (ADLs) required. The ADLs, as defined by insurance companies, are, bathing, continence, eating, dressing, toileting and transferring (safely moving into or out of a bed or seat).
LVN or RN: By definition an LVN or RN can set up and administer medications, check and understand medical charts, manage medical information for your parent, attend doctor appointments and advocate effectively in ER situations.

Within each of these categories you will find people with a great variety of experience. Some will be experienced at working with terminal illnesses, others with dementia and Alzheimers. Some will have worked only in a supervised care facility, such as skilled nursing or assisted living. Others will be accustomed to working independently in a client's home. Some will want a live-in situation and others will prefer hourly work. There are agencies which provide caregivers, doing all the background checking for you (and charging accordingly) and there are also independent caregivers who work directly for you. Naturally, good caregivers come in all ages and nationalities.

If you're actively thinking of getting a caregiver of some sort to help you, consider approaching it as you would the hiring of an employee. For example:
1. Write down the aspects of care which are most important to you.
2. Select caregivers to interview who actually have experience in those aspects. There's no need to pay for an RN if what your parent really needs is someone to keep them tidy and drive them around. Conversely, you'll be making your life more difficult if what you really need is medication management and you hire someone who can't tell the difference between Digoxin and Darvocet.
3. Talk in detail with their references and ask the hardest questions you can think of. For instance, ask for two things that they were unhappy about with the caregiver in question. Find out how many other caregivers they've used. If they've only used one, they may not have great perspective. If they've used 50, they'll have lots of advice and good stories for you.
4. The peace of mind in having a caregiver comes from knowing their common sense reaction matches yours. If at all possible, interview prospective caregivers in person . There's much to be learned from body language and eye contact! Ask questions that put them on the spot. You're not trying to ferret out murder and mayhem in the interview. But you are trying to learn as much as possible about a new person ahead of time, so there are fewer surprises late on.
5. Be honest about your parents' foibles, their general way-of-being. Are they bubbly? Do they prefer to be alone? Are they hard of hearing? Do they accept they need help or that you need help?

Do as much as you can to assure yourself that you are making a good choice. This will stand you in good stead when your parent tells you that the new caregiver is incompetent, rude or lazy.

Be prepared to supervise the caregiver quite closely once you hire them. Although the ultimate objective of having the caregiver is to give you relief, in the beginning it may take more of your time. You'll have to back them up during rough patches, be available to answer questions, give moral support, all to ensure that they are accepted by your parent and that they want to stick it out.

In my next post, I will write about care managers. In the meantime, if you have questions about any of the above or want more detail on caregivers, please post a comment or email me.