Q: DEAR Regina, my best friend suffers with Alzheimer’s and has needed 24 hour care for a couple of years now. Her husband has had a hard time coping and finding the right care. How can I advise him when hiring help? He has dealt with dishonesty, stealing and neglect of care with my friend. He won’t ask for help but will take most of my advice. I help where I can but she needs someone there even when he is home from work. He is worn out.
A: This is a common situation family caregivers find themselves in. By the time they reach this point they will not ask for help as it seems useless. I am sure he is worried beyond belief. Thank you for noticing his stress and caring enough to seek help for him.. We all need that earth Angel from time to time.
What you can start with is making a check list of what he needs help with, what are your friend’s needs are and how the carer is to address it, what are the qualifications of the caregiver, do they have training and experience in this kind of care. I often will find that people say they have experience and they do, but they still lack understanding of what dementia care is. Dementia care is beyond the basic care needs of most elderly patients. It is not a bedside hospital care need. In fact the earlier stages are more companion care with some assistance to help that person get started with a task. (Not doing the task for them). A few things to consider
•Personal Care: how much assistance do they need with bathing, eating, dressing, toileting?
•Household Care: how much cooking, cleaning, laundry, shopping is required, can your friend with dementia be a part of this?
•Health Care: does the person have medical concerns to be addressed like medication management, physician’s appointments, physical therapy?
•Emotional Care: what stage/level of dementia is the person at to determine companionship, meaningful activities, conversation?
•Financial Cost: what can you afford? Health Aid, LPN/LVN/RNA, RN Determine the care involved.
Begin asking your interviewee about their relationships with their parents and their grand-parents. Were they involved with their life positively or were they just there existing and no real connection? How do they deal with stress? These qualities will reflect in their care for other people.
Next you want to determine if your friend needs night time care and if so, will the caregiver need to stay awake? You do not want the same caregiver working the night and they have to do a lot of night care and then function properly the next day. It is not healthy to expect good care when the person is not getting enough sleep. You will have a grouchy caregiver during the day if they are up. On the other hand that caregiver sleeps in the night and ignores the care your friend needs, will there be a potential risk of skin break down or your friend harming self while caregiver is sleeping? This will help you decide if 24 hour live-in care is appropriate or not. If your friend doesn’t require night care other than an occasional need then the caregiver can be a light sleeper. You do not want to pay someone to sleep when there is care needed.
So make a job description and be very clear on what you want the caregiver to do. Keep in mind that if your friend requires a lot of supervision/direction some household task may get missed until there is a better time. Make a schedule for your friend that is appropriate to her likes and dislikes. This will help her function at her best.
Other things to consider when hiring :
•Is driving required
•Language skills (verbal and non-verbal)
•Ability to learn, are they set in their own ways of caring or will the carer listen to your needs as well as the person they are caring for. (This is beyond basic care)
•Make a contract for what they are responsible and what you are responsible for
•If the person calls in sick how will you deal with this? Will the company you hire send in another person? Who handles the schedule?
• Do you need a third-party to help manage or can a friend do this for you?
Choosing the right care can be a challenge in many aspects. There is no one fits all to choosing the right caregiver. People want jobs and there are a lot of people that look at care going as just a job. It is a job and caregiving goes beyond the basics of task. Without love attached to caring it is just task oriented care.
Asking for help does not mean that we are weak or incompetent. It usually indicates an advanced level of honesty and intelligence.
— Anne Wilson Schaef
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