Prepare seniors for a caregiver at home

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Dr. Cheryl Phillips is a San Francisco-based doctor specializing in geriatrics and past president of the American Geriatrics Society.

Wanted: Licensed caregiver, to provide full-time, at-home care for elderly parents guaranteed to balk over a complete stranger invading the privacy of their home. Indeed, who ever thought their home would double as a caregiver’s workplace?

People 65 or older – our fastest growing population segment – increasingly are being persuaded, cajoled and otherwise prevailed upon by their children to open their doors to paid caregivers, whose presence redefines their home.

In some cases, the health aides are welcomed and become part of the family. In others, seniors may see them as intruders, and lash out or curse while getting bathed or fed.

Most seniors say they prefer staying at home to moving into a facility or in with relatives or friends, according to a 2007 AARP survey. Home seems to offer familiarity, privacy, independence. In some cases, people stay put because they can’t sell their house.

But spending the golden years at home often means adapting both home and mindset to accommodate live-in caregivers.

The initial hurdle is psychological.

“Once we got my dear, sweet mother-in-law in her 80s past the first battle – ‘I don’t need any help, I am doing just fine’ – she still didn’t want caregivers in her house who weren’t part of her family,” says Cheryl Phillips, a San Francisco-based doctor specializing in geriatrics, and past president of the American Geriatrics Society.

“How many of us would want someone we don’t know – and may not like – living in our space, creating a very intimate relationship not based on our choices?” she asks. “Do the health aides get to watch your TV? Can they park their car in your garage? Can their kids visit? Each point may get negotiated.”

Experts offer these tips for ushering in an aide with minimum stress:

• Introduce the health aide into the home gradually, in shorter shifts, advises Dr. Eric Rackow, a professor at New York University School of Medicine and president/CEO of Senior Bridge, an organization that manages at-home care.

Be prepared, he says, for the older person to struggle at first with this new reality: “Not only is someone sharing my home, but whether it’s four hours or eight or 24 hours a day, I’m dependent on a quote-unquote stranger.”

• Don’t forget that aides have their own lives, too. “To demonstrate concern for an aide,” says Rackow, “consider showing her where she can comfortably put her personal things, and offer to add some foods that she might enjoy to the shopping list – especially if the aide will be working long days or living in.”

• Track the older person’s important possessions.

“I encourage seniors to think of their aide like anyone else coming to your home to provide a service,” says Shellie Williams, a doctor specializing in geriatrics at the University of Chicago Medical Center.

“Therefore you should not leave out in open sight cash or sensitive legal, financial or medical information, or credit cards.”Of course, verify identity before admitting a stranger into your home, Williams says.

• Establish ground rules.

As Williams puts it, “This is your home,” not the caregiver’s.

Remember: “Aides are employees; we hire them to provide care,” says Debra Greenberg, a psychiatric senior social worker in geriatrics at Montefiore Medical Center in New York City.

“Becoming a part of the home may set up an unrealistic expectation if we think of aides as surrogate family.”

Lines do blur: Some families bond with caregivers, breaking bread over dinner.

But don’t lose sight of the work relationship, agrees Marki Flannery, president of Partners in Care, an affiliate of the Visiting Nurse Service of New York.

“You don’t just want someone ‘nice.’ You want someone who has been trained in the many safety and care skills needed to provide the client with the best possible care,” she says.

“Don’t hire someone you think is going to be a good friend, but rather hire someone who is trained to act like a guest in the client’s home – friendly but professional,” Flannery says.

Resources

• AARP: www.aarp.org • The Eldercare Locator: www.eldercare.gov • National Association of Professional Geriatric Care Managers: www.caremanager.org • A Place for Mom: www.aplaceformom.com • Family Caregiver Alliance: www.caregiver.org • Bureau of Labor Statistics, profile of home health aides – www.bls.gov • Caring.com: www.caring.com/help-at-home • National Aging in Place Council: www.naipc.org

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