Each of us has strengths . . . and, well, areas that could use improvement.
As a family caregiver, you may often feel inadequate. Or guilty. Or think that you aren’t doing enough.
Such negative self-assessments are common.
A more balanced assessment would acknowledge that you also have qualities that shine.
Most of us believe that to be better people, we need to focus on our trouble spots. Over the next months, we will be drawing on the science of positive psychology, which shows that cultivating what works is just as productive as scrutinizing the things that aren’t working well. For example, each of us has characteristic “signature strengths.” Wisdom may be one of yours.
Wisdom and knowledge
Are you the type of person others turn to when they need advice? If so, you probably have the strength of wisdom and knowledge:
Curiosity and a love of learning
Willingness to look at all sides
Ability to change your mind
A tendency to take time to reflect, look inward
An understanding of social dynamics
Wisdom is more than being smart. It’s a special kind of intelligence that blends the heart and the brain. The more life experiences you have had—including losses—the more opportunities you have had to develop a wider perspective. The wise individual is able to listen to the heart but not be overcome by emotional extremes.
Using both sides of the brain. Wisdom is commonly associated with age. Brain studies reveal that older adults use both sides of their brain—the analytical side plus the more intuitive side—more equally than do younger adults. As one scientist put it, “they are in all-wheel drive.”
Cultivate your wisdom. Learning from the habits of wise individuals can help you foster this strength. Explore something unfamiliar. Try a new perspective. Pause and reflect. Strive to interpret the actions of others with kindness and compassion.
Has your mother fallen recently? She’s not alone! One out of four older adults 65 and over experiences a fall each year. That makes falls the leading cause of injury for older adults.
Falls are serious business. A few statistics: In the U.S. an older adult dies once every 20 minutes as a result of a fall. Disabilities from a fall include injuries that can be life changing: a traumatic brain injury or broken hip. Especially for seniors, falls pose a danger to an independent lifestyle. They often usher in a permanent need for daily assistance.
Who is at risk for falling? Has Mom or Dad fallen twice in the past year? Have you noticed balance or gait problems? Has there recently been a severe fall? These are signs of “high risk.” Other signs involve poor vision, or taking medicines that list dizziness as a side effect.
A fall risk assessment
To be safe, ask your relative’s doctor to do a fall risk assessment. This includes a review of
underlying medical conditions. Many chronic diseases affect and the ability to get around.
the home environment. The doctor can write an order for an occupational therapist or other trained professional to do a home assessment. They can identify simple ways to remove hazards and make the home safer.
medication use. Some types of drugs, or daily use of four or more prescription drugs, increase the risk for falling.
A recent review of numerous studies show that some strategies are better than others. The most effective measures for preventing a fall include:
Exercise, especially activities that promote balance.
Getting regular eye exams and following through with corrective procedures.
Removing hazards around the house.
Wearing sturdy shoes and slippers. A firm sole is better than a soft cushy one because it’s easier to feel the ground below.
Are you worried about a fall? As the Orange County expert in family caregiving, we at Senior Life Management understand the difficulty of your situation. You can’t be pushy about changes. And at the same time, the consequences can be pretty serious. Put our experience to work for you. Give us a call at 949-716-1266.
It’s not easy to lose abilities and admit you need help. The reluctant elder in your life is more likely to ease into acceptance if you provide good listening, compassion, and a commitment to working together. In this third installment of our series, we look at elders’ concerns around privacy and pride.
Privacy. Having someone underfoot can feel intrusive, especially if your relative is used to living alone. Perhaps he or she fears being judged, or that word of unhealthy food choices or alcohol use may get back to the family. Maybe your relative tends toward hoarding and is embarrassed. Or has worries about safety with a stranger or the risk of theft. All of these are reasonable concerns for any adult who values their independence. You can address privacy concerns by
starting with part-time help;
hiring a friend;
working with an agency that does background checks and drug testing.
Pride. “Do you think I need a babysitter?!” Our culture values self-reliance. Anything that implies a need for help suggests weakness or incompetence. When you approach your relative,
shift from “we think you need help” to “we want to help you stay in charge of your life.” As noted in Part 1 of this series, working with your relative toward a common goal is a welcome and respectful approach;
clarify what type of care is needed. For instance, a nurse to dress a wound is different from someone who cooks and cleans;
start with a short-term arrangement, framed as “while you recover” or “just to see how it goes.” Then consider a more permanent arrangement;
talk about getting help as a way to liberate your loved one’s energy to do other activities he or she really enjoys;
emphasize your relative’s other abilities. If Mom can no longer do housekeeping, make sure to praise her often about her cooking talents.
Please Note: Senior Life Management does not specifically endorse the activities of these organizations, but offers their information as a sample of the kinds of materials and services that are available.
It’s a common refrain and the bane of many family members: Your loved one is having trouble, yet he or she refuses outside help. This can put your relative at risk. But if the worst happens and things go south, it also ends up making more work for you. Doubly frustrating when you know it could have been prevented.
Rather than battling head on for acceptance, you might try a softer approach:
Build empathy. Ask your loved one what their concerns are. Just listen and try to identify the hot-button issue underneath the reaction:
Is it an issue of cost? – He or she may not know about Medicare coverage or the actual cost of the service. Your loved one may also underestimate his or her financial resources.
Is it an issue of control? – Fear that this is the beginning of the end in terms of living independently.
Is it an issue of privacy? – “My home is my refuge from others.” Or concern about being judged for lifestyle choices.
Is it an issue of pride? – “I don’t need a babysitter!”
Is it lack of knowledge (or denial) about their health? – Some people minimize the toll an operation or disease is likely to take.
Is it an issue of feeling loved? – “My family will take care of me.”
Validate feelings. All of these are valid reactions and worthy of exploration. You might start with, “I hadn’t thought of it that way. I see why you’re concerned….”
Explore thoroughly. Before problem solving, ask more questions. “Tell me more about that. It’s important that I understand.” The more your relative feels “heard” and the more you genuinely comprehend his or her issues, the easier it will be to work together to find a viable solution.
In subsequent articles, we’ll talk about ways to address these concerns with dignity and respect.
At Senior Life Management we have observed that a special family trip builds priceless memories. Don’t let a disability quash the thought! As the Orange County experts in family caregiving, we can help you identify needed support services and find an outing that matches well with your loved one’s abilities. Give us a call at 949-716-1266.
To find the accessibility of national parks service, go to the National Park Service website. Select a park of interest. Under the “Plan Your Visit” menu, go to the page for Accessibility.
Sleep has been under-rated. There is no doubt that miracles occur daily in hospitals. But in the race to vanquish disease, simple things like sleep can get short shrift.
Choosing Wisely, a white paper by the American Academy of Nursing, has listed several common hospital practices that unintentionally get in the way of a solid recovery. Spending too much time in bed—not walking early and often—is one concern. Another problem is interrupted sleep.
Promote a full night’s sleep
Sleep is one of the body’s most healing activities. It has a cyclic pattern that needs to be respected. When your relative is hospitalized, do what you can to advocate for:
Medicines being given during waking hours. (If needed three times a day, suggest 10:00 p.m., 6:00 a.m. and 2:00 p.m.)
Lights out, monitors silent, and doors closed to your relative’s room at night.
No middle of the night blood draws. Ask that these occur when your loved one is awake in the morning.
Vitals checked just before bed and then in the morning. Have blood pressure, pulse, temperature, pain, and respirations been fairly steady? If so, do they really need to be taken at 1:00 a.m. and 4:00 a.m.?
Effective and long-lasting pain management applied in the evening. This way pain will not cause your loved one to wake up in the night.
Of course there are reasons a patient may need midnight attention. Maybe the situation is unstable. The illness not yet under control. Perhaps a test is needed to determine the goals of care. Or to make immediate treatment decisions. But if things are generally stable, it’s perfectly appropriate to ask, “What are the real risks of no interruptions between 10:00 p.m. and 6:00 a.m.? Can it wait?” Healing may be a higher priority.
Is advocacy not your thing?
At Senior Life Management, we know how hard it can be to navigate the medical system. Hospital staff mean well, but they are short on time and have many patients to care for. As the Orange County experts in family caregiving, we can advocate for your loved one and help be sure that he or she is supported for genuine healing. Give us a call at 949-716-1266. You don’t have to do this alone!
Beginning this month, Medicare started sending out new cards to all its members. The mailings will take place in waves. The person you care for may not receive theirs until later in the year. You don’t need to do anything. The new card will arrive automatically. (The only exception to this is people who are enrolled in a Medicare Advantage plan. Those cards will remain the same, so no mailing expected.)
Medicare benefits have NOT changed! The program your loved one is enrolled in stays the same. Just the card is changing.
Why change the card? Primarily, it’s for security reasons. When Medicare first started, it made sense to use Social Security numbers as the identifying number for beneficiaries. That was before the age of identity theft.
The Medicare Beneficiary Identifier (MBI). Medicare is giving everyone new numbers. There will be no rhyme or reason or hidden meaning to the combination of letters and numbers assigned. Nothing to reveal information about the cardholder.
Destroy the old card securely. Shredding or burning the card is best. It does have your relative’s Social Security number. You don’t want that getting into the wrong hands!
Watch out for scammers. Sadly, there are always those who prey on elders during a change like this. Be aware that Medicare will telephone only if the beneficiary has phoned in and left a message requesting a call back. The insurance company for Part D (drugs) or Medicare Supplemental Insurance (Medigap) may call. But they will not ask for the Medicare Beneficiary Identifier. They will already know it. If someone calls and requests verification of the number, hang up immediately. Then call Medicare at 1-800-MEDICARE (1-800-633-4227).
We can help. At Senior Life Management we understand that the health care system can be very intimidating. As the Orange County expert in family caregiving, we’ve got your back. Give us a call at 949-716-1266.
If the person you care for has a lung condition, there may be times when breathing is a challenge. Start by noticing patterns: is there a time of day, type of activity, or emotional state that triggers the difficulty? Is the person sitting, lying, or standing? Consider these options:
Remove dust and replace furnace filters frequently.
Eliminate or reduce strong odors. Bleach, paint, perfume. They all exude chemical particles that can irritate the lungs.
Raise the head of the bed. Lying flat makes it harder for some people to breathe.
Institute a No Smoking policy. No secondhand smoke in the house. And, of course, the patient should not smoke.
Find a better position. Sometimes it helps to sit up straight or brace elbows on a solid surface, such as the arms of a chair or a table.
Turn on a fan or open a window.
Add moisture. Consider a humidifier.
Pace yourself. Plan the day so there are few activities, and time to rest in between. Even something as mundane as a shower counts as an activity. Anything that is tiring.
Guided imagery or deep-breathing exercises. These strategies can calm the anxiety that comes with not enough oxygen.
Slow, focused breathing. Breathing slowly through pursed lips helps some. Counting to extend an exhale helps others.
Talk with the doctor
If these strategies don’t ease the difficulty, talk to the doctor. There are medications that can open the airways. There are also specific breathing exercises. Does your loved one like to sing? Believe it or not, joining a singing group might help. Or ask the doctor if there’s a “Second Wind” or “Better Breathers Club.” These support groups help people get appropriate exercise and provide opportunities to share tips about living with breathing limitations.
Want help managing symptoms?
At Senior Life Management we can help you get the right mix of medicines, therapy, and changes in the home so that breathing becomes much easier. As the Orange County experts in aging well, we know the local resources and can come to the home and help you identify unnecessary lung irritants. If breathing is a problem, give us a call at 949-716-1266. There are ways to ease “air hunger” and the anxiety that comes with it.
AtSenior Life Management, we have found that there usually comes a time when an older relative will need help handling finances for senior life care. Certainly, everyone’s worst fear is falling prey to a scam. But less drastic circumstances can signal the need to have a talk.
It’s important to recognize that this a delicate topic. By Implication, the elder’s competence is being questioned and independence being threatened. Even if there are blatant signs such as: utilities being shut off, bounced checks, parent expressing worry or concern about having enough money-it’s best to step gingerly.
Seasonal or life events can be a good way to initiate the conversation. A hospitalization, for instance, is a prime opportunity to suggest you step in for a few weeks, just until the patient “gets back on their feet”. Or tax time: “Taxes are getting more and more complicated. How about I come over and we can sort through some of these things together”.
In an ideal world, you would introduce the idea of talking about finances gradually. If your life far away, you might mention it in a phone call and then bring it up during a visit. And you wouldn’t need to collect everything at once. Start with a “where are your documents?” discussion, just in case. Later you can work up to things such as bank accounts and passwords.
Once you have permission to participate in your loved one’s finances, you can then use technology to make the process easier.
And if you are worried, give us a call at 949-716-1266. Or email us at Kari@seniorlifemgmt.com or contact through our site. We work with families all the time who find out too late that there are problems. This is one of those situations where a stitch in time really can save nine!
Juggling the demands of home and work has never been more complicated. Grown children often live far from their aging parents. Women, the traditional family caregivers, are in the work force more than ever. And it is not uncommon for middle-aged people to have children still at home at the same time they are caring for their aging parents. So an aging life care association can help them.
If any of this sounds familiar, you are not alone. One in five households is caring for an older adult. The good news is, a variety of programs can help pull together the assistance you need.
One of the biggest issues in getting help is overcoming your own feeling that you are supposed to do it all. (Or your parent’s pressure that it needs to be you.) Part of working with your family member as a team includes being honest with yourself and honest with your parent about what you can and can’t do. Then you can solve problems together to find workable solutions that meet everyone’s needs.
You can make your life easier, and find the help in aging life care for aging parents more efficiently if you consult with an Aging Life Care Associations™ Professional. These professionals know the local programs and eligibility requirements. They can save you time and money.
An Aging Life Care Professional can
make a home visit to discuss concerns with your parent.
conduct a complete assessment of needs.
make recommendations tailored to your parent’s preferences, resources, and support system.
Family members who have cared for a loved one for a long time acknowledge that they are able to do a better job when they accept help from others. Even when they enjoy the process, it can still be a lot of work. And caring for an aging parent may go on for an extended period of time. You need to pace yourself. A willingness to accept help is the first step.
For many family caregivers, noble but inaccurate beliefs can create obstacles to getting help:
“I should be able to do this by myself.”
“It’s selfish to think of my own needs.”
“My [brother/sister/cousin …] won’t do it the right way.”
“Dad won’t let anyone help but me.”
If these sound familiar, you are not alone. Beliefs such as these, however, represent an unfairly distorted view. They don’t take into account the realities of modern life. And they can interfere with your ability to care for your parent for the long term.
If left unchecked, such beliefs lead to depression and burnout. In fact, family caregivers have a much higher incidence of depression and greater health problems than their noncaregiving peers.
You can learn to pace yourself and accept help by combating these distortions. Professionals in cognitive therapy say the simplest way is to recognize negative self-talk and offer yourself an alternate view. For instance:
“Should Statements.” Idealistic thoughts focused on how things “should” be rather than on adapting to the realities of a situation.
Alternate perspective: Instead of “I should do it all,” remind yourself, “I would prefer to do it all, but that’s not possible. It’s better that I get help than exhaust myself and do a bad job with Mom.”
“Labeling.” Applying false or harsh judgments on yourself or others.
Alternate perspective: Instead of “It’s selfish to think of myself,” remind yourself, “I am not selfish. I do a lot to care for Pop. But I need to pace myself for his sake as much as mine.”
What inaccurate beliefs might you be holding that keep you from getting help? How might you change your self-talk about them? Provide an alternate perspective?
Caring for an aging parent has many rewards. But that doesn’t mean you don’t need a break now and then to recharge your batteries. Many family caregivers don’t take needed breaks because they worry that others won’t do a good enough job in their place.
Although concern for your parent’s comfort and safety is appropriate, it’s also important to distinguish between real threats and a tendency toward perfectionism. For instance, it’s not uncommon for one sibling to feel like none of the others help. At the same time, the other siblings feel there “isn’t enough room” for them to pitch in because the primary caregiver is so particular about if, when, and how things get done.
Voltaire once said, “The perfect is the enemy of the good.” If you are having trouble getting, or allowing, others to help, you might want to consider the following:
Is a hot dinner every night necessary, or could Dad be just as satisfied by a hearty sandwich?
Your sister might not do your mom’s hair just right, but the tradeoff may be an opportunity for a rekindling of their relationship.
As a compassionate friend, what advice would you give someone in a situation similar to yours?
If the perfect is getting in the way of the good for you, it can be hard to let go. The stakes seem very high. Be gentle with yourself, and look at these tips from researchers in the field of perfectionism:
Start small. Ask someone to take over a routine task, such as picking up a prescription.
Consider it an “experiment,” not a permanent change.
See what happens. If things don’t go as planned, were the errors life threatening for your loved one or simply irritating for you? Would practice or more information have enabled the helper to do better?
Were there any positives to the situation? Did they have value?
Try again. Don’t expect it to be easy the first time. As with any learning process, the more you do it, the more comfortable it will feel.
How does the perfect get in the way of the good in your caregiving life? Start small. As an experiment, what little task are you willing to ask for help with?
Okay. You’ve decided it’s time for some caregiving help for your parents. The next obstacle may be that Mom or Dad wants “only you.” Part of working together as a team is learning more about your parent’s priorities. Ask him or her to tell you why they don’t want help from others. Concerns may include:
Safety. Fears about “strangers” can be addressed by seeking helpers from your family member’s natural community: friends, church, or neighbors. A licensed and bonded home care agency provides screening for drugs and criminal history. If you are thinking you might hire someone privately, please read our article below about hiring help yourself. Another option is to hire an Aging Life Care Professional to help you find safe, professional caregivers who have had special training in elder care.
Cost. If your family member does not have many resources, he or she may be eligible for free or low-cost services. Go to www.benefitscheckup.org to see what may be available locally. A consultation with an Aging Life Care Professional often pays for itself, because these professionals know of many services available to veterans, railroad workers, and other special groups.
Dignity. It may be difficult for Dad to admit a need for assistance. You can spare his pride by emphasizing the benefit to you. For instance, tell him how much the extra help would relieve your worries and make it easier for you to sleep at night.
If your parent remains resistant, it may be necessary to set limits. State specifically what you are able to do, and offer suggestions for the things you cannot do. Start small and whenever possible, involve your family member in choosing who will help and when they will come. For example:
“I know you feel most comfortable with me, but John wants to participate, too. Let’s have him come one day next week, just to try it out. What day would work best for you?”
“I can help on the weekends. But that still leaves Wednesday, which I can’t do. Of the two agencies we interviewed, which one did you like best?”
An Aging Life Care Professional can assist in this process by helping you define the issues and then facilitating a family meeting.
Why do you think your loved one wants only you? Safety? Cost? Dignity? How might you address his or her concerns and still express your need for help?
Some tasks are more than one would ask a friend or unskilled helper to do. But bringing a meal or taking your parent shopping is simple. And even having one less thing on your To Do list can be a big relief.
Family caregivers often report the most difficult part is the act of asking someone to help. That’s understandable. We’re all busy. You don’t want to intrude. Friends and relations even say, “Keep me posted, and let me know if there’s anything I can do.” But it’s hard to remember and follow up when the time comes and you realize you could use a helping hand.
With the Internet, tools are now available that can help everyone stay more connected. One especially useful tool is a simple, free, online calendar service offered by Lotsa Helping Hands, a nonprofit technology company.
allows you to create a “community” of interested individuals.You enter their names and email addresses into your account and can easily send updates about your loved one’s condition. (For those familiar with the Internet, this online service is like a private, family blog.) You can upload photos. People can write back. Conversations can occur online. Only people you have authorized to be part of your online community will have the login information needed to participate.
The calendar tool is what makes Lotsa Helping Hands special. No longer do you have to make embarrassing phone calls asking for help. No more leaving messLotsa Helping Handsages and getting three positive responses. Then you have to call two people back and say no, but ask them to please respond next time…
With Lotsa Helping Hands:
You post an errand on the calendar (e.g., take Mom to hairdresser, Weds. 3:00).
You send an email request to people in your community.
A community member willing to help clicks on the task on the calendar.
Anyone coming after that sees the task is taken.
You and the helper receive an email confirmation.
Email reminders are sent to you and the helper a week before and the day before the task.
Now when someone asks, “Is there anything I can do to help?” you can reply, “Yes, give me your email address. I’ll keep you updated on Mom. And if we need something, I’ll send you an email.”
No fuss, no muss. And to top it off, there is no charge to open an account at Lotsa Helping Hands. It’s free!
Services in the home are divided into three kinds. Which service you choose depends on the level of training needed in the staff. Requirements set by Medicare may also determine which type of service will be covered.
Home Health Care. This service is provided by nurses and other medical professionals.
Home Care. This service is provided by uncertified staff.
Hospice Care. This service is specifically for persons with a life-limiting condition. Services are provided by nurses and other medical professionals.
Home Health Care is skilled medical care to help an individual regain their health. Typically, home health care is used following a hospitalization or surgery. The role of the staff is to help homebound patients with a complicated medical condition that can be managed or improved. A doctor’s order is required.
Home health care is short-term care. It normally involves a few visits over several weeks. For instance, a registered nurse, a physical therapist, or an occupational therapist may make hour-long visits once or twice a week. Although the doctor orders home health care, you have a choice as to which provider you hire.
Home health care is generally covered by Medicare or other health insurance.
If your family member needs 24/7 access to medically trained staff, a skilled nursing facility is the most affordable option. Medicare and most insurance will pay for this kind of care for a limited time. A doctor must determine that your family member needs round the clock access to medical attention. You have the choice as to which facility to use.
Whether you need home health care or a skilled nursing facility, an Aging Life Care Professional can help you select the company best equipped to deliver the services your loved one requires.Home Care is nonmedical care to help a person remain in their own home.There is no need for a doctor’s order. Nonmedical home care includes
personal care (such as bathing and toileting);
dressing and undressing;
assisting with walking;
transferring in and out of a chair or bed;
visiting and companionship.
Nonmedical care does not mean the person lacks skills. The individual caring for your family member needs to have an understanding of the basics of elder care. Although certification is not necessary, many in-home care providers are former certified nursing assistants or home health aides. They gained their initial training and experience in a nursing home. Now they prefer to work one-on-one with clients.
Nonmedical care at home can be vital to keeping your parent independent and safe. Unfortunately, health insurance, including Medicare, does not cover nonmedical care. If your family member has long-term care insurance, nonmedical home care may be covered. Check your family member’s policy for details.
An Aging Life Care Professional can help you save money. After meeting with your parent and conducting an initial assessment, the care manager can make several suggestions. He or she will create an individualized plan. Often there are options available that provide less expensive alternatives to in-home care. For instance:
Automated medication reminders
Community resources, such as home-delivered meals or local Dial a Ride
Safety equipment, such as a ramp or grab bars
A personal alert system should your family member fall
A move to an assisted living facility which offers a more home-like setting than a nursing home, and has round the clock access to nonmedical care.
Some nonmedical home care may be available for persons with low income.If your parent is on Medicaid or Supplemental Security Income (SSI), contact the local Area Agency on Aging. The state Medicaid office or local Veterans’ Service office may also be able to help. Hiring an Aging Life Care Professional who knows community resources may be the most efficient way to find low-income services. An Aging Life Care Professional can determine whether your family member is eligible for local programs. In addition, these professionals know whether a waiting list is in place and how best to apply.
If your family member does need in-home care, an Aging Life Care Professional can help arrange these services cost effectively. You can read more about Our Services or request more information be sent to you. Or you can send us an email at email@example.com or call 949-716-1266. We’d be happy to talk to you about ways to save money while meeting your loved one’s needs.Hospice Care is skilled medical care for individuals with life-limiting illnesses. Like home health care, hospice involves weekly hour-long visits from a team of medical professionals. Both the patient and the family have access to the team’s support services. A doctor must recommend hospice based on a diagnosis of an incurable condition. In addition, the doctor must estimate that the patient has six months or less to live.
Hospice care emphasizes the quality of life. The focus is on keeping the
patient comfortable emotionally, physically, and even spiritually. Nurses and physicians help manage difficult symptoms (pain, nausea, and fatigue). Social workers and chaplains assist with emotional and spiritual issues (anxiety and depression). Nurse’s aides come several times a week to bathe and groom the patient. And a volunteer is available to give family members a few hours off each week.
Most people wish they had received the support of hospice earlier in their condition.
Patients on hospice understand that their condition does not have a cure. They are willing to forego curative care. Instead, they wish to focus on improving the quality of the weeks and months that remain to them. Most people think of hospice in terms of a cancer diagnosis. In fact, hospice can provide powerful support for individuals with other incurable conditions, such as COPD, congestive heart failure, and advanced dementia.
Hospice care is covered 100% by Medicare.
If you think your loved one has a life-limiting disease, ask the doctor if hospice is appropriate. If so, you have a choice of hospice providers in your community. An Aging Life Care Professional can help you select the one that has services tailored to your family member’s condition.
Which of these services seems the most appropriate for your situation? Home Health (medical)? Home Care (nonmedical)? Hospice?
Hiring someone directly has many risks and many responsibilities. Make sure you are well informed. Simple as the caregiving job may seem, being an employer is not easy. And bringing strangers into the home is not a small matter. You may want to have a home care professional (an Aging Life Care Professional or a home care agency) do the hiring for you.
Here are some things to keep in mind if you hire someone yourself:
Criminal background checks. You want to be sure that the person coming to your loved one’s home does not have a history of elder abuse or run-ins with the law. Even the nicest seeming people can be trouble. Con artists typically have winning personalities.
Drug screening. You want to be sure that the person caring for your loved one is mentally sound. You don’t want someone in the house who is working while under the influence of drugs. If you decide you want to require drug testing, be prepared to pay for the expense.
Home security. From protecting Mom’s valuables to arranging for a key, there’s a delicate balance between convenience and caution. (Experienced home care professionals have systems worked out to make sure your family member’s home is appropriately protected. They know how to minimize hassles for your parent and the caregiver while providing security for your loved one’s assets. They are usually required to also have insurance against a possible theft.)
Training. How do you know if the caregiver really knows and understands elder care? Can they handle an emergency and make good decisions? Do you have the time to verify training and educational certificates? Just because a person says they have done something before, doesn’t necessarily mean they have. Sadly, competence is hard to verify unless you are experienced with recruitment and hiring. (Home care professionals test for competency. And many provide training opportunities for their employees.)
An honest accounting of hours. Unless you are present much of the time, how will you know that the caregiver worked the hours he or she bills for? If your loved one is unwell or has memory problems, he or she may not be able to monitor time spent providing care. (Home care professionals have systems in place to confirm the hours worked.)
Quick replacements if the caregiver is sick. By hiring the caregiver directly, you are the employer. As such, you need to be ready with your own “Plan B” in case the caregiver is unable to come to work. Is your parent safe without assistance for a day? Two days? Three? Or is he or she dependent on the caregiver for meals? Medication reminders? Supervision to make sure the stove is turned off, or that your loved one does not wander? Once you become the employer, you have to not only hire the employee, but also be ready with an alternate plan if your employee gets sick.
Protection from lawsuits if the caregiver gets hurt. If you hire someone on your own, he or she may file a lawsuit against you if there is an injury on the job. As the employer, you are required to pay Workman’s Compensation Insurance to cover potentially disabling incidents. Without it, your assets are at risk because you are individually liable.
Social Security and other taxes. As an employer, you are responsible for Social Security, payroll taxes, and unemployment insurance. There are many legal obligations, deadlines, and penalties if you do not comply. To hire someone legally as a contractor, rather than as an employee, their terms of engagement must fit the criteria of your state’s Labor Code. A person may say he or she is an independent contractor, but that claim can be called into question if you set the days, hours, and duties. If they do not qualify as an independent contractor and they are being paid without taxes being withheld, it is against the law. If it is found that you or your parent were the employer, you must pay all back payroll taxes plus penalties. You might even have to appear in court. If you plan to hire help directly, check with an accountant to find out what your tax responsibilities are.
Discipline, hiring, and firing. Would that all employee/employer relations were trouble free. Unfortunately, they are not. Your employee will need some training. There will be a period of getting used to each other. Your loved one will have preferences, and so will you. Communicating these priorities effectively is an art. Enforcing them is an even more delicate art. Then there is the matter of compatibility. Not all personalities are a good fit. If differences are irreconcilable, letting an employee go is yet another art, though one that may have legal and financial ramifications. Make sure you understand the state and federal laws about this subject. Moreover, if/when you do let someone go, depending on your loved one’s needs, you may have to have someone else chosen, screened, and ready to put into place, perhaps even the next day.
Hiring help directly is certainly an option, but it is not as simple as it may seem. This is why many families turn to an Aging Life Care Professional. Whether he or she offers home care services or works closely with an agency, an Aging Life Care Professional can explain the legalities and help you be sure you are covered.
How will you address issues such as payroll taxes, workers’ comp, and background checks? What about when the caregiver is sick and cannot come in?
Home care professionals can provide you with caregivers trained in the special needs of elders. Plus, they carry insurance and handle many of the supervisory and legal requirements involved.
(If you work through a referral service to find a home care company, be sure to ask how they receive payment. Many referrers do not charge the family, but receive payment instead from the providers. You may want to ask specifically if they receive fees from the companies they refer to. Their answer will give you important information about their objectivity.)
When interviewing a home care provider, consider the following questions:
How long have they been in the community?
What types of screening do they do for their caregivers? Criminal background checks? Drug screening?
How do they test to be sure the person knows basic caregiving skills?
What types of training do they provide for their caregivers?
Are their caregivers employees? Does the home care company handle Social Security and other taxes for their caregivers?
What happens if a caregiver cannot come to work on a given day?
How do they verify that the caregiver worked the hours claimed?
How do they supervise caregivers in the home?
What are their procedures for addressing problems?
What kinds of insurance does the company carry? Workman’s compensation for their employees? Insurance against possible theft by a caregiver?
Can the company give you references of professionals or agencies that refer to them?
Family Health Companion is The “Invisible Workforce”
A recent study by the Johns Hopkins Bloomberg School of Public Health calls family health companion is unpaid caregivers and the “invisible workforce” of the health care system. Released in the Feb. 15 JAMA Internal Medicine, the study examined how family health companion’s involvement in older adults’ health care activities relates to caregiving responsibilities, supportive services use, and caregiving-related effects.
Swallowing involves the coordination of many muscles in the mouth and throat. The action pushes chewed food down toward the stomach. At the same time, the throat needs to close off the windpipe to the lungs.