I’m new to the Medicaid aide service through MLTC. New aide started Monday for six hours a day. She is nice but hard to read. I’m not seeing her really trying to engage with my mom. She gives her dinner and helps shower her. The rest of the time is spent watching tv. She does the bare minimum of the list I made for her. Basically I asked she clean up kitchen counters and bathroom after use and quick vac the floors. She has not taken the trash out. When watching tv, she sits on another couch that’s about 12 feet away from mom. I have cameras in plain sight at my moms home so I can see there is very little interaction. This makes me sad. I don’t want to jump the gun and complain or offend the aide as this is just her first week. My mom has dementia and when I ask her what she thinks of her she just says “she's ok” or “I don’t know”. ( It’s important to note that with her previous aide right from the start Mom said “I like her, she’s good! That aide had to leave after only 2 weeks). But I don’t get that happy response from Mom with this current aide which troubles me. How do I get the aide to be more interactive with Mom and take a more active role with light housekeeping without being confrontational or offensive? Is it too early in the game to seek someone else who will be a better fit? On the other hand, I don’t want her to think this level of care is fine. I really need help with this ASAP.
You are absolutely right to want the best fit for your mom’s needs.
You left a specific list. So, I feel there isn’t a lack of communication.
You have cameras set up. A picture is worth a thousand words!
Is she new to caregiving? Does she have experience with patients with dementia? How far along is your mom’s dementia?
Did you tell her about your mom’s personality?
For instance, “Mom likes to do puzzles. Mom likes to chat over a cup of tea, etc.
I told our caregiver that mom would love for her to share a pot of tea or coffee with cookies.
Mom loves seeing photos of children. Please feel free to show photos of your kids to her.
Mom lived with us and I followed the agency’s rules.
The aide did bathe mom.
Housekeeping was only for mom’s room and kitchen area.
I requested light housekeeping, vacuum her room, empty trash, change bedding. Prepare light snack and meal.
In our case, the agency told us that the aides were companions to the elderly, as well as caregivers.
If this is private pay, explain that your mother enjoys socializing with others.
Socialization is important and is one of the favored qualities of assisted living facilities and nursing homes.
You say that you made a list, but are you able to have a personal conversation with her, perhaps saying how appreciative you are to have help in specific areas because your mother is no longer able to do these tasks.
If there is no improvement after a reasonable amount of time, go ahead and look elsewhere. I would give her a chance to find her way. Maybe she simply forgot the trash.
I had one aide that was a perfect fit for mom. I asked if I could have her every week. They agreed and mom was happy with her.
I am wondering if the sitting far away is part of the Covid training protocol in caregiving these days.
Keep us posted on your progress.
You aren’t alone. It’s challenging overseeing caregiving for our parents.
I am glad that you have some help. Some of us went without help for far too long which is a recipe for complete exhaustion!
I really appreciate your suggestions and am going to see how the rest of the week goes. It's so hard to be a caretaker when every decision can affect your loved one.
you know... trust in your instincts and your mom's..... not sure? talk with the aide and point blank ask her why she is not engaging so much..; maybe she is tired or her heart wasn't in this to start with.
When you're working in a person's home and establishing a relationship, you can't just go at it like a bull at a gate. Some clients do like the bright'n'breezy approach, true, but others are far more reserved; so it's a mistake on a caregiver's part to make assumptions.
I've been doing a double-up round this week, attending calls with a co-worker to clients who need two people to support them. My co-worker is great, very experienced and conscientious, but ohmygod she NEVER shuts up! - but it didn't seem to bother anyone apart from me :) I expect they'd describe her as chatty and friendly. I was mentally calling her other things by the end of the round...
NYCmama, if the tasks and routines that have been specified are being done to a reasonable standard, I should give the interpersonal stuff more time to develop. You say this lady is nice? - so maybe she's just not quite as extrovert as the short-term aide your mother liked.
The more active role with light housekeeping: again, a caregiver can't make assumptions, and this part you have to take VERY seriously. I might think "I'll just take the recycling out and wipe down the counters," and you might think that harmless enough, BUT!!! - if it isn't on the support plan, it serves me right if I get my ears ripped off by my line manager because the client's family has complained that I interfered. You cross boundaries at your peril.
Sitting on the other couch - also correct - "hands, face, space."
She isn't an effusive person at all and a bit opinionated about certain things. If I'm feeling that way, what is my mom feeling? Hard Hard for me but I will wait a bit more and see if I'm still feeling the same way by week's end.
The second one spent all her time on the phone. Sitting on a bar stool in the kitchen and only did anything when directly asked. The 3rd one kept having personal family issues so she had to leave early all the time.
The wonderful lady who has been with us for 1 1/2 years was actually a substitute for #3 who couldn't make it one day because of a " fender bender". Lorraine has been a God send. She treats my husband with kindness and respect, can get him to shower and take his meds when he's being hateful, is right there when he's trying to stand up to help, but won't insult him if he tries to do it himself.
She makes him all different kinds of things to eat, she doesn't care if he wants to eat pie for breakfast, she just fixes it and gives him a protein drink along with it.
If she had her way my house would be vacuumed and mopped every day, we compromised with mopping his bathroom everyday and the rest of the house as needed.
I did inform the agency of the deficiencies of the other workers. I felt they needed to know how some of their employees acted.
So, it's okay to request another caregiver until you find the right one. Its better for your LO, and you will be happier too. And thats
Important!!
Many times people don't really know what a hired caregiver's job is and will often attach other duties onto it that are not part of the job. Agency caregivers who earn next to nothing, have their job duties laid out from them by their bosses about what they are supposed to do and what they're not supposed to do. The only real concern of whatever agency they work for is that they put their time in. The time and hours are really the only think the agency itself has to answer to the state for. Anything else is on the aide personally. People sometimes don't understand that we are not entertainers. You've probably seen the tv commercials for homecare agencies that show some senior and their aide cooking together, playing cards, doing puzzles, and having a great time. It's NEVER like that. Think about an aide on a six hour shift (like yours). After the feeding, hygiene care, and light housekeeping is done there's probably four or five hours left on her shift. Maybe play a game of cards or do a puzzle for an hour like in the advertisements. Then what?
In addition to the totally gross and laborious chore of bathing, toileting, diapering, wiping a**, and feeding some elder the aide also has to make sure the home is adequately clean and safe. They have to make sure your LO doesn't get hurt or into trouble during their shift. This is the job.
The job is not become a one-person circus to make sure the senior that aide is getting minimum wage for, doesn't experience a moment of boredom.
If your aide is doing an adequate job, isn't ripping your mother off, and not being abusive then consider her a good aide. You will not get better unless you're hiring and paying privately.
As for her not meeting your chore list requirements. Offer to drop her a fifty extra in cash each week and watch how much she starts cleaning. I will tell you honestly speaking as an in-home caregiver for almost 25 years (private pay many of those years). If I was making minimum or just above on some job and some elder's adult child made me a chore list, I'd throw in their face and walk away.
Will they send out a replacement caregiver for her?
I had to let an agency caregiver go for similar reasons.
If she doesn't work out, call her supervisor for a replacement. Let the supervisor know that it wasn't a good match for your mother.
For home health, the key is documentation.
Design, then print out a form that documents what is to be done and when.
Each shift must be filled out and approved before payment is meted out.
For example
Arrived-
Greeted-
Observed for-
Breakfast given-
Client ate-
kitchen cleanup-
Bathing-
Note Bowel results-
Rest-
Remove trash-
Check for supplies-
Sign out-
Then, at least you have a framework of the job at hand
As far as personality, I’m afraid that is the luck of the draw.
We are caregivers, yes, and if you get a nice one, great.
But what you are describing may be more under the role of family than caregiver.
I put it out there because I'm new to this process, and needed feedback - but I'm no pushover. With Covid-19 still so rampant, of course I'm reluctant to have aides coming and going; so I'm praying I can find the right "one" ASAP.
Your response was spot on - thank you!
Realize that caregivers, generally speaking, are not well educated and focus on cleaning/housekeeping and feeding, changing soiled garments. Some are there to 'sit' with a elder (and deal with hygiene needs) to insure they are safe.
* It is critically important to be very specific with a caregiver what your expectations are.
- Write out a list and go over it with her.
- Show her exactly what to do so there are no misunderstandings; ask her "do you understand?
* Why do you NOT want to confront caregiver? This is education and training, and is essential.
* If you allow a caregiver to sit and watch TV rather than do\ her job, you cannot expect anything different.
- What skills and qualities do you want in a caregiver?
- If a caregiver doesn't want to work, she'll do what she wants and test your boundaries.
* You must deal with your own fears of asserting yourself. What is in your way to communicating clearly what you need and want. This is a job; it is 'work' - people have to know what to do based on what you tell them you need them to do.
* Once you talk to her and go through a 'to do list,' ask her "Can you do this?
* Role play talking to your mom and see if she can do it. She may not have - both - the skills, maturity, or interest in actually interacting with your mother. She just wants to get paid for doing the bear minimum.
* Ask her if she wants the job and if she is willing and able to do what you ask her to do. If she doesn't do it, get someone else. Why would you even consider keeping her on?
It is like training a dog - the one who really gets trained is the dog's owner. The dog does what it wants until it is told what else to do, or how else to behave.
* SETTING BOUNDARIES and EXPECTATIONS are essential.
* Get assertiveness training for yourself. Don't be a door mat . . . for anyone. This may be a life long learning, indicate low self esteem, overwhelm and or a combination of a lot of factors. You need to step up to the plate or give someone else the responsibility of training and working with the caregiver.
Do not allow this to continue.
How to address without being confrontational... Can you talk to them via the camera system? If so, pop in pretty often and ask how it's going to make her aware that you are observing. You gave her a list of chores - so print multiple copies of the list with check boxes. Ask her to initial it as she completes it. After she leaves for the day, go there and see if all the things are done. If anything is left undone, highlight what was not done,leave her a note and take a picture of it, that says 'there were dishes left in the sink, please make sure they are all washed before leaving so we don't create a bug problem' or something similar.
It is possible that you have not given her enough to do. If you check behind her and see everything was done and you also notice her sitting on couch a good while, there just isn't enough tasks to fill 6 hrs. Watching tv w/mom - if that's what mom likes to do - inhibits conversation. If she is on a cell phone all the time, there is NO conversation and never will be. Cell phone use should be very limited when you're on the clock. If mom is not a real tv watcher, then tell caretaker you don't want the habit started with mom. Perhaps encourage mom to do some leg lifts/arm lifts, etc to stay mobile