It may seem to you as though taking care of a person with Alzheimer's disease requires a never-ending series of decisions. One of the most sensitive decisions is whether you should hire someone to provide all or some of the care. This becomes complicated by the fact that the person with Alzheimer's may say he does not see the need for more care, or may not want to be taken care of by a stranger. The family caregiver may also feel uncomfortable about hiring an outsider to provide care that he or she was previously giving. A variety of feelings, ranging from guilt to mistrust, together with practical issues such as finding the right person and figuring out how to pay for the service, further complicate taking this step.
Your family may have differing perspectives about what care is needed and who should provide it. However, as the disease progresses it is almost always necessary for more than one person to take care of the person with Alzheimer's, and if family resources are not available, ultimately a professional caregiver will be needed at least some of the time.
Before you hire someone, try to get a clear idea of what you would want him or her to do and the number of hours of work involved. It will cause problems if you do not express your expectations and agree on a plan. Also be sure to provide a good picture of the person who needs care--not only the physical care needs but also some history and the kinds of things the person likes to do. Try to match the potential home care worker to the interests and abilities and temperament of the person with AD. Remember: Care is about relationships and you want to make the best match you can.
NOTE: It is essential that the person you hire understands the effects of Alzheimer's disease and how to communicate with and provide care for a person with this illness.
Once you have hired someone, familiarize the aide with the home, the schedule, the person's taste in food and any other details that will help her to be appropriately responsive to the person she is caring for. Be sure that she has emergency contact information and understands the protocol.
It may help the person in your care to accept the new caregiver if you tell him that the aide is there to help you. Do not suggest in any way that it is because he or she is too much trouble for you. You too will have to learn to trust the person you have hired and to accept that she may not do things exactly as you would. She may do them differently but well enough. Encourage the aide to ask questions. In time, the person you have hired will understand the needs of the person she is caring for, and everyone will feel more comfortable. However, if you get the feeling that the person is not right, don't be afraid to make a change. Sometimes it takes some trial and error to find the right person.
NOTE: At first, you may feel uneasy about leaving the aide alone with the person you have cared for. This is natural. And don't be surprised if you are not sure what to do with the free time you have worked so hard to create for yourself. This too is natural.
Caregivers who have been reluctant to hire a stranger to care for a family member often find that a warm and caring relationship develops that goes beyond everybody's expectations.
A primary caregiver – particularly the caregiver responsible for a senior diagnosed with memory loss or Alzheimer's disease – must account for the needs of the patient. A primary caregiver has every right to insist that a caregiver for an elderly person:
- Have some knowledge of the aged person's condition, whether it's Alzheimer's disease or some other ailment.
- Be able to show compassion.
- Be comfortable around older people in order to be attentive to the senior's needs.
- Maintain the client's dignity.
- Be tuned in to the elder's habits and lifestyle, especially when the client has trouble communicating.
Parents may need a caregiver to help with a child (or an adult child) who has a cognitive impairment, physical disability, or other special needs. By asking similar questions as those above, parents can decide if a friend is suitable, responsible, and good with children.
Hiring a Friend for a Caregiver
Caregivers are hired for all sorts of reasons, but a disabled adult who hires his own caregiver(s) has to consider more than compatibility when considering a friend for the job. Companionship or in-home support – helping with domestic chores, grocery shopping, helping the client organize bills, etc. – may be something a good friend is willing to do as employment.
Using a friend as a personal care attendant (PCA) takes deep consideration. The PCA position is considered critical and the applicant must be dependable, trustworthy, and must be able to show a willingness to learn the client's daily personal care routine.
PCA duties are very specific. Friends or not, applicants need to know that the job may include bathing, skin checks, dressing, and toileting, just to name a sample list of PCA caregiver tasks. Employers must emphasize that the PCA has an enormous responsibility in that the client's well-being depends on how well and how efficiently the worker performs. The person must be reliable, and must show up for work even on weekends and holidays.
There are benefits to hiring a friend as a caregiver, especially if the client has known the applicant for a long time. The client knows the friend's personality, level of intelligence, and shortcomings. Friendship may be an incentive to do a better job. The friend probably knows much of what has to be done for the client and may know the routine without much training.
The risks of hiring a friend as a caregiver can start with disturbing results from a background check. Otherwise, the client may have difficulty firing a friend who just isn't performing as expected. A friend may expect frequent raises or days off. And finally, the client may find the friend is not all that dependable or the friend wants to rearrange a schedule for his own benefit.
How to Select an Agency
There are several ways to approach the task. You may ask your friends, family, or co-workers if they know somebody who will be willing to work as caregiver for your AD patient, you may post ads in the local newspapers or in the online message boards. However, many people prefer to deal with professional caregivers’ agencies, who specialize on delivering home-based services to the patients. This way, you may have a higher degree of confidence on the experience a responsibility of the employees and you have better ability to get sustainable support, provide by the organization.
So you have to decide if you want to hire through a caregiving agency (which is more expensive, but the workers are usually supervised and bonded), or if you want to find someone on your own (which will require a lot more on-going supervision).
To select an agency, follow the recommended steps:
- Interview several agencies.
- Get references and CHECK THEM.
- Make a list of services you want and ask the agency what it will cost.
- Ask what the steps are in the care planning and management process and how long each will take.
- Find out how and when you can contact the care manager.
- Find out if the agency has a system for sending a substitute (stand-in) aide if the regular one doesn't show up.
- Ask if the agency will replace the aide if that aide and the person in care do not get along.
- Ask about the skills and ongoing training of personnel.
- Do they have staff especially trained to work with dementia?
- Ask how they keep track of the quality of services.
- Ask for the services needed by the person in care, even if the insurance company is trying to hold down costs.
- Be aware that if a social service agency is providing the care services, they may limit you to only the services that they provide.
- Ask them to tell you about any referral-fee agreements they may have with nursing homes or other care facilities.
- Know what you have to do to lodge complaints against the agency with the state ombudsman or long-term-care office.
- Get in touch with the local/state Division for Aging Services to check for complaints against a particular agency.
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