“My husband does not want a babysitter.” “Mom doesn’t want to pay for care.”
“Dad insists he can take care of Mom.”
“My mother thinks she is fine, but she’s not cooking and therefore losing weight.”
“My wife will not let anyone clean the house or assist her in cooking. She can’t do either anymore but thinks she can.”
The above snippets might sound familiar to you. Maybe you can relate because those are the same phrases you are hearing from someone you care about, that you are over-caring for, or that you are fearful will have a severe accident if help in the home does not happen soon.
The following list contains five mistakes that families might be making when it comes to the care of their family member and some interventions or changes that you might want to consider to be successful in bringing in home care that in the end will increase the quality of life and allow your family member to live at home longer.
1) Families tend to assess the need and fear for the safety of their family member.
They use phrases such as: “You should…,” “You need help,” or “You are not safe.” This approach typically leads to resistance because older adults don’t generally like being told to do something. It could be construed as a threat to their independence, autonomy, and/or privacy.
It is better to say that you are concerned about their safety first or that you worry that if they break a hip, they could end up in a nursing center. Then you can say: “Let’s look at options to keep you in your home and independent.” Do your homework and know the community resources and the agencies that have a good reputation in your area.
2) Families hire care and expect the parent to pay for it.
Remember, your family member lived in a time where anything over $10 an hour was too much to pay for anything. So, telling them care is $28-40 an hour could bring resistance. Better to start slow and say, “I think we can get you the support or assistance (not saying the word “care”) that you need for $250 a week.” Followed by – “This is so much less expensive than assisted living and you get to stay in your home.” Ask the family physician to prescribe help in the home on an Rx pad so they are more amenable to the idea as a health matter.
3) Some families want full-time care and often that is what is needed. However, you are not going to get buy-in that way.
If you start slowly, with maybe 4 hours a day three times a week, you have a chance of being successful. As the relationship develops, you can add days or hours. It is all about the relationship. Use the guidance of a Professional Care Manager who can be the conduit to the older adult receiving care and provide a little counseling along the journey. The Care Manager builds a relationship of trust. Often the older adult will take direction from the Care Manager, but not his or her child who might be 62 but is still seen as a ten-year-old.
4) Adult children want their parent to decide to bring in help and pay for it even when the parent has a dementia.
Those with dementias have difficulty with decisions and organization. I would say that this approach does not work in about 90% of clients with dementia because they are fearful of spending any money and they deny any deficits in their functioning. Adult children of aging parents who have legal powers need to make decisions without parental approval. You might need to use “therapeutic fiblets” to make it work. A “fiblet” is a necessary white lie, to redirect your family member that is struggling with dementias and discourage them from any behavior that might be detrimental. A fiblet might be, “Your doctor says you must have 4 hours of a personal assistant a day or else you need to move to assisted living. I am going to help you stay in your home. That is why we are trying this plan.” A fiblet could be calling the caregiver a different term, such as a personal trainer, a cook, a handyman, or a driver. When in fact, the person is a generalist caregiver and can do all you need to be done, you just need to change the name of the job to something that sounds adult and not like a babysitter or nurse. We can help you design a personal strategy at Eldercare Services.
5) Families tell the parent that they can choose a caregiver thinking that agencies will send several care providers so they can be interviewed for the choice.
In reality, a family would have to pay each caregiver for his/her time and then again it would not be easy to choose, especially for someone with a dementia. It is best to leave the matching up to the home care agency you want.
In my experience, when you have resistance, dementia, denial of need, or on-going hospitalizations, you need to hire a Professional Care Manager to help you with the approach, the introductions, the creative instructions, and the coaching to both the new caregiver and to you, the caring family member.
When you need to use “therapeutic fiblets”, remember you are doing it only to protect self-esteem and reduce anxiety for your family member and yourself. If this causes you to feel any guilt, join a support group. We have a free group on the 2nd Thursday of every month from 6-7:30 pm in our office.
Caring can be a joy, an opportunity, and a challenge at times. Allow your family member the opportunity to stay home for as long as possible and put together a team to assist you for all the transitions that this journey brings.