Caregiver

[DawnM]

Quick Question.

I am trying to find someone to help Dad around 10-15 hours per week.   Right now the needs aren't too great.   He doesn't need help in the shower or with toileting, etc....however, I imagine shower help may be coming right around the corner.

I have found 2 potential people right now.   One is a male who has cared for ALS patients before, seems very nice and helpful, and in easy going.   However, he says he won't do "personal care" like showering and toileting.

The other is a female, who was a nurse but hasn't renewed her license to practice in the USA (she was a missionary for years.).  She will help with whatever is needed.   

Dad typically prefers a male, especially if they help him with dressing, etc....however, the "I don't do personal care" has me concerned.   He WILL take dad out for walks, to his appointments, etc....which is our immediate need.

Dad doesn't think he needs ANYONE, so bringing them both in to talk to dad and letting him decide isn't an option.   He will just say, "I don't need anyone" and stop the discussion.    I have to be the one to pick and decide.

[TravelingChris]

That is hard,  I guess right now I would pick the male since your Dad is probably overwhelmed with all the medical things going on with him right now.  

[mlktwins]

I would go with the female who has nursing experience.  And…speaking from experience, my dad went from no help with showering or toileting to needing it overnight.  My DH did it until we could get care in there 3 days later.  Happened overnight with both my in-laws too.
 

If not for that, I would probably go with the man to start.  

He will need someone kind, but firm.

Also, my dad still doesn’t think he needs care.  I make the rules for the caregivers…not dad.  He is paying the bill, but they report to me.  

Edited February 24, 2022 by mlktwins

[Katy]

Go with the nurse. 
 

 

[kristin0713]

I agree that you should go with the nurse if he might need more care soon. You found someone now, but who knows if she or someone else to do the personal care would be available later. 

ETA - would it be an option to hire both of them for half the time, or do they want more hours? This way he could have some male companionship and there's also a backup if one is sick. 

Edited February 24, 2022 by kristin0713

[Innisfree]

From experience, you'll need more than one person. You'll get to the point where you need more hours, more patience, and more stamina than one person can offer. You'll need a backup, even if you don't need many hours right now. And, you'll be lucky if the first people you hire are still working for you at the end of this road. It's a stressful job. 

Personally, right now I'd try to hire both, if possible. If not... whoever you hire is unlikely to be the last person you hire. I might start with the man, but keep the nurse's number, and be ready to keep interviewing others. Or start with the nurse, and push through your father's objections at the start instead of later. Being able to get through this process with *only* male caregivers isn't likely, so you're going to have to do that at some point.

Sending best wishes and hugs. It's hard.

[Faith-manor]

I would hire both and split duties if finances will allow. My father went from 'needs a driver, someone to get him our of the house, someone to supervise and make sure meds are taken", to "needs a lot of help" in a crazy short period of time. This also fives you back up for scheduling. But, I would be looking for a replacement for the male aide since you need someone who will help with personal care.

[mmasc]

I’d also go with the nurse, for the reasons already stated by PP. If you like her personality, then your dad will probably like her and adjust to having her around, even though he prefers a man or nobody. 

[skimomma]

If you can't hire both, I would go with whichever one seems most suited to being firm about helping.  As others have said, you will go through more than one person in all likelihood so setting a precedence that the person WILL be helping even if he is resistant will give you the most immediate benefit.  If the very first person you hire gets steamrolled, it will be more difficult in the long run.

[HS Mom in NC]

A friend of our family had an elderly father who needed increasing levels of care and insisted on male help only for personal care.  It was a nightmare for the adult son who was single and working.  Son was too accommodating. So few men are in that line of work that it's completely unrealistic.  The amount of calling, interviewing, scheduling, rinse, repeat that was the son's life was staggering and he had to fill in the gaps himself most of the time.  That was before the current shortage of caregivers. Remember, most CNAs (the most common level of qualification to care for elders) makes around minimum wage and few get benefits. Turn over and burnout are huge.

I'd nip that unrealistic expectation in the bud right away. There's a shortage right now. I'd tell Dad in whatever way is necessary (you know him best) that if I have the option of a male I'll take it, but odds are slim to none I'll be able to find one, so expect a female. He'll need to adjust to the idea now and throughout the process.

I think it's really important everyone involved is realistic all the way through this. Put those expectations and any necessary corrections into explicitly stated words. You can be kind and loving when you correct unrealistic expectations, but be very careful to never lie to yourself or anyone else involved about what you can actually make happen.  I helped my mom with caregiving for my elderly grandparents.  Grandad was sharp and realistic to the end, but Grandmother had dementia and Mom had a harder time facing cold hard reality sometimes.  She still has guilt 12ish years later because she was too idealistic. There was never an option that was ideal.  It was 3 years of choosing between crappy choice A and crappy choice B. And those crappy choices were the best options possible this side of heaven. I'm so sorry you're dealing with this.

I agree that it's best to hire both if you can.  Having a back up matters, especially if you're working and don't have siblings to help. Caregivers get sick sometimes.  Caregivers hit their limits sometimes. Caregivers take vacations sometimes.  Caregivers have other obligations sometimes.  Caregivers get significantly better offers sometimes. Caregivers don't always like their patients and find different ones sometimes.

[Grace Hopper]

2 hours ago, HS Mom in NC said:

A friend of our family had an elderly father who needed increasing levels of care and insisted on male help only for personal care.  It was a nightmare for the adult son who was single and working.  Son was too accommodating. So few men are in that line of work that it's completely unrealistic.  The amount of calling, interviewing, scheduling, rinse, repeat that was the son's life was staggering and he had to fill in the gaps himself most of the time.  That was before the current shortage of caregivers. Remember, most CNAs (the most common level of qualification to care for elders) makes around minimum wage and few get benefits. Turn over and burnout are huge.

I'd nip that unrealistic expectation in the bud right away. There's a shortage right now. I'd tell Dad in whatever way is necessary (you know him best) that if I have the option of a male I'll take it, but odds are slim to none I'll be able to find one, so expect a female. He'll need to adjust to the idea now and throughout the process.

I think it's really important everyone involved is realistic all the way through this. Put those expectations and any necessary corrections into explicitly stated words. You can be kind and loving when you correct unrealistic expectations, but be very careful to never lie to yourself or anyone else involved about what you can actually make happen.  I helped my mom with caregiving for my elderly grandparents.  Grandad was sharp and realistic to the end, but Grandmother had dementia and Mom had a harder time facing cold hard reality sometimes.  She still has guilt 12ish years later because she was too idealistic. There was never an option that was ideal.  It was 3 years of choosing between crappy choice A and crappy choice B. And those crappy choices were the best options possible this side of heaven. I'm so sorry you're dealing with this.

I agree that it's best to hire both if you can.  Having a back up matters, especially if you're working and don't have siblings to help. Caregivers get sick sometimes.  Caregivers hit their limits sometimes. Caregivers take vacations sometimes.  Caregivers have other obligations sometimes.  Caregivers get significantly better offers sometimes. Caregivers don't always like their patients and find different ones sometimes.

Agree! One of my elders “fired” half a dozen care aides before we found someone who could put up with his blustery ways. Thankfully it was care provided through the VA and not only was it covered $, there was a list and no shortage of providers those years ago. 
 

I think you need two people - a bath aide who will come specifically for that task 3 days a week (or as often as dad will cooperate and can afford it), and someone else who is able to provide companionship AND toileting assistance. Not sure where your male candidate is drawing the line at personal care, but if he’s not willing to assist with toileting, he’s not going to be the guy for you for very long. 
 

Be sure you are communicating with the doctor and insurance company to find out what’s covered. And Dawn, I am sorry this is a sad consideration, but being realistic, if your father’s prognosis is terminal, hospice and palliative care services are fantastic and can help provide these services and even equipment under Medicare. Most people have a negative association with the word hospice and never take the opportunity to receive the full scope of available services. In your shoes, I’d be “shopping” the hospice agencies in your area. There’s also a designation a step away from full hospice. Palliative care clients can receive services if their diagnosis is terminal but death is not imminent. Everything varies state to state, agency by agency, thus the need to survey your local area for information. Your physician in the meantime may be able to help you out by writing orders for some in home health care services. Maybe he can’t, but you should ask.   
 

Regarding the letter… I agree that it is best to be as straightforward and realistic as possible. However, when you are caregiver to someone in mental decline, there comes a time when the little white lie is not a sin. “Did you feed the cat?”  “Oh yes, he was so hungry!” Cat has been gone for years. The good news that someone hears and “acts” on such concerns provides comfort and eases the mind of the elder, whereas “Don’t you remember that cat got eaten by a coyote years ago?” would not be a comforting response despite being true. All that is a lengthy way to say, you can chat happily with him about the letter, type it the best way you can, getting around to it only when you have time to do it (here’s where you are totally honest and let him know you only have 15 minutes at a time because of your other responsibilities), let it go back and forth for “editing” a few times, then send but not really send it out. Stretch out the time it takes to get the task done. He will perhaps get bored and move on to something else. Anyway, that’s how I handled things like that in my caregiving years. 

Edited February 24, 2022 by Grace Hopper

[mlktwins]

Agree with @Grace Hopper about hospice and palliative care!!  They will need an official diagnosis though and he refusing to go to the kidney specialist. 
 

When we were lining up hospice for my in-laws, it was easy having a “good” diagnosis for hospice care for FIL.  He had aggressive prostate cancer and congestive heart failure.  It was not so easy for my MIL.  She didn’t have any major diagnosis.  She was just 94 and done.  We went through all her medical records and the hospice doctor found something she could use.  She passed about 5 weeks later.  What they had on file as the hospice diagnosis as what went on the death certificate.  We did not do autopsies.

[Catwoman]

The main advantage I can see for hiring the male aide is that he is probably physically stronger than the female, and because your dad is unsteady on his feet, I would much rather see him out for a walk with a strong male who can (hopefully) catch him if he starts to fall. Also, if he falls inside the house, the male will most likely have an easier time lifting him.

As others have said, it might be a good idea to hire both people and split the hours between them — assuming you can give both of them enough hours to make the job worth their while.

[Catwoman]

I forgot to mention this in my last post, but I wouldn’t worry too much about the male aide not doing personal care, because it’s not something you need right now. What I have seen with friends who have hired aides for their elderly parents, is that there is a lot of turnover and the aide you hire today might be long gone by the time your dad needs help with things like showering. 

My vote is to hire the person who is best for your dad right now, and worry about later… later.

Also, because your dad hasn’t needed care like this before now, I think the aide’s personality should play a very big part in your choice. Which one do you think your dad would like best on a personal level? If this person is going to be in your house for 10-15 hours a week, that’s a lot of time to be spending with someone he doesn’t like chatting with.

[Spryte]

I would hate to see you lose the opportunity to work with the nurse. The former nurse here was fabulous, just a huge asset to us when things got tough. 

I’d also want your dad to feel comfortable with his caregiver and potential companion, though. 10 - 15 hours a week isn’t a ton, but enough that he needs to feel comfortable.

Is there a way to get both on board? One for walks and outings, maybe companionship, and one to be available during the time your dad showers, etc? That way when you need more hands on deck, you’ll have established relationships with both.

[Grace Hopper]

Just now, Spryte said:

I would hate to see you lose the opportunity to work with the nurse. The former nurse here was fabulous, just a huge asset to us when things got tough. 

I’d also want your dad to feel comfortable with his caregiver and potential companion, though. 10 - 15 hours a week isn’t a ton, but enough that he needs to feel comfortable.

Is there a way to get both on board? One for walks and outings, maybe companionship, and one to be available during the time your dad showers, etc? That way when you need more hands on deck, you’ll have established relationships with both.

Not pointing out just your post, Spryte, but just based on it and a few others, I’m going to re-emphasize one thing: toileting. I believe dad is in a wheel chair full time now and I assume that comes with the need for toilet Inc assistance. If that isn’t yet a need, a decline in health could make it a need pretty soon. Whoever is hired, if someone just for companionship, that person should be willing to assist with toileting. 

[HS Mom in NC]

1 minute ago, Grace Hopper said:

Not pointing out just your post, Spryte, but just based on it and a few others, I’m going to re-emphasize one thing: toileting. I believe dad is in a wheel chair full time now and I assume that comes with the need for toilet Inc assistance. If that isn’t yet a need, a decline in health could make it a need pretty soon. Whoever is hired, if someone just for companionship, that person should be willing to assist with toileting. 

Agreed.  Don't underestimate how much work finding a new caregiver will be if the dad starts having toileting issues next week, next month, next quarter, or even next year.  Getting someone who can handle whatever is a real possibility in the future should be the highest priority. Old people don't adapt to change well in general, and the elder in question here hasn't adapted mentally and emotionally to his current, obvious, serious reality.  @DawnM already has a preschooler in the house who is dealing with transition from an unstable background and she's working full time with a nasty boss in a place of employment currently experiencing unprecedented stressors.  Getting someone who can handle what is extremely likely a soon to be rapid decline is critical.

[Spryte]

9 minutes ago, Grace Hopper said:

Not pointing out just your post, Spryte, but just based on it and a few others, I’m going to re-emphasize one thing: toileting. I believe dad is in a wheel chair full time now and I assume that comes with the need for toilet Inc assistance. If that isn’t yet a need, a decline in health could make it a need pretty soon. Whoever is hired, if someone just for companionship, that person should be willing to assist with toileting. 

Oh, no, I was under the impression that dad didn’t currently need assistance toileting, and that he is using a walker but not in a wheelchair. Never mind me, I’m apparently behind!

[Spryte]

Though, again, I’d encourage Dawn to find two caregivers right now, so that when care needs increase (and they will) she’s got an established relationship with at least two. If the male she found isn’t adequate, then another.

 

[Grace Hopper]

2 minutes ago, Spryte said:

Oh, no, I was under the impression that dad didn’t currently need assistance toileting, and that he is using a walker but not in a wheelchair. Never mind me, I’m apparently behind!

You may be right! I can’t remember exactly. 😂 But if it’s needed, it’s needed, kwim?

[Catwoman]

12 minutes ago, Spryte said:

Oh, no, I was under the impression that dad didn’t currently need assistance toileting, and that he is using a walker but not in a wheelchair. Never mind me, I’m apparently behind!

That was my impression, as well. I thought he was moving very slowly and was unsteady on his feet, but that he was still walking on his own.

[mlktwins]

18 minutes ago, Spryte said:

Oh, no, I was under the impression that dad didn’t currently need assistance toileting, and that he is using a walker but not in a wheelchair. Never mind me, I’m apparently behind!

You were correct.  He doesn’t currently need help with showering and toileting and he isn’t in a wheelchair.

[DawnM]

5 hours ago, Spryte said:

Oh, no, I was under the impression that dad didn’t currently need assistance toileting, and that he is using a walker but not in a wheelchair. Never mind me, I’m apparently behind!

No, you are correct.   We only make him use a wheelchair when we go out because his walking is so slow.