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Confessions of a Professional Caregiver

Posted by Jill Troman on Mar 14, 2014 10:36:00 AM

We thought it might be interesting to interview several of our seasoned In-Home Caregivers and get the "lowdown" on what it's really like to care for an elderly person or disabled adult at home.  What do they love about the job?  What are their gripes?  What do they really want clients and their families to know?

 Confessions of a Professional Caregiver

Here's what some of our professional caregivers had to say on some "hot topics"...

What do you enjoy most about In-Home Caregiving?

Caregivers were unanimous in their preference for caring for an individual in a home environment over an institutional setting.  All expressed satisfaction in cultivating a relationship with their client and his or her family.  "The job is simply more personal and rewarding".  Caregivers also appreciate the slower pace of homecare when compared with the sometimes frantic pace of hospitals or assisted living facilities where nursing assistants frequently assist numerous patients. Caregivers reported that they felt a higher level of satisfaction because they felt they played a key role in their client's quality of life.  

Is it uncomfortable when family members "pop in" to observe the caregiver caring for the client?

Most caregivers indicated that they understood that family members needed to observe care tasks so that they developed a level of confidence in the caregiver and her abilities.  One caregiver stated that she "encouraged client's family members to visit and observe.  Trust develops that way and family also can see how hard we work; it's just not easy to care for an elderly person."  

What is the most frustrating thing that family members do?

 "Forgetting to tell me about a change in medical condition or medications that might alter their loved one's behavior can definitely be frustrating".  Another caregiver raised a concern that sometimes family members stick their heads in the sand and refuse to take important actions or face difficult situations with elderly parent(s) because it's uncomfortable. Sometimes family members will hire a caregiver and then step completely out of the picture, leaving the professional caregiver without support.  

If a family member has a concern about the way a caregiver is taking care of a loved one, how should it be addressed?   

One caregiver shared this recommendation,  "It's terrible when a family is disatisfied with care. In most cases, it's just a communicationproblem.  Don't wait until things snowball and become unbearable."  Provide your caregiver with specific feedback and recommendations for improvement.  Commuincate directly but respectfully and recognize the things that he/she is doing right.  Be careful not to throw the "baby out with the bathwater" if there are enough positive qualities about the caregiver.   

How do caregivers really feel about being asked to do housekeeping tasks in addition to personal care duties? 

This is definitely a "touchy" topic!  Professional caregivers and certified nursing assistants all expect to assist with light housekeeping and sanitation since their elderly clients may not be able to handle these tasks effectively.  Routine cleaning of kitchen, bathroom and bedroom is considered part of the job.  The caregivers we interviewed expressed frustration when clients requested "deep cleaning" like scouring tubs or doing laundry for an entire household.  

Do caregivers like receiving detailed care instructions from family members or do they resent it?

"I don't like step by step instructions for completing normal tasks.  It comes across as micro-managing.  However, it's great when a family member provides a general schedule of activities and a brief summary of needs and preferences."  In general, caregivers appreciate some guidance and recommendations on how best to care for the client.  However, they appreciate the opportunity to complete tasks in their own way.  All agreed that it is essential to have a solid understanding of the client's expectations in order to avoid misunderstandings. 

What's one thing you really wish you could tell your clients?

"Remembering to say 'please' and 'thank you' is very important to me!".   Expressing gratitude definitely increases a caregiver's work satisfaction.  Obviously, a caregiver who feels appreciated and valued will want to stay working for their client.  

Another caregiver secretly wishes that she could share with her client's family just how hard she works.  "Sometimes I get the feeling that family members don't fully understand how emotionally and physically exhausting it can be to care for a dementia patient all day...it's satisfying for me but some days are really tough."  

 "I am not a housekeeper for the whole family."  One caregiver for an elderly woman felt taken advantage of when she was expected to clean up after messy kids and pets.  

 If you are a professional caregiver, we would love to hear your thoughts!  Feel free to share your comments with our blog audience below.    


 

 

 

 

Topics: Caregiver Information, senior care, live in care, caregivers, caring for a loved one, Atlanta Home Care

"My elderly aunt isn't bedbound; How did she develop a bedsore?"

Posted by Jill Troman on Mar 7, 2014 10:29:00 AM

Pressure ulcers, more commonly referred to as "bedsores" are primarily a concern for bedbound, hospitalized or immobile individuals, TRUE or FALSE?

Caring for bedbound senior

The correct answer to this question is FALSE.  While its certainly true that immobile persons are at higher risk for developing a bedsore, other, less likely candidates may also be at risk. 

During a recent physician's appointment, my friend, Kate, was surprised to learn that her elderly aunt had developed a bedsore even though she is mobile and for the most part gets around independently.  The sore, located, in the tailbone region,  was classified as Stage II, not an insignificant matter.  How did Aunt Pat, develop a bedsore?  It turns out that a couple of key risk factors were present.  Aunt Pat, is 90 years old, very thin, diabetic and lives a sedentary life style.  Her skin is very thin, almost transparent looking.  She is prone to sitting for long periods of time in her favorite arm chair while she reads or knits.  Getting in and out of her chair is sometimes uncomfortable so she tends to "stay put".  In addition to weak skin, stressed under the pressure of sitting for long periods, reduced blood flow to the area probably exacerbated the problem.  Since she is also a diabetic, sores are slow to heal and frequently become infected.  My friend recalls her aunt mentioning once or twice that her backside was sore but  didn't take it seriously.

Kate's aunt complains of aches and pains so often that she just assumed it was nothing out of the ordinary.  Fortunately, Aunt Pat's case was treatable with topical ointment and did ultimately heal well.  As a result of this incident, Kate has becoome very diligent about checking Aunt Pat's skin regularly for signs of breakdown.  A practice which is recommended for anyone charged with caring for an elderly loved one.   

Bedsore Basics 

Pressure ulcers or "bedsores" can develop when a person stays in any one position for a long period of time.  Sores most commonly develop over pointy, bony areas like the tailbone, heel or hip but can develop anywhere on the skin. The blood flow to the area slows down or stops, causing the skin tissue to die, resulting in the pressure ulcer.  The ulcer starts on the inside and works its way out to the skin's surface.  Pressure uclers can start forming within several hours but may not be visible until 3 to 7 days later.  Any changes in skin condition or color (redness) over bony areas can indicate the start of a pressure ulcer. Prompt reaction is essential!  Simple pressure ulcers can quickly progress to life threatening open sores. At the first sign of skin breakdown, contact your health professional for guidance. 

Prevention Tips

  • Seniors who are mobile should get up from bed or chair every couple of hours to increase blood flow.   
  • Bedbound individuals must change their position every 2 hours.  Keep ankles and knees from touching each other using a pillow or air cushion.  Use a heel cushion to protect this  pressure point.  Never drag or pull the body to change positions. Consider purchasing a specialty mattress or overlay designed to stimulate circulation and reduce pressure.    If the primary caregiver is not able to handle the repositioning either physically or due to scheduling issues, consider hiring an In-Home Care Provider to assist with this duty.  Certified Nursing Assistants are trained in proper positioning technique along with other essential personal care tasks.                                            
  • For those who spend large periods of time in a chair or wheelchair, weight should be shifted every 15 minutes to reduce risk of pressure ulcers.  Consider purchasing a specially designed seat cushion to minimize pressure on sensitive areas.

  • Do your best to ensure that your loved one maintains a balanced diet.  Diets rich in protein, vitamins A,C, E,  Zinc and Iron all promote wound healing.  Small, frequent meals are generally recommended. Adequate fluid intake (primarily water) is also essential.  Offer small quantities of liquids throughout the day.  Seek the advice of a qualified dietician for special dietary concerns or needs.  

  • Individuals with bladder or bowel control problems are at increased risk for pressure ulcers.  Contact with urine or bacteria from stool can weaken the skin tissue or cause skin infections.  Make sure skin is kept clean and dry. Use mild or hypo-allergenic cleaning products.  Check with your physician about the possibility of using skin barriers and ointments to help keep moisture away from the skin.  Use absorbent pads or adult diapers to assist in keeping skin as dry as possible.  Always remove these products immediately when soiled and cleanse the area thoroughly.  

  • Inspect the skin on a daily basis for signe of redness or breakage.  Feet are often overlooked.  Do not forget to remove  coverings and check feet, especially heels for signs of pressure sores.  Look for redness, warmth, swelling, sores, or complaints of tenderness.  Report  conerns promptly to a medical professional.  

Bedsores can lead to serious infections and even death.  They should be taken seriously and treated by a medical professional.  Caregivers should be vigilant about bedsore prevention. However, it is important to recognize that not all cases of pressure ulcers are preventable. Sometimes sores develop despite the best efforts of a conscientious caregiver.   

Are you struggling to care for a loved one at home?  Don't become overwhelmed!  Contact the team at Easy Living Services for a prompt consultation.  We'll help you to create an affordable care plan for your loved one.  Call us today...770-442-8664.


 

  



 
 

 

 

 

 

 

 

 

 

Topics: senior care, taking care of a parent, pressure ulcers in seniors, bedsores

Hoarding and Seniors: Is it Just Clutter?

Posted by Jill Troman on Jan 20, 2014 10:21:00 AM

senior hoardingThe TV show, "Hoarders" is a fascinating glimpse into a world most of us can not fathom.  Cameras take us into the homes of hoarders; cluttered with debris, trash and seemingly useless items.  We watch as mental health workers and organizational specialists work to clear the mess and help the individual to let go of their "stuff". Often, the individual with hoarding issues is an older person.

What causes this behavior and how can a loved one intervene?

In one research study published in 2001 by Steketee and Kim, a link was acknowedged  between elders and hoarding, noting that 40% of hoarding complaints to local health departments involved senior residences. Hoarding is more than just an organizational problem or an eye sore.  It can inhibit the senior's ability to take care of basic hygiene needs, prepare/store food and pose a general health and safety hazard. A recent U.S. study, for instance, found that 45% of older hoarders could not use their refrigerators, 42% could not use their kitchen sink or bathtub and 10% could not even use their toilet.  Not surprisingly, many seniors with hoarding behaviors become socially isolated.   Embarrassed and ashamed of their surroundings, they often stop inviting house guests.  These issues can pose grave health consequences for anyone, and especially a senior citizen.

What are the primary causes of senior hoarding behaviors? 

  • Memory Problems--With memory of past experiences becoming hazy, a hoarder may gather and keep objects as reminders or as a substitute for memory.  

  • Emotional Attachment to Possessions--Hoarders can develop extreme attachment to their belongings and view them as an extension of self. Objects can come to represent security and safety.  Throwing items away can be a terrifying prospect.  Additionally, the hoarder finds purpose in controlling and "managing" their possessions and tremendous guilt in discarding anything.  

  • Compensation for Loss-- All seniors are faced with losses as they age; loss of family & friends, physical or cognitive impairments that reduce independence, and sale of home.  Acquiring and keeping objects can serve as an expression of grief or a coping mechanism.  

  • Isolation--Elderly hoarders tend to live alone and without an adequate support system.  Hoarding can become a way for an isolated senior to comfort himself with objects when family or friends are absent from his everyday life. 

  • Trauma--The current generation of seniors lived through a number of traumatic world events including the Great Depression, World War II, and the Holocaust.  These events undoubtedly instilled the value of living frugally, saving, and intolerance of wasteful behaviors. These values and actions were prudent when facing the intense events of their generation.  However, the same behaviors can become obsessive and unhealthy with age and possibly lead to hoarding behaviors. 

 Is Your Loved One at Risk?

What behaviors or characteristics might indicate that your senior loved one might be at risk for developing a hoarding problem?  Watch for the following:

  • Mail and bills are piling up at home. 

  • Difficulty walking safely through the home due to clutter.

  • Frustration trying to stay or organized or make decisions. 

  • Difficulty handling their daily activities. 

  • Expired food in the refrigerator and pantry.

  • Closets and drawers that are jammed packed and disorganized.

  • Compulsive shopping.

  • Difficulty deciding whether to discard items.

  • Significant health episode like stroke, dementia.

  • Loneliness and lack of support network.

Look for an upcoming blog post which will tackle the complexities of helping a senior with hoarding tendencies. Learn intervention strategies and where to go for outside help, if necessary. 

Atlanta Caregivers

Topics: senior care, senior safety, senior hoarding, hoarding among seniors

Cost Of In-Home Care Likely to Rise Due to Overtime Laws

Posted by Jill Troman on Oct 8, 2013 12:11:00 PM

New regulations requiring payment of overtime wages for homecare aides, while well intentioned, will likely have some unintended, negative consequences for elderly clients.

Senior Care Without a doubt, nursing assistants, charged with caring for elderly clients at home, work hard and shoulder heavy responsibilities.  Caregivers deserve to receive fair wages for the essential care they provide.  The issue at hand involves payment of overtime for caregivers working on a "Live-In" basis for seniors. The term "Live-In"  applies to caregivers who go to an elderly client's home and stay for a number of days at a time.  This arrangement greatly benefits many seniors who prefer the security of having someone with them at night for urgent needs. Seniors with dementia or impaired memory function typically need Live-In care to insure safety and prevent falls.   "Live-In" care is only offered to clients who sleep well through the night and typically do not require assistance during night time hours. Clients who have frequent needs during the night are required to have care billed on an hourly basis so that the caregiver can also be compensated appropriately.  If 24 hr care is provided on an hourly basis, several caregivers are required to cover the shifts; (2) 12 hour shifts per day. While technically, present in the client's home for at least 24 hours, A "Live-In" caregiver is able to sleep 8 hours at night and has some downtime in the evening hours.  These caregivers are paid a flat, daily rate for this service.  Historically, they  have been exempt from overtime pay due to the fact that they have rest time and are not actively working at all times.   

How will this change affect Elderly Clients?

Clients receiving In-Home Care services will definitely take a hit in their pocket books. The former companionship exemption was a significant factor in helping to keep senior home care affordable.  With overtime pay now required for hours in excess of 40, clients will pay significantly more or get used to having numerous caregivers rotating in and out of their homes.  For most seniors and their families, continuity of care is considered critical.   A continuous stream of different caregivers can be confusing for an elderly client and possibly elevate anxiety levels. Communication regarding a client's changing needs is more challenging when multiple caregivers are involved.  Faced with these negatives, many families may decide to hire their own, private caregivers to care for their seniors.  Private caregivers may not have the training and credentials of those retained through an agency.  Hiring home care workers under the table could expose some seniors to abuse, fraud or substandard care since supervision and agency oversight is lost.  What is a senior to do when a private caregiver gets sick or doesn't show up for work?  In all likelihood, the elderly client will be left to fend for himself unless family or friends are available to step in.  

Due to expense or hassle, many families may turn away from in-home care altogether and turn to assisted living or nursing care institutions instead.  Research data indicates that given a choice an overwhelming majority of seniors would prefer to remain at home with assistance. Loss of independence and control combined with less personal attention make institutional living less appealing to the senior population. 

What about the truly wonderful people who have been earning their incomes as Live-In caregivers through In-Home Care agencies?   Will they actually benefit from the new overtime provision?  Probably not.  The overall demand for Live-In assistance will likely decline sharply as costs increase significantly.  These caregivers will likely be forced into  "underground" or private hire situations to find assignments without the numerous protections offered by reputable agencies. 

Who will really benefit from removing the overtime exemption for home care workers?  Its unclear but quite possibly the only benefactor will turn out to be SEIU, the largest and fastest growing member of the AFL-CIO.  Politics as usual?  Let's hope not; the lives of seniors, the disabled and chronically ill will be impacted. 

 


Topics: elder care, In Home Care, senior care, Atlanta Home Care, Atlanta Caregivers, Around-the-clock caregiver, 24 Hour Caregiver

Hospital Advocates for Older Adults

Posted by Jill Troman on Sep 30, 2013 5:00:00 PM

hospital advocates for seniors

 

Your senior loved one has been admitted to the hospital for treatment. You can relax now, knowing that he or she is secure and well cared for in a hospital environment...right?  While its true that medical professionals will strive to provide the highest level of patient care possible; many factors put seniors at increased risk for problems during hospitalization.  With nursing shortages and financial stresses increasing for most hospitals, adequate care for the complex needs of older patients can pose significant challenges.  The resulting gaps in care can be serious with medical errors, falls, medication mistakes and infections on the rise.

 

 Common Risks for Hospitalized Seniors:

1.  Falls:  Seniors may become disoriented due to illness or sedatives and as a consequence are at increased risk for falling.  Serious or life threatening injuries can occur as a result. 

2.  Delirium:  Sleep disturbance, change in normal routine and introduction of new medications can put seniors at risk for developing a serious complication like delirium.  As many as 1/3 of patients over 65 and 70% of seniors admitted to intensive care units experience delirium.  Symptoms of delirium include confusion, anxiety, paranoia, hallucinations, and agitation.  These behavioral changes are often first noticed by family members or friends. 

3. Pressure Sores:   Break down in an elderly patient's delicate skin may occur during a hospital stay, resulting in painful bed sores.  Open wounds put a senior at risk for infection. Seniors who are not capable of repositioning themselves are at increased risk for this serious complication. 

4. Medication Errors and Side Effects:  Seniors are frequently taking multiple medications at the time they are admitted.  Incomplete medical information and histories may result in adverse reactions when new or contraindicated medications are prescribed by the hospital's attending physician. Potentially serious side effects may go unnoticed by hospital staff who are unfamiliar with a patient's normal condition.  

5. Malnutrition:  Studies show that approximately 58% of patients over 65 experience problems eating and/or poor appetite while hospitalized.  This can put older adults at risk for malnutrition and slower recovery rates. 

6. Infection: Serious and sometimes drug resistant infections are rampant in clinical settings.  Elderly adults, weakened by illness are more susceptible to hospital acquired infections.  

These serious and potentially life threatening complications underscore the need for all elderly patients to have an advocate for them while hospitalized.  In many cases, the advocate will be a family member or trusted friend.  However, in some cases, family members live out of town or can not be available due to work schedules or personal obligations. In such instances, a paid advocate makes sense to cover the senior's needs during hospitalization. 

How will an Advocate help?

1.  Monitor patient safety.  An advocate can remain at the bedside to make certain that patients who are at risk of falling, remain safe.  This will prevent the use of safety restraints. Additonally, the advocate can monitor the patient for changes in mood or behavior which could signal medication interactions or infection. 

2. Meet physicians.  An advocate can meet with hospital personnel to convey important medical history and current medication dosing.  An elderly client might be too ill or confused to ask appropriate questions regarding his care or treatment plan. An advocate work to make sure that needs are addressed in a timely manner. 

3. Bedsore prevention.  Some elderly patients will not be physically able to reposition themselves to prevent the development of risky bedsores.  An advocate can make certain that he is repositioned every 2 hrs to reduce this risk.  

4. Prevent Infection.  Senior patients will need an advocate to remind all personnel and visitors who enter the room, to wash their hands to prevent the spread of infection. Many seniors are just not up to this task.  An advocate can assist with trying to get a private room for a client or loved one.  Having a private room can greatly reduce the risk of disease cross contamination.  

5. Monitor Nutrition.  Seniors often do not eat well while hospitalized.  Often, hospital aides remove meal trays too quickly, before a senior patient has finished or even developed an appetite.  The advocate can encourage or feed, if necessary, to promote adequate intake.  Advocates can also make certain that patients are served food that takes into account any dietary restrictions. Outside food items can also be brought in as a treat with nurse's approval.  

 6. Comfort Care.  Elderly patients may feel anxious or frightened when hospitalized.  He may feel a profound loss of control.  Having an advocate, whether  family member or paid professional,  can offer reassurance and security during a difficult time.

 *Busy work and family schedules may prevent you from being with your parent as much as you would like.  That's where a "Hospital Advocate" from  Easy Living Services can be an invaluable resource. Rely on a trained caregiver to provide companionship, supplemental personal care, and to serve as your loved one's advocate when you must be away.  A professional "Hospital Advocate" can fill in family care gaps and provide peace of mind.  

For more information,  contact us at 770-442-8664.

Topics: senior care, Atlanta Caregivers, Hospital Sitter, hospital stay