Last month, I met with two brothers/sons (Ted and Ray), trying so very hard to do all the right things to care for their mom, Grace. Thirty years ago, and just after her husband passed, Grace made clear her desire to “LIVE AT HOME FOREVER.”
As she aged, Grace hired an Accessibility Contractor to make accommodations that would make her home safer and more accessible, just in case her mobility and dexterity changed. At the time of our meeting, Grace was living exclusively on the first floor, but maintained that the larger house, with the extra bedrooms upstairs, was necessary so that the family could continue to gather “at home.”
One son, Ted, lives close by and took on the day-to-day responsibilities of frequently visiting his mom, organizing private help to assist Grace as needed, and responding quickly to her multiple, daily phone calls.
The other son, Ray, lives 1,000 miles away. He took on financial responsibilities, such as bill paying and checkbook reconciliation, and did all he could from a distance.
Before long, however, Ray recognized that Ted was doing much more than he, often at the expense of his own family’s needs, and reached out for some help from Healthassist. He wanted to know what they might do differently to improve the situation.
Assistance with physical care
It was following a fall at home resulting in a broken hip, and a long recovery in both the hospital and a skilled nursing facility, that Ted and Ray orchestrated their mom’s return home. They hired a private homecare company to provide daily assistance.
They were astute enough to know that they couldn’t physically care for their mom with their lack of knowledge and experience and, more important, knew that her boundaries and sense of dignity would be violated if they tried.
They described how numerous home health aides and certified nursing assistants flowed through the household. When I probed, they didn’t seem to know who was in charge and how decisions were made about who would be there, or when. Worst of all, their mom was not happy. She resented these “strangers” in her home and she regularly “fired” them.
Ted and Ray were now questioning whether their decision to take mom home was the right one and if an alternative living environment was necessary. Both were worried about the potential of going against Grace’s wishes to remain in her own home.
Home healthcare providers need to be managed as you would any employee
After listening to their story and appreciating how distraught they were, I found myself stating the following:
“The success of your plan to care for your mom, thus honoring her wish to remain at home, will be a direct result of the quality of the caregivers you hire. The way to ensure that quality is to invest in those caregivers and to manage them as if they were your own employees.”
They were surprised!
Both Ted and Ray are successful businessmen and manage large teams of individuals in their respective fields. They understand that hiring the right people, utilizing a comprehensive job description, outlining specific expectations, continuously providing feedback and coaching, are all critical to the success of their employees.
But they hadn’t applied those same principals to the “work environment” they’d set up in Grace’s home. They thought that once they hired the home healthcare company, they’d done their job. They’d invested a lot financially and now needed to invest more of themselves in the process.
The responsibility of care partners/family members
The good news is that these two brothers were incredibly motivated to do the right thing, reflecting that Grace and their dad had raised them well! So, here’s what they did, and it’s what I encourage any person hiring care to be delivered to a loved one at home to do:
- Invest in the relationship with the homecare company. Know the person with whom you are contracting, the person who will be responsible for placing caregivers in the home, and the person managing them while they’re there. Meet with the management team regularly to outline expectations and to provide direct feedback. Know that you have a lot of choice when hiring these companies, so if your specific needs are not being met, begin to investigate alternatives.
- Require that you, and your loved one, interview all caregivers. Make it clear as well that you will make the final determination as to whether the direct caregiver is not only qualified, but the right fit.
- Insist that a consistent schedule with a regular team be established. Then make sure that all involved in the care of your loved one share knowledge and experiences according to pre-set guidelines. Communication methods may include daily texting or emails, writing in a communication book in the home, regular phone calls, meetings, etc. Whatever works best for you to monitor the situation.
- Develop standard documents, up front, that can be used to communicate information, train future caregivers, and hold caregivers accountable. Some examples are:
- A specific job description for caregivers. This may be an enhancement of the one the homecare company uses.
- A “typical” daily schedule for your loved one, including what time they get up, what they generally do hour by hour, and how they like to do it.
- A “caregiver responsibilities” schedule that follows your loved one’s schedule. Include very specific things like the way they prefer to shower, dress, eat, where they like to sit, etc. This document requires tremendous specificity and although tedious to create, will be instrumental in the caregiver being able to anticipate your loved one’s needs.
- Spend time with the direct caregiving team members, both individually and as a group. Get to know each other as people. Caring for an older adult is incredibly hard work and takes tremendous skill, proficiency and patience. Learn from them as they learn from you.
Ted and Ray have begun applying these principles and I’m pleased to say that the situation has improved considerably. Grace is much more accepting of help from her caregivers and has come to view the team that cares for her as “her new, younger friends.” She’s engaged in learning about their lives, their families and their cultural traditions, and has stated she feels the need to take care of them a little bit, just as she took care of her sons. We couldn’t ask for anything more.