For the most part, those in the helping professions prefer to work with people who have involved and supportive families - it makes their jobs that much easier. The reality is that family dynamics are often complicated and for a variety of reasons, it can take an outsider some time to locate family members or other concerned party.
An elderly woman has a history of falling. Someone has been in and out of the hospital. An 86 year old woman has been wandering the neighborhood and strangers bring her home. The person next door looks disheveled much of the time and or "an odor" is coming from the apartment. An "eccentric" person collects so much "stuff" that it creates a hazardous living situation.
It's at this point that red flags begin waving when an elderly person living alone shows signs of needing some kind of help. This is when the neighbors call Social Services or law enforcement agencies to come in and assess the situation.
Adult children who were abused or neglected by their parents may get past their hurt enough to step up just enough to ensure their parents are comfortable or have their basic needs met. Some can put feelings aside to provide more hands on care. For others, the damage was too great to have any meaningful relationship.
It's so common to hear that one family member assumes responsibility for caregiving and usually, though not always, it's a woman. While almost everyone experienced in field work would agree that cases involving caring family members have better outcomes than those with little or no involved family, there are some instances when what is perceived as over-involvement can be problematic from an agency's standpoint.
As is true in any profession, there are aides with various skill levels and different personalities. Since personal care is just what the title suggests, it is very important that the aide assigned is a good fit for the person (s)he is caring for. If a family member seems "too picky" or demanding and is specific about how care should be provided, the family may be classified as "difficult to work with".
Sometimes there are misunderstandings due to agencies having to work within the parameters of the Medicaid program. If an aide is asked to perform a task that isn't listed on the care plan or something out of the ordinary occurs during the course of regular duties, a new assessment and care plan may not offer the remedy that was intended to fix the problem when it reoccurs.
I had a situation of an agency reporting a patient's daughter for "not allowing the aide to do her job properly". This was a devoted daughter that was available to train the aides but her involvement was interpreted as interference for the agency. The agency in this case was so afraid of complaints being made that it put the focus on the daughter as causing risk and then referred her to another agency.
Fortunately, the daughter had begun application for the Consumer Directed Program, which suited her mother's and her needs. She had been told that this program "will give you your life back" and I reassured her that it would, based on learning about her life as a caregiver and considering the success with others I have seen.
The majority of caregiving does involve women, but I have witnessed some men that hold the reins. In one instance, negative accusations were made against a son that travelled from out of state to care for his father, who was hospitalized on and off over a three month period. The picture painted of the son was contrary to the reality. Going by verbal description, he was someone to be feared rather than an admirable son taking care of his ailing father.
There was suspicion that the son was abusing his father physically or financially. The apartment was reported dirty and unsanitary; and supposedly, a dog was living in the apartment and dogs weren't allowed. All of the allegations proved false.
In my observation, caregivers in our culture are expected to handle multiple roles and looking after loved ones usually requires bringing in other skilled help. The hands-on care most commonly in demand is under-valued in the workplace, which makes it challenging to attract qualified and dedicated people.
Instead of the tug of war that takes place when a caregiver enlists the help of an agency and wants to have a supervisory role, an understanding of the expectations and limitations between all the parties involved could help people work together amicably. Explaining why something has to be done a certain way could make the difference between a person feeling as if (s)he is being told what to do versus feeling trusted enough to understand and be included.
When to do and when to step back and allow others to share is a delicate balancing act for caregivers. We're programmed for giving, have difficulty asking for help and feel guilty when we do. It's helpful to remember that if we don't take care of ourselves, we won't be good for anyone else. Our needs are important and worthy of our attention.
Maureen Hildebrand has 10 years experience as a Case Manager delivering services to the adult care population in both public and private sectors. She has a Master's in Public Administration with a specialization in government. Maureen is currently working as an Elder Care Consultant based in Putnam Valley, NY and her contact information is seniorservicesspecialist@gmail.com.
