Maybe this is a “good” problem to have with a full-time aide, but I still want the best for my dad, so I’m going to try to fix this too.

My previously independent 84-year-old father broke his hip back in January. After months in the hospital and zillions of complications, he was in a nursing home for 3 months, and is now in his own home with a 24 hour aide.

At this point, he does not have any debilitating medical problems other than lack of muscle strength plus stiffness, the therapy has helped him -- and the more he does, the better he is likely to become.

The problem is that, from things large to things small, his caregiver does EVERYTHING for him. On the small, the occupational therapist gives him silly putty to get him to use his hands -- but today when he was filing his nails with an emery board, the aide took it away from him and proceeded to file his nails for him, so he lost an opportunity to do a “real life” thing with his hands. On the large, she hauls him out of chairs with his gait belt when he is capable of sanding up himself. And by constantly ordering him around, she is also numbing his mind. I could go on and on.

He will only go downhill if he sits in his recliner most of the time and has everything done for him, all decisions made for him, etc.

Thoughts?

Hun let me make something perfectly clear you wont be "firing" this girl she will be rescheduled to a new client probably immediately

quote:

he told ME yesterday that the next time the caregiver tried to do something he could do by himself, he would tell her that “my daughter wants me to do more.” I told him it’s not what I want, it’s what HE wants. I told him (a good heart-to-heart) that he was 85, and if he wanted to take it easy at this point, I would support him. But he had told me he wanted to get better, and I was working on that premise. Without hesitation, he said he wanted to work to get better. Then he said he was going to tell the aide that “the nurse wants me to do more.” Well, when he says “HE wants to more” then he’ll really be there, but it’s a start!

Sweetie, it doesn't matter. This isn't like a 40 year old trying to rehab - he's 85!!! If he wants to say he'll do more because the DOG wants him to, that's just FINE.

Who pays the agency? Did your dad employ them or are you in charge of his affairs (DPOA, etc.)? This matters because the agency follows the money...

quote:

If after all of this, especially if the caregiver proves that she is not signed up to enable my father’s progress

The bottom line is this: if you don't like the color of the woman's EYES, you have the right to replace her (IF you have DPOA over your dad's care). You really do not have to rate her care or judge her character, etc. If you don't like how she's caring for your father, replace her. It's really just that simple. If you want to keep her in reserve, cut her hours and hire a second caregiver with whom she will have to cooperate. Hiring a second caregiver would be the best compromise between firing her or keeping her.

quote:

Maybe we should replace the caregiver regardless (what you all think, and I know deep down would be best. Is that my answer?)

**Cheers from the peanut gallery**

Look I wouldnt waste one more moment on her...you may think shes nice but if my hired employee DOES NOT follow my instruction even once...unless English is her second language....your outta here....period.
Sweetie not for nothin you say you dont do well bein a boss....Uh I hate to point this out but havent you been doing administrative duties since this all began....
If it looks like a boss smells like a boss an acts like a boss....Oh yeah an PAYS like a boss its a boss

AN everytime you hesitate think of this phrase

cause if ya dont your day may end up like this.....

Rolling in the aisles with laughter! Wait, I can’t stop. Gasp… There, I’m ok now.

A major topic in our house these days - should we replace the caregiver? Why do I find this so hard?

This is my thought, and please feel free to kick me in the head and knock some sense into me.

At the family meeting, especially if I can get the Plan of Care, I will be prepared. Since I’ve already spoken to everyone privately, and they have already received my list of questions, they should be prepared, too.

We will have a nice, civilized, well-organized discussion. I am told this should run 1-2 hours. Since the nursing supervisor and caregiver supervisor will be there, they will hear everything first-hand. My efforts will be to ensure clarity. I will write up my summary of the proceedings and drop it off at their office, asking for corrections.

Mean time, my dad knows what's afoot. And he told ME yesterday that the next time the caregiver tried to do something he could do by himself, he would tell her that “my daughter wants me to do more.” I told him it’s not what I want, it’s what HE wants. I told him (a good heart-to-heart) that he was 85, and if he wanted to take it easy at this point, I would support him. But he had told me he wanted to get better, and I was working on that premise. Without hesitation, he said he wanted to work to get better. Then he said he was going to tell the aide that “the nurse wants me to do more.” Well, when he says “HE wants to more” then he’ll really be there, but it’s a start!

By the end of next week, between the meeting and my father talking back when she does things for him that he already knows how to do, we’ll see how the caregiver is working out.

<This is the part where you can kick me in the head if you want.>

If after all of this, especially if the caregiver proves that she is not signed up to enable my father’s progress, I will take him to my house for a week. We will do his exercises and ADLs on more regular basis, he will get some good eats, and with his new vision of doing for himself, maybe he will feel more empowered and see the caregiver in a new light.

Maybe we should replace the caregiver regardless (what you all think, and I know deep down would be best. Is that my answer?)

Mean time, while he is here, I can be interviewing new caregivers.

Thoughts?

quote:

Personally, I would run that woman off quicker'n a jackrabbit on fire. At the most, I am suspicious of her motives. At the least, I am disgusted at her lack of professionalism and patient goals. ANY caregiver worth their salt will try continually to get a person to improve their ADLs (activities of daily living). One that does NOT do so is NOT, repeat, NOT acting in the best interest of her patient.

Oh fer the love of.......DITTO!
Ya wanna borrow my size 9's Lan Ill fed ex those puppies to ya fastern chit flyin from a slingshot!
Dont ask lol lets just say meadow muffins are funnern hell ta pitch

quote:

One day I asked him to write down the numbers. She said, "He can't write."

What do you mean, he can't write??? I told her that before he broke his hip he used to write out his own checks, and also letters to his Congressmen.

And then he proceeded to write out the numbers with sure, solid handwriting.

I could give you many of these examples, but they all come down to one thing - she does not have the philosophy of enabling him, but doing every little thing for him.

Personally, I would run that woman off quicker'n a jackrabbit on fire. At the most, I am suspicious of her motives. At the least, I am disgusted at her lack of professionalism and patient goals. ANY caregiver worth their salt will try continually to get a person to improve their ADLs (activities of daily living). One that does NOT do so is NOT, repeat, NOT acting in the best interest of her patient.

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So Lantern bust it open what the heck is she doing with him that you have an issue with???
Oh please DO TELL

BG, you really do know people, don't you? And treat 'em right, too.

It's a lot of little things.

Take the "TeleHealth" machine, which gathers things like blood pressure, oxygen, etc. and sends it to the nurses. It's been an ongoing (polite) effort to get her to "let him run it."

We also write the info down for our own tracking. One day I asked him to write down the numbers. She said, "He can't write."

What do you mean, he can't write??? I told her that before he broke his hip he used to write out his own checks, and also letters to his Congressmen.

And then he proceeded to write out the numbers with sure, solid handwriting.

I could give you many of these examples, but they all come down to one thing - she does not have the philosophy of enabling him, but doing every little thing for him.

See next post for butt-chewing prep that is under way - advice welcome!

quote:

Originally posted by lantern567:
Applause, cheers, whistling from the bleachers!

Healing the inside, yes! Motivating and getting the person to do something, yes! Allowing a person to accomplish something and feel good about themselves, yes! BG, it sounds like you should write a book and I'll be the first one to buy it!

Awwww gee willikers Lantern

quote:

It has been a struggle for me to get CGs to directly address my Mom instead of talking in front of her like she is a sack of potatoes or something.

Grrrr now why in the hell do people do that? That just pisses me off when someone does that like hello do you NOT comprehend theres a living breathing human being your talking about no more than a few feet from you you monumentally ignorant.......woops **better get that temper under control** but dam
Yup got those here too

So Lantern bust it open what the heck is she doing with him that you have an issue with???
Oh please DO TELL
lol I feel a butt chewin comin on here I think!

You all here are helping my father and me very much.

Yesterday, I drove to the visiting nurse office and in a bumbling way asked to get more involved in "what is going on." I've been pretty involved especially in the nursing/meds issues, so they were surprised that I felt that I wasn't involved enough. Well, they ain't seen nothing yet.

I spoke face to face not only with the nursing supervisor but also the caregiver supervisor. The outcome is that we will have a family meeting at my dad's house with all the disciplines represented - nursing, therapy, caregiver. And at the end we'd better have a plan that enables my dad and doesn't hold him back. My husband, who sees things much as I do, will also go, so it won't just be me against all of them, with my dad as ping-pong ball in the middle - with everybody talking about him like he wasn't there. (Yes Bobcat, I hear you on that one.)

And Moms_Buddy, what you say about allowing the person to be as independent as possible is so true. It is more work, but it is so important to the emotional well-being of the patient. I will be sure to bring that into the discussion at the meeting.

To Bobcat's question, the caregiver spends a lot of time with him - I can feel a separate post coming on just on that issue. Actually, I can think of dozens of questions I'd like help with. It's overwhelming! Yikes!!!

It's one thing to assist someone who honestly CAN NOT do whatever it is... but to enable them to not have to TRY is as harmful as whatever caused their problem in the first place!

Sure, it may be EASIER for someone else to do it, might be NEATER, might be QUICKER, but that does NOT help the person keep whatever shreds of independence they have left!

Standing back while someone sorts through a decision or a deed is pretty tough, but it helps the individual more than simply enabling their disabilities.

Good for YOU!! I hope the caregiver understands and gets behind your wishes to assist ONLY when your father actually can NOT do something for themselves!

quote:

Let's hope now I can find that person in the caregiver agency who will listen to me.)

Remember, THEY work for you and your Dad. It is a very competetive business. It may require them to send the nurse back to reevaluate him and rewrite the care plan.

Yep, we love our BG, couldn't agree more about the book she could write and you would be behind me in line to buy it. .

It has been a struggle for me to get CGs to directly address my Mom instead of talking in front of her like she is a sack of potatoes or something. (just because she is vision and hearing impaired and can barely move is no reason not to acknowlege her brain). She may appear to be a sack of potatoes at times but nothing is further from the truth and I can think of little else more depressing than to be talked about as if you weren't there.

Some aides act like you describe because it really is easier to just do it for the patient than take the extra steps (lazy). Others may be afraid of disaster just around the corner if the patient picks up a spoon on their own (confidence). Then there is the "match" game. The right person at the right time thing....

How much time does the CG spend with your Dad? Good luck to you. Now that you know you have a point, this really shouldn't be too hard to put back on track. I can't wait to hear your report.

(BTW, welcome to ECO.)

Applause, cheers, whistling from the bleachers!

Healing the inside, yes! Motivating and getting the person to do something, yes! Allowing a person to accomplish something and feel good about themselves, yes! BG, it sounds like you should write a book and I'll be the first one to buy it!

quote:

On the other hand, he is acting as "institutionalized" as when he was in the nursing home.

*chuckle* Oy vey do I know that behavior in fact I just ran into that this weekend with a younger guy who was having it all handed to him *I dont know some gals I work with see a younger man and lose their everlovinmind*
Good lookin oh yeah still a patient though so get up off your butt an do SOMETHIN!
Needless to say Nurse Ratchett or whatevertheheck her name was came out and made the boy DO for himself...by the time I left he was feelin pretty darn tired but pretty darn good inside.
Haaaaa I know ole BG was strokin a boys ego on Saturday somethin fierce
Hey it worked....
Not for nothin but some of these workers (can not even bring myself to call them nurses assistance puleeease) forget that there is more to the care than just the basics you have to heal their insides too...broother!

Have fun with the butt chewin Ill send ya some good waves cause there aint nothin better to me than a lil butt chewin...well as long as it aint my butt that is....

Thanks again so very much!

I am gearing up for phone calls and face-to-face discussions with all the people involved. You've given me some backup for what I was sensing, but wasn't sure of. You certainly must have the professional and personal experience to know what's what, Bunnys-grl! It will actually be a nice way to put it that this aide will be better for a hospice patient, and not for my father, especially with his latest improvements.

As for being "in like" with the cg, she is hard-working, and I really think she thinks her job is to do everything for the person. But unless she can get on board with treating my father in a way that does not disable him, I think we need to move on to someone else. I'm not sure how my dad will appreciate this, since his world has been a whirlwind of change with different hospitals and nursing homes. Some stability would be nice.

On the other hand, he is acting as "institutionalized" as when he was in the nursing home. Almost like what you read about with a kidnapping victim getting attached to and following the orders of their kidnappers. This sounds weird -- or does it to those of you with experience?

Going to be an interesting week. I'm sure I'll report back on how it is going.

Wow, I've needed this place. Reading some of the other posts is a real eye-opener, too!

(And just for the record, in the hospital I did catch some medical things that doctors said wrong, but I will say especially that head ICU nurse, was right on the ball - and by going to her I knew I was being heard. Let's hope now I can find that person in the caregiver agency who will listen to me.)

Are you "in like" with this particular cg?
If not have her removed from your dads case because we DO promote independence in our patients that is what we are there for unless it is Hospice period.
She may be a wonderful cg/person but it sounds to me like she is better suited to Hospice cases.
If they are unable to do for themselves or have a little trouble is the only time we should "take over"...lets say for instance if they are having memory issues, a patient does get frustrated when they can not do a task at the regular speed they used or I witness a look that indicates they are unsure of what it is they are doing and thats when Im all over that but I usually will say something like "hey you've worked all your life its time to let me treat you like a king/queen". I also let the family member of record know what I am seeing when it comes to decline.
I usually get something from them along the lines of "Oh hush yourself" **chuckle** too cute now admittedly that doesnt always work you do have to have a repore with your patient does this particular cg have this with your dad and you or is this a person who looks like she just wants the job done?
In that case its time to change it up.
Look hun there is at any given time over 100 cg's in an agency this one may not be the right or perfect fit for you and dad and she needs to listen to your input also, your his daughter whether or not she feels you are being overbearing or over protective or over active is irrelevant she NEEDS to listen to you.
Now Im not saying your any of these things this is what I hear over the years this is their interpretation, but I happen to see both side of this since I not only do this for a living I am also a caregiver to a LO.
If I see anyone doing what you are witnessing I speak up and tell them to knock it off I know what my MIL is capable of, if they do not listen I will speak up to their boss and get the problem fixed after all I pay for the service
As for the other issue my motto is everyone is unique just because a person comes to me in failing health doesnt mean they are dying it just means they need some TLC everyone has a different "clock" yanowaddimean?
Thats an irresponsible person who would made a prediction to you then turned around and said she was wrong cause if shes worked long enough then she should know better

Oh yes! Somebody who understands!!! Thank you thank you thank you.

My dad is not a hospice case - even though during his 1 month in intensive care, they told me he would likely die. Every step of the way I've been there, and knew on a daily basis what was going on, and many times, medical professionals at all levels have been wrong. When the ICU head nurse told me, "You are right again", I knew I should trust myself.

...Long story of hospitals and nursing homes in between then and now...

At this point he just got his catheter out after 6 months, and no longer has CDIFF alternating with serious UTIs. He's 99% off his "antidepressants." He could get better - not playing basketball for sure, but more independent.

To get him out of the chair, she uses the gait belt to help pull him up, not unsafely. Sometimes he needs it, like if he is in a low regular chair in a restaurant, but if it's from his wheelchair with cushions, he can do it himself. She should let him! Hey, he has a lift recliner, and she even pushes the up/down buttons for him, though he can do it himself.

He has several walkers - one with 1 set of wheels with the tennis balls, one with 4 wheels and brakes. With the 4-wheeled one, he tools around like a champ and seems to exercise his legs more, and not rely on leaning on his arms. With the other one, he leans heavily on his arms and seems to struggle. But she has convinced him that the 4-wheeled walker is only good for outside.

I have spoken to the cg on several occasions to "let him do for himself" but this does not seem to be her philosophy.

I have spoken once with the cg's boss's boss, and they assured me that communication and changes would be made. I feel like their business model is to get the patient dependent, suck them dry of all their cash, and leave a withered husk, like a spider. Maybe I'm exaggerating, but given what level I think my father could get to, I am angry that they would take that away from him.

In further discussions with the cg's company, I am going to discuss the job description, and ask them about the protocol for when they see changes, how the nursing staff interacts, etc. just as you have described.

THANK YOU for letting me know what normal procedures are, and what I should be looking for.

Hi hun
Any thoughts?
Oh yeah.... tell that cg she is to ALLOW dad to do for himself, if she can not figure that out then she needs to be replaced unless of course your dad is a Hospice case and there will be no measures taken for rehabilitation, then and only then should a cg "do" everything for their patient if they can not do for themselves.
Honey it is permissible to outline to your employee just what you expect of her thats part of her job description
If she doubts that tell her to READ the cover sheet in her binder outlining her patients ability to do ADL's, it states right there what he is capable of doing himself and what he needs help with...she is to follow that guideline without fail unless she sees a decline in abilities she should then call her office and report what she is seeing so that a staff nurse can come to the residence and access the case and make changes to the report themselves.
Hope this helps

Add
When you refer to her hauling him out of his chair exactly what is she doing???
Grasping the back of the belt to assist in lifting to his feet?
If he is capable of doing this on his own without too much trouble then she should be doing "stand by assists" ie standing by his side at the ready in case he should lose his balance or fall she is then to grab the back of the belt for the assist.
Using a belt in this manner should be done with caution elderly are frail this belt is not meant to be pulled or tugged it is a safety measure only that is it.
Also shouldnt he have a walker?

This message has been edited. Last edited by: Bunnys_grl,