1. Understanding Why Seniors Resist In-Home Care

Explore the psychological and emotional reasons behind resistance

Many seniors come to realize that “growing old is not for the faint of heart.” When seniors begin to have difficulties with daily tasks, additional care may be needed for their own safety. There are facilities, of course, but most families tend to favor at-home care, if possible.

Unfortunately, seniors may equate requiring care with the loss of routines and familiar habits. The fear of losing control and being unable to deal with daily living without help is very powerful.

We all need and deserve privacy, including ailing seniors. In such an event, everyone – family, senior, and caretaker – needs a meeting to firmly set boundaries. What is private? What is public? Who sets the rules?

Everyone’s voice deserves to be heard.

The cost of in-home care may be a valid concern to seniors who do not wish to become a burden to their loved ones. However, few families realize that the expense for 24/7 assisted living may exceed $4,000 per month, and this is rarely covered on a long-term basis. In-house care is billable by the hour. Such work is only for a specified number of hours each week, very likely making the expenses more reasonable.  Depending on the hours of care required, in-home care can be more budget-friendly.

Seniors may struggle with trust issues when interacting with an unfamiliar caregiver. B’zoe Care trains its certified caregivers in establishing trust, empathy, and active listening – listening to what remains unsaid as well as to what is said.

Discuss fears about losing independence and personal autonomy

Seniors’ fears about losing independence and personal autonomy are real and can lead to negative feelings of self-worth. The lack of control can be devastating, and some of the most obvious consequences of a lack of control are:

1. No longer being able to drive. This is a serious loss of freedom for any senior.
2. Requiring help with everyday activities such as cleaning and grooming.
3. Fearing being moved from one’s familiar home into a facility.
4. Lacking the ability to make medical or financial decisions for oneself.
5. Increasing social isolation.

Family and seniors should feel free to discuss these concerns without guilt and shame. The fears are legitimate and should be dealt with gently.

Address concerns about privacy invasion and stranger presence in the home

Seniors have legitimate concerns about a stranger in their home, and boundaries and limitations should be established immediately; for example, said stranger may be required to knock on any door to announce his or her presence.

Privacy of financial and medical information is paramount. For the sake of their own peace of mind, seniors can establish several safety policies:

1. Important records should be kept locked away.
2. Regular credit monitoring can prevent undue fraudulent activities.
3. Any computer should be safeguarded with a strong password.
4. A potential in-home caregiver should be carefully vetted.
5. Any issues should be addressed as soon as possible.

Examine the stigma associated with needing help and aging

The elderly were once automatically respected. However, in these youth-oriented times, aging and needing help can have a certain stigma attached that associates getting older with being less than one used to be.

 

This patronizing stigma can be responsible for the delay of needed healthcare, which can worsen the condition. Seniors may refuse to use the necessary walking or hearing aids due to the fear of appearing “old.” In today’s culture, youth is revered, and this reverence can decrease with each birthday. Seniors can help combat this stigma by maintaining their physical and mental health and staying active. A senior’s entire lifestyle can be enhanced by building new relationships and learning new hobbies.

Highlight the importance of maintaining dignity and self-worth

Instead of accepting the denigrating stigma of age, seniors need to maintain their dignity and self-worth. Knowing their own value helps seniors improve their mental health, reduce feelings of anxiety, and strengthen relationships with friends and family. This can lead to greater self-esteem and improved emotions, which equals greater life satisfaction.

Seniors who feel respected feel safe making choices regarding their day-to-day living and maintaining greater control over their lives; they will also feel freer to request assistance when needed.

Analyze how past experiences may influence current attitudes toward caregiving

The past shapes the future. For seniors, their prior experience with caregivers can affect their current attitude toward being a recipient of caregiving. If these seniors were previously caregivers themselves, such as with children, they are likely to be more accepting of receiving care. However, this acceptance may be tampered with by a fear of becoming a burden.

2. Early Warning Signs That In-Home Care May Be Needed

Identify physical changes that indicate the need for assistance (mobility issues, balance problems)

As people age, physical changes and mobility issues are normal; however, these changes should not be ignored. Changes include the following:

1. Difficulty with normal movements. Getting up from a chair or climbing stairs has become more difficult.
2. Movements that require nimbleness. It may not be as easy as it once was to use buttons or thread a needle.
3. Falls and near-falls. As seniors age, retaining balance becomes harder while stumbles and falls become more frequent. This easily leads to seniors no longer engaging in their favorite activities.
4. Muscles and joints can become more painful.
5. Hearing and vision may weaken.
6. Personal habits may change and deteriorate if taking a shower becomes too risky.

For seniors undergoing physical changes, safety becomes the major concern, and they should be encouraged to seek appropriate medical attention and embrace a healthy lifestyle. The family can help secure the senior’s home environment against falls. They should be encouraging and ensure that their beloved senior does not become isolated.

Even with failing physical strength, seniors should prioritize physical movements. Fortunately, the City of Seattle is very senior-friendly with an abundance of programs promoting both physical and mental health. Some of the well-known groups are: Greenwood Senior Center, South Park Senior Center, and Central Area Senior Center. Each center provides programs that include mild physical activities and various social programs for enjoyable activities.

3. Recognize cognitive changes that affect daily living (memory lapses, confusion with medications)

Normal cognitive changes in seniors can be expected. According to the National Institute on Aging, what is not normal is having these changes begin to affect day-to-day living. When that occurs, cognitive changes may be serious or lead to dementia. Here is what caregivers and family should watch for:

1. Forgetting recent occurrences more frequently.
2. Losing track of a conversation and repeating something over and over.
3. Simple words may become difficult to recall or use.
4. Becoming confused while performing ordinary tasks.
5. Becoming careless with medication.

Observe changes in personal hygiene and home maintenance

When cognitive decline occurs, so may personal hygiene. The senior may refuse to see it as a problem; family and caregivers should look out for the following:

1. The senior may not shower or bathe as frequently as needed. This may be due to a fear of falling.
2. Clothes are not being laundered and may become dirty and odoriferous.
3. The aforementioned problems may not bother the ailing senior.
4. Just as a senior can neglect himself, he or she can neglect the home. Dirty dishes and disorder may have become the new standard. The door may be unlocked, placing the senior in danger.

There may be several reasons for these behavioral changes, from arthritis, balance problems, or a general cognitive decline as a result of depression or dementia.

This may be the time to consider in-home care services. The sooner the family can intervene, the better the chances of improving the senior’s day-to-day existence.

Notice nutritional concerns and weight loss or gain

All of us, but especially seniors, should be aware of normal nutritional concerns. For seniors, weight gain can result in cardiovascular problems, joint pain, and Type 2 diabetes. Higher weight usually equals lower quality of life.

While weight loss happens less frequently, the reason can be an undiagnosed medical condition. Both weight loss and gain should be reported to the senior’s physician and monitored on a regular basis.

Spot social isolation and withdrawal from activities

Family and caregivers should be familiar with the signs of senior loneliness and isolation. It is easy for older people to feel isolated while yearning for the world they used to know. This withdrawal from what was once familiar will negatively impact the senior both physically and emotionally. Reliable signs to watch for are less social interaction, less or no time spent on favorite activities, and neglect of personal care and surroundings. Other signs are changes in sleeping habits and increased feelings of anxiety

When a senior is suffering from isolation, the caretaker can gently arrange for a physical checkup and recommend community resources, such as senior centers, meal deliveries, and community activities, to lessen the senior’s isolation.

Assess safety hazards and incidents in the home environment

The lovely home inhabited by your beloved senior is filled with charm and beauty, as well as hidden safety hazards and lurking dangers. For that reason, a professional assessment of the space is recommended to prevent injuries and falls.

A good start to rid a home of hazards is to remove clutter that can act as an invitation to a fall. Other factors that can cause falls are insufficient lighting and loose rugs. If necessary, the furniture can be rearranged to accommodate wheelchairs and walkers.

4. Starting the Conversation: Communication Strategies That Work

Choose the right time and setting for sensitive discussions

There are times when family members need to have a serious discussion with their aging loved one regarding additional care, finances, etc. While the senior may show reluctance to talk about emerging mobility or cognitive problems, when and where to have this talk is a crucial factor in helping to lower the senior’s resistance.

The family should ensure that the surroundings are calm and private with unnecessary distractions.

Use “I” statements to express concerns without blame or judgment

When speaking with a beloved, ailing senior about a possible problem, use I statements to discuss your feelings rather than turning the conversation into a “you” blame game. For example, there is a clear difference between “I was so worried when I couldn’t reach you for lunch,” and “You never remember to tell me when you go to the neighbor’s!”

The first is a non-judgmental expression of concern, while the second is judgmental and has blame attached.

Listen actively to understand your loved one’s fears and preferences

Quite simply, active listening is one of the most precious gifts you can give someone. It goes beyond hearing words. Active listening responds to what is not being said. This requires being at maximum focus, rephrasing what was said while being entirely non-judgmental. (It sounds easy, but it isn’t. Practice helps.)

Such a focus on listening is unfortunately rare. However, when it truly matters, active listening can open new worlds for you and any senior who is counting on you.

Involve seniors in the decision-making process to maintain control

When seniors have a say about their lives, they can revel in a sense of control rather than dreading being controlled. Active listening, as mentioned above, is a huge part of assisting them in keeping their autonomy. The senior needs to feel relevant and actively listening is a strong way to reinforce that concept.

Provide the senior with choices. “What do you want for dinner?” may turn into an overwhelming question. Instead, ask, “Would you like a burger or lasagna?” Two easy choices, and the senior has become a part of the decision-making process. The same technique works with other choices, as well. Instead of asking, “What would you like to do?” ask, “Do you feel like gardening or a walk along the beach?” The ability to make choices can evoke a sense of power.

Present in-home care as a way to maintain independence, not lose it

The family discussion aimed at convincing a senior that some in-home care may be necessary will likely be fraught with tension.

Take the time to explain that any in-home care plan will be personalized to include the senior’s needs and wishes. This way, he or she will retain all familiar surroundings and habits. Discuss the senior’s daily routine and provide reassurance that his preferences will remain unchanged – unless, of course, for medical reasons. Explain that it is the implementation of in-home care that will make the continuation of the established routine possible, with the major difference being the senior will no longer need to worry about keeping track of appointments and medications.

Address specific concerns with factual information and reassurance

Several surveys have confirmed that 75 to 90 percent of seniors prefer the comfort and familiarity of aging in place. That is a clear trend. However, fears and doubts remain. Below are some of the major concerns and the best way to address them:

1. As mobility and risk of falling become issues, the seniors will become worried about personal bodily safety. Fact: a professional home assessment agency will identify and assess any potential hazards in the home, from stairs, bathroom, and clutter. The senior will be safer than ever.
2. A senior may well be reluctant to permit a stranger into her home and personal life. Fact: In-home caregivers hired through reputable agencies are thoroughly vetted and tested for proper qualifications, including background and emergency protocols.
3. Vulnerable seniors may be reluctant to lose control of their lives and routines. Fact: A personalized care plan tailored to the senior’s lifestyle, habits, and needs will enable them to have a strong voice regarding their own care.
4. Another concern may be the caregiver’s training. Fact: Most agencies, including B’zoe, vet their staff on their knowledge regarding eldercare. Many of them, including B’zoe, provide further training to broaden the caregivers’ caregiving and medical knowledge.
5. When additional care is needed, cost is an obvious concern. Fact: in-home care usually consists of flexible hours. Some seniors may only require help for a few hours each day or during the week. This flexibility most assures that the monthly cost will be less than the expense of a 24-hour nursing home.

Consider involving trusted family members, friends, or healthcare providers

A senior surrounded by a trusted team can be assured that all efforts for their well-being are being made, especially regarding their physical and emotional vulnerabilities, as well as to prevent isolation.

Lack of socialization and the ensuing isolation can lead to declining health. The more people who are available to provide an emotional, cognitive, and physical boost, from a caring medical team to grandchildren who love romping with Grandma, the greater the odds are that the senior will remain in good health and connected to the present.

A team, especially one filled with caring family members, provides the senior with a purpose – to get up in the morning, to remain healthy, to anticipate the next get-together.

Addressing Common Fears and Misconceptions

Debunk myths about in-home care being only for “sick” people

Myth: In-home care must include a form of medical service.

Fact: In-home care refers to any type of care, including assistance with daily routines, grooming, dressing, housekeeping, shopping, and meal preparation.

Myth: In-home care is rarely affordable.

Fact: In-home care will likely cost less than an assisted living facility because a facility charges for around-the-clock care, while in-home care is far more flexible.

Myth: In-home care may lead to the loss of autonomy.

Fact: The very purpose of in-home care is to support and increase the senior’s independence by allowing him or her to stay at home and enjoy a familiar environment.

Myth: Only seniors who live by themselves can use in-home care.

Fact: In-home care is for singles or people living with family. Family may not be available at all necessary times, and in-home care is designed to be there when they aren’t.

Clarify the difference between assistance and dependency

Everyone needs help at times. The difference between help and dependency is in the degree of independence the senior retains while he or she is being assisted.

Basic assistance is just that – support for someone who is essentially independent and in control of his or her life. Providing them with help empowers them to function at a higher level. For example, installing bars in bathrooms helps ensure the senior’s safety.

Dependency, on the other hand, occurs when the senior relies more on the caregiver to take care of normal daily needs than is necessary and relinquishes control and independence to the caregiver.

Explain how professional caregivers respect privacy and boundaries

Invasion of privacy and boundaries is one of the main points of resistance for seniors who oppose in-house care. Trust will likely grow as the senior and caregiver work together; however, a professional caregiver can help in building trust and confidence:

1. Private spaces make for successful relationships. The senior needs his or her own room and a quiet space to relax.
2. Belongings, like spaces, are private and need to be respected as such.
3. The senior’s family is likely financing the in-home care. Nevertheless, that does not mean the caregiver should automatically share all personal information about the patient with them. Discretion is key, as is providing information on a need-to-know basis.
4. Confidential medical information should only be shared with members of the medical team.

Address financial concerns and insurance coverage options

Life is expensive; installing in-home care for a senior can add to it. Unfortunately, too many families are unaware of the available cost-saving programs.

Options for meeting the cost of in-home care include taking out a reverse mortgage and self-pay by using life insurance funds, or by taking out a death benefit loan or long-term care insurance.

Discuss the flexibility and customization available in care plans

No two seniors are alike, and health care plans can be made just as customized. Each plan is intended to reflect each user’s individual needs and can be adapted as circumstances change. People evolve, and optimistically, their health plan evolves with them. For this reason, plans should be reviewed regularly and adjusted according to need.

Care plans are not just about health. In-house caretakers are companions and expected to support seniors with their evolving emotional and personal needs. As a simple example, if the senior has joined a Thursday gardening group, the care plan should be adjusted to ensure that the caregiver – or a respite caregiver – is available at that time.

Reassure about caregiver screening, training, and reliability

Let us get the obvious out of the way. Do not hire a caregiver without proper screening and background checks. That would be putting a vulnerable senior at considerable risk. Instead, assure the senior that any responsible agency will do the following for each caregiver candidate:

1. Agencies have a screening process that includes background checks (most of these include a criminal history check for state and federal), education and employment verification, references from previous employers, and more.
2. Agencies may do drug tests.
3. Many agencies have in-house training programs covering specific skills.

Highlight the social benefits and companionship aspects of care

Regarding in-home care, it is usually the need for day-to-day assistance and medical oversight that comes to mind. That is only half the story. Seniors requiring assistance may suffer from isolation and depression, and for that reason, companionship can provide desperately needed and critical social and emotional benefits.

1. Loneliness will gnaw and create unbearable pain. An in-home caretaker can do much to prevent isolation.
2. Once the senior and caregiver have created mutual trust, the caregiver frequently takes on the role of confidant and friend. Their mutual space turns into a safe space.
3. Having a companion with whom to do things and learn things assures greater self-esteem and intellectual stimulation.

5. Gradual Introduction Strategies for In-Home Care

After being told that an in-home caregiver will be assisting the senior in various daily tasks, the senior is likely to be taken aback and nervous about the impending unknown. Such important news is best broken gradually.

1. Begin by having a general, honest, non-judgmental conversation with the senior about in-home care, with a strong emphasis on how a caregiver will enhance his or her autonomy.
2. Emphasize how a caretaker in the home will increase independence and provide a personalized health care plan for discussion.
3. After reviewing the available list for a caregiver, allow the senior to make his or her choice. Have this chosen caregiver come for visits and a few shared outings. Ensure that the senior and the caregiver are comfortable with each other. Allow for a few meetings for rapport to develop.
4. Family members can use gentle persuasion to challenge the senior’s resistance to an at-home caregiver. If needed, a trusted healthcare provider or religious leader may also add to the conversation.

Start with minimal, non-intrusive services like light housekeeping

1. Approach the caregiver’s duties gradually, beginning with some light housekeeping and preparation of meals. This should not feel overly transgressive to the senior. As trust slowly builds, the caregiver’s duties can increase.
2. Light housekeeping can include doing the laundry, cleaning the kitchen and baths, and some tidying of the living quarters.

Introduce companionship services before personal care needs

As stated above, companionship is a vital part of in-home senior care. It’s a way to create a bond and build trust. Once the bond is in place, the senior will feel more comfortable allowing the caregiver to assist with personal needs such as bathing and grooming.

A gradual introduction is recommended to avoid overwhelming the senior. This can be followed by introducing greater emotional support.

Begin with short visits to build comfort and trust

It is best to help a senior adjust to a new caretaker in short spurts of time so as not to overwhelm him or her. One short visit at a time in a comfortable setting does it best. Seniors will be comfortable in their own familiar surroundings in the presence of a family member.

A discovery of mutual interest can begin the bonding process; however, do not panic if it does not. The discussion can include daily routines and the senior’s favorite activities.

The length of the visits should increase gradually, with each visit allowing for more informational exchange.

Allow seniors to interview and choose their preferred caregivers

The senior must maintain as much autonomy over the choice of caregivers as possible. This sense of independence can be established at the beginning of the relationship by allowing the senior to be a part of the interview and hiring process and express his or her needs and concerns.

Create trial periods to demonstrate benefits without long-term commitment

Let’s be realistic. Relationships don’t always work out as planned. That is why using trial periods to establish a positive and effective client/caregiver bond is a practical way to enjoy a long-term commitment. Below is how to best arrive at a mutual commitment:

1. The expectations of both parties should be clearly defined, including duties to be performed and the time needed for completion.
2. Acknowledge that having a new caregiver in the house can be awkward. Discuss how the patient, the family, and the caregiver can work together.
3. Ensure that everyone has access to the care plan and an opportunity for input.
4. Everyone should agree on the duration of the trial periods. One or two weeks can be a reasonable start. This can then be extended to a month.
5. If possible, a family member can spend time with the candidate and review the list of necessary tasks.
6. Don’t expect the candidate to be a mind reader. Provide feedback.

Gradually increase services based on comfort level and emerging needs

Life changes. People change. Needs change. Flexibility is everything.

Assessing a patient’s changing needs is one of the most important functions of a caregiver’s job. It is important to realize that as needs grow, so do the services offered by the caregiver. If the senior resists, the caregiver can gently explain that said changes are designed to improve the senior’s quality of life.

Maintain family involvement throughout the transition process

Family Involvement in the care of a disabled senior is crucial to the senior’s well-being. As the family undergoes the transition of having a caretaker on board, they can help the senior deal with the expected resistance of having a stranger invade the senior’s privacy.

For family members who desire more involvement with patient care, the caregiver can train them to do a number of tasks.

6. Ensure caregivers understand and respect cultural preferences

Caregivers are fortunate in that they can meet people of varied cultures. Of course, that translates to showing respect for cultural differences.

This provides the caregiver with a great opportunity to learn and broaden his or her horizon.

1. The caregiver can consider this new culture and how it fits with his own beliefs and biases.
2. Allow for time to develop a trusting relationship.
3. The caregiver can ask about the patient’s dietary restrictions and fit in some other respectful questions.
4. The caregiver can ask about touching habits. Certain cultures are very “handsy” while other cultures consider it rude to touch anyone outside of the family. It never hurts to ask.

Address how to handle concerns or requests for caregiver changes

This article is all about making relationships work. Alas, while it’s a commendable goal, it cannot always be achieved. If you used an agency, be diplomatic but firm with your concerns and complaints.

1. Whatever the concern, be specific. “You have a bad attitude” is vague. “You keep snapping at my mother” conveys a specific problem.
2. Communicate effectively and professionally
3. Highlight your concern by referencing the behavior, not the person misbehaving.
4. Consider more training for the caregiver.
5. If you suspect elder abuse, contact your local agency immediately.

Establish routines that respect the senior’s lifestyle and preferences

As has been stated, growing older isn’t for sissies. Seniors have had years of enjoying a certain lifestyle. It would bring joy to the senior to be able to continue living this familiar life.  Integrate old routines with new ones that respect seniors’ lifestyle and preferences. Make it personal.

1. Involve the senior in the creation of the health plan.
2. Introduce any changes to in-home care gradually.
3. Discuss the patient and his favorite activities.
4. Continuously assess if the routine meets the senior’s needs and goals and be prepared to modify it over time.

7. Building Trust with Professional Caregivers

Emphasize the importance of caregiver-client compatibility

Of course, a caregiver’s skills are critical for the family and the patient. In many cases, however, the patient’s and the caregiver’s compatibility and personalities will lead to improved care and satisfaction for the senior and greater job satisfaction for the caregiver, an important factor in retaining the caregiver on a long-term basis.

When the caregiver and senior are compatible, the senior:

1. Can communicate more easily.
2. Feels less isolated and anxious.
3. Greater trust in the caregiver will likely end in better care being accepted.

When the caregiver and senior are compatible, the caregiver:

1. Enjoys greater job satisfaction.
2. Less job-related stress.
3. Can build a more harmonious relationship with the patient.

Discuss how to communicate preferences and boundaries clearly

When two people work and live together, clear communication is paramount. The following hints work well in establishing preferences and boundaries.

1. Expectations and boundaries should be communicated as soon as possible, much of it during the interview. If an additional situation arises following the hiring, either party can speak up immediately.
2. A regularly scheduled discussion to discuss smaller issues can prevent larger issues down the road.
3. Practice patience. People make mistakes.

Explain the process of finding the right caregiver match

Caregivers can be invaluable, but the secret is to find the right caregiver who will be compatible with your senior. You want a good fit, and the following is how to find it:

1. Your first step is to be clear about what services you need. Is it primarily companionship, medical assistance, or personal care? Your needs will determine your best fit.
2. If your senior lacks social connections, the caregiver may be his main social contact. If that is the case, the caregiver should be able to arrange plenty of activities and engage in stimulating conversations with your senior. In some situations, personality can matter.
3. Consider whether you need full or part-time care.
4. Make a list of the duties and responsibilities you want the caregiver to engage in. This should provide you with the skills you need to look for.
5. You can go through the interviewing, background checking, and hiring process by yourself or use a professional agency.
6. During the interview, ask specific questions that can help you determine if this person will be the desired match for your senior, both as it relates to skills and personality.

Highlight professional training, certifications, and background checks

When looking for your ideal caregiver match, remember that you may be looking for familiarity with varied skills, from cognitive decline to diseases such as diabetes.

1. All caregivers should receive basic training, which includes helping with day-to-day living, grooming, hygiene, shopping, driving the patient to events or appointments, emergency fundamentals, and medication management training.
2. For patients with Alzheimer’s, additional training is required.
3. Some caregivers require basic CNA (certified nursing assistant) training. CNAs have received additional medical training in monitoring vital signs.

Available Certifications:

1. Basic training: National Caregiver Certification.
2. Professional National Caregiver Certification Course: This certification is given to caregivers who work with senior patients.
3. There are several specialized certificates for Dementia, palliative, First Aid, and emergency preparedness.
4. Deep background checks are recommended. If hiring through an agency, insist that the agency does these verifications.

Encourage ongoing communication between all parties

Open communication between all parties is crucial. The medical team must speak in simple terms instead “medicine lingo” to ensure being understood. Everyone should speak clearly so that the senior, who may be hard of hearing, can understand. Medical instructions should be put in writing.

Address how to handle concerns or requests for caregiver changes

This article is all about making relationships work. Alas, while it’s a commendable goal, it cannot always be achieved. If you have hired through an agency, be diplomatic but firm with your concerns and complaints.

1. Whatever the concern, it should be documented with time and.
2. Be specific. “You have a bad attitude” is vague. “You keep snapping at my mother,” conveys a specific problem.
3. Communicate effectively and professionally
4. Highlight your concern by referencing the behavior, not the person.
5. Consider more training for the caregiver.
6. If you suspect elder abuse, contact your local agency immediately.

Establish routines that respect the senior’s lifestyle and preferences

As has been stated, growing older isn’t for sissies. Seniors have spent years enjoying a certain lifestyle. It would bring joy to the senior to be able to continue living this familiar life.  Establish routines that respect seniors’ lifestyle and preferences. Make it personal.

1. Involve the senior in the creation of the health plan.
2. Introduce any changes to in-home care gradually.
3. Discuss the patient and his favorite activities.
4. Continuously assess if the routine is meeting the senior’s needs.
5. Foster independence and dignity.
6. Encourage self-care: Allow them to perform tasks on their own as much as possible, promoting self-worth and confidence.

8. Involving Family Members in the Care Decision

Define roles and responsibilities for each family member

It is to the advantage of all seniors who need help with day-to-day life to have family members take on a role in making in-home care decisions. Potentially, each family member can establish a defining role, along with their integral responsibilities. This ensures that the senior is getting everyone’s best efforts:

Adult children: these tend to be seen as the most logical to help with daily bathing, grooming, cooking, and dispensing of medication. They may also relay the senior’s condition, change of condition, or any worries to the senior’s medical team. Adult children may be the senior’s financial advocate and primary companion.

Spouses are viewed as comfort givers to the senior and others and can collaborate with other family members when changes need to be made to the in-home care plan. If the senior is living at home, the spouse will likely be more involved in day-to-day care.

Grandchildren are sheer joy. They can take their favorite Grand to fun activities or join him or her in favorite hobbies such as gardening. They are the best at providing their Grand with cheerful companionship.

Create a united front while respecting the senior’s autonomy.

Family differences (all families have them) may interfere with everyone’s desire to provide a senior member with the best care.

1. The first and possibly most critical step is to ensure the senior’s wishes are respected, supported, and prioritized by the family. All family members must work on creating a supportive environment for everyone and provide a united front.
2. Practice active listening as described in this article. Hear what everyone is saying as well as their unspoken words and needs.
3. Ensure that the senior is a part of all discussions, and, wherever possible, his or her choices should be prioritized. Any disagreements might best be voiced privately, without the presence of the senior.

Schedule family meetings to discuss care needs and options

A family member should be selected to oversee the administrative part of the family meeting – keep in mind this is not a BBQ-in-the-backyard type of get-together. This is an official meeting and should be handled accordingly. The person who is selected to be in charge should have a list of attendees, create an agenda, and establish the general guidelines:

1. Identify the attendees and the reason for the meeting (such as the need for a new caretaker.
2. Encourage everyone to express their genuine feelings and ask questions.
3. If a note-taker or time-keeper is required, assign one.
4. Emphasize that the comments need to be respectful and non-judgmental.

Address disagreements and conflicting opinions constructively

Disagreements within families are natural. When the topic is a senior’s healthcare, simple disagreements can turn into a hot topic, such as the following:

1. Siblings may disagree about whether a parent should have full-time in-home care, part-time in-home care, or be placed in an assisted living home.
2. The family may have conflicting opinions about financing the senior’s care. (for more, see the relevant section in this article.
3. Use non-threatening “I” comments, as in, “Sometimes I feel we don’t spend enough time with dad,” instead of “Why are you all putting the heavy burden on me!
4. Look for common ground and start there.

Consider professional mediation when family dynamics are challenging

One of life’s ironies is that family is usually all we have, while at the same time, family dynamics can be brutal. The truth is that people raised together may feel more anger than affection toward each other. When the family is dealing with a sick elderly relative, a professional mediator may add calm and reason to a difficult situation.

Establish clear communication channels between family and caregivers

Effective communication between caregivers and the family begins with honest and open communication. Both parties should meet on a regularly scheduled basis, such as once a month. Video meetings and phone calls do count.

The caregiver should convey medical information and news in a jargon-free way. Details are important. If problems have arisen, both the caregiver and family need to solve the problem in a non-judgmental way.

The caregiver should include the family in as many care decisions as possible. When/if a family member needs to be a respite (temporary fill-in) caregiver, he or she will already be up-to-date.

9. Making In-Home Care Feel Less Intrusive

The majority of disabled seniors opt to age at home. It’s a familiar place where they feel comfortable. That creates the need for an in-home caregiver to tend to the senior’s physical, emotional, and medical needs.

Let’s consider some ways a caregiver can feel less intrusive while taking care of the senior:

1. Reassure the patient that their autonomy is respected.
2. Discuss how the senior and the caregiver can work together to respect the senior’s privacy.
3. The caregiver should encourage the senior to opine about the care plan. His opinion should be respected, and the caregiver may find a way to make adjustments to the plan (with the family’s okay) that works for all concerned.

Establish clear boundaries and respect personal space

Establishing clear boundaries and respecting personal space is crucial for both seniors and their caregivers to foster a healthy, respectful, and sustainable caregiving relationship.

Here’s how to achieve this:

1. Open communication and defining expectations

• Discuss needs and preferences: Openly communicate about caregiving routines, schedules, and activities.
• Clearly define roles: Outline who is responsible for specific tasks and responsibilities.
• Use “I” statements: Express needs and concerns using “I” statements. For example, “I feel overwhelmed when I’m expected to be available every hour” instead of “You demand too much attention”.

2. Respecting personal space

• Private areas: Provide a private space, such as a bedroom or quiet corner, where the senior can have solitude and maintain a sense of autonomy.
• Knock before entering: Always knock and wait for permission before entering a senior’s room or personal space.
• Respect personal belongings: Ask for permission before touching or handling personal belongings, reinforcing their sense of ownership and autonomy.
• Observe non-verbal cues: Pay attention to body language or non-verbal cues that may indicate a desire for more personal space or solitude.

3. Setting boundaries for time and responsibilities

• Schedule specific caregiving hours: Establish and communicate clear schedules for caregiving tasks, including breaks. Learn to say no to tasks that are beyond your ability to handle.
• Prioritize self-care: Actively prioritize and schedule time for self-care activities like hobbies, exercise, or relaxation to prevent caregiver burnout.

Maintain familiar routines and daily schedules

Seniors are used to their specific schedule. Familiar routines fill the senior with a sense of security and independence and can promote his or her overall well-being. The following will help in establishing regular routines and schedules.

1. Being consistent with bedtimes and morning times helps the body maintain a steady sleep cycle.
2. If possible, keep to a regular meal schedule.
3. The familiar should invariably win by default. For example, use familiar routes when keeping appointments or doing errands. And while it is best to establish a route, remember to be flexible.

Encourage continued hobbies, interests, and social connections

Some seniors dread what they consider giving up life for a “4:00 p.m. senior meatloaf dinner special” life. It does not have to end up like this.

While growing old can have its moments, a mindful caregiver, while aware of the senior’s limitations, knows how to provide in-home aging with a sparkle. Such a caregiver will encourage and nurture new and old passions, interests, and help broaden the senior’s social connections.

The benefits of aging happily in place are as follows:

1. For anyone, including seniors, engaging in hobbies and interests lowers stress and increases a sense of well-being.
2. Taking part in beloved activities provides needed mental stimulation.
3. It is too easy for seniors to feel lonely and isolated. Social activities can lessen health risks.
4. Most senior centers offer recreational activities, fun events such as excursions and dances, cooking classes, etc. It is one of the opportunities for seniors to be surrounded by people like them.

Create opportunities for the senior to teach or mentor the caregiver

One of life’s wonderful opportunities is that everyone can impart knowledge, regardless of age.

When a caregiver has ascertained the senior’s interests, the senior, without a doubt, will appreciate that the caregiver is interested enough to ask questions. Simple skills such as gardening, knitting, or cooking can be shared; this allows for questions to be asked naturally.

If both the senior and caregiver enjoy learning, they can join a book club, painting class, or yoga class together.

The senior can focus on the caregiver’s strengths and applaud all efforts. This will go far in elevating the caregiver’s confidence.

Maintain privacy in personal areas and possessions

All seniors deserve privacy. When a caregiver shares the home, it is a good idea to:

1. Create a special “personal space” for the senior. This can be a favorite window seat, an area in the bedroom, or any place where the senior feels comfortable. This space can be personalized according to the senior’s taste.
2. Once boundaries have been established, it is crucial, except in cases of emergencies, that the caregiver respects such boundaries.
3. The senior’s belongings are private and should not be handled without the senior’s permission.
4. The senior may be a patient but still retain privacy in the bathroom. Be clear on the grooming boundaries.
5. As a responsible caretaker, he or she can add tremendous value to the job and encourage autonomy by letting the senior complete whatever tasks he or she is capable of.

Ensure caregivers understand and respect cultural preferences

Caregivers are fortunate in that they can meet people of varied cultures. Of course, that translates to showing respect for cultural differences. This provides the caregiver with a great opportunity to learn and broaden his or her horizon.

1. The caregiver can consider this new culture and how it fits with his own beliefs and biases.
2. Allow the time to develop a trusting relationship.
3. The caregiver can ask about the patient’s dietary constrictions and fit in some other respectful questions.
4. The caregiver can ask about touching habits. Certain cultures are very “handsy” while other cultures consider it rude to touch anyone outside of the family. It never hurts to ask.