Every few months, I find myself standing on the doorstep of a new client, ringing the doorbell.
Who will she be, I wonder, this new member of the community of elders whom I meet in my work as a certified nursing assistant and companion to elders. What family photographs will I see on her walls, what medicines on the table by her bed? Will I have the skills she needs? Will she accept help from me, a person she's never met?
Looking back on these moments of mystery on the doorstep, I'm struck by how high the stakes are when we try to help frail and vulnerable people as they grow older. When a family calls my agency to ask about home care, chances are this is just one step in a long journey. Perhaps their mom is struggling to cope at home with illness or injury. Perhaps their World-War-II-veteran husband has escalating memory problems that trigger agitation or even rage. Even in more fortunate circumstances, asking an elderly person to consider home care is a big step.
My hope in this essay is to demystify home-care by telling you something about it from my point of view as a practitioner with eight years of experience in the field. This work is by its very nature private, yet as the baby-boomer generation ages, there will be more and more elders who need the assistance of direct-care workers in order to live safely at home. That's why I write about my experiences -- taking care, of course, to preserve client confidentiality by changing any identifying details about my clients and their families.
Suppose you are an adult daughter named Alicia, and I'm here to help your mother, Mrs. Josie Delancey. You and your mother have met with my agency's staff to discuss her situation. At age 85, Mrs. Delancey has been living alone in your family home since your dad died five years ago. But lately you and your three siblings have seen a big decline in her health. She was hospitalized twice in the past year, once with pneumonia and more recently with a fractured wrist. Her arthritis makes it difficult for her to stand up from a seated position. She's no longer able to drive, and has become increasingly sad and listless. Her once-immaculate house fills up each week with discarded newspapers and used cat-food cans. She's been losing weight and needs help with using the toilet as well as cooking, cleaning, medication reminders, and rides to the grocery store.
As you can see in this scenario, you and your mother have already given us lots of information that will help me do a good job. My supervisor has worked with you to set up a care plan that specifies what tasks your mother does independently, where she needs a little help, and where she needs substantial assistance.
Indeed, since my agency uses secure email and web-based documentation tools, the information flows quickly and easily between the family and the client, agency supervisors, and caregivers like me in the field. Today, as I meet your mother and set about making her breakfast, I have a mental "Client Care Map" in my head that will grow and change with each visit.
Included in my mental Client Care Map is a list of intangible "Tools of Support." It's been my experience that the emotional support a caregiver can offer is just as important as the assistance we provide our elderly clients in the activities of daily living. As caregivers, we need both strong arms and kind smiles. When clients or family members resist care, or when something about our presence triggers some negative response from a client, we need to be able to work with the situation as tactfully as possible.
I remember visiting a friend of mine who was under hospice care, years ago, before I embarked on my career as a caregiver. I noticed that the hospice caregiver would help my friend get situated on the toilet and then wait outside the bathroom, with the door barely ajar. It was a small detail, but my sense was that in respecting my friend's privacy at this vulnerable moment, the caregiver was supporting her independence and autonomy.
Finally, I would like to express my appreciation for the many family caregivers with whom I have worked over the years. A couple of years ago, I worked with a family caring for their 82-year-old father. He loved baseball, so for Father's Day his son bought him a tablet device with a link on the home page to the Baseball Hall of Fame website. He especially loved the online exhibit, Picturing America's Pastime. Looking at the pictures and telling stories about games he remembered gave this elderly man hours of enjoyment. I'll always remember the thoughtfulness of the son's gift and the joy it gave his father.
Mary Ann Barton is a certified nursing assistant, elder companion and blogger who writes about health, healing, and caregiving for elders, their family members, and their paid and volunteer care partners. She finds joy in singing and is writing a book about finding rest and renewal as we care for others. You can contact and learn more abut Mary Ann here:
http://JoyousParadox.com Elder-care blog