By Leslie Eckford
Picture that you have been through the hiring process for a caregiver to assist your elder parent. You’ve done all the steps that you must do including criminal background checks, drug screening, the interview, checking references and finding what looks to be a good fit of temperament and personality between your mother and the caregiver. The first month of employment seems to be going smoothly, you check in with your mother frequently, in person, by phone call or by video chat and she says that she likes this person who is helping her. She tells you something funny that they have talked about and what a great lunch the caregiver makes. You are being careful to also touch base with the caregiver to get her point of view, learn of any problems or concerns that she might have about how your mother is doing and how the schedule is working out. All seems to be going well.
Eventually, though, you may expect to have some bumps in the road. In any relationship, there are differences of opinion. When it comes to the care of elders, this may take the form of how and what and when to do certain daily care tasks. Add to the mix conditions like dementia or arthritis and physical pain, and the daily picture has the potential to get contentious.
Let’s start with an example that I know will be familiar to many of you. Let’s say that your mother has always been a fastidious person who maintained a polished look and wouldn’t think of not showering daily. Her energy in her earlier life to be active and busy was the envy of her friends and a source of pride for her. As she has aged, that energy has become a thing of the past. She has congestive heart failure and every activity takes major effort for her. She did the best that she could to manage this change, even sleeping in her clothes so that she could appear somewhat put together in the morning. She doesn’t realize that she appears disheveled, is wearing clothes that could use a good washing as well as needing attention to her own hygiene. Like many elderly with various medical conditions, she finds taking a shower or a bath an exhausting ordeal.
Then you hire the caregiver, who assures you that she has some great ideas about how to help your mother get bathed and dressed. Your mother has different plans. She absolutely refuses to have any part of this, especially to have another person in the shower with her. It has become a showdown for who will have the power and control, your mother or the caregiver.
At this point, you may start looking back at those enticing assisted living advertisements, hoping to pass this on to someone else. However, I suggest that you stick with it and work with the caregiver and your mother. Sometimes you may feel like you are a member of the state department going back and forth between two warring nations. But, it is usually worth the effort. I have worked with some caregivers who are super efficient, productive and thorough. They may have a need to get tasks like bathing and dressing done first thing in the morning and have a hard time being flexible for an elder who doesn’t really feel like much of anything until noon. Sometimes it is simply a matter of getting both parties to agree that other tasks be done first (have breakfast, read the paper, have a phone call with a friend). Other times, you may encounter a caregiver who has a resistance to changing the daily agenda. If you have discussed changing the time or frequency of baths and the caregiver insists that your mother take the bath daily at the caregiver’s preferred time, then it may be a point to find a different caregiver. A power struggle of this type in one area can lead to others. It defeats the purpose of having and paying for assistance.
More often, however, you may find that the very nice caregiver has a hard time being firm with your mother. I have heard many stories of families whose elder parent absolutely love the caregiver, but on visits, the family discovers that the parent hasn’t had a bath in weeks. The caregiver is trying to be respectful and understanding with the elder, or has met terrific anger and opposition when they have tried to encourage a bath. They may not have the skills or experience in dealing with someone who downright refuses care. And, to be honest, standing up to your parent may be the last thing that you want to do too! If your caregiver is from an agency, it would be wise to have a conference with the agency supervisor and see if the supervisor can support the caregiver and advise on how to get a better outcome or provide some additional training. If you have hired privately, you would be in the supervisor’s role. There may be experienced caregivers on sites like Care.com who do caregiver training if you have a really strong preference for this caregiver and the funds to do so.
The reality is that unless you have endless amounts of time and energy to be constantly in the hiring and firing process either privately or with the agency, it is worth it to build a good working relationship with the caregiver. These power struggles between the elder parent and the caregiver can arise out of many issues besides hygiene and dressing. How food is prepared, how the clothes are washed, how many hours the elder may want to nap throughout the day, driving, whether the elder wants to wear oxygen by nasal canula as prescribed, time the caregiver spends on the phone, the list goes on and on.
Working together, with input from all parties, may be time consuming but result in a desired outcome. That is the main reason that you and your family are doing this: to have your family member safe and well cared for and at the same time recognizing them as an individual with rights. The key is in the balance.
Have you had an experience with resolving such a battle or disagreement? Please share your story, your thoughts and responses in the Comment section. Interested in more ideas for conflict resolution with a hired caregiver and an elder parent? Here is an article from Agingcare.com that addresses family caregiver conflict but can be useful in this situation too.