Uncertain Paths – Transitioning to Home Care

Posted on August 29, 2013

Your mom is in the skilled nursing facility and the social worker/case manager is talking to you about sending her home. It is recommended that she not be without personal care assistance/home care. All of a sudden, there are many decisions to make.

  • Do you bring her to your home?
  • Do you care for her every day in her own home?
  • Do you contact a home care agency or hire a caregiver privately?

No matter what is decided, this is unfamiliar territory that brings to surface many fears and anxiety. Hiring outside help for a parent creates a tremendous storm of emotions.

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Normal thought processes include:

    • You know that no one can care for your parent the way you do, or at least not with as much love and concern.
    • You truly wish you could care for your loved one full-time, you just can’t.
    • Your parent is most likely in a vulnerable state.
    • They may not have ever needed to have an outsider care for them before. Their anxiety about this can easily increase


  • You know that at some point, you will have to get back to other aspects of your life, causing a sense of urgency.
  • You will not be able to oversee every detail of care once that care has been entrusted to a caregiver.

Here are a few helpful hints to follow to assure a smooth transition for you and your loved one.

  • Remember that this is a major life transition for both you and your parent.
  • This is causing anxiety for everyone involved because it is a significant departure from the ‘norm’. Give yourself permission to feel the anxiety, fear and guilt. However, don’t allow it to cause you to make sweeping decisions that might eliminate YOUR anxiety, but create more for your loved one.
  • Make a plan of action that takes into account EVERYONE’s needs and expectations. Don’t leave yourself out of the equation. Decide how much care and support you can realistically provide on a consistent basis and use this as a benchmark when hiring outside help. For instance, you could agree to do the grocery shopping once a week, pick up prescriptions, transport to medical appointments, etc.
  • Remember that your presence and involvement is still crucial. Even if the caregiver is Florence Nightingale reincarnated, your loved one still needs YOU. By continuing to offer assistance and support in a predictable way, you will be providing a sense of a familial continuity that cannot be duplicated. Just remember to set your boundaries so that you are not overextending yourself.
  • Have clear expectations outlined when meeting with your caregiver including housework, meal preparation, care needs and preferences, work schedule, personality preferences, etc. This provides a firm foundation on which to start, eliminating guesswork on the part of the caregiver and frustration on the part of the family.
  • Make sure these expectations and needs are clearly defined in a Plan of Care to be followed by the caregiver with an established system of reporting.
  • Let go. Allow your caregiver the freedom to establish a routine and rhythm in the home. Accept that they are not you and will have a different work-style. As long as good care is being provided and she/he is a good personality fit, you are ahead of the game.

When faced with a major life transition, we are forced to adapt. In order to adapt successfully, remember to be honest with all involved about your limitations, anxieties and fears. There is no ‘right’ way to be/feel. By focusing on the best solution for all involved, you will be able to come through for yourself and your parent, laying the groundwork for a smooth and successful transition.

Great Expectations in Home Care

Posted on August 29, 2013

Home Care is a very flexible and cost-effective way to provide a safety net for senior member of the family to continue living in their own home and communities. Even though home care requires less adjustment than a placement in a group home or assisted living facility, it tends to have strong undercurrents of emotion and expectations for the entire family.

Home care is a life transition. Having a virtual stranger coming into your home to help manage the most basic aspects of daily living can trigger deep emotional responses. For the senior in need of care, loss of autonomy, independence and privacy are very real. This may be piled on top of other recent losses in health and relationships. No one, in my experience, has EVER welcomed the need for home care as it is typically follows some sort of loss or series of losses.

For the family, guilt, fear and inadequacy are feelings that are very relevant and real as well. Many, if not most, adult children wish that they had the time or lived close enough to provide the care they feel their parents deserve. Fear enters in, with the control and direction they lose when hiring someone to provide the care. Feelings of inadequacy can surface, especially if they had attempted to provide the care themselves and it became overwhelming. These emotions are all very natural it is best to acknowledge them as they come to the surface. Often, the act of hiring outside help brings these feelings to the forefront. If left unaddressed, they can have detrimental effects on the success of home care assistance.

Often when people are not aware of or do not want to acknowledge these intense emotions, there is a tendency to place unrealistic expectations on the caregiver. No matter how hard the caregiver works, they will never be a replacement for the adult child. The caregiver is an individual with their own history and personality. They will not immediately understand every nuance and preference of each client.

Clearly defining tasks and reviewing skill is vital to beginning this professional relationship, which most reputable home care agencies will do with an in-home assessment and a plan of care. Once the expectations are established, they should remain constant as the caregiver establishes a rapport with the family and can be adjusted if the condition of the client changes.

At the outset, the focus of the caregiver should always be on the safety and well-being of their client. Housekeeping duties can be included, but shouldn’t be at the expense of quality care.  Obvious adjustments can be made as the caregiver settles in to their routine. Clearly, if a caregiver is just NOT the right personality, that should be addressed as soon as possible. However, if the caregiver is competent and professional, it may help to wait a little while rather than rush into a change. Learning the temperament and rhythms of a new client takes a little time. After a while, the caregiver will develop a regular routine based on these daily rhythms and will increasingly be able to anticipate situations and changes and how best to deal with them.

In short, no one can care for your parents like you can. However, if your situation requires outside assistance, do your best to understand the limits of the professional home care relationship and guard against placing unrealistic expectations. If the home care professional provided is caring and competent, provide space and flexibility for the relationship to develop. This should help everyone ease into this life transition with minimal discomfort and allow this new relationship to flourish.

– Gabriela Brown, CSA

Constant Companions Home Care

Hearing Loss – Bringing Seniors Back into the Conversation

Posted on August 29, 2013

Nearly one-third of people over the age of 65 are hard-of-hearing while nearly 50% of people over the age of 85 suffer from some form of hearing loss. Because hearing loss is usually a gradual process that begins in one’s forties, it is commonly not recognized until it is significant. It is important to be able to recognize signs of hearing loss, have it diagnosed and treated.

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Symptoms of hearing loss:

  • Have trouble hearing over the telephone
  • Find it hard to follow conversations when two or more people are talking,
  • Need to turn up the TV volume so loud that others complain,
  • Have a problem hearing because of background noise,
  • Sense that others seem to mumble, or
  • Can’t understand when women and children speak to you.

Hearing loss in seniors can lead to others mistakenly thinking that seniors are confused, difficult or apathetic. Additionally, the senior may be embarrassed by the loss and resist seeking out medical help. The inability to fully communicate can lead to frustration and isolation.

Use the following strategies to bring these seniors back into the conversation:

  1. Make sure that you are looking at the listener and you are in a well-lit area.
  2. Don’t shout, this can often create increased sound distortion.
  3. If there are 2 or more people present, make sure that only one person is speaking at a time.
  4. Address them directly by saying their name before starting a conversation so they have time to focus.
  5. Many people with hearing loss rely on lip-reading. Keep your hands away from your mouth and avoid smoking, chewing gum or eating while talking.
  6. Slow down a little but not too much. A natural and unhurried rate of speech allows the hearing impaired person to capture more words, read lips and facial expressions.
  7. If one ear is better than the other, make sure you are directing your speech to the better ear.
  8. Hearing loss can include certain sound distortions. They may hear your voice but not be able to decipher certain words or pitches.
  9. Minimize extra noise in the environment when have a discussion, like turning the TV or dishwasher off.
  10. If possible, avoid having discussions in settings that may have sudden loud sounds like busy streets, near construction areas or near airports.
  11. Depending on the level and type of hearing loss, certain words are almost impossible to understand, try rephrasing the sentence or find a different word. Don’t repeat the word or sentence over and over again.
  12. Avoid sudden changes of topic. When the subject is changed, clearly state the new topic and look for acknowledgement before proceeding.
  13. Write specific information, such as appointments, directions and schedules down, if you are talking over the phone, have them repeat the information back as many words and numbers sound similar.
  14. Understand that illness or tiredness may affect any person’s ability to follow a conversation.
  15. If the listener looks confused, clarify that they understood what you were saying.

If you suspect hearing loss, see a doctor as soon as possible to determine the cause and treatments available. Remember to be compassionate about discussing the possibility of hearing loss with your loved one. It is important to be supportive regarding the options and opportunity for treatment. Motivation for the decision to seek treatment should be to increase their quality of life by providing the ability to participate in social interactions to the best of their ability.