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September 10, 2004

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Publication Date: Friday, September 10, 2004

There's no place like home There's no place like home (September 10, 2004)

Caregivers make house calls to elderly patients

By Diana Reynolds Roome

"My mother sings all the time, and she's smiling. That's the most important thing for me," said Ginger (who didn't want her last name published). "She's in her own home. She knows where her cats are, and her neighbors, and her garden."

Things haven't been this good since her mother started showing signs of Alzheimer's disease. Her parents are still living together in their Mountain View home of 55 years, but keeping them there hasn't been easy.

Pride and prejudice

When Ginger realized a year and a half ago that her parents needed more than occasional help for everyday tasks, she tried at first to step up her own contribution. This meant going over more often from her home, a mile so away, to help them. Her father cooked and was determined that he could cope. Then her mother started calling 911 for information, the police would turn up, and things got more chaotic. Both were telephoning Ginger too, increasingly often at work, and she was forced to take time out of her working day to run over and check on them.

In July, Ginger decided to quit her job as a business manager and take care of them herself. But despite her love and dedication, she discovered she was not cut out to be a fulltime caregiver. She eventually decided to return to work part-time, and found an agency to provide four hours of help a day. But she hadn't reckoned on the fierce resistance of her parents.

"We had a myriad of caretakers, but Mom would want them out of the house. Dad wanted to believe he could do everything. There was such friction that the caretakers kept leaving," she said.

Match game

When Ginger called Home Instead, the Mountain View-based south Peninsula office of a national and international senior care agency, she was at her wit's end. The first caregiver was "sweet and hard-working" but had to leave due to a family emergency. Ginger wondered if the whole cycle was about to start again. Then came Emily Williams.

"From the moment Emily stepped in the door, she and my mother became companions," said Ginger. "There's this trust between them. It's so much more than the cooking, and help with the bathroom and shower. They look at flowers, go grocery shopping and talk to the neighbors together. They're friends."

Williams arrives at 8 a.m. each weekday, and helps Ginger's mother with washing and dressing. Then she cooks breakfast, and the three sit down together.

"They want me to eat with them," said Williams, who hails from New Orleans and cooks a full Southern breakfast of grits, sausage and eggs. "But I don't fill them up, and I need to watch their diets so we have fruit, nuts and juice, too."

Later, she does house cleaning, laundry, dishes, and feeds the three cats (plus four strays) and changes their litter box. She puts out medications and makes sure they both take them. (Licensed agency employees are not allowed to administer medications, though private caregivers can.)

When Ginger's father sometimes drives himself to visit friends, and her mother gets very sad when he leaves and fears he won't come back, Williams reassures her and helps her regain her composure. Sometimes they put on the old classics, and sing and dance along.

"I go along with most things she says," said Williams. "I let her help me make the bed and do dishes. She likes to be busy. She'll place a shoe so carefully on the couch. Then when she's not looking, I go and put it in the right place. She's got a sweet nature about her -- we have fun."

Williams, a certified nurse's assistant, received training from Home Instead, including non-medical training offered through the Alzheimer's Association. But she attributes her success as a caregiver more to personal experience -- for example, returning the care of the great aunt who raised her, and now acting as companion and helper to a roommate who is ill.

"I was born to do what I'm doing, and I love it," said Williams, who at 53 thinks she is in good shape, physically, mentally and spiritually, with no problems to bring to her job. The fact that she recently survived a brain aneurysm only intensified her sense of life's value.

An agency instead

Finding the right match between a family member and a caregiver involves "a potpourri of different issues," said Gee Gee Williams (no relation to Emily), geriatric case manager and founder of ManageAble Care, Palo Alto.

"The challenge is to match the skill level of a caregiver with a client's needs, which run the gamut from disabling physical conditions to severe cognitive deficits. If a caregiver has been working with a stroke survivor, then suddenly they're with a dementia patient who is wandering or combative, they can end up feeling overwhelmed," she added.

Many people have success looking for a caregiver independently, through ads, neighborhood networks, social workers, private brokers or organizations that offer counseling and assessment. Agencies like Home Instead visit with the client and as many members of the family as possible to assess the situation and find out preferences.

"Often families wait until the last minute before seeking help. They are stressed and may not have a good sense of reality," says Bob Cunningham, president of Home Instead, Mountain View. "We try to bridge the gaps, and put all the pieces together."

An agency can provide a screened, trained caregiver at short notice, providing respite care, a few hours every week, or 24-hour live-in services, with an assurance of a quick replacement if necessary. Home Instead's "Rise-and-Shine and Tuck-In" offers help with the critical hours at the beginning and end of the day.

Agencies typically cost more but handle issues such as scheduling, advice about safety and adaptive measures in the home, as well as supervision, support, screening, insurance, taxes, benefits and workers' compensation for the caregiver. But whether finding a caregiver through an agency or independently, it's a good idea to interview several people and try to gauge personal compatibility as well as a skill match.

"When you're talking about an 80- or 90-year-old client, they may have inbuilt prejudices, so caregivers may be set up for failure before they start," said Gee Gee Williams. "A caregiver is handling the most intimate things, so sensitivity has to be there. A client may want her steamed vegetables done a certain way, so all these things have to be taken into account."

"It really makes all the difference in the world to have the right fit, someone whose personality gels with the senior," said Ginger. "It is frustrating because you may have to go through a few caregivers, but it is so worth it."

For her mother, finding Emily was a little piece of magic. "She's always happy now," said Ginger.

E-mail Diana Reynolds Roome at diana@dianarr.com

Resources:

www.homeinstead.com, 691-9671

ManageAble Care, 328-9332

www.alznorcal.org, (800) 660-1993


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