Virtual assistant to make scheduled calls to cognitively impaired uncle?
August 8, 2014 2:31 PM   Subscribe

My mom wants her life back and is thinking of hiring a virtual assistant for my uncle who has Parkinson's. Tips and pitfalls for hiring a VA to make scheduled calls to my uncle?

This is long. My uncle has Parkinson's and some additional cognitive issues. His *retrospective* memory is fine to the millisecond and into the past: he can lucidly, humorously, and appropriately banter in real-time and continue conversations from the day before. He's in there. (He is/was a smart guy who ran his own business.)

But, right now, he has almost no prospective memory or goal-directed behavior. He can't plan and anticipate more than about 30-45 minutes into the future. And, unfortunately, he has incomplete awareness that he's impaired in this way.

Currently, we have him in an apartment about 10 minutes away from us. My mom has some groceries delivered and also does shopping for him once a week. She also has a cleaning service in once per week. She also calls twice a day to remind him to take his medication, and she comes over a few times a week to throw in laundry, run the dishwasher, and drive him to and from the health club for classes. Before my mom arrives, she calls him 1.5, 1, and 0.5 hours in advance, to prompt him to get up, get dressed, and be ready to go. (He knows where he's going and why he's going, and he's up for it, he just can't plan to make it happen. He lives in the now.)

My mom would ideally like to cut back to one or two social calls a day, one social visit on the weekend, and medical stuff. She'd like to cut back as much as possible on all non-social and non-medical stuff.

So that means we'd like to be responsible for someone (a virtual assistant?) who would stage wake up/get ready calls to my uncle and to coordinate in real time between my uncle and a taxi service. My mom would still be doing scheduling, asynchronous stuff, and ad hoc stuff, but she wants back her large blocks of time during the work day.

We are thinking of going the virtual assistant route because he refuses in-house help. We do know there are services (both private and state) where someone would hang out in the home and even drive him around. But, he doesn't think he needs it and it makes him very uncomfortable. The last one mentioned to him that she did hospice work and it really made him upset and angry. (He does fine with women instructors at the health club and does best with "dudebro" physical therapists and trainers.) As far as we can tell, he's "content" to putter around in his apartment, eat, listen to the radio, watch TV. He may or may not spend time on the computer and even walk over to Starbucks. I'm not sure about the last part. He thinks he's functional, and he is. But anything requiring the slightest bit of planning/sequential behavior doesn't happen.

He *is* seeing a therapist. (To the degree he grasps his situation, of course he's frustrated, embarrassed, and depressed.) And, eventually, he'll *need* more assistance, and we're prepared to help him accept that when the time comes. But, right now, we think we can get by with logistics. We've been having trouble finding an agency where they'd be willing to *just* do driving: their business model is that they want to be in the home for X hours per week. And the places that *just* do driving can't or won't stage phone calls to him, so there's still a coordination problem.

By some miracle we do have some money to throw at this problem, ~$1000/month give or take, though the less, the better:

1. Is a virtual assistant the right way to go? We would provide the VA with a schedule of when to make brief calls to my uncle and when to coordinate between my uncle and a normal taxi. We don't *think* there'd be any judgment calls the VA would have to make, and he or she'd be able to touch base with us any time if needed. We *do* need a friendly voice with a name who could hit the right emotional note: friendly (even banter-y?), no-nonsense, not-embarrassing, warm but professional.

2. Would a VA be willing to do this, and is the applied emotional intelligence a reasonable expectation? Like, would someone be game? I'm imagining like a smart, emotionally intelligent independent contractor with a great phone voice (either USA-based or really culturally savvy), who will take the time (who we'll pay to take the time) to understand the personality situation.*

*Now that I'm thinking about it are there case workers(?), social workers(?) who would be more appropriate for this? Could we afford them? Could we "customize" what they'd do?

3. How would we titrate/frame responsibilities to make this attractive to a high-quality VA? Would they want more responsibilities? How many "hours" should we be prepared to pay per week to hit the right quality/cost balance? I'm guesstimating that this would be a lot of fragmented time which we could maybe pad out (6-12 hrs/wk?) because it's time-bound and can't be batched.

Bottom line, my mom would like to outsource non-social and non-medical care stuff as much as possible without it being more money, time, and trouble than it's worth. How do we find savvy people and pay them fairly? I am open to my premises being questioned or "being crazy" callouts. We're emotionally close to the situation. Thank you.
posted by zeek321 to Health & Fitness (7 answers total) 1 user marked this as a favorite
(We're in Illinois, USA.)
posted by zeek321 at 2:35 PM on August 8, 2014 [1 favorite]

You can probably hire a "Task Rabbit" person to do this.

My concern is that we tiptoe around people we love and let them run our lives. Your uncle would rather run you and your mother ragged than accept help. That's not fair.

Can you approach your uncle from the angle of "we love you and want to help, I'm sure you'd HATE it if you became a burden to us. We can arrange for a helper to come and do for you. We'll be here to visit you often."

It does no one any good to burn out as a caregiver.
posted by Ruthless Bunny at 2:38 PM on August 8, 2014 [3 favorites]

You might check with a local senior citizens group or AARP. My area, rural oklahoma, has a service where you can sign someone up to get a call once or twice a day as a sort of welfare check. it is staffed by volunteers i think. I cna't for the life of me remember the acronym, but i really doubt it is the only service of its kind. As far as the taxi thing, do you live in a large enough city for Uber? You could probably find a driver or drivers to set up a permanent schedule with through them.
posted by domino at 2:38 PM on August 8, 2014 [2 favorites]

My father lived for 16 years after a stroke that damaged his memory and ability to plan and organize himself in a way that sounds very similar to what your uncle is dealing with. I feel you - brain stuff can be baffling and frustrating like nothing else. However, he had my mom living with him so it was a different scenario than what you've to to manage.

I don't have any first-hand experience with a VA, but as someone who kind of gets where you're coming from, I think it could work with some caveats and combined with maybe a couple of other measures.

A couple of ideas --

1. It sounds kind of obvious, but visual reminders where a huge help. While my dad had my mom there to keep him on task, she simply could not remind him a million times a day what he was supposed to be doing without losing her own mind in the process. So there wound up being a lot of signs and schedules in the house. Huge ones -- poster board and markers with "today's schedule" on it and stuff like that... He groused about it, but he used them. She got huge clocks readable from halfway across the room and those sectioned pill containers for the days of the week with GIANT type on them (he refused to wear his glasses). You might find some "stuff" like that helpful.

2. Meals on Wheels - have you heard of them? Yes, they deliver hot meals to seniors who need them, but they also do a lot of driving and well-check kind of stuff. You might try checking with them in your community to see what they offer. My parents had both volunteered for them for years before my dad got sick, and being able to quickly plug into a group of volunteers and trained professionals in this area wound up being a huge help. When he got somewhat better, my dad was able to drive and deliver some meals himself -- that schedule helped. And the other volunteers knew to keep an eye on him. Maybe something like that?

Take care of yourselves. This is hard stuff.
posted by pantarei70 at 3:10 PM on August 8, 2014 [1 favorite]

When I lived in Manhattan, Kansas, there were a couple of children's museums with hands-on activities for kids. The one we usually went to was small and had a staff of one. It was open very part-time, like a few hours a day, four days a week. I am thinking it was open on weekends and then for blocks of 2 to 4 hours a couple of other days.

They initially had a college student on staff whose major had something to do with career aspirations related to kids. She was wonderful. When she left, they filled it with some not very educated mom or something like that. Quality went way down.

So, based on that, I would try going to the local college and advertising there. I would get a copy of their catalog (or peruse it at the library) and write down all the majors that seem remotely related to medical/elderly care/social work type stuff. The right student may do really well at this and be thrilled to have part-time work.
posted by Michele in California at 3:28 PM on August 8, 2014 [1 favorite]

You mention that he uses a computer. Would he be receptive to getting some of these reminders via a smartphone or tablet? It would be fairly easy to automate a lot of these things (even text messages and phone calls at designated times), but if he really needs a human to nudge him to action, this is a no-go.
posted by nobejen at 5:25 PM on August 8, 2014 [1 favorite]

Your uncle needs home help, regardless of how he feels about it. Your mum needs to stop taking on this responsibility and pass it over, any sort of virtual assistant is not going to cut it. Your uncle's needs are only going to increase, start planning for it now.

You have $1000 per month to spend? That will get your uncle quality help that will give your mother the break she needs. Start phoning local domiciliary care agencies and ask about male carers - the dudebros - and start interviewing. Then introduce them slowly. "Have you met my friend Fred? He has a great interest in local sporting team" or whatever suits your uncle's interests, then start leaving them alone together for increasing amounts of time until your uncle is firm friends with Fred and Fred is administering his meds, doing the shopping, supporting him to clean, whatever. You need to start with a few hours per week then build up. You can also employ your own person, it doesn't have to be through an agency - advertise through the local paper/ listserv for someone with the specific traits and skills your uncle needs.

Your uncle will need full support to live at home before his Parkinson's progresses to the point he needs to move into a nursing hone. The sooner you start this process, and acclimatising him to home help and give your mum a break, the better for everyone involved.
posted by goo at 7:51 PM on August 8, 2014 [7 favorites]

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