Care & cleaning services for elder
May 26, 2021 3:58 PM Subscribe
My near-centenarian grandfather needs a stable, comfortable living situation and his family is gradually warming to the idea of hiring a professional to assist in his care on a continuing basis. Maybe. I'm hoping for some advice about norms/expectations, because no one in the family has experience with this.
My grandpa is mobile and self-sufficient in many areas of his life, he is mentally present, rarely confused (but sometimes forgetful), proud. Now and in all the time I've known him I would describe him as a kindly egomaniac in that it's his nature to only ever reflect on himself, his past accomplishments, his day-to-day net worth, his own worries and concerns- but he is highly social, always friendly, never angry, easy to chat with (if you yell -- he's deaf but too proud/cheap for good hearing aids).
Since his retirement many years ago he has bounced around the homes of his four children (my mother's generation) who live variously in North America. Hosting him is a burden- he is a slob, always having had a mother or wife or children to clean up after him. This shouldn't have been tolerated, but it was, and now he legitimately is too old to do much of his own tidying up. Further, his lifetime of having had this privilege prevents him from easily/consistently apprehending that it is a major burden to host him. His children are themselves aging and all of them have come to dread the hot-potato responsibility of taking care of him.
And they shouldn't have to bear all the responsibility of taking care of him! He is a fairly rich man; ideally he would have a home of his own in the same town as one of his children, somewhere with a nearby medical center, and employ a part-time or full-time nurse/caregiver to handle his daily needs, keep his diet in check, and be a continuing (but not sole!) social outlet. He can easily afford this and he could be healthier and happier in that life, if he could accept it for himself.
However, my grandpa greatly fears death and loss of his personal freedom (which is how he would perceive this) and he resists any life change that would suggest he is coming closer to the end of his life. He is also very tight with his money. He will neither want to have a caregiver nor pay for a caregiver. Until now his children have indulged him, year after year, but I feel the dam is breaking after the covid year, and if I can provide some guidance to them about better options then change is possible. I want my mother to have freedom of her own in her impending retirement. And I want her and her siblings to be free from guilt/resentment when considering my grandpa.
I guess that is a whole lot of largely superfluous context to a set of simple questions: what is involved in hiring a nurse/caregiver? (Is there a better term for this sub-profession?) How does someone proceed in finding/vetting one? Where can I look for reliable information? Am I off track in my understanding about the work such a person does?
And further: how can I help my mother and her siblings become more comfortable with this idea? And my grandpa? I imagine the situation I've described is far from uncommon.
My grandpa is mobile and self-sufficient in many areas of his life, he is mentally present, rarely confused (but sometimes forgetful), proud. Now and in all the time I've known him I would describe him as a kindly egomaniac in that it's his nature to only ever reflect on himself, his past accomplishments, his day-to-day net worth, his own worries and concerns- but he is highly social, always friendly, never angry, easy to chat with (if you yell -- he's deaf but too proud/cheap for good hearing aids).
Since his retirement many years ago he has bounced around the homes of his four children (my mother's generation) who live variously in North America. Hosting him is a burden- he is a slob, always having had a mother or wife or children to clean up after him. This shouldn't have been tolerated, but it was, and now he legitimately is too old to do much of his own tidying up. Further, his lifetime of having had this privilege prevents him from easily/consistently apprehending that it is a major burden to host him. His children are themselves aging and all of them have come to dread the hot-potato responsibility of taking care of him.
And they shouldn't have to bear all the responsibility of taking care of him! He is a fairly rich man; ideally he would have a home of his own in the same town as one of his children, somewhere with a nearby medical center, and employ a part-time or full-time nurse/caregiver to handle his daily needs, keep his diet in check, and be a continuing (but not sole!) social outlet. He can easily afford this and he could be healthier and happier in that life, if he could accept it for himself.
However, my grandpa greatly fears death and loss of his personal freedom (which is how he would perceive this) and he resists any life change that would suggest he is coming closer to the end of his life. He is also very tight with his money. He will neither want to have a caregiver nor pay for a caregiver. Until now his children have indulged him, year after year, but I feel the dam is breaking after the covid year, and if I can provide some guidance to them about better options then change is possible. I want my mother to have freedom of her own in her impending retirement. And I want her and her siblings to be free from guilt/resentment when considering my grandpa.
I guess that is a whole lot of largely superfluous context to a set of simple questions: what is involved in hiring a nurse/caregiver? (Is there a better term for this sub-profession?) How does someone proceed in finding/vetting one? Where can I look for reliable information? Am I off track in my understanding about the work such a person does?
And further: how can I help my mother and her siblings become more comfortable with this idea? And my grandpa? I imagine the situation I've described is far from uncommon.
One thing to keep in mind is that, no matter how much you might want your mother and her siblings to have a break from your grandfather, you can't make them make the better choice. And you can't stop him from refusing help from a caregiver/firing the caregivers/complaining so much to your mom and other family that they give in and discontinue the caregiver. Just go into it with that understanding in the back of your mind and you will feel much better throughout this whole process.
This article from Family Caregiver Alliance has good advice on how to broach the subject, how to find someone, and how to come up with a reasonable job description. You can MeMail me for a more detailed document on training and duties-I can't find a web version.
Unless your grandfather has actual medical needs (bandage changes, injections, things like that), you need a caregiver but it's unlikely that you need a nurse. Caregivers can help with bathing, dressing, grooming, setting up his medication or reminding him to take it, some tidying (but usually not heavy housekeeping) and some companionship. You will probably need more than one person and you will probably want to start with *some* help and work up. For example, start with someone 4 hours a week and package it for him as a housekeeping service, rather than a care service.
posted by assenav at 4:18 PM on May 26, 2021 [6 favorites]
This article from Family Caregiver Alliance has good advice on how to broach the subject, how to find someone, and how to come up with a reasonable job description. You can MeMail me for a more detailed document on training and duties-I can't find a web version.
Unless your grandfather has actual medical needs (bandage changes, injections, things like that), you need a caregiver but it's unlikely that you need a nurse. Caregivers can help with bathing, dressing, grooming, setting up his medication or reminding him to take it, some tidying (but usually not heavy housekeeping) and some companionship. You will probably need more than one person and you will probably want to start with *some* help and work up. For example, start with someone 4 hours a week and package it for him as a housekeeping service, rather than a care service.
posted by assenav at 4:18 PM on May 26, 2021 [6 favorites]
It should be pretty easy to hire a woman who can come in daily and "do" for him - cooking, cleaning, shopping, errands if that is all he needs. I would think from your description, he wouldn't have too much of a problem with that, once he accepted the idea of having his own place instead of living with his kids. It would be possible to rent an apartment or townhouse and have someone come in, say 4-8 hours a day to the things a traditional wife would do for him. Many companies (like this) can help staff a position like this or you can hire directly. If he is not a native English speaker (assuming he lives in an English speaking country) you might want to hire someone from his own ethnic group.
Another option is an apartment in an assisted living facility. Some of the high end ones are very nice - you have your own apartment but centralized dining hall plus you can contract for additional services. This might be more flexible but also trigger more resistance.
posted by metahawk at 4:20 PM on May 26, 2021
Another option is an apartment in an assisted living facility. Some of the high end ones are very nice - you have your own apartment but centralized dining hall plus you can contract for additional services. This might be more flexible but also trigger more resistance.
posted by metahawk at 4:20 PM on May 26, 2021
The AARP has a good breakdown of what you’re looking for.
posted by MexicanYenta at 4:57 PM on May 26, 2021 [1 favorite]
posted by MexicanYenta at 4:57 PM on May 26, 2021 [1 favorite]
When my grandparents were still living in their home, they had a PSW who came in to doing things like you described. She helped them by cooking, light cleaning, helping with dressing/bathing, driving to and from appointments when they couldn't drive anymore, took them to see friends, etc. In my province (Ontario) what you are probably looking for is a personal support/care worker (PSW). The person my aunt hired was referred from the local seniors centre to care for her father in law several years ago, and it worked out that the PSW was looking for work again when my grandparents needed care a couple years ago. In terms of vetting her, as I understand it she had excellent references and a clean vulnerable sector police check (the kind you need to work with children and seniors in Ontario).
My grandfather was very resistant to the idea and warmed to it over time. Having the PSW around gave him back freedom in his life from having to depend on my aunt for care, who couldn't always be there when he wanted her to be. He had someone who was there on a consistent basis and allowed them to resume activities like going out for social visits with friends. It also gave my aunt and my mom peace of mind knowing someone was there with my grandparents during the day keeping an eye on things. Having the PSW around allowed them to stay in their home for several more years until their care needs went beyond what she could provide and they moved into long term care. For me as a grandkid, I was very grateful to the PSW for the excellent care she gave my grandparents when they needed it. I knew they were safe when she was there, and I can't thank her enough for that.
posted by snowysoul at 6:23 PM on May 26, 2021 [4 favorites]
My grandfather was very resistant to the idea and warmed to it over time. Having the PSW around gave him back freedom in his life from having to depend on my aunt for care, who couldn't always be there when he wanted her to be. He had someone who was there on a consistent basis and allowed them to resume activities like going out for social visits with friends. It also gave my aunt and my mom peace of mind knowing someone was there with my grandparents during the day keeping an eye on things. Having the PSW around allowed them to stay in their home for several more years until their care needs went beyond what she could provide and they moved into long term care. For me as a grandkid, I was very grateful to the PSW for the excellent care she gave my grandparents when they needed it. I knew they were safe when she was there, and I can't thank her enough for that.
posted by snowysoul at 6:23 PM on May 26, 2021 [4 favorites]
+1 for working any personal connections. My grandma got on much better with a woman from church who needed work than the agency caregivers she’d previously had (who were sweet and tried hard to build a relationship, grandma just wasn’t having it).
posted by momus_window at 6:59 PM on May 26, 2021
posted by momus_window at 6:59 PM on May 26, 2021
For my dad, we use an agency that provides different levels of care, ranging from nurses to companions. My dad doesn’t (yet) need any nursing care or help with things like dressing or showering, but he can’t be left alone anymore because of his dementia and so the people who come to help offer companion/helper service like driving him to appointments, making him lunch, and just generally hanging out. It’s been a huge help!
Anyway, I strongly recommend using an agency because the people they employ will be vetted and background checked, and they are professionals. Caregiving is hard, hard work and at least in the case of the agency we use, we’ve been really impressed with how unflappable and experienced the caregivers have been. It’s a specific skillset like any other job and some people really have a gift for it. Asking around and seeing who people you know and trust have used for their own loved ones is very helpful.
posted by cakelite at 7:21 PM on May 26, 2021 [4 favorites]
Anyway, I strongly recommend using an agency because the people they employ will be vetted and background checked, and they are professionals. Caregiving is hard, hard work and at least in the case of the agency we use, we’ve been really impressed with how unflappable and experienced the caregivers have been. It’s a specific skillset like any other job and some people really have a gift for it. Asking around and seeing who people you know and trust have used for their own loved ones is very helpful.
posted by cakelite at 7:21 PM on May 26, 2021 [4 favorites]
My father lives in an independent living community for seniors. He has an apartment but they also have a dining room where he can get one meal a day. They provide a lot of activities - concerts, lectures, transport for shopping. And they have an in-house agency providing this kind of care. It's handy because we can increase or reduce it according to his needs. The apartments include some housekeeping - weekly cleaning and linens washed. We also contract separately for ever more services as his needs increase. If your grandfather is willing to consider this kind of housing it has some pluses - community, activities that are accessible without having to go somewhere or be dependent on a family member to get there.
We found it and prior caregiving agencies through a mix of talking to my father's geriatrician and other people we knew dealing with elder care. Careful vetting is obvious extremely important with all of these sorts of services and yeah that's the advantage of an agency. Also if he reaches the point of needing more than 4-8 hours of care an agency is more able to cover multiple shifts.
posted by leslies at 5:12 AM on May 27, 2021 [1 favorite]
We found it and prior caregiving agencies through a mix of talking to my father's geriatrician and other people we knew dealing with elder care. Careful vetting is obvious extremely important with all of these sorts of services and yeah that's the advantage of an agency. Also if he reaches the point of needing more than 4-8 hours of care an agency is more able to cover multiple shifts.
posted by leslies at 5:12 AM on May 27, 2021 [1 favorite]
"Home health aide" is one keyword you might try. Such a person can help with activities of daily living (ADLs) like getting dressed, bathing, meals, dishes, laundry, as well as conversation, taking him to medical appointments, and running basic errands. An aide can typically come work with him in any living situation -- eg if he were living with a relative, you could still hire an aide to come in and just do things for him; if he's in an assisted living apartment but needs something more than they provide you can hire an aide to come in just to help him.
You can hire someone privately (i.e. just by contracting with them directly) or through a home health agency. An agency is typically more expensive per hour but has the advantage of doing some vetting and being able to arrange substitutions/coverage if your primary person gets sick, etc. We've worked with an agency and they schedule caregivers in chunks as short as 4 hours, up to 12 hour shifts, and they can do any frequency -- you could hire somebody to come for 4 hours a couple days a week, or you can get a combination of people for 24 hour/7 days a week, and you can change the arrangement as needed. It's nicer for him if you can consistently get the same person or people.
Depending on his condition there may be some longterm care insurance coverage or Medicare coverage for home health aides for ADLs (typically this will cover only a certain number of hours per week). Sometimes a local council on aging (or equivalent) can help with costs or referrals. Sometimes there are local programs such as Meals on Wheels (where they would come deliver meals once or twice a week and come chat a bit) or people who volunteer to help seniors with tasks/visits.
posted by LobsterMitten at 6:44 AM on May 27, 2021
You can hire someone privately (i.e. just by contracting with them directly) or through a home health agency. An agency is typically more expensive per hour but has the advantage of doing some vetting and being able to arrange substitutions/coverage if your primary person gets sick, etc. We've worked with an agency and they schedule caregivers in chunks as short as 4 hours, up to 12 hour shifts, and they can do any frequency -- you could hire somebody to come for 4 hours a couple days a week, or you can get a combination of people for 24 hour/7 days a week, and you can change the arrangement as needed. It's nicer for him if you can consistently get the same person or people.
Depending on his condition there may be some longterm care insurance coverage or Medicare coverage for home health aides for ADLs (typically this will cover only a certain number of hours per week). Sometimes a local council on aging (or equivalent) can help with costs or referrals. Sometimes there are local programs such as Meals on Wheels (where they would come deliver meals once or twice a week and come chat a bit) or people who volunteer to help seniors with tasks/visits.
posted by LobsterMitten at 6:44 AM on May 27, 2021
To build on what leslies said above, my great aunt actually felt like she gained back a lot of her independence after moving into a senior living community. Meals and housekeeping were a lot more reliable, and she didn't have to rely on her children's schedules and whims in order to go places. If your grandfather balks at the cost, maybe increased independence would be a good selling point.
posted by SamanthaK at 10:51 AM on May 27, 2021
posted by SamanthaK at 10:51 AM on May 27, 2021
Is he a USA veteran? If it's mostly the money preventing him from hiring a home health aide I discovered that my elderly aunt qualified through the VA for 2 hours twice a week or 3 hours once a week for a free aide. She had a slew of outside doctors but maintained a connection (yearly primary care appointment) with the VA for the free perks. (Free audiology and FREE HEARING AIDS!) Of course 4 hours a week isn't very much help, but it might ease him over the money hump by removing that barrier. He would be free to hire the aide, if he liked her, for more hours if he wished. I bet this benefit could move with him as he moved about the country, since VA benefits are national and not dependent on state benefits.
This aide did errands, washed dishes, did laundry etc. because that's what my aunt wanted, but I imagine there's a wide range of tasks this person could do.
posted by citygirl at 10:52 AM on May 27, 2021
This aide did errands, washed dishes, did laundry etc. because that's what my aunt wanted, but I imagine there's a wide range of tasks this person could do.
posted by citygirl at 10:52 AM on May 27, 2021
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One of these women was a friend of a friend of my uncle's who needed some supplemental income. The other was hired directly as a home helper but I'm not sure how (service? ad? truly no idea sorry).
posted by phunniemee at 4:17 PM on May 26, 2021 [4 favorites]