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Guidelines can help raise comfort level with in-home health aide

Wanted: licensed caregiver, to provide full-time, at-home care for elderly parents guaranteed to balk over a complete stranger invading the privacy of their home.

Indeed, who ever thought their home would double as a caregiver's workplace?

People 65 or older — our fastest-growing population segment — increasingly are being persuaded, cajoled and otherwise prevailed upon by their children to open their doors to paid caregivers, whose presence redefines their home.

In some cases, the health aides are welcomed and become part of the family. In others, elders may see them as intruders, and lash out or curse while getting bathed or fed.

Most folks say they prefer staying at home to moving into a facility or moving in with relatives or friends, according to a 2007 AARP survey. Home offers familiarity, privacy, independence. And in some cases, people stay put because they can't sell their house.

But spending the golden years at home often means adapting both home and mind-set to accommodate live-in caregivers.

The initial hurdle is psychological.

"Once we got my dear, sweet mother-in-law in her 80s past the first battle — 'I don't need any help, I am doing just fine' — she still didn't want caregivers in her house who weren't part of her family," said Cheryl Phillips, a San Francisco-based doctor specializing in geriatrics, and past president of the American Geriatrics Society.

"How many of us would want someone we don't know — and may not like — living in our space, creating a very intimate relationship not based on our choices?" she asks. "Do the health aides get to watch your TV? Can they park their car in your garage? Can their kids visit? Each point may get negotiated."

Experts offer these tips for ushering in an aide with minimum stress:

Take it slow: Introduce the health aide into the home gradually, in shorter shifts, said Dr. Eric Rackow, a professor at New York University School of Medicine and president and CEO of Senior Bridge, an organization that manages at-home care.

Be prepared, he said, for the older person to struggle at first with this new reality: "Not only is someone sharing my home, but whether it's four hours or eight or 24 hours a day, I'm dependent on a quote-unquote stranger."

The other side: Don't forget that aides have their own lives, too. "To demonstrate concern for an aide," said Rackow, "consider showing her where she can comfortably put her personal things, and offer to add some foods that she might enjoy to the shopping list — especially if the aide will be working long days or living in."

Protect valuables: "I encourage seniors to think of their aide like anyone else coming to your home to provide a service," said Shellie Williams, a doctor specializing in geriatrics at the University of Chicago Medical Center. "Therefore you should not leave out in open sight cash or sensitive legal, financial or medical information, or credit cards." And of course, verify identity and have a family member run a background check before admitting a stranger into your home.

Establish ground rules: As Williams puts it, "This is your home," not the caregiver's.

Remember you're the boss: "Aides are employees; we hire them to provide care," said Debra Greenberg, a psychiatric senior social worker in geriatrics at Montefiore Medical Center in New York City. "Becoming a part of the home may set up an unrealistic expectation if we think of aides as surrogate family."

Lines do blur: Some families bond with caregivers, breaking bread over dinner. But don't lose sight of the work relationship, said Marki Flannery, president of Partners in Care, an affiliate of the Visiting Nurse Service of New York. "You don't just want someone 'nice.' You want someone who has been trained in the many safety and care skills needed to provide the client with the best possible care," she said.

"Don't hire someone you think is going to be a good friend, but rather hire someone who is trained to act like a guest in the client's home — friendly but professional," Flannery said.

on the web

Getting started

with a health aide

Online family resources include:


The Eldercare Locator:

National Association of Professional Geriatric Care Managers:

A Place for Mom:

Family Caregiver Alliance:

Bureau of Labor Statistics, profile of home health aides:

National Aging in Place Council:

Associated Press

Guidelines can help raise comfort level with in-home health aide 09/21/10 [Last modified: Tuesday, September 21, 2010 7:43am]
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