As Alzheimer’s progresses, the person with the disease will likely need a level of supervision and assistance that one caregiver can’t provide without assistance. Often, this situation necessitates that professional caregivers come into the home.
It’s not uncommon for people with dementia to resist this change. Having to spend the day with a person you’ve never met and allowing them to help you perform some of the most intimate self-care tasks understandably makes some people with dementia feel uncomfortable and vulnerable. People with dementia don’t have the cognitive skills and emotional control to cope with major changes. Also, cognitive changes make it more likely for the person to feel threatened by or suspicious of a new person in their home. And the person doesn’t have the reasoning skills to understand why it’s necessary for the professional caregiver to be there. Keep all of this in mind if you encounter resistance from the person. Rather than trying to reason with them, validate their feelings, reassure them that everything is going to be OK, and focus on the positives in the situation. Try some of the following approaches to ease the transition.
Reframe the caregiver’s role
Some family caregivers have found it helpful to use language to describe the new care provider that doesn’t threaten the person with dementia’s sense of authority or independence. Some people refer to the new person as an “assistant” or a “housekeeper.” Frame the reason for the aide being in the home in terms of the caregiver’s needs (“I’m so busy and I need help with things around the house”) rather than the person with dementia’s need for supervision and care.
It might also be helpful to help the person get acquainted with the new care provider by having them come to visit while the primary caregiver is present. The caregiver could introduce the aide as a friend of theirs to make the person with dementia more comfortable. After a “visit” or two, being left alone with the aide may cause the person with dementia less anxiety.
Give the caregiver a head start
Give the caregiver a head start by helping them get to know your loved one. Prepare an introduction document with useful information they’ll need to work with the person with dementia. Include details such as:
- What triggers anxiety or irritation in the person
- What soothes them when they’re upset
- Effective redirects – to a snack, a topic, an activity
- Personal history, including birthplace, hobbies, career, military service
- Information about important people in their life
- Details about their daily routine
- What their cognitive strengths and weaknesses are
- Specific instructions for the self-care tasks the caregiver will need to help the person perform, including language used to describe sensitive tasks,
Make sure it’s a good fit
If the professional caregiver is a mismatch with the person with dementia in terms of personality or level of training, it will be much more difficult to help the person with dementia feel comfortable with them. If possible, involve the person with dementia in the process by asking for their input or even having them present at the interview (if possible).
Here are some questions to consider asking when choosing an in-home professional caregiver
- Tell me about your experience as a caregiver.
- What do you like and dislike about the caring profession?
- Do you have training in dementia care?
- Are you trained in first aid and CPR?
- Can you perform transfers or provide weight-bearing care?
- Describe your experience caring for people with dementia.
- Do you have references?
- What days and times are you available?
- My loved one sometimes is resistant to care, insulting, and is prone to dementia-related behavior. (Describe a situation that is likely to arise) How would you respond?
- Are you willing and able to provide reliable transportation for my loved one?
- Describe your other commitments. Would you be available for weekend respite care?
Here are some questions to ask when choosing an agency:
- Is your agency licensed with the Texas Dept. o f Aging and Disability Services?
- Are the caregivers bonded and insured?
- How extensive are your background checks?
- How would issues and concerns be addressed?
- Would we have the same caregiver every time?
- Ask them to provide a quote for hourly rates before they visit your home.
- Do you have a registration fee, trip fee, or minimum hours?
- Do your rates increase on nights or weekends?