Finding the Ideal Caregiver: Essential Considerations When Hiring a Caregiver for your Elderly Parent

Ms. Shamitha’s 73-year-old mother grapples with advanced-stage Parkinson’s disease, requiring constant care due to its degenerative nature. The disease renders her susceptible to falls, causing tremors in her hands and difficulty breathing. Unfortunately, under the supervision of maids, she experienced four falls last year, resulting in bruises and the need for stitches. While she uses a wheelchair outdoors, she navigates her home with a walking stick, a detail Ms. Shamitha has emphasised to the maids who oversee her care.

Despite her mother’s worsening condition, Ms. Shamitha, like many middle-class Indians, feels constrained to rely on maids for her mother’s care due to cost and convenience. In an attempt to save money, she opted for untrained maids. However, recognising her mother’s need for substantial attention, Ms. Shamitha acknowledges the importance of considering professional caregivers. The limitation of professionals not handling additional household tasks like cooking and cleaning is a concern, leading her to weigh the costs of additional services such as laundry and food delivery.

Experts like us aim to highlight the increasing risks associated with untrained Individuals caring for frail or sick elderly individuals—a concerning trend we’ve observed. In our experience, bed sores and urinary tract infections are prevalent issues arising from inadequate care provided by maids to immobile seniors. Bed sores, a sign of insufficient turning, can lead to infections and, in severe cases, maggot infestation, necessitating hospitalisation, as described by Ms. Sowmya, who has attended to such conditions.

Tasks that may seem simple, like transferring a bedridden senior to a wheelchair, can become painful or fatal if mishandled by untrained individuals. Ms. Sowmya emphasises the potential dangers, noting that manual transfers, often done singlehandedly, can result in bruises, particularly when the basics of caregiving, such as transferring legs safely, are not known. The lack of proper training poses a significant risk, especially for diabetic patients, where improper handling can have fatal consequences.

Observing this growing trend, we conducted a small study revealing that nearly 90 percent of caregivers lack the necessary experience or training for senior care duties. While the figure may raise skepticism, it reflects the stark reality. Employers often neglect to provide training, expecting these helpers to undertake nursing functions like medication management, tube feeding, insulin injections, and complex tasks related to feeding and grooming. The lack of education poses a significant risk, potentially leading to unsafe conditions for older adults. Untrained caregivers may struggle with complex nursing care instructions, leading to mental exhaustion and a heightened risk of physical abuse directed at the patient.

We strongly recommend seeking professional help when ‘maids care’ falls short, especially if they struggle to provide appropriate care to sick and frail elderly individuals. This becomes crucial during health deteriorations or when family members lack the time or ability to supervise. Monitoring is vital, emphasising that caregivers alone cannot be solely responsible for managing the patient. Older adults with mild to moderate disabilities or multiple medical conditions requiring round-the-clock nursing care should have trained caregivers. This includes those needing frequent blood sugar monitoring, insulin injections, Ryle’s tube feeding, wound dressings, vital signs monitoring, and management of multiple oral medications, all of which benefit from trained ‘nursing’ care.

When an older adult faces significant functional impairment, extending beyond the capacity of a single paid caregiver, it becomes imperative for a family member to provide additional support. Unfortunately, some families mistakenly believe that once they’ve hired a caregiver, their responsibilities are over, neglecting the necessity for round-the-clock management. It is crucial to ensure that both the paid caregiver and family caregiver receive adequate rest and can cope with the physical and emotional demands of their roles. This is particularly vital considering the exhaustive nature of caregiving, both physically and mentally, as we have addressed in our discussion on ‘compassion fatigue.’

During our recent visit to one of our skilled nursing homes, our care manager demonstrated the importance of soft skills in communicating with frail, elderly individuals. In this instance, she expressed care by gently asking an elderly, slightly demented lady about her breakfast habits. Recognising the challenges in getting her to eat, the manager employed a tactic, mentioning that the breakfast was ‘brought from the church,’ involving her pastor. Such communication skills are essential when dealing with unwell elderly individuals who require constant attention and care, often resembling the needs of children.

Few family caregivers may choose caregiving, while others face it as an unexpected responsibility. Same with paid caregivers, only very few see it as a profession with a ‘calling’ behind it. We, social gerontologists at advantAGE seniors view caregiving, whether by a paid professional or a family member, as more than just a job—it’s a calling. Below, we’ve outlined several qualities of a professional caregiver that you should consider when selecting someone to care for your loved one.

Explore the 10 unique skills to look for in a caregiver.

1. Compassion:

In an another section, we extensively covered the significance of ‘compassionate caregiving’ and its profound impact on patients. Compassionate caregiving involves understanding others’ distress and having a genuine desire to alleviate it. Given that many elderly clients face hopeless and distressing situations, especially with chronic conditions, being caring and empathetic is a fundamental prerequisite for caregivers. Without compassion, all other qualities hold little meaning or impact in the realm of caregiving.

2. Communication:

Effective communication skills, both written and verbal, are indispensable in this role. In our coma facility, even when patients are in a comatose state, we insist that nurses and caregivers speak to them before each task—a seemingly futile exercise with meaningful implications. Additionally, interaction with family members or other caretakers is necessary to discuss care and provide updates on the patient’s condition. Communicating with elderly patients is inherently complex due to the normal aging process and associated deficits. The elderly, particularly those advanced in age, may exhibit memory decline, slower information processing, hearing loss, and visual impairments. While words may lose meaning for someone with dementia, a substantial portion of human communication is non-verbal. Inadequate communication with this vulnerable and increasingly frail elderly population can compromise efforts to deliver quality care.

3. Observation:

The significance of communication is acknowledged, but it extends beyond merely talking or listening to elderly patients. Due to diminished faculties, articulating health concerns can be challenging for them. They may actively conceal issues due to fear of revealing deterioration. As a caregiver, you bear the absolute responsibility of being the patient’s eyes, ears, nose, and touch. Utilize your observation skills to discern subtle clues about the person’s daily changes, noting signs of a sudden stroke, injury, or gradual shifts like reduced food or fluid intake, decreased mobilization, or increased drowsiness. Vigilance in the patient’s environment is crucial to address potential hazards and prevent falls.

4. Interpersonal Skills:

Whether you’re working with a patient at their home or in a care setting, caregiving is inherently social, involving interactions with many people. While being an extrovert is not a requirement, possessing a reasonable level of social skills greatly aids in establishing rapport and building trust. As a caregiver, there are moments of monotony and exhaustion, and strong interpersonal skills serve as a source of recharging. Many patients, feeling hopeless and isolated, find comfort in the positive demeanour of a happy and jovial caregiver. Recognise that, for numerous patients, the caregiver is their sole point of contact, underscoring the vital importance of interpersonal skills.

5. Time Management:

As a caregiver working with a single patient, you essentially act as your own manager, responsible for efficiently organising your time to ensure tasks are completed as scheduled. This requires adept multitasking, task prioritisation, and efficient work, all while finding moments for relaxation. In a care setting with multiple patients, your shift may be demanding, leaving limited free time. Additional responsibilities like report generation, managing medication, and nutrition charts add complexity. Successfully prioritising tasks and managing time without compromising quality is the hallmark of an effective caregiver.

6. Methodical:

Precision and organization are crucial qualities in a caregiver. Just an example, searching around for items like a micropore can be time-consuming. The saying “a place for everything, and everything in its place” holds true for caregivers, ensuring efficiency and avoiding unnecessary searches. Knowing the location and expiry of items, timely replenishing the medicine box, and ensuring the readiness of emergency medications and equipment like oxygen concentrators contribute to a methodical approach. In emergencies, every second counts, and a caregiver should be able to locate necessary items promptly.

7. Hygiene:

Personal hygiene is foundational for skin health, particularly in older adults. Caregivers play a pivotal role in addressing potential lapses in hygiene that some older adults may experience. Engaging in open dialogue with clients about their grooming habits is essential to find effective strategies for maintaining cleanliness. Caregivers are tasked with upholding high standards of cleanliness, assisting clients with regular bathing, dressing, and contributing to light housekeeping to create a clean and germ-free environment.

8. Patience:

While some people naturally possess limitless patience, it’s a virtue that caregivers must cultivate. Dealing with elderly clients facing various challenges—whether mental, physical, or both—requires enduring patience. Clients may exhibit cranky attitudes, impaired communication abilities, or irrational behavior, leading to frustrating situations. Caregivers must remain calm, composed, and wear a smile even in challenging moments. Having a nearly unflappable personality is vital for successful patient care; otherwise, one may fall short as a caregiver.

9. Initiative:

Caregivers often find themselves working alone in the patient’s home, without immediate instructions for daily activities. While specific medical instructions may come from treating doctors and nurses, ADLs (Activities of Daily Living) require proactive decision-making. In the absence of prompt instructions, caregivers must show initiative, making informed decisions and taking action in emergencies. Excuses like “You didn’t tell me” are not acceptable, emphasising the importance of caregivers demonstrating initiative without constant prompting.

10. Physical Strength & Stamina:

Family caregivers, particularly elderly spouses with declining strength, often struggle with the physical demands of caregiving, leading to a potential decline in the quality of care provided. Caregivers engage in diverse physical tasks, from household chores to lifting patients. Recognising the intensity of the job, professional caregivers endure long periods on their feet, sometimes throughout their entire shift. Physical strength and stamina are essential aspects of caregiving, demanding a combination of physical, mental, and emotional strength.

This challenging profession requires a unique fortitude, and possessing the qualities mentioned above makes one well-suited for the role.

Job Description is a Must

When crafting a job description for in-home caregiving, whether for an individual caregiver or an agency, it's crucial to articulate your family's specific needs and expectations for the caregiver. Identify whether you require expertise in dementia care and specify the type of personal care assistance expected.

To create an effective job description, start by compiling a comprehensive list of tasks you want the in-home caregiver to undertake. This task list serves as a foundation for clarifying the skills, qualifications, and past experiences you desire in a paid caregiver. Use this information to structure your job description, including the following sections:
- Roles and responsibilities
- Qualifications and education requirements
- Preferred skills and desired traits
- Additional notes/information

It's essential to mention specific details such as the presence of pets in the home or any other unique aspects that potential candidates should be aware of. Even if you decide not to publicly post the job description, outlining caregiving tasks and expectations will provide clarity on your needs. This clarity, in turn, facilitates the identification of in-home caregivers who align well with your requirements.

Monitoring the caregiver is essential

To ensure your needs are consistently met, it’s essential to regularly evaluate your hired caregivers. Initiate the relationship by providing a detailed list of tasks and responsibilities to the caregiver(s)/agency. Collaborate to create a daily care plan based on this list, ensuring agreement before the first visit.
Regularly review the care plan, ideally every 20-40 days, to monitor the work, make necessary adjustments, and address any misunderstandings. Conflicts may arise between the caregiver’s actions and the care receiver’s preferences, and resolving such conflicts can be challenging. In such cases, having an agency representative to assist in managing these issues can save you both time and stress.

Avoid common mistakes while employing a caregiver

To navigate the complexities of caregiving, steer clear of these common mistakes that can pose challenges for families. Be vigilant in avoiding these situations whenever possible.

1. Paying caregivers “under the table”:

While hiring an independent caregiver might seem cost-effective, paying them off the books create a bad precedent. This practice can establish expectations for “cash incentives,” and the caregiver might react negatively if not provided regularly. Better to offer tokens of appreciation, especially on festival days, is a good way to acknowledge their good work. We do not discourage tipping; in fact, we encourage it.

2. Granting excessive control or access to paid caregivers:

Family members should maintain involvement in their loved one’s care, even with trusted caregivers in place. Lack of family oversight can make older individuals susceptible to abuse, neglect, or exploitation. Staying informed about their loved one’s life is crucial for preventing potential issues. Many caregivers take excessive control and start. Never delegate decision making to the most trusted caregivers. Better to ask them to stay within the mandate.

3. Naming a paid caregiver as a healthcare or financial agent:

Although it might seem convenient, appointing a longtime caregiver as a healthcare or financial agent can lead to vulnerability. Trusting a caregiver with significant roles in powers of attorney poses risks, and it’s advisable to choose someone outside the usual caregiving role, even considering professionals in some states.

4. Maintain Boundaries in Family Matters:

It’s crucial to prevent caregivers from becoming involved in family affairs over time. As familiarity grows, caregivers may unintentionally assume roles resembling family members. In some instances, caregivers have been observed delving into matters unrelated to caregiving. This involvement, often marked by gossiping, can disrupt the harmonious atmosphere of a home. Occasionally, caregivers may inadvertently act as catalysts for family dysfunction, potentially pursuing personal goals that diverge from their caregiving responsibilities. Establishing and maintaining clear boundaries helps preserve a healthy caregiver-patient relationship.

4. Lack of a Contingency Plan:

While the concept of aging in place with caregivers is commendable, it might not be the optimal choice for the entire duration of an individual’s later years. The need for skilled nursing care may arise, or securing 24/7 caregivers could become financially or logistically challenging. It is crucial for every family to establish a plan for the scenario when remaining in the home is no longer viable. Moreover, if the decision involves depending on only one or two individual caregivers, having a comprehensive plan becomes imperative. Contingency measures should be in place for instances where they might fall ill or encounter circumstances that hinder their ability to continue working.