Monday, September 22, 2008

Caregiving in the Home

For family caregivers responsible for seniors: remember to breathe. You are no good to anyone if you cannot breathe. Caregivers need quality of life assessments, especially for the frail spouse. Demand that your doctors provide assessments and consider home support. Reassess the polypharmacies, contact your pharmacist for help in ensuring that prescriptions are necessary as often some may be contraindicated.

Another issue arises for seniors cared for in their own homes by outside agencies or hired professionals. They are at risk from workers, such as PSWs who can prey on them physically, emotionally and financially. The recent (2007) Sue Grafton novel, T is for Trespass, is a mystery novel about an ailing senior at home. It demonstrates the vulnerability of seniors to those who may prey on them. Our society has moved from a nursing model of care (Nursing Homes) in which the majority of staff were highly trained nurses with experience in dealing with seniors who have resistance, denial, anger, chronic diseases and exhibit mobility and lifting issues, as well as complex pharmacologies. It is only nursing staff, or those with special certificates, who are legally able to administer medications.

There are agencies that recruit caregivers from other countries. Some caregivers may be 'nannies' with little experience in eldercare. The agencies can placement fees to a caregiver, and the Federal Government supports a Live-in Caregiver Program. The Toronto Star quotes $4500 for one agency, with 34,000 caregivers in Canada - we're talking big bucks). It is important to encourage worker programs, but I question Temporary Worker Programs. It is a difficult situation, as we are desperate for health care professionals, and standard vary around the world.

Eldercare in Canada is currently an unregulated industry. The majority of staff in what we now call Long-Term Care, has many workers who are unregistered and untracked and may or may not have PSW qualifications. Whether a PSW works in the home or in a profit or non-profit agency workers can move from employer to employer if they are fired or prove to be inadequate or abusive. No controls are in place, as there are for preschool, home caregivers for children, i.e. nannies. Those applying from other countries can forge documents and recommendations, which an unsuspecting family or agency could not explore. Other countries do not provide the kind of training that we find in, for example, the British system of training nannies. Some are not necessarily trained in the ways of physical therapy, chronic diseases, mobility and lifting issues.

With a fourteen-module PSW course in Canada there is standardization of practices and ethics, but agencies do not have a way of knowing about the type of education a worker has received in other countries. Canadian agencies continue to hire and recruit absolute strangers to live and work closely in Canadian homes with our loved ones. This is an industry that needs to be regulated. Youtube is filled with violent incidents recorded by suspicious family members in the United States. This is a situation that must be prevented from occurring in Canada.

If you are thinking about hiring caregivers in the home ensure that their references are accurate. Check out their education, experiences, qualifications and reasons for termination of employment, if applicable. Pop in or phone frequently to ensure that there is a quality of care in the home. Set up a contract with a professional agency to determine standards of care. YouTube shows startling (American) videos of Alternate Decision-Makers who have been suspicious of their hired caregivers. A wise person ensures the safety of their loved ones by thoroughly checking out employees. American College recruitment videos show the dignity that can be accorded to keeping seniors in their homes. This is an honourable profession and one which must be respected. Our elders deserve it.

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