Dad (99) has been taking care of Mom (97), and still thinks he can carry on. Mom is incontinent with dementia. He has been talking more, and getting forgetful. Forgets to take his medication, and give Mom hers. I live at a distance, and try to get down to help when I can. The Medicare nurse that comes in 3 times a week recommended a home health agency, and a consultant will be coming in tomorrow to talk about getting help. I am Medical POA, but was told Dad is of sound mind so I can't go over his head. Dad has fired caretakers, because he believes he is doing great, and blames Mom for getting rid of caretakers due to her yelling at them, but it's him. He is in denial of his frankness, and thinks asking for help is a sign of weakness for this WW2 vet. Anyway, the nurse recommended that if we hire a caretaker, we get cameras installed. Now, I am concerned because Mom and Dad are so vulnerable, and I am sick thinking someone could abuse them. Do background checks show enough about the caretaker? I have sent out pleas to friends in the neighborhood about anyone they know who does caretaking to no avail. Any suggestions on good caretaking agencies?
We had already started with a timed pill-dispenser (recommended by the nurse who did the initial eval.) Despite having audible and visual reminders from that, she would sometimes not take them. Hired help was mainly to check on her, make sure she took her meds and whatever you want to do for the remainder of the hour (she really didn't need much help at that time.)
We also had cameras installed - before hiring of aides, more to check in on her as we are too far to check in daily, and to ensure unscrupulous people did not gain access! One outside, one just inside covering entry and part of kitchen and later one in the basement. MOSTLY these were to keep tabs on her, but came in handy when bringing in outsiders. Surprisingly the admin staff told us NOT to tell the aides we had cameras - probably that way they couldn't find ways to circumvent recording?
Certainly anything valuable or vulnerable paperwork (think papers that might have personal information on it) should be removed or secured before hiring anyone.
You have been told dad "is of sound mind"... so who exactly told you that? Has anyone actually tested him, more than just the mini-mental exam or a few questions in the doctor's office? Many who are in the earlier stages of dementia can "perform" well in front of doctors or others. They are not there all the time and may not be familiar with the person's capabilities previously, so they may not see the declines that you see. Becoming more forgetful is definitely a sign that more testing is needed. Any way to get that done without telling dad what it is? Forgetting the meds for himself and mom can lead to more issues! But that can be a combination of forgetfulness AND losing awareness of day/time, also a cognitive decline. Is he also repeating himself? If so, he needs to have a REAL cognitive test. The Medicare nurse may be able to perform this test. It does need to be more comprehensive than just the mini-mental exam.
It also, regardless of whether your POA becomes active or not, to get help in if dad refuses to let them in will be the big challenge. ANYONE, documented cognitive decline or not, can refuse treatment/help.
Also, since you mention he is a WW2 vet, have you explored any VA assistance? They do provide funds/help with those who qualify - check with local VA office, they may be able to assist. Maybe if he knows the help is available, free and is coming from his service time, he might relent some.
Also: in short, there were some concerns brewing about mom, cutting her slack because of her age (90+)...but the trip to visit my sister was what made the symptoms more apparent; I gave examples to the family practice MD with whom we had a great relationship. He was shocked because she had been so slick at the visits nothing seemed amiss, and they saw him regularly enough. The neurologist did not feel the need at age 95 or so to do any testing to confirm the obvious which he was able to ascertain with his years of experience simply sitting down and talking...it was so sincere and conversational that neither mom or dad was aware of him using his keen clinical skills to be able to generate an accurate diagnosis...or accurate enough. I know there are many who will say they should do scans etc...but to what end? At least imo, the family is still left to deal with the issues and behaviors regardless of what it is called, and at that point, the meds are more likely to not be of any benefit or cause side effects that would make for worse problems.
Caregiver agencies. There are none that can guarantee their workers integrity no matter what they say. The 20/80 rule is here too. Only 20% are good enough, I’d say 5% are actually what you expect, 80% are not worth your time. I never hired anybody that I didn’t have an opportunity to meet and work with first. The agency I worked with was willing to pay for one hour for training at my house, and I added paying one hour of training too. That was so I could determine whether or not I wanted to hire them at all. In any case ———-
Nanny cams are a must. Remove all valuables from the house is a must. And tell them you have nanny cams. That will help weed out a bunch of undesirables right off the bat. Even still, I’ve had caregivers who interviewed well, then watched the cams & they actually turn the nanny cams away so that I couldn’t see them! Fired! I always used them in the beginning and I would let them know if I saw something I didn’t like. That way they knew I actually used the nanny cams. Later, i only spot checked or when I felt suspicious of something. They were very valuable, Cannot say enough good about nanny cams. Put one in every room that your family occupies on a regular basis and one in the kitchen. They do eat your food and may do things you don’t like that you will want to know. Leave them out in the open. Have them keep daily logs with name/time and read them. Be on site as much as possible. Randomly show up.
I prefer private caregivers, an agency as a backup. Less expensive. Hire someone who is hungry to work. They will be more reliable. I used craigslist. Gave the basics, vague about my location, no phone number at this point - you have too many to weed out, that I had nanny cams, that I had high standards, and my deal breakers for Immediate dismissal. good people want a good employer and trustworthy coworkers too. I would give a starting pay and mentioned there were fast increases for the right person. I asked for resumes at the interview, ahead of time was better,and i would not contact anyone who could not form a decent reply back to me. first I email, then call, then an initial face to face away from the home at a nearby fast food restaurant. I wrote notes during the interview. Paid $10 an hour for the 1st four hours. considered orientation training, a get to know you and me time. $13 an hour for two weeks $14 an hour for one month $15 an hour after that. Rates may have changed at this point but that’s not too bad to begin with. I did the training. Agencies would pay one hour and I would pay one hour for two hours of training with any of their staff. I also offered holiday pay for the five major holidays during the year. Including Thanksgiving eve and Christmas Eve. If you don’t you will never have any time off for them. You really have to treat it like a business. I bought them gifts for their birthdays, their anniversaries, snacks on Fridays, I spent a half hour at every shift change talking to them about their personal lives. As unreliable as some caregivers can be, they are also one of the least appreciated and don’t have much fun in their jobs. I remember jobs where we always had office parties and had special occasions to get together, etc. Caregivers don’t. They work their butts off and have to be polite to their clients and employers can forget that there are people too and they want to feel like they are a valuable employee. This is not a job because it’s all about the money. Anyway that’s my two cents and the longest post I’ve ever made on this website. And ALWAYS ALWAYS TRUST YOUR GUT!
I know how hard it is to see your parents struggle & not know exactly how to help & my heart really goes out to you. I hope you find the best solution to help your parents & ease your worries.
If Mom and Dad don't Mind paying out of Pocket for Help, It might be worth the Ride at this Point. However, With a caregiver from an Agency, Mom and Dad will Be daily Monitored and any of their own Reports about their Physical and Mentality will be Reported as they see fit.
I would try to make sure you get the same person all the time. Some agencies will send out whoever is available. So your parents might get a different person everytime. I think it's best if they have the same caregiver so they can build a relationship.
Good luck....but as countrymouse said, they are not a substitute for boots on the ground family and friends.
https://health.mo.gov/safety/fcsr/backgrounds.php
The HHA consultant should, if she's worth her salt, be able to answer even searching questions and set your mind at rest. Would it be possible for you to take part in the consultation through a telephone conference call or anything like that?
The reason I ask about the friends is that there isn't really any substitute for boots on the ground; and if possible it would be good to have someone keeping a close eye on this important new relationship just until it's bedded in. It would be quite a lot to ask, and the friend would need to have plenty of common sense and of course be welcome in the home, but you never know.
Your poor poppa. The thing is, it's not so much a sign of weakness as being forced to accept that change is on its way; which unfortunately, inevitably, it must be sooner or later. Keep stressing to him that the help and support are his best way of continuing care for your mother at home.
You must sometimes wonder what happens if God forbid anything happens to him, too.
Have you had a chance to look around at what alternative options there are in your parents' area?