Month: January 2017

6. How Patients see Home Health Aides – The Aide as Slave/Servent

In this series of blogs, we are discussing ways that care receivers look at their aides or caretakers. In this section we will look at the Aide as servant or even slave.

“Anita! Pick up these clothes I left on the floor. I need them ironed!”

“Anita! I’ve told you many, many times, I like the toothpaste to cover ALL the toothbrush bristles. Can’t you ever get it right?”

“Anita! How could you buy this brand of spaghetti?  Don’t you know the store brand is just as good?”  [shortly after] “Anita!  You got the store brand of raisins.  Don’t you know, the quality is never as good with the store brands?!”

Who is this person? I have seen a number of patients who believe that they are hiring a servant, or worse, a slave, when an aide arrives to take care of them.  They are wrong twice.  First of all, they aren’t usually paying, Medicaid is.  Second, an aide has very specific tasks, based on the patient’s particular deficits and needs.  This list of tasks is almost always outlined on a document sent by the agency providing the service.  This list never includes:

  1. Taking abuse (being spoken too rudely or roughly
  2. Taking care of the patient’s spouse, children, pets or friends
  3. Providing cordon bleu cuisine
  4. Heavy cleaning (like ironing, window washing) or
  5. Mind Reading

But let’s for arguments sake, allow that an aide is a type of servant. Dealing with servants is a skill that takes training and experience.  Even rich people who grow up with servants don’t always do this well.  And many people, who themselves worked in the service industry, even as home health aides, forget all they learned and experienced when they are now receiving care.  There is an ancient expression which explains the proper attitude to take with servants:   “Noblesse Oblige.” As many of you know, it means nobility obliges you to act nobly,” that is, to treat the less fortunate (those who depend upon you) with respect.  When you are in charge of someone whose livelihood depends upon your good will, you are obliged to treat them civilly.  That doesn’t mean you let yourself be taken advantage of or otherwise mistreated.  It means that you call your aide by whatever name they invite you to use, you say please and thank you, you apologize for providing any extra work, and you don’t demand they do anything that they are not supposed to do.  By the same token, the aide should call YOU by whatever name you choose, provide the services they are supposed to, bring their own food, stay off the phone for most of the time, (apologize if there is a communication difficulty), and treat you politely and civilly.

Many “care receivers” believe that if you cut some slack with the aide, they will get something back. Please look at a coming blog called Negotiating with your aide, to see more on this topic.

5. How Patients see Home Health Aides – The Aide as Mother

As I noted in the first blog in this group, caretakers can play different roles in the lives of those they tend. Because of the nature of personal care, one of the most intense roles is that of the mother, washing, feeding, dressing and other intimate roles as needed.

Our earliest template for receiving care is motherhood. Our mother prepared food and fed us; bathed and dressed us; toileted us and soothed us when we were agitated or depressed.  When once again we require someone to perform these acts, there is an inevitable regression toward the helpless passivity of infancy, as well as the inchoate rage resulting from unmet needs.  An adult, lying in a cold, wet, soiled diaper in a nursing home re-experiences all the rage or despair of a neglected infant.

And, woe to the aide causing this neglect! I have seen so many patients explode in what seemed to others to be an overreaction to a trivial event.  To the patient, though, the humiliation and distress of lying soiled, having a run of mucous sitting on one’s face, not being properly shaved or coiffed, being seen exposed or naked, wearing mismatched clothes, having to eat foods one doesn’t like, getting up too early or going to bed too late and on and on and on is not trivial.

When needs are chronically unmet, some patients go into a depression characterized by withdrawal, increased passivity and dependency. They stop trying. I’ve been told that nursing home administrators love this because these patients don’t cause trouble and their increased needs result in additional reimbursement.  That’s for another topic!  Other patients become chronically enraged, alienating all those around them for the sins of a few.

Aides and other caretakers need to be made aware of the potency of their caretaking acts. Their work must be done without taking away dignity and control.  When I’ve done training for aides, I came up with five rules for not being a bad parent (aide).  These may seem obvious but you’d be surprised at how many of them are violated regularly.  These are:

  1. Inform the patient what you are going to do beforehand, don’t just start working on them or moving them around.
  2. Give the patient some control over the process (Which shirt do you want to wear?)
  3. Ask the patient to help within his/her capabilities (“Here’s the soap. Could you wash your stomach?”) This is a particularly good idea for washing the patients genitals as some patients are mortified by others touching them and some are overly stimulated by it.
  4. Perform the care gently and slowly and announcing what you are about to do (“Are you ready for your next spoonful?).
  5. Perform the care in a timely manner.

If you are the “care receiver,” or their therapist, it is useful to explore any strong feelings being generated by the care-giving or care-giver. This is not to blame the victim.  There are plenty of lousy aides and inept caregivers.  In fact, I would venture to say that all caregivers are inept occasionally, or always inept in some ways.  But life happens.  Every meal is not going to be perfect.  Sometimes you have to wait for things.  If there is a negative or critical response to all care, then sometimes the “care receiver” needs to look inward.  What are you expecting?  Who is the caretaker playing in your early life?   In the next blog we look at the Aide as Servant.

11. How Patients See Home Health Aides – The Aide (or Patient) as Bully

Continuing the theme of Concerns and Issues with home health aides, I would like to talk in this post about bullying. A very …

10. How Patients See Home Health Aides – The Aide as Persecutor (3)

In this blog I want to discuss aides who are actually deliberately malicious in their behavior. These are serious situations …

9. How Patients See Home Health Aides – The Aide as Persecutor (2)

In this blog we will continue talking about ways in which aides can impair the lives of their charges. Aide as Reorganizer …