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.

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