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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

There are aides who rearrange things in the patient’s house in ways that make more sense to the aide but leave the patient searching for things, especially if that aide is not around. This can be especially true regarding cooking utensils and foodstuffs, bathroom articles, soaps and laundry detergent, and clothes and other personal items.  I’ve had several sight-impaired patients whose aides rearranged their belongings either from a misplaced sense of helpfulness or from sheer stupidity. This can be devastating as you try to navigate your environment and maintain some sense of independence.  Some patients with dementia, may think the aide stole things when they cannot find them.

This is something that can be prevented as the aide begins work. While the aide always receives a list of required duties, the patient, or patient’s family, can also include a short list rules (this will be the subject of another blog).  One of these is an instruction NOT to rearrange or move things around.  It is also useful to go over this with the new aide, verbally and remind them if things are out of place.  Remember, also, the aide may forget where something goes.  If so, it is to be hoped that she will ask.  The patient or family member who finds things being reorganized and doesn’t like it should say so firmly as soon as they discover it is going on.

An aide who decides to redecorate might consider the following:

  1. Ask the patient or family member FIRST!
  2. If the patient agrees, tell the patient where you are placing things and remind them several times.
  3. Label drawers or closets. A post-it note can be very helpful. This will also help other aides (patients may have two or three).

Another very common problem concerns aides (and patients) with differing languages and/or accents. This problem is magnified when the patient is hearing-impaired or suffers from memory loss.

  • Aide as alien:

This is a difficult issue. In large cities, particularly NYC, many aides speak English as a second language or have thick accents that take some getting used to.  Additionally, many patients also have limited English skills or themselves speak with a thick accent.  This can cause serious communication problems between the patient-aide dyad.  Other problems include aides with very low voices working with hearing-impaired patients.  This is not something dealt with in “aide-school” but it ought to be.  Aides can be encouraged to speak slowly, enunciate better and not take personally having to repeat themselves.  It is of great importance that they be at least aware that there is a problem and that it is not exclusively the patient’s fault.  The patient or family can help be aware of the problem and find a mutual solution.  The time to deal with this is when the aide arrives and the language problem becomes evident.

I would like to relate a situation like this that I was able to repair. The patient, Ms. X, an MS survivor, told me in her very weak voice that she didn’t understand her new aide’s name.  She said she had asked, twice, but couldn’t make out the answer.  She was depressed and uncomfortable about having an aide she couldn’t identify or call (She didn’t want to yell “Hey, you!”)  With the patient’s permission, I went to the aide, introduced myself and asked her name.  She mumbled something several times which I couldn’t understand and then finally showed me her ID.  In tiny letters, there was a name I had never heard before, “Edverlith.”  I said to the patient, “You know, your aide has a name I never heard before and which I find difficult to pronounce.  To the aide, I asked:  “Is there some name or nickname that Ms. X could use that would be easier for her to remember and say?  The aide suggested Edy.  The patient’s mood improved during the rest of the session. This was confirmed, the following week when Ms. X told me she felt that my intervention had given her some control of her environment as she could call the aide by name.

This solution may seem simple, but the patient could not articulate her discomfort and couldn’t think of what to do. If there has not been initial education of the aide, the next good time is when the problem in communication occurs. It can be helpful to have an outsider intervene.

In the next blog I will discuss deliberately malign actions by aides.

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