How to Get Along with Your Parents' Caregivers

My mother's parents lived long lives, and in their last decades, they lived them with what seemed like every possible kind of caregiver.

First, my mom cared for grandma and grandpa in their home—until her own physical and emotional health began to suffer. Next came a series of freelance caregivers, and some fit the definition of that word better than others did. Finally, after enduring a broken hip, a heart attack, colon cancer, blindness, recurring bouts of pneumonia and the heartbreaking advance of dementia, grandma moved into an assisted-living facility in a private home and grandpa went to a skilled nursing home.

By the time my grandparents moved into separate homes, the kind of care each needed was distinct. Grandma was in relatively good physical health, but she no longer recognized any of us, including Grandpa, and needed aides experienced in caring for people with dementia. Grandpa, on the other hand, could no longer hear, see or speak, and needed help with everything from feeding himself to getting out of bed and into a wheelchair. Neither was able to voice a real opinion on their separation. So, based on advice from their health-care providers, we made that difficult decision.

At each step of the way we struggled with anxiety and doubt, not only with how best to care for Grandma and Grandpa, but also how best to work with the people we depended on to make our relatives’ daily lives as comfortable as possible.

"I feel like it's all common sense," says Virginia Morris, a journalist and author of How to Care for Aging Parents, a guide that the AARP has called “essential” to managing the care of older people. In some ways, Morris adds, it's like any employment situation: Treat the people who care for your loved ones as you'd like to be treated.

Mary Lynn Pannen, a registered nurse and incoming president of the National Association of Professional Geriatric Care Managers, agrees. Pannen--who is CEO of Sound Options, a Tacoma, Wash., company that provides geriatric care management services--says her company recently surveyed its employees who provide care for elderly clients and found, "The one thing caregivers wanted was respect. It wasn't money."

But your relationship with those who perform some of the most intimate daily duties for your parents is not just financial or professional, it's emotional. And knowing a few rules up front can help you make the best of it.

No. 1: Plan ahead.

"People want to do everything," says Morris, letting out a sigh. "I think that, especially with a parent or spouse, we feel so responsible. It's so important that we get it right, and there's so much guilt if we get it wrong."

That's one big reason, she says, that early planning for old age is so important. The first step, taken years in advance, is to ask questions about the kind of care your aging relatives would want. The next step is to research the services available to them before you are faced with a crisis.

"If Mom falls and breaks her hip and she's being released from the hospital in 24 hours, what are you going to do?" asks Sandy Markwood, chief executive officer of the National Association of Area Agencies on Aging. "It's a lot easier if you have some references as a starting point."

One place to start your research is with the Eldercare Locator, a project of the U.S. Administration on Aging that provides information about services for seniors via a Web site and telephone line (1-800-677-1116).

No. 2: Hire the right people.

Whether you are hiring someone to help in the home, looking for an assisted living facility, or searching for the right nursing home, it pays to spend a lot of time doing research up front so that you can compare and contrast to find the best fit for your parents’ needs. Because most nursing homes are certified by the federal government and inspected by states, it may be somewhat easier to find out about them than other kinds of care. One place to start is with Medicare's Nursing Home Compare program.

As for hiring caregivers, says Markwood, "We spend so much time when we're parents interviewing child day-care providers. The same level of scrutiny needs to be applied to any in-home worker for older adults. They need to be interviewed, bonded and insured, and you need to have a background check. It's that important to ensure the safety and quality of care."

No. 3: Check in often, and look for changes.

No matter what form of help your parents are receiving, it's important to stop in and see them as often as you practically can, sometimes unannounced. This will help you see for yourself how well your parents are doing, and how they get along with their caregivers.

"You do need to check in, and if you can't check in, you need someone to check in for you," says Morris. "A friend, a neighbor, another member of the family, a member of the church–someone."

Look for changes in weight, grooming, demeanor and in the way caregivers and your parents talk, or don't talk, to one another.

No. 4: Cultivate a good relationship between the caregiver and your parent, and between the caregiver and yourself.

You remember the kind and vital man your father was for most of his life. But in some cases, especially if your parent has dementia or otherwise has become difficult in old age, the caregivers may never have met that person.

It may help build a bond between the caregiver and your parents if you talk a little about your parents' younger and happier days, says Morris. Post a few pictures of better times and be sympathetic to the challenges faced by the caregivers.

"It won't hurt to say, 'He wasn't always so difficult, and I'm sorry he isn't always civil to you,'" says Morris.

No. 5: Pick your battles.

Know this, says Morris: A caregiver, no matter how wonderful, is not going to treat your parents exactly as you would.

"Remember, this is just a paying job for them," says Morris. "They're not going to be as in love with your parent as they would be with their own parents or spouse."

You will have to learn which battles are worth fighting, she says. It's one thing if the caregiver persists in giving pastries to your diabetic mother for breakfast. It's another if she gives her frozen string beans when you'd prefer Mom to eat fresh. Ask for what you want, in other words, but be realistic.

And Pannen says it never hurts to ask if you see something you’d like changed, especially if you’ve hired an agency to help you find caregivers.

“A good agency would try to accommodate all those needs,” she says. “To my mind, why not ask?”

No. 6: Be kind.

Taking care of people is a hard job, and in some cases, it doesn't pay well. When caregivers do a good job, make sure they–-and their supervisors–-know it. Write letters of thanks and send copies to their bosses. Give them a small gift (if your parent lives in a care facility, make sure there are no rules against employees receiving gifts from clients). Bake cookies for the nursing-home staff. Pay your private caregiver a bonus. Just say "thank you" whenever you can.

And when you do have to complain, make sure you're respectful and courteous.

No. 7: Help when you can.

You're coming by to visit and check on things anyway, why not come at mealtime and help feed your father? If you're spending the afternoon talking with your mother, why not fold the laundry, too? You may be paying the caregiver, but that doesn't mean you shouldn’t pitch in if you’d like to. The gesture could also help you develop a good relationship with the caregiver.

No. 8: Don't be afraid to speak up.

When you see something seriously wrong, don't hesitate to point it out or consider another caregiver or facility for your parents.

Do your parents have bedsores? Are they getting the right amount of pain relief? Does the caregiver put off taking them to the toilet, give them sedatives instead of exercise or use restraints? All are problems that you should address, says Morris.

"You definitely have to be on top of everything," she says. "Again, the most important thing is calling in regularly and checking in regularly. It helps if everyone knows somebody's around and watching."