Anyone have a caregiver for an elderly relative?

[k3am]

Just curious about what is/isn't reasonable expectation for a caregiver. In our circumstance, the caregiver is for my mom who has dementia and lives alone. 

1. Would it be expected that the caregiver would not allow her (mom) to enter into a large/expensive contract (in this case, a new HVAC system) without alerting one of her children?

2. Would it be expected that the caregiver would find a way to distract her from something she really wants to do, but we've discouraged? (In this case, going to the bank to get a debit card)

3. Would it be expected that even if it wasn't wanted, that the caregiver would prepare a meal before leaving for the day? Caregiver is there from 8a-5p, with the expectation that it would ensure that she gets breakfast/lunch/dinner and all AM/Afternoon/Evening meds.

My natural inclination is to say that... all of these things are things we would expect the caregiver to do. But I'm honestly not sure and maybe my expectations are too high. The woman who stays with her is nice enough, has expressed concerns, etc. (She told us - after the fact - that she thought that the HVAC people were taking advantage of her, for example.) At the end of the day, the caregiver ensures that she gets at least 1 meal a day (mom always claims she's eaten breakfast, whether or not she has - and sounds believable when she does it) and all her meds taken, so maybe that should be enough? It's better than what was in place before we got the caregiver.

Side note: I hate this arrangement. 8 hours a day of care is not enough for her. But I'm not POA, my mom is adamant about not wanting to go into assisted living (potentially memory care), my oldest sister is adamant about not "forcing her" (yet older sister does very little to help with anything), and my middle sister wasn't willing to force the issue (but she may be coming around to the idea, since if oldest sister isn't helping out, the brunt of care coordination falls onto my middle sister, since she's local, and I'm not)

[quesyrah]

I hired caregivers for my elderly parents with dementia and they wouldn’t have done any of those things. At least not without checking with me first.

I found managing the caregivers to almost be more work than managing my parents. And at $4,500 per week I found that ridiculous.

[waverly]

I don’t think caregiver can do 1&2 because they are not conservator. This is why my sister just applied for conservatorship.

If the expectation is breakfast, lunch and dinner then I would expect that. 3 meals a day not 1.

My thought is the nutrition and meds would be their primary responsibilities.

[ECB]

#3 - yes, that's 100% reasonable to expect.

The other two - it's a lot harder. You say she has expressed concerns, but as at least with the HVAC, it was after the fact, sure - I'd ask her that moving forward, to please reach out as soon as she has any misgivings.

I understand your POV and I don't think you're totally off base. But at the same time, it's clear the caregiver doesn't feel they have the authority/right to out and out stop your mom from doing something that perhaps she shouldn't. And I don't know how fair it is to put that burden on a caregiver. I do think the primary focus is on basic day to day functioning - eating, meds, showering (perhaps), etc.

As you have concerns about her only having 8 hours of care, I think this all lends to the possible need that your mom perhaps shouldn't be in her own home/ independant anymore.

[Leeham Rimes]

My grandmother had a caregiver. She was there solely for medical needs/safety and essentially babysitting. Transferring from bed to wheelchair, bathing, toileting, dressing, and then watching her to make sure she didn’t get hurt or wander off and making sure she ate.

1 and 2, no I would not expect that. That is not a caregiver. That’s a conservatorship (and damn near impossible to get. The bar for being mentally able to make choices is low, at least in my state. If someone wants to make really bad decisions, that’s their right. ) in fact if an aide tries to do more beyond what they’re contracted for, they can get in trouble/fired.

3, I would assume that food would be made if that was written into the employment contract. My grandmothers aide never did bc it wasn’t part of her duties. (I mean made dinner. The aide only made her lunch as per the contract)

[Leeham Rimes]

Also just bc someone has power of attorney doesn’t mean they can use it whenever they want. The person has to literally be unable to make the decisions, not just making bad ones, but actually and physically unable.

For my father that meant failing his mental cognition test (or whatever the terminology is) when his ammonia levels were so high, his brain stopped working right and couldn’t hold a conversation, dial a phone, etc. My mother was able to use her poa for him for a while and then it ended when he barely passed the same test about 8 months later.

[Leeham Rimes]

Also, I’m sorry you’re dealing with this. Elder care is very expensive and very difficult bc usually the elder person is fairly indignant about being questioned/or expected to give up any freedoms that they’re used to having even if it would be better for them if they did. I would look into an elder care lawyer and an estate planning lawyer that specializes in elder finances and paying for nursing homes bc it’s a nasty shock in an emergency to see what they’re on the hook for.

[bittybomb]

My mom’s caregiver would definitely have checked in with me for any of those things. And she always fed her and actually encouraged her to eat before she left for the evening. My mom didn’t have dementia though.

I’m sorry. Caring for aging parents is really tough.

[VillainV]

I have never seen a non-family caregiver do either 1 or 2. I wouldn’t expect them to interfere in any kind of financial matters. I’d this is a big concern, you may need to see about limiting your mom’s access to her accounts, or requiring that a family member approve these types of things.

For example, my MIL (who is of sound mind but very vulnerable) has a very small amount of money in her main checking account, no debit card, and a low limit credit card. The bulk of her money is in an account that she specifically set up to require my husband or SIL to approve withdrawals over a certain dollar amount. She’s already fallen victim to 3 scams that we know of (luckily smaller dollar amounts, a few hundred dollars each) and is terrified that she’ll get scammed out of a larger amount.

As for #3, if meal preparation is part of her duties, I’d make sure to set the expectation/amend her contract to include preparing all 3 meals even if she’s not there to serve them all. I’d make sure all groceries were provided, in an amount that she would be able to prepare enough for herself for meals that occurred during her shift.

[bittybomb]

Mar 23, 2022 18:11:55 GMT -5 quesyrah said:

I hired caregivers for my elderly parents with dementia and they wouldn’t have done any of those things. At least not without checking with me first.

I found managing the caregivers to almost be more work than managing my parents. And at $4,500 per week I found that ridiculous.

I think this is true. It was so hard to find someone that I both trusted and also that my mom felt comfortable with. We ultimately lucked out and found a gem of a woman who adored my mom and my mom adored her. She was with her for a few years until my mom’s passing in 2019, and I’m still in regular contact with her - she checks in on me and my family and I check in with her to see how she is doing. She was a Godsend and it made all the difference I knew my mother was truly being cared for by someone who cared for her and didn’t just see her as a paycheck.

[Leeham Rimes]

Mar 23, 2022 18:58:35 GMT -5 VillainV said:

I have never seen a non-family caregiver do either 1 or 2. I wouldn’t expect them to interfere in any kind of financial matters. I’d this is a big concern, you may need to see about limiting your mom’s access to her accounts, or requiring that a family member approve these types of things.

For example, my MIL (who is of sound mind but very vulnerable) has a very small amount of money in her main checking account, no debit card, and a low limit credit card. The bulk of her money is in an account that she specifically set up to require my husband or SIL to approve withdrawals over a certain dollar amount. She’s already fallen victim to 3 scams that we know of (luckily smaller dollar amounts, a few hundred dollars each) and is terrified that she’ll get scammed out of a larger amount. [

I’m so glad that your MIL is understanding that she needs people to help her not get scammed. So many elderly refuse to accept the possibility of needing any help which leaves family with no legs to stand on until things get dire.

[k3am]

Regarding #1, I don't know that I'd expect her to completely block the transaction, but I'd expect that since.. someone is coming into the home, that maybe we'd at least get a text as a heads up? My mom was able to finance a $14k HVAC system when she's not really competent to enter into a contract. I know that we can't modify her life insurance/will/etc because she's not competent, so I'm not sure how she can enter into a financial contract.

The Bank situation.. my mom can not get to the bank by herself. The caregivers instructions are to drive her to medical appointments, regular household errands (groceries, etc), and social stuff she choses to attend (church, mainly).

We have her set up so that she can only access a smaller account (vs. her full money), but with access to a debit card, she was able to set up 17 subscriptions for stuff she doesn't need/want/remember signing up for (beauty supplements, weight loss pills, prize subscribtions, etc. I spent today cancelling everything. Left unchecked, those subscriptions would have charged her over $1k per month. We make sure to leave her with cash for everything she could need and then some.

She has a durable POA in place, which as far as I'm aware, doesn't require her to be declared incompetent (although I'm sure she would be). I'm not listed on it, only my sisters are (I was 17 when it was put in place).

Some of these issues I'm not even sure that being in assisted living would help eliminate.

It's basically the worst. I've filled out a dementia directive that basically states that if I end up with moderate to severe dementia, I don't wany any kind of life saving measures, even the most basic.

[k3am]

And yes, I agree.. we need to consult with an attorney. Alas, I've been overruled on this..

[raleighnc]

When my grandmother got to a certain point, my aunt had durable power of attorney and there were new checks that required her signature as well as my grandmother's (I think). I think it was mainly to pay bills because my grandmother was still able to contract someone to renovate her bathroom (against the advice of all the family). I'm not sure the durable POA would prevent her from signing a contract. (But you are right that it's always in place vs. a springing POA).

I would absolutely tell the caregiver that she is only allowed to drive to a list of pre-approved places that does not include the bank, car dealerships, etc. And that she will not answer the door without clearing it with one of you (a ring doorbell could help). There's absolutely no reason to answer the door for anyone unexpected these days (and it's frankly dangerous - my friend's elderly father was distracted by one scammer about roof damage while another one slipped inside and robbed him. Then they hit him on the head as they left). If it's important, they will call in advance and make an appointment when one of you is there.

The caregiver can at least call one of you if something like this is going on.

And if the caregiver is supposed to make three meals a day, she needs to at least make and offer them and put them in the fridge for later. Obviously she can't force your mom to eat, but there's no point in asking your mom if she's hungry or has had breakfast. The food just needs to be offered.

[raleighnc]

You can also get several of the preloaded gift cards if she really needs it and only load small amounts. Something that can't be used for a subscription.

[Leeham Rimes]

Since your mother cannot drive herself, then I would definitely have a conversation with the caregiver that your mother may only be driven to the pre-approved places and nowhere else. Literally spell it out. Not “errands” but “grocery store, post office, bagel shop, coffee shop, church, and nowhere else” This does put your caregiver in a bind if your mother gets angry that she can’t be taken “xyz” place. It was hard for my aunt (who had my grandmother live with her) to say no to my grandmother bc she’d get really mad, start yelling, but I think eventually my aunt was able to side track my grandmother but i know it was incredibly stressful to butt beads.

[af1212]

Is this person a private employee of your family? Or do they come from an agency?

I think there are very different expectations about what they can and cannot be required/asked/expected to do based on this info.

[k3am]

Mar 23, 2022 20:53:57 GMT -5 af1212 said:

Is this person a private employee of your family? Or do they come from an agency?

I think there are very different expectations about what they can and cannot be required/asked/expected to do based on this info.

The caregiver is through an agency

[k3am]

This is all very helpful, by the way. For the most part, we’ve been flying blind and learning as we go.

FWIW, nothing will be changed unless I force an issue.

[af1212]

Mar 23, 2022 21:04:01 GMT -5 k3am said:

This is all very helpful, by the way. For the most part, we’ve been flying blind and learning as we go.

FWIW, nothing will be changed unless I force an issue.

The caregivers I am familiar with through agencies (two elderly grandmothers and a sickly stepfather - four different agencies total) would not have done the things you mentioned.

They had very clear things they were allowed to and not allowed to do, and any changes had to come following a meeting with the director from the agency, as well as the designated family members.

It might be worth it to reach out to the agency and see if you can get a list of their general policies as well as the specifics for your mom’s care.

In all four of the agencies we worked with there was a binder with all of that information kept at the home, and all parties reviewed it and signed it.

[FastHands]

I'll echo others that #3 is reasonable but maybe needs clarification. I would give some slack to someone who perhaps was thinking they didn't want to waste food. If the expectation is that each meal be provided whether she wants it or not, then spell that out with the caretaker/agency. Once clarified of course I'd expect it to be followed.

1 and 2 are too much to expect.
As others mentioned, there are generally very very specific guidelines for services. I will also add that my experience has been (even pre-pandemic) that the caretaker roles are low-paying and the staff had very little work (/life!) experience. And they get yelled at a lot. We had a few lazy people who were frustrating, but by and large they were doing the best they could in a job that can be draining and thankless. They 100% shouldn't be asked to get in the middle of financial situations, and I'd bet their contracts actually expressly forbid it.

I'm sorry, it's all so hard. You want to protect your loved ones and be fair to ppl trying to do their job and also keep your sanity.

[af1212]

In regards to the evening meal, in my loved ones situations there wouod need to be super explicit instructions written into the binder like - caregiver will prepare a meal consisting of blah blah blah and leave it for the client before she/he clocks out, even if client refuses the meal.

[quesyrah]

Mar 23, 2022 20:53:57 GMT -5 af1212 said:

Is this person a private employee of your family? Or do they come from an agency?

I think there are very different expectations about what they can and cannot be required/asked/expected to do based on this info.

I agree. The caregivers I had for my parents came from an agency. They had a long list of things they weren’t allowed to do.

I even had to sign a waiver to allow them to hand my mom her meds (not that they ever did it which is a whole other story).

[jewel]

We have had full time care in my grandparents' home for probably 7 or 8 years now.

My mom and her sisters are managing it - they originally used an agency, but their main worker decided to leave the agency so they pay him directly now. They agreed to pay the same rate, and he's making a lot more money now. He is connected to a large market of caregivers and has been incredibly helpful in finding new weekend/fill in people, as needed.

Anywany...for the first two, there's no way he could physically stop my grandpa from doing stuff like that, but he would indirectly try. He very regularly texts my mom with any financial things that come up. He also doesn't take my grandpa to the bank at all - he can't drive himself, so the only way he gets to the bank is with my mom or one of her sisters, and they would certainly get involved as much as they could. I would see if you could talk to the caregiver and agree that "household errands" should never include the bank or any major financial decision (like a car dealership or something?) or even make a list of the specific places they are allowed to go. And I'd also ask that the caregiver let you know if she hears about any new financial decisions your mom might be making, so that you can try to intervene ASAP.

For the third, I'd ask the caregiver to prepare 3 meals a day, regardless of what your mom requests. If your mom is refusing food, she could even prepare something that can be refrigerated and doesn't require any reheating, like a sandwich, or cut up some fruits and vegetables.

Overall, I'd try to get better day to day communication going with the caregiver. If she isn't interested in texting, maybe there's a care app you all can use? She can't force your mom to eat or take her meds, but I think it would be nice for you guys to know as it happens in real time (especially for your local sister, in case she can follow up a couple hours later).

I'm sorry. It's so hard for everyone, and this kind of care is just so incredibly expensive and complicated.

[starlily]

I'm sorry you're having to deal with this. Dementia is a horrible disease.

#1 and #2 typically are not within the scope of the caregiver's responsibilities. #3 is a reasonable expectation, and I'd clarify with the caregiver that all meals must be prepared regardless of what your mom says.

I say this gently and with love, but you may need to force the issue of a higher level of care and financial oversight with your mom and siblings. Yes it will be terrible, but scrambling to figure stuff out when things really hit the fan, which they will, is even worse. Does a POA exist at all?

[Leeham Rimes]

I know you said your siblings and you are on a different page as far as your mother’s care. I would still meet with an elder care attorney and an elder care estate planning attorney for my own knowledge as what legal options exist and how to protect her estate when she needs full time care bc that is about $8k a month, and that’s not even a top notch facility.

I don’t think your mother will do well with assisted living. This is not a knock to them but assisted living is not for people who need the level of care your mom does. My mother tried assisted living for my dad and she got mad at them bc they didn’t do as much as she expected but he needs a round the clock baby sitter which is absolutely not what assisted living is, he doesn’t even have the mental capacity to walk to the call help button when he needs help. It’s for seniors who are mostly independent but need some help with certain things, which I think is beyond your mother. and most charges are a’la carte in addition to the rent you pay which is about $3,500/mo

I’m sorry, this is so difficult even when siblings agree. When they don’t? It’s hell on earth. Look into elder law attorneys in your area. Consults here are about $250 and worth every penny.

Managing an elders care is a full time job and a stinky one at that.

[livinitup]

I think expecting #2 from a non-related, paid care giver is really messy. First, you are expecting the care giver to completely understand what your mother intends to do, decide for herself if it is a good/bad idea, and if she decides it is a bad idea to “find a way to distract her” from doing it.

How is the care giver supposed to accomplish all of that without ever getting it wrong and never overstepping her role? It’s your mother’s banking decisions. The care giver works for the woman who presumably has no restrictions on her access to banking. And “distract” just seems like a soft way of saying “stop” her from banking - and that is very far out of scope.

However, I hear that the underlying fear is that your mother is not making good banking decisions. So, that needs to be addressed and sorted. But not by the person with the least amount of information and authority.

[womet]

I haven't read all of the other responses, but my grandmother has Alzheimer's and currently lives alone. We're moving her to an assisted living place soon though. She currently has at home help during the week days (some, not all days). They help her with her glaucoma drops, they prepare her lunch and/or dinner, and do some light housework (help her strip the bed, wash towels, etc). My mom prepares her hot meals in advance, so the caregiver just heats them up. If your mom has dementia, she shouldn't be driving and someone else should be in complete control of her money. People with dementia are at risk of being taken advantage of financially. My mother took over all of my grandmother's financial stuff-- my grandmother doesn't have her checkbook. And she sold her car several years ago, after getting her diagnosis. Good luck!

[k3am]

Leeham Rimes, I actually think she’d do well with assisted living. She absolutely HATES having a caregiver. With assisted living, they would check in on her, make sure she eats, make sure she has meds, and if she wants to socialize she can, if she wants to chill in her apartment and watch TV all day, she can do that too. Right now they literally just sit and watch TV with her, and help with light housework. She complains daily about them. She has a long-term care policy. An assisted living facility would actually pencil out to about the same cost as the level of care she needs (8 hours is not enough), and she would have more of the independence that she looks for, but it would still be supervised.

starlily, we have a durable POA.

I am frustrated that her HVAC system went out, she hired a company to come try to fix it, when that would work, she bought a new system using financing. Her caregiver knew about this. We knew NOTHING about this. We didn’t get a heads up it wasn’t working, that there would be people in the house, or that she’d entered into a contract. Her caregiver knows that she does not have access to a credit card, checks, or her banking information. How are we supposed to make sure it gets paid if we don’t know it exists? Luckily I found an email regarding it (since I check her email daily). And then TWO weeks later, she felt the need to tell me that she felt my mom was taken advantage of. Well, I wasn’t there.. but the caregiver was. She could have called or sent a text, not necessarily to stop it, but to give us a heads up so that WE could stop it.

[Leeham Rimes]

Make sure you understand the terms of the LTC policy. With my fathers they only covered a fraction of the billed amount and my mom had to pay the facility directly and then submit invoices for reimbursement. My mom had no idea until it was an emergency. Her attorney helped her with language to negotiate the price of the LTC facility, which is different than assisted living and not covered under the LTC policy.

ETA: also, in order to activate my fathers LTC policy it required vast amounts of paperwork, doctor consultations/medical records, medical evaluations. It took I want to say about 3 to 4 months. Unfortunately it’s not as easy as presenting insurance card and getting things covered. At least for my fathers policy, so definitely look into it and see what needs to happen to get the policy activated asap