Featured Article: The Owner is the Client…
The Ultimate Caregiver Challenge
By Regina McNamara, RN, MSN, MPH, Owner
My siblings occasionally remark that I built a senior care company so that I would have someone to care for ME. I never considered our service to be something I would ever actually use.
Until I needed a new knee….
No one’s perfect and my right knee was never quite right. A bit misaligned, causing occasional gait problems. But nothing serious. However, decades of wear and tear, beginning with cheerleading injuries and progressing to hiking, race-walking, and general misuse of the joint led to clients, friends and family suggesting a new knee.
I figured how hard could this be? I have watched our caregivers assist clients with joint replacements, having returned from rehab and they did wonderfully. And they were all older than I.
Decisions made: surgeon, hospital, no rehab, straight home after 24 hours, skilled home care. The last decision was the simplest. I frankly had little idea of what condition I would be in post op but I know I wanted one of my finest caregivers. And the best home health care company.
I asked Angie (See Kudos column in December newsletter) to be my caregiver. Flattered but uneasy, she accepted the challenge. Gentiva (See them in Providers column this issue) was an easy choice for superb skilled home care.
For those of you who have never had a total knee replacement, take note. It is painful, a bit frightening, and the post op care is as important as the surgery itself.
My perspective on roles of clients and caregivers was considerably changed, lessons learned.
A few of the many lessons Angie taught me:
A confident, take-charge caregiver is an enormous comfort even to clients who think they already know everything.
Clients and families who occasionally complain about “bossy caregivers” may well be correct but it was an enormous relief that Angie took charge as soon as I arrived home. Room straightened, fluids in place, meds set, schedule for therapy done, ice machine in place and working well, flowers watered, laundry done. My job? To rest and heal. To say that this was comforting to me is an enormous understatement.
Usually the caregiver, NOT the client is right.
We realize this flies in the face of the usual “the client is always right “ but it simply is often the case. When I rarely felt like eating, small meals with protein appeared out of nowhere. Same with fluids. Drink….Eat… I obeyed. A smart caregiver knows the signs to watch for to avoid problems whatever the client’s condition. On my second night at home, my knee seemed unusually swollen, warm. I was in pain. And in a panic. We advise our staff that as the client “becomes stressed, you stay very very calm”. Now I saw it in action. Angie calmly checked the leg. No drainage, not that hot, it’s hot in the room, not really any more swollen than yesterday, etc. Have a drink; take your pain med, ice and leg up. Result? Instant calm.
Chemistry is EVERYTHING. Occasionally, a client will call and say her caregiver is “very competent, nice, but….”
Then we ask about chemistry. This is usually the issue. Caregiver and client must match up, must be able to enjoy each other’s company, and must communicate well. This is the basis of the caregiver/client relationship. Angie is smart; she is also funny, quick, and silly at times, and always upbeat. When she thought she was out of earshot, I could hear her working away and singing…. How lovely…Good chemistry.
Some Things we were WRONG about:
- Ask the client what she would like to watch on TV, and watch it with her.
I found that in a sometimes groggy/tired state I really didn’t know what I wanted so I let Angie choose a show or movie. She chose, I enjoyed. Horizons opened. We watched movies I may never have chosen but they made us both laugh every day.More laughter, less pain.
- Be professional at all times.
Angie would be downright silly and goofy at times. With two cats in the house she worried and played with them even though I disliked them.
We joked about boyfriends, what she did in her spare time. We discussed nursing school for her. The mood lightened, the pain lessened, a bond formed. Sharing personal information is the caregiver’s choice but can be a source of entertainment to the client.
- ASK the client what she wants to eat. And wants to do.
What if she wants to eat and drink nothing? To do nothing? Angie would ask generally and if she wasn’t sure how to cook something, I would show her a few things around the kitchen and let her go at it. She did amazingly well and we both learned about a few new dishes. Meals are important but it often needs to be client and caregiver working together. When doing nothing is not an option you need a caregiver to gently nudge. Time for exercise. Time for a walk. Time for meds. Time for nap. Stop overdoing it. Not bullying, just caring.
When It’s time to leave
We are often surprised when a sort term case is over and the caregiver is preparing to return home. The emotion of the client and family is at times overwhelming. This was difficult to understand, We are pleased that they enjoyed their caregiver. We are glad that they are well enough to be on their own.
What’s the problem??
Now I understand. I really miss her. My gratitude is profound. It was a very busy time. My plan was simple. I would go straight from hospital to bed, planning to stay there. Forever. Now, walking with cane outside. After only two weeks. Well nourished, hydrated, on the way to total recovery. Angie left a great transition plan. A daily to do list. Exercises. Ice. Elevate. Listen to the therapists. Walk. Eat. Drink.
It is as if she is still here. Thank you, Angie. ■