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cide which kind o f care is needed on your own. If you have decided on an agency for you home care services, the social worker or visiting nurse will be able to make an assessment o f your elder's needs and will develop a Plan o f Care. If you can afford it, a “ geriatric case manager” will (for a fee) assess you elder’s ability to perform activities o f daily living, w ill monitor the care provided, and will act as a primary or supplemental fam ily advocate. This is especially helpful if you live far aw ay and are unable to monitor your relative. Once the level o f care needed by your elder is assessed, you can proceed to selecting an agency or private home health care worker. Prior to deciding on a home care agency, it is advisable to check out whether the agency is licensed and whether any complaints have been filed with the Better Business Bureau. W hen contacting an agency to request services, you will be assigned a social worker who will advise you o f the services you need, such as equipment for the home. This person will also review medical insurance and eligibility issues with you and will locate additional services that m ay be needed to provide a level o f comfort for the home care patient. A registered nurse will make an initial assess ment home visit to develop a Plan o f Care, will make home visits to monitor the patient’s health, oversee the care plan and make adjustments as needed. The Plan o f Care will specify exactly what type o f service is to be given how often and by whom. W hen interviewing candidates for the job, make sure you interview several candidates in order to select the most qualified and compatible person for the job. If you are hiring your own worker, it is impor tant to check references carefully and to request proof o f training or certification. M ore importantly, the home care worker must be compatible with your elder. You m ay even want to hire someone on a trial basis before agreeing to a long-term contract. If you hire a health care worker on your own, without using an agency, be careful. Prepare a contract that specifies days off, vacation, your policy on lateness and absences, and notification in case you or the worker decides to terminate employment. To protect yourself and your relative, have a secondary plan that includes people who can help you if the worker does not show up. A s caregiver, it is your responsibility to, develop a Care Plan, which outlines all the service needs and special needs o f your relative. One o f the most difficult aspects o f caregiving is managing your elder’s home care services. Y o u are dealing not only with your elder’s illness, but also the difficult task o f overseeing the care provided to your loved one by a stranger. For the elderly, accepting help from an outsider signifies coming to terms with their own frailty, which in turn represents a loss o f inde pendence. W e looked at the many losses faced by the elderly in “ H ow to tell if your Elder needs Care” (O c tober 2002, Our Life). To the elderly, no longer being in control o f their own lives represents an enormous loss and can lead to depression. Often, an older person w ill try to sabotage the home care plan by resisting help, thereby creating a conflict with the home care worker. A s caregivers, w e must anticipate potential problems o f this kind and be prepared to intervene. A n antagonistic relationship could develop be tween your elder and the home care worker. When problems between patient and home care worker oc cur, the best solution is to help the home care worker gain an understanding o f your elder’s needs. Without criticizing, explain how you would like things done, remembering to praise what is working well. Com m u nicate to your elder that having home care will allow her the freedom to remain in her own home, and will allow you as the caregiver, to spend more quality time with her. It is also likely that your parent m ay feel abandoned by you, and misses the closeness you shared in the past, before the “ stranger” arrived. Try to maintain a closeness, which involves touching, talking about "the good old days" or enjoying simple outings to the movies or a park. If possible, include the home care worker in some o f these activities. This will allow you to develop a partnership between your elder and the home care worker. M ake certain that the worker is fully aware o f any dietary restrictions, medication re quirements, and medical history. A list o f emergency contacts should also be provided for the home care worker. Inform the home care worker, in writing, o f your wishes in case o f an emergency or illness involv ing your elder. I f possible, pay surprise visits to the home to insure that the proper care is being provided. Preparing for home safety is another important aspect o f keeping the elderly at home, whether they are independent or have home care services. These safety tips can help to prevent accidents, or even limit the scope o f services needed. A partial list o f some home aid tips to ensure safety for the elderly follows: - Home Care Equipment: cane, walker, wheelchair, commode - Safety bar in the shower and bathtub; a bath seat in tub if the person is frail - Phone by the bedside and in the kitchen; a cordless phone that is easily accessible - Nightlights in hallways - Smoke alarms in each room; fire extinguisher in kitchen - No scatter rugs, loose electric cords, or overloaded extension cords. НАШЕ ЖИТТЯ”, СІЧЕНЬ 2003 17
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