In-Home Care: What to Do When Things Go Wrong

7 common problems and solutions
Elderly Woman and Younger Woman
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Home care problems: health or financial issues

When you're providing home care for someone, in your home or theirs, it's common to have problems -- and this doesn't mean you're failing. Some have easy solutions, while others take more work. Sometimes the best decision is to switch to a different care setting. Here are some ideas for addressing common home care problems. They may also help you decide if home care is the best choice for your friend or relative.

Health issues

If the person in your care is showing signs of declining health, the first thing you should do is call his doctor. (Dial 911, if it's a medical emergency.) Before calling, write down all of your concerns and observations to prepare for your talk. Get input from others, professionals and nonprofessionals, who spend time with him.

It's also a good idea to have a list of his medications on hand when talking to the doctor. Have the person in your care talk to the doctor directly if he's able. (He may prefer privacy when speaking.) You can provide additional details to the doctor from the caregiver perspective.

SEE ALSO: Find In-Home Care Help Near You

What you can do: Start by brainstorming with professionals involved with the older adult.

  • You may want to suggest to his doctor that you hold a team meeting. Include all health providers involved in his care, including -- and especially -- those making home visits. This is helpful for deciding what changes, if any, can be made in the home care setting, or if it's time to consider other options.

Financial issues

Providing home care can be expensive, especially if you're using lots of paid caregivers.

What you can do: Review all financial assistance options for the person in your care, including Medicare, Medicaid, veteran's benefits, and private insurance policies.

  • Consult with an elder attorney who specializes in senior financial planning. It may be worth even a one-shot visit to help you organize.

    SEE ALSO: Find In-Home Care Help Near You

  • Ask family and friends to pitch in. With some extra help, you may be able to reduce paid care hours.

  • Try to be realistic about finances. Avoid getting yourself into debt.

  • Find out if he qualifies for Medicaid. If he's low-income and can't live independently, he may be eligible.

Home care problems: boredom and caregiver conflicts

General boredom

Boredom is common for anyone who's frail, ill, or unable to be as active as he'd like. It can be profound, causing depression. Boredom isn't always easy for caregivers to deal with, since people in need of home care usually have real physical conditions that limit their ability levels.

What you can do: There's often a cycle of boredom, in which people who are bored can't imagine anything making a difference. You may be able to help him break out of that mind-set.

  • Try talking to the person in your care. Find out if there's anything he craves, misses, or dreams about.

  • Suggest a variety of activities. Offer movies, music, books, restaurants, people to invite over, walks, shops, or parks. See if anything sparks his interest, and run with it as best as possible.

  • Contact a local senior or community center. Ask about outreach programs, such as volunteer readers or home-delivered meals. Meal delivery is often more of a social check-in than a source of food.

  • Look into door-to-door transportation to the senior center. If he's able to use such a service, the knowledge that he can get to the center relatively easily can encourage him to get out of the house.

  • Ask family members or friends to set up a rotating visiting schedule. Include all ages to provide variety as well as steady companionship. There doesn't always need to be a "fun" activity planned -- simply hanging out with someone else can break boredom.

  • Steer conversation to his unique skills, talents, and past experiences. Encourage him to take on the role of teacher and storyteller.

  • Consider hiring a companion who's an older adult. This may be especially valuable if relatives or friends are scarce.

  • Other ideas: Consider bringing in a pet. Vary his scenery. Move the wheelchair to different spots during the day, including outside (weather permitting). Talk strolls and car rides, and wheel his bed to a different place every now and then.

Problems with a caregiver

It's hard to find oneself suddenly dependent on strangers for basic care, so it's not uncommon for an older adult to complain about paid caregivers, especially initially. Whether or not these complaints are well founded, it's important to hear them out and try to help resolve them.

What you can do: Talk to the people involved.

  • First, speak with the person in your care. Try to get the full story, at least from his point of view.

  • Then gently bring the subject up with the caregiver. Remember, you're not necessarily trying point a finger but to figure out whether, together, you can come up with a solution. You know the older adult best, so sometimes simply explaining a personality quirk or special need can help smooth a relationship.

  • If tensions and home care problems persist, it's probably time to look for a new caregiver. Naturally not every match is the right one, so it can be worth trying a new person to provide home care.

Home care problems: emotional issues

Depression or low spirits

Declining health and losing independence can cause depression. Yet some older adults find new pleasures or peace in their older years, and they experience both ups and downs. Depression can be treated effectively in a number of ways.

What you can do: Talk with the person in your care and ask about his feelings.

  • Take the time to really listen. You may learn immediate ways to help, such as inviting a good friend to visit, looking into tension with a home caregiver, helping arrange a visit to church, or opening curtains for more light. Sometimes just having a sounding board can cheer someone up.

  • Ask if he's interested in talking with a professional mental health counselor. Many people are more comfortable talking about their feelings with professionals or people outside the family. If the depression seems prolonged or severe, talk to his doctor and ask about a psychiatric assessment. Find out from a professional if she thinks antidepressants are warranted.

Family tensions or conflicts in a group of caregivers

Home care can be stressful for everyone. Schedules get overloaded and privacy disappears -- not to mention the worrying and sadness everyone feels about the health of the person in your care.

What you can do: In a word: talk.

  • Hold family meetings (or caregiver meetings, if friends are caring for the person as a group). Bring concerns and fears into the open. Whether it's a teenager who's embarrassed by having a portable commode in the house, a husband who feels he never sees his wife on weekends anymore, or the person in your care feeling humiliated by needing someone else to dress him, airing feelings not only relieves pressure but offers a starting point for finding solutions.

  • Give serious consideration to hiring a geriatric care manager or professional mental health counselor if things are really rocky. A professional can facilitate family meetings and make sure everyone's concerns are heard.

Your own emotions

If you're the one in charge -- the home care manager, the person with whom the buck stops -- it's normal for you to fall apart from time to time. If, however, falling apart becomes the norm, it's time take care of your own emotional needs.

What you can do: Again, talk about it -- and learn to take care of yourself.

  • Confide in friends or your spouse, and consider a caregiver support group or professional therapy. None of these are a sign of weakness. Seeking help is a sign of strength.

  • Pamper yourself. Take time for restful treats like a massage, weekend getaway, or round of golf, or sneaking home from work early to take a nap.

  • Hire caregivers to spell you. You'll need the chance to get some breaks.

  • Recognize when you're at risk of crumbling. Realize that it may be time to review the home care plan.



Kate Rauch

Kate Rauch has spent more than two decades writing about health for websites and print media, including WebMD, Drugstore, the Washington Post health section, and Newsday, as well as HMOs such as Kaiser Permanente (in the San Francisco Bay Area) and Group Health (in Seattle). See full bio

almost 3 years, said...

Hi, My boyfriend and I live with his 72 year old homebound mother. She has numerous health issues that due to self neglect and dementia, her health has deteriorated badly. She refuses to due anything to improve her health. She refuses to have physical therapy, because it hurts, she lays in bed all the time and her muscles are weak from lack of use. When she does get up her legs hardly support her weight (she's 5' 2" and weighs almost 200 pounds). Her eating habits are unhealthy. She eats 1 1/2 gallons of ice cream a week and hardly eats nourtrishly. There is no reasoning with her because she believes she is competent to make her own decisions. She gets angry, mean, hateful, and demanding when new health options are addressed to her. She hasn't showered or washed her hair in 3 years and her hair smell like vomit, it's because she doesn't want to. She refuses change. We both have health issues that need to be taken care of, and we have to put them off because there is no one to stay with her. We are both overwhelmed and STRESSED about this situation and don't know what to do. She refuses to be put into a nursing home, because she believes we are faking our health issues, and we can continue caring for her. We are both financially struggling to make ends meet and she keeps demanding that we have to give her our money because she doesn't have any. That's not true. She gets social security, and only pays the utility bill. We pay all the other expenses, but she complains she never has any money. We don't know what to do, except that we can't continue caring for her. Any advise please?

over 4 years, said...

My 89 year old mother was diagnosed with mild dementia 5 months ago; otherwise, her health is very good. She has lived in our house 4 years and we take good care of her. We try to not leave the house for too long, a few hours at most, because we worry about mom. Our daughter and her family recently moved to Pittsburgh and we live in CA, so my husband and I want to move to Pittsburgh too so we can be close to our grand children, the 2nd of whom will be born in 4 months. It will probably take us about a year to move there. And, we want to travel to Pittsburgh together when our 2nd grand son is born a few months from now, but my siblings are not able or willing to commit to pitch in caring for mom while we go on this trip. Also, my mother in law lives near us and she recently lost her husband. She found a nice independent living apartment in Pittsburgh, and so my husband will move her into it in a few weeks. My husband is an only child so we should be close to his mom who is 83 and currently in good health. As I say, we want to travel to Pittsburgh when our next grandchild is born, and we recently retired so we want to travel which we can't do now due to mom's dementia. I asked my 2 brothers if they will care for mom when we take trips. We did not get much response. One brother says we should bring in care givers into our house when we travel. We said we hate that idea of a stranger staying here for 2 weeks while we're gone. He said we could get nanny cams and put dead bolts in our internal doors. And there's an app so, while on our trip, we can see if the care giver is abusing mom or nosing through and stealing our stuff. We feel we could not enjoy a trip that way so we do not want to do this, but my brother keeps insisting we should do that....My close-by brother said he'd only take mom in to his house "for a few days" because he states his house is not safe...(I wonder why it is safe enough for a few days but not longer than that so we think it may be just an excuse.) My brother in Montana just lost his wife a few months ago, and even though he normally leaves Montana each winter, he doesn't know what he wants to do this winter because he's grieving so much...We doubt we can count on him to fill in when we go to Pittsburgh when our next grandson is born a few months from now.. So we found a Respite Care facility that is located very near my close-by brother. My brothers don't like this idea as they think mom should stay in my house with care givers such as Visiting Angels. Do others feel the way we do that we'd rather have mom stay in a Respite Care facility for 1 or 2 weeks than to have strangers come into our house while we travel? Already this Fall my husband and I took 3 separate trips to Pittsburgh because we can't leave mom home alone. This is not how we want to spend our retirement traveling separately and living in a big house we don't want or need. A few days ago, we told my 2 brothers we want to move to Pittsburgh and take our mom to an assisted living apartment there. They were mad at me. They said I owe it to mom to stay here in this house because she babysat for us when our kids were little. I told my brother who lives near all 5 of HIS grand kids how would he feel to live far from them? Years ago, my Montana brother moved to be close to HIS grand kids so he should understand our need to be near our grand kids. Also, we want to move because we live in a big 5 bedroom house on a large lot that we no longer want to maintain; this house is too much for us at this stage of our lives. We are unhappy living here. Our big house has become a big albatross to us. And we live in a very high tax state where we get very few services so the area is becoming more blighted which makes us stressed. I feel our unhappiness with living in this house in this city is translating to an unhappy environment here in our house. We want to move into a small condo in Pittsburgh, and we would not have privacy if mom moved in with us so we want her to move into assisted living. My 2 brothers finally said it is ok for us to go and take mom to assisted living in Pittsburgh, but I get the vibe there are ill feelings. How do I get them to understand? Or, are we wrong to do this? ps - We told my brothers it will probably take a year to get this house ready and sold and a lot can happen in that time.

almost 7 years, said...

This article of the in-home care issue has just about pushed me over the edge. I commented about the quality of care my friend is getting along with the lack of morals and ethics. The patient I refer to is constantly getting messed over by this company. Now I find out that the boss over the franchise calls for a meeting at the house so he can meet the new Guardian. My view is that he was not invited to the first meeting so let it go. But instead, the fact of the matter is that if he wants to meet this person, meet her at her office or have her come to him, because if she comes to the house, she wiil have to charge for several billable hours just so he can walk in and beg my friend to please give the caregiver from WWF 1 more chance. I see now he only cares about keeping the case and will say anything to get the chance of keeping the client. Is it hard to consider private care when the insurance pays it all, and what kind of issues with the administrative part are going to come up?

almost 7 years, said...

Hi Deyes, I'm so sorry to hear about your situation that sounds really difficult. You may find this article useful ( ). I also suggest you seek the professional help of a doctor, as I've heard from other caregivers they can help reduce aggression with medication. If you have any further questions, I encourage you to post a question in our Ask & Answer section located, here ( ). I hope that helps, please take care. -- Emily | Community Manager

almost 7 years, said...

we have a gr son that live with us who is bipolar , does not work . This is getting Carl more upset all the time just plain mean mouth and one night he tried to choke me , he still drives and at times seems normal . He refuses to go to the Dr . I am ready to move but wont we have been married 57 yrs . any suggestions . No the gr son cant leave no income and we have had him file for ssi

almost 7 years, said...

I'm still having caregiver problems. I find out the boss is telling the companion-housekeeper to put things away. You dont move things that have been in the same area for 10 years. So that will be #4 . Maybe it is time to do the individual route because I catch her talking to the Ms. like a darn puppy, so kidlike it makes me wonder, and then to be hanging in the only place she has that no one has just pilfered through, "her bedroom". Invasion of private space is a no-no. Daily issues would stop occuring if her space is respected and by no means invaded.

about 7 years, said...

Keep a sense of humor. Relocate your wife and children first a place they can survive and then get a court to declare him a ward of the state or you know what makes him mad just get him mad enough to bust your chops and once he does call the cops

about 7 years, said...

the comments about how to deal with depression of person, how to provide variety. examples of what can go wrong with a caregiver and how to handle.

over 7 years, said...

This is a really helpful article. My Wife and I are caring for my elderly father (86) after my Mum died. We have been here 7 months and frankly are really struggling. I have other family but they have all taken a step backwards leaving us with it. We have 4 young boys to care for as well. We're now at the point where we are looking to move out and re-establish ourselves. The challenge is Dad's care. He's stubborn and refuses to go into an aged care facility (he is classed as needing High Care). I'm waiting to hear from the Geritricians at the hospital for another review along with an aged care assessment. After that I do know what to do so any tips greatly appreciated.