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

7 common problems and solutions
Elderly Woman and Younger Woman
All Rights Reserved
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.

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

SEE ALSO: Find In-Home Care Help Near You

  • 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.

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

    SEE ALSO: Find In-Home Care Help Near You

  • 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