California law requires 120 hours of training, 20 of them hands on with real patients, to become a home health aide.
But most people, family caregivers like you, are usually thrown into this work with little warning when a parent, spouse, friend or other loved one is diagnosed with Alzheimer’s disease, or is recuperating from surgery or other serious medical treatment.
There’s simply no time for you to hit pause, enroll in caregiving course at your community college and learn what you need to know.
But that doesn’t mean you can’t get some instruction. In Arizona, a citizen’s group has done a remarkable job of putting together a “Principles of Caregiving” curriculum that can be used by anyone, anywhere.
It provides a kind of “best practices” starting point for anyone facing the daunting task of helping another person deal day-to-day with a debilitating medical condition, helping you make better decisions about what you can handle yourself and when it’s time to call in the pros.
Home health aides are trained to avoid patronizing the people they care for when they’re discussing medical matters from doctors’ orders to medication management. Using cliches, finishing a person’s sentences or putting the focus on yourself are all listed under “barriers” to communication that are to be avoided. Letting people finish what they’re saying, even if it takes some time, clarifying what they’ve said after they’ve finished speaking and asking open-ended questions to keep the conversation going are all encouraged. Alzheimer’s disease can present particularly-daunting communication challenges because, as memories start to disappear, people can become more easily confused and agitated. Accepting these statements without trying to refute them, then adding in the message you need to get across is generally seen as the best way forward when memory impairment is an issue.
Observation, reporting and documentation
If your loved one’s medical situation changes, you’re going to want to tell their doctor right away. But getting the best help requires the best information. Health aides are trained to take good notes as they go about their daily routines, watching for telltale signs of deeper problems. Chapter six of the Arizona curriculum lists joint deformity, joint pain or tenderness, swelling, decreased range of motion and numbness or tingling as the main warning signs that an injury may require medical attention.
Noting changes in behavior is also important, and having dates and times included with your notes can be extremely valuable if you end up having to take your loved one to the doctor. Try to stick to the facts exactly as you observe them. Sticking to who, what, where, when and why will make it more likely that a medical professional will actually use what you’ve recorded.
Working closely with another human, even one you’ve known your whole life, increases the risk of bloodborne infection, including hepatitis B and C which often have no symptoms. Home health workers are counseled to make sure they’re up-to-date on their shots, and you could probably benefit from the same advice.
Hand washing is the most-emphasized infection-control method for home health-care workers. They’re advised to wash their hands before and after any contact with their clients and even before and after using protective gloves. Liquid soap dispensed from a pump with warm water is considered the best option for keeping things clean. Rubbing your fingernails against the palms of your hands to clean under your fingernails is also recommended. It should take you about 20 seconds to wash your hands. The pros recommend singing happy birthday to yourself in your head twice to make sure all microscopic bugs are dead.
Though you might think food when the subject is nutrition, home health aides get a fair bit of counseling to focus first on water. Adequate water intake helps with kidney and bowel function and is especially important for those on seizure medications or experiencing a urinary tract infection. Encouraging your loved one to drink water, or other fluids that contain lots of water, should be a main focus.
Dehydration is a serious threat for elderly people, and many studies have linked dehydration with increased death rates in older people. Check out this paper from the Netherlands. Dehydration increases the risk of cardiovascular complications, “bladder infection, respiratory infection, kidney stones, fever … low blood pressure and medicinal intoxication.”
Dark urine, dry skin and less-frequent sweating are all signs that the person you’re helping may be suffering dehydration. Experts recommend that you encourage consumption of eight to 10 drinks per day. As far as food is concerned, obviously, a diet that leans towards plants and lean protein and away from sugars, carbs and fats is preferred.
Helping your loved one get up is one of the most difficult and potentially-injurious activities you’ll regularly encounter in home caregiving situations. It’s possible to get a little help by using a gait belt, basically a wide fabric belt positioned around a person’s middle, to help provide extra grip points when you’re dealing with someone who is able to bear 50 percent or less of their body weight on their own. Wearing non-skid shoes is a good idea whenever doing a transfer. Probably the most important thing to realize here is that this is a little bit kung fu. You’re going to get better results if you understand how to use proper foot positioning, leverage and other methods to get things moving without hurting yourself or your loved one. Check out an online resources called Body Mechanics: Positioning, Moving and Transfers by Singapore SilverPages.
It’s likely that medications are going to be an eternal part of this work, and keeping them organized is likely to be key to keeping your stress levels as low as possible. The American Association of Retired People recommends keeping notes including the name of each medication, prescribing doctor, purpose, dosage and other comments in an easy-to-find and easy-to-reference location. Being able to lock up the meds is also advised in situations where mom or dad is forgetful, and it’s important to understand which medications cause which side effects so you know what to look for.
These days, we have plenty of electronic tools to help us with this work. A spreadsheet or other digital document can work well for keeping track of medication details such as doses, last order dates, ordering physician and side effects . You can also find a plethora of apps for your smartphone or tablet that will do the job. It’s even possible to find digital pill dispensers that will automatically dole out each days dose and send you an email if pills are not being taken. They’ve even got motion sensors to let you know when mom is approaching the pillbox. Check out the Wirecutter review of auto pill organizers. Seriously, they looked at 22 different models. All of their current picks are under $100.