And obviously, not only is it often a better fit in terms of privacy, food choices, and overall contentment, putting off the nursing home as long as possible also means they keep their social security earnings longer as well. The primary causes for the eventual shift from home to the nursing home are safety and the need for additional nursing care.
Caregivers are not home health nurses
The Texas program works like this: following application with the state's Health and Human Services office, a home visit is made by a trained caseworker. They assess the needs of the client, their health, their ability to continue to live independently with help, and the ability of family members to help.
Approval is a lengthy process, but at the time of approval, the caseworker determines the exact number of hours per week the person is eligible for and the exact schedule that would work best. The case is then turned over to a private agency for the assignment of one or more caregivers. This is usually a home health agency, but not all such agencies work through the caregiver program. The state office then monitors the private agency to verify that the proper care is being provided.
Caregivers are not specially trained in most cases, though a few may be CNAs. Their primary duties are meal preparation and household tasks that the client is unable to perform themselves, but which are integral to their ability to stay in their homes. Things like bed changing, laundry, and even grocery shopping are on the list the caregivers can do.
They are not allowed to drive the client anywhere, nor are they allowed to perform any medical duties, like administration of medications.
Which brings us to the quality of care
As much as I appreciate both the program and the caregiver who has stuck with my dad the longest, she comes with a huge amount of drama. Because she has no formal training in caring for dementia patients, she often forgets what his mental health needs actually are.
Dementia patients need calm atmospheres and stability. They don’t tolerate change well. And they don’t make decisions easily. In my dad's case, even moving his things around can create a huge setback.
If there were one thing I'd recommend to the state's program managers, it would be to incorporate continuing education for these caregivers. They don’t need to be certified, but they need constant reminders of how to manage their clients. My dad's caregiver is a fabulous housekeeper and cook. She literally loves doing laundry and has no problem managing the many aspects of my dad's care I am unable to provide.
But. She forgets that my dad's thought processes are at roughly one-tenth the speed of her own. She expects him to eat like a person without dementia and can't understand that he doesn't want variety. He wants the same thing every day. And that's okay.
He doesn't want his things moved around the house. He doesn't want his closets cleaned out or his bookshelf moved to the other room. He doesn't need the pantry rearranged once a month. And added noise makes it impossible for him to concentrate.
The worst part though is that she forgets to leave her drama at the door. She brings her boyfriend issues to him. She rants about her boss and her adult children. She tells him when she's having a bad day. And then she can't understand why he suddenly has one too.
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