Once a medical doctor has decided that a patient is a “fall risk”, meaning that he or she has a condition that could cause a sudden fall and subsequent injury, than the patient requires supervision at all times. Sometimes it means hiring caregivers, and less than ten percent of seniors have a long term disability insurance policy that covers it. The other ninety percent pay out of pocket. Caregivers usually cost at least $15 an hour if paid under the table, and $26 an hour or more if hired through an agency. California has In Home Support Services (“IHSS”) which pays caregivers directly at $11 per hour but they take six weeks to process his or her registration and first paycheck, and also they’ve been cutting back on hours for their patients for several years.
Seniors sometimes sell their home and move into an Assisted Living Facility, but they don’t provide 24/7 fall risk supervision. They’ll ask the patient’s family to hire a private caregiver to work in their facility, which is not included in their care package.
Over ninety percent of seniors pay out of pocket for caregivers. Obviously they don’t like that and also it’s an invasion of their privacy, and so what do they do? They verbally abuse their caregivers. That’s the person they take it out on. They’re sweet to their kids and to the managers at the caregiver’s staffing agency, but when they’re alone with their caregiver in the privacy of their own home they’re mean.
For example, in 2007 I met Dorothy in San Francisco, a 93 year old woman whose doctor said that she did not have dementia. I looked in her refrigerator and found moldy milk that was several weeks past its expiration date and so I threw it away and replaced it. Dorothy threw a temper tantrum that was the size of an F5 hurricane and it lasted for two weeks. Her son, Willis, swore that she didn’t have dementia, and he talked to her doctor again who confirmed that she didn’t have the condition. Dorothy was just plain mean. I talked to Willis about it and he said that she had always been extremely kind and sweet to him, and then her neighbors said the same thing about her. Clearly she was cruel only to her caregivers, who sometimes lasted for only three weeks.
At ninety three years old she could still shift blame. For example, when I asked her why she fired her caregiver she showed me the backsplash behind her cooktop which was covered in a very thick layer of dark brown grease that was probably thirty years old. After that she showed me her kitchen floor. It was vinyl sheeting that had been installed during the 1970’s and it had dark brown stains permanently embedded into it around the base cabinets. I’m a professional kitchen designer and so I know products: The damage was caused by normal daily wear for thirty years. People stand at the countertop while they make food and so it’s a heavy traffic area, and eventually those spots break down and become susceptible to embedded stains. Her caregiver couldn’t have fixed that. Even if it was old dirt, it would have been unreasonable to expect a new housekeeper to restore it after it hadn’t been mopped for thirty years; it would take a professional carpet cleaning service that has a steam machine and they might refuse to do it.
She fired her caregiver for that.
That’s actually very common and for that reason staffing agencies tell their clients that the caregivers are not allowed to perform deep cleaning and that they’re not allowed to do housekeeping for more than 20% of their shift. They’re not allowed to ask the caregivers to clean their house off the clock, nor can they pay them “under the table” to do it.
A different problem area in senior care is lifting patients because it causes back injuries. In order to transfer a patient from a wheelchair onto a bed it’s necessary for him or her to stand up for a moment and take about three small steps. If the patient can’t do that than it’s necessary to use a hoyer lift, and many refuse to do so. For example, many years ago I registered with a senior care agency that tried to assign me to such a patient, and after I requested a hoyer lift the agency never called me again. The franchise owner’s background was in the IT industry, not senior care, and he didn’t understand that lifting patients put his employees at risk for back injuries and put his business at risk for worker’s comp claims.
It’s necessary to modify their homes to remove every trip and fall hazard and to make everything accessible (ADA compliant). Most accidents happen in the bathroom and so I wrote an article about how to design bathrooms for seniors, which you can find by copying this address into your browser: http://snaptwig.com/article/designing-bathrooms-for-seniors