Carers from an agency, is this normal?

[RoseMartha]

Looking for some insight on what they actually do when caring for your aged parents.

My parents carer spend most the time in the kitchen drinking tea and either writing up notes or on her phone. Is this normal?

They are paying for someone to administer medication, make breakfast if necessary (cereal), and help with washing and dressing in season appropriate attire. Currently my parents still going to the day centre in summer wear. The carers know where the clothes are. My parents are not dressed when they arrive.

Being on the kitchen and not doing the tasks detailed in the care plan is not normal unless either/both parent(s) are refusing care.

There should be a detailed care plan for each parent. With individual tasks which are expected to be done within the allocated time.
This needs to be agree by your parents (& you) and the agency.

It can be a balancing act of having enough detail to prompt the carer without having to go into a specifics (e.g. assist with personal care and assist with dressing but not having to detail the carer to add a vest / cardigan on cold days).

How "With It" are both parent, can they not pick out their own clothes and change to winter cloths?
The carers can have a habit to use the first of each item so when doing laundry swapping out the summer gear may be the easiest solution.

Ask that the agency provide a booklet which should be used by the carer to documented what they achive on a daily basis. They may have a preprinted one but the Agency instruct the carers that the last task in the house is filling this out.

You check that what is being document is being done.
How may of the agreed tasks are achieved each visit.
Why the task are not achieved. Are your parents part of the problem??
Then there is a conversation between your parents (& you) and the agency. On a daily weekly etc basis until the care is to a satisfactory standard.

They could be refusing care as they are stubborn. And naturally do not want to lose their independence.

I speak to the agency regularly. Usually about the same things eg clothing issues.

Left to choose their clothes themselves my mum in particular will wear the same outfit for weeks on end without it being washed. Doesnt matter if weather appropriate or not.

Neither of them think to use the washing machine ever. My sibling and I do all their washing and cleaning and gardening and shopping and admin and phone calls and take to appointments etc. (We also both work and have dc).

They sometimes strip wash themselves but refuse baths and showers.

I have left clothes out and I put away most the summer stuff carefully informing the agency where the winter clothes are.

My parents think they do not need the carers. My sibling and I put it in place as it was clear they do need help.

My mum is less with it.

You need to talk to the carers on the ground to get their side of the story.
Experienced carers will be able to introduce managing strategies to encourage your parents to accept their help.

If you and your sibling both work this may result in you calling into the house while they are working.

Washing is a difficult one as they likely grew up when strip washing was the norm. Again it may be a case of having the carer set up the water on fixed wash days.

On the clothing, if your parents are not dressed have the carers first job be putting yesterday's clothes in the washbasket.
You could try set up a hanger system with coloured hangers and a cloth bag for undies for each day of the week so one outfit from the skin out is grouped together.

If you've put the carers in place and your parents don't want them then they're not going to let them do what you've planned for. This means you've probably put the carers in place too soon to be of use.

The carers can not force your parents against their will to do what you've written in the care plan as that's assault.

The agency who attend my mother use an App and each visit is documented in that. So it says what medication she has had, food, her mood etc.
She has 30 minute visits but is refusing all personnal care so visits are typically lasting half that time.

@JustLikea
We haven't put the carers in place too soon. They refuse because they have dementia and in their minds they still think they are capable of going into town and shopping when they don't set foot outside with help. They also think they still do this. They havent done this for two years.

If we did not help they would be in care homes.

@NK346f2849X127d8bca260
An app sounds useful. Yes that is an issue and frustrating when you know they need it. Thinking of you.

To put it blankly. My parents smell and no one can get then to wash, not even us.

I have spoken to ASC recently also, who have done an assessment and think they need more help than currently have. But that is in the processing and applying department atm.

@SolasAnla thank you. I will speak to agency again. That sounds a good idea.

If you or your sibling can be there on a fixed day, set it as a wash day.
One approach is to explain the carer will be in trouble with the boss if the wash is not done on the day. So on non-wash days the carer reminds them that wash day is Xday. You will know best for which emotional appeal may be more successful as logic won't work with dementia.
How is the wash setup and how steady are they on their feet? Is it possible that they can't safely wash or reach places? A plastic chair in the bathroom which allows them to sit and wash may be helpful.

Apart from the smell how is their skin and do they heal well?

If they keep refusing and they are wiping properly with no skin issues it may be a case of gritting your teeth and making do.

My mum always wanted to be dressed before the carers arrived. She hated the indignity of a strip wash in the kitchen (the bathroom was too small for a second person). She would be dressed in dirty clothes, inside out, back to front. As far as I know the carers never challenged her about what she was wearing. As I was not there when the carers left in the evening after helping her to bed I could not be sure that the clothes she was wearing would make it to the wash basket.

In the end I got the carers onside and she was told that she had to wait for them to help her dress "because of insurance" so that worked well enough. They would ask her if she had washed and she would say yes but it was apparent that she wasn't being truthful.

"Fortunately" she had a fall and ended up in hospital and is now in a home.

Carers can’t force them to wash or get dressed in appropriate clothes, they can only encourage them but have to respect your parents decision. Do you have access to their notes?

Sorry NB
If you are getting a plastic chair get a shower chair with the "bottom" access opening in the seat.

@SolasAnla
Thank you for your reply.
Wash set up is taking turns in the bathroom. Carer asks if they have washed if one or both is already dressed when she arrives which is more likely in the summer.

Fairly doddery on feet. Often have bruises on arms when they stumble into the door handles they say.

Chair is a good idea thank you

Skin is fairly thin but no sores.

@IthinkIsawahairbrushbackthere
Thank you that was helpful. How did your mum manage the transition to a home?

@Theworldisquiethere
Yes I realise that but spending most the time in the kitchen even when not writing up notes on her phone isnt on really is it?

The other day they were not ready when transport came to take the to day centre. My mum wasnt even dressed. The carer knew what time they would arrive etc and instead of encouraging my mum more just spent the time in the kitchen on her phone.

Carers have a lot of notes to fill in and have to record if clients refuses to get dressed. Ask carer to show you the notes and you will see how much there is to do.

I’m sure you’re aware, organising a person (let alone 2 people) with dementia is like herding cats. I used to be a carer and sometimes the person would get so angry with me if I tried to hurry them or make them change their clothes. How do you know they spend so much time in the kitchen on their phone?

Thinking ahead, have you got POA. I would be arranging a cleaner and gardener at least. Online shopping. Prescription delivery. How much of what you are doing is sustainable with young DC?. They must take priority.
As a district nurse I saw previously struggling patients absolutely thrive in care homes. Clean, well fed, stimulated. Carers were so pushed for time I saw them leave their car engines running whilst they ran in and out. Muddling on at home falling about all over the place is often the worst of all worlds. For sufferers and their beleagured families.
What they need will soon trump what they want, but it often takes a crisis to get there.

Something to bear in mind is that when someone tries to persuade, it can often have the opposite effect and reduce compliance with anything as the person feels bullied or got at, so trying to persuade however kindly can induce anxiety and agitation and then the carer will withdraw because nothing is being achieved, can you arrange to be there one day when the carers visit? So you can speak directly to them and find out if they are withdrawing at the first "No" or if they have tried to talk/persuade and what result that has had?

You say you and your sibling can't get them to wash, in your parents view they have strangers coming into their home (where they are the 'boss' for want of a better word) trying to get them to do things that they a) believe they can do themselves, when it suits them and b) are very personal and associated with pride and not wanting to admit, even if aware, that they are struggling with.

Unfortunately this may actually be beneficial in the long run for getting your parents longer visits and more help if their care needs aren't being met on grounds of refusal Vs the need for that care (from a carers pov that's balancing duty of care with rights and choices - carers are taught to assume capacity unless specifically proved otherwise and that even what we may see as a 'bad' decision is still theirs to make unless it puts someone in immediate danger of harm) your parents may also be seeking/getting validation from each other when refusing care.
Could you also speak to the day centre and find out what they present like there too?

I'm really sorry this is happening, dementia is such a hard condition to deal with and there's no set way to deal with it as each person and situation is different.

@RoseMartha

Looking for some insight on what they actually do when caring for your aged parents.

My parents carer spend most the time in the kitchen drinking tea and either writing up notes or on her phone. Is this normal?

They are paying for someone to administer medication, make breakfast if necessary (cereal), and help with washing and dressing in season appropriate attire. Currently my parents still going to the day centre in summer wear. The carers know where the clothes are. My parents are not dressed when they arrive.

I have done care in the community for many years, they should complete all tasks in care plan, but unfortunately if your parents are composmentous( I think that's how you say it) and they refuse carers cannot force them to wash change clothes etc, it is frustrating I used to ask a few times and always log in care plan for refusal etc, as for being on phones, I never used my personal phone I had a work phone which we had to use to clock in out of clients homes and record any concerns back to the office in and what tasks were completed etc, I wouldn't drink a drink at clients property especially in recent times due to covid and risk of having it not knowing and passing onto vulnerable people, do your parents offer them drinks etc or do they help themselves, I also use to do the bit extra with putting washing on hoovering etc if I had time. Hope this helps you a bit xx

@ann122 Thank you. Yes that is helpful.

@Maverickess Thank you. Yes I will speak to the day centre. I do see that if they are being stubborn the carer can not force care.

The agency promised the carers would have them ready by the time transport arrived and this is not happening a lot of the time.

@cptartapp Yes poa's in place.
They cant afford cleaner etc as their money is going down rapidly on the help they currently receive and living expenses on top. Luckily its winter which we get me out of gardening for a few months. We were supposed to take it in turns but as most things it has fallen to me.

Because of money situation I contacted ASC who have done initial assessment which I mentioned up thread is still in processing stage, have not heard anything for a couple of weeks. I could chase it but have had to chase things for my SN daughter this week and had meetings for her in my 'spare' time.

I have suggested care homes with my sibling who says no. My parents would not agree either.

@HollysBush we have cctv to cover all doorways to outside, the back door is in the kitchen. Various people were regularly targeting them, entering their house without permission. Then demanding money, and harassing them for it. I spoke to the police on several occasions about this.
The agency are fully aware of this.

@TopBitchoftheWitches
Yes I read the notes the other day. They do one side of A4 not all solid writing.

I know it is hard to get them to do anything. I struggle to get them out for medical appointments of which there are many.
.

It's worth bearing in mind that the carers should, ideally, be writing down every detail of how many times and in what ways they have tried to get your parents to cooperate.
If it isn't written down then it didnt happen is the view that's taken.

So, they need to cover their selves by logging all efforts.

Of course, that can also be a cop out.
"Would you like a wash?"
"No"
"Ok then".

The carers that went in to my mum were worse than useless in terms of actually doing anything, but she did eventually get used to them, and they were very kind to her, so I had to just give up the fight to try and get any of the agreed things done in the end.

If your sister is saying no to the care home maybe she can step up with the gardening etc. Easy to say no when you're not doing the lions share.
And if you wait for a person with dementia to agree for a care home you will wait forever. Pre dementia, I'm sure they'd be a lot more rational about the effects of all this on the lives of their DC.

Thank you

Just an update different carer last few days has hardly spent any time in the kitchen at all. Which I thought was interesting.

No one it seems can get a jumper on my mum. She is about day 8 on the same t shirt.

Sometimes it's personalities gel sometimes it's a more experienced carer. Ring the Agency and ask if she can be permanently assigned.

If your mum can remember promises see if the carer can get her to promise to change "tomorrow" so first thing the next morning the carer opens with you promised I would get that for the laundry. That way your mum is doing a favour for the carer.

Or, morning!
Here's that jumper we were talking about yesterday.
Lets just try it on and see if you might like it.