Carers and the uncomplaining elderly

[Sambucus]

My elderly father has returned home from hospital for palliative care. He is still pretty with it but very disabled and nearly bed bound. He hates ‘making a fuss’ and either won’t ask or won’t realise what is possible. The carers arrived tonight and asked if he needed anything, dad said no and they went away. Do I have to spell out everything they need to do? Eg Plump pillows for comfort, encourage getting ready for the night, giving him a drink etc? I don’t want to seem pushy but I also don’t want him to get a cursory fly past because he will suffer in silence. All advice welcome.

I'd make them a list.

Check pad/help to the loo?

To just walk away is poor. They should have a list of what to check/do. Refill drinks, make a snack/plump pillows & adjust bedding (pressure sores can be avoided doing this) bed space safe (clear access to the bathroom, rubbish in the bin) I appreciate that all seems trivial but he needed more input in time.

I find this with DPs. The carers ask if they need anything, DPs say no and they leave. However there are lots they should be doing but my mum and dad are from the generation where help is for the weak! Both in their late 80s. Social services should be able to help.

I so agree with you!

I've had this discussion before with carers / care companies

Apparently carers have to follow the care plan - literally! Yes. you do have to spell it out and get it included in the care plan.

What makes sense to you and me as a basic human comfort just doesn't count if it's not in the care plan ...... it's mad!

I've found that care companies seem to make more effort if family/ relatives/friends are actively involved in the day-to-day care and regularly make 'requests' and 'suggestions ' .......

Some carers genuinely care and will go above and beyond anyway.

Some carers do the bare mimimum of what they're paid to do.

I would advise you to 'seem pushy' (in a very polite way) because that's the way to get the care your father needs x

Thank you for all the helpful replies, you’ve encouraged me to be assertive. I hadn’t thought about clearing the path and rubbish so all good suggestions. It sounds like I’m going to have to write absolutely everything down and be very specific. I guess I can’t assume anything!

It's cultural incompetence. We're not the only culture like this but in majority British culture you're not supposed to ask for help, the other person should help you before you ask, or intervene if they see you struggling, and if you are asked you say no the first time and will need to be persuaded with several rounds of 'only if youre making one' 'you really shouldnt have' etc. To be fair it's not very easy to fit this culture into professional care setups which means that the carers can be from the majority culture and it still doesnt work.

So yes, I would make a list and in the early days I would try to be around and nudge/ model the interaction as well.

You do have to be specific. If carers used their initiative it could be very disorientating. They are coming into such a personal space.
One of my relatives is very assertive and will ask for exactly what he wants - empty the bins, corned beef sandwich anda kit kat, slide him back up the bed and put a pillow under his feet, half a jugful of orange squash. My other relative will say he is fine and when I get there he is dehydrated and sat in a weird position in his tilting chair because he couldn't remember how to work it. So he has a care plan that says "remind him to drink enough, check chair position - should have feet up and make sure control is in pocket not on floor".
🌻🌻🌻

My Mum's carers have a list. If I am there and it is a new lady / person I know mum less keen on then I pop up a few times and make helpful comments.

Mum isn't very good at advocating for herself eg if they rush her (she gets v short of breath), she is too polite.

Doubly important because carers have to record what they’ve done, and if the record repeatedly says “nothing required”, care is reduced or withdrawn.

Another thing is the carers need to know when to assist the patient and when to do something for them.
eg if the patient can get their own drink, the carer might need to remind them, assist them pressing the right button to get out of their chair, be there while they shuffle to the counter, make the drink, and shuffle back, assist pressing right buttons to sit down. Because the patient needs to do stuff so they dont lose the ability.
I find it so hard, it's like reverse toddler years. But the carer doesn't necessarily know which patients can make a drink and which need one made.

More really helpful tips, thank you! I’ve started writing the list - can I assume a level of capability eg making the bed, emptying a catheter bag, boiling an egg or do I need to give more detailed instructions?

My mother when she was at home had two care companies assigned to her. The staff from the first were very diligent (or 'bossy' as she called them) - made her a meal, checked her fridge, I got phonecalls about every little thing. Sadly they went bankrupt as they couldn't pay the mileage. Another company took over and sent the most pathetic carers, who didn't even notice when she'd taken a fall one afternoon and broken her arm! I don't know why she didn't feel pain but it was very swollen.