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This is a correction of an attempt to previously ask a question in which I omitted the most pertinent information about the caregiver's reason for waking my mother "to use the bathroom." Anyone who out of curiosity, clicked on the nonsensical question, would then have been treated to a diatribe about the sad state of elder care in Hawaii. In terms of the embarrassing omission, my new kitten's habit of leaping on the computer keyboard to get my attention was likely the cause. Now please allow me to clarify: the caregiver in my mom's new adult foster home, told me she woke my mother at 11PM to use the bathroom before going to sleep. Perhaps this is done to minimize the amount of times my mother is likely to wake said, caregiver; it may also be because my mother, seemingly, will not ring for assistance, and risk disturbing the new caregiver. Not surprising, after what the last caregiver said and did to her. Unbeknownst to me, the last caregiver had said to my mother, "I do not get paid enough for you to wake me in the middle of the night to take you to the bathroom; so stop drinking water at night." My poor mom. My mother has instructed me not to tell the present caregiver about how mean the other was because it will cause the new ones to do the same. I did anyway. In the last post I went into great detail in explaining how the State of Hawaii, lowered the qualifications for having an adult foster care home from CNA, Certified Nursing Assistant to NA, Nursing Assistant, out of consideration for the largest demographic of caregivers, given language barrier, and how it might preclude their ability to obtain higher than an NAs license and/or preclude a CNA from hiring them should the need arise. The State of Hawaii, unlike Washington and Oregon State, does not allow family members to provide home care for their loved ones, and likewise get paid. Hawaii law makers, apparently, believe that an elder is more likely to be abused by a family member, than an under qualified stranger. Most kupuna suffer from complicated health issues that require greater training and competence than an NA can possibly, provide. While a family member is more likely to go the extra mile in attempting to get the proper care for a loved one, and minimize suffering without pay, state lawmakers, ostensibly do not see it that way; it still claims the inexperienced, licensed NA is still the safer bet . Be that as it may, I have increasingly needed to be my mother's voice. I never dreamt speaking on her behalf would lead to her being abused. Thank you, for any and all help.

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Mymamalovesme, your posts have helped me better understand the difficulties you are facing. Unfortunately you are dealing with a culture where standards of living ar low and if there is a chance of making money they will or have to take it. They may have absolutely no interest in caring for elders and this may well be the case if the primary caregiver has a full time job out side the home.. The grandparents may be even less interested in caregiving than their daughter but may have to do it to keep a roof over their head.
How does this help you. I am afraid it does not, your only solution is to find better care for Mom.
One thing I would suggest though is that you visit the RN who interviewed your caregiver and try to find out what happened during that interview. Again they will have a conflicted interest because the care homes guarantee their income too.

As far as the bell is concerned purchasing a wireless doorbell will not guarantee Mom will use it or that it will be answered. The care giver may leave her unit somewhere she can't hear it during the night. I would be inclined to buy a large bell as heavy as Mom can pick up. Use something like a zip tie and attach it permanently to Mom's bed. Zip ties have to be cut off so if it is missing you will know someone deliberately removed it. No one deserves this kind of treatment especially the vulnerable elderly. So the agency thought you are too fussy. Well show tham what fussy really is. Do not be afraid of these people. It will be hard but you can do it.
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In your position, I would diligently be searching for a different care situation for mom, closer to me. Based on her medical issues she needs a higher level of care. With mom's care sorted out I would then be working to change the regulation of these foster homes.
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Thank you Veronica91,

Everything you said, makes perfect sense.  Initially, I had befriended the caregiver; she and her family, seemed like kind people.   I will make the effort anew, but need to come to an agreement on a few matters concerning my mother's care.   Hopefully, we can come to a mutually satisfactory plan of care.

Please allow me to unpack a few things:

For starters, I suppose if she were the only caregiver in the house, nightly assists would be a non issue.  She is not. It's a family affair.  Her mother and father are both certified, Nursing Assistants, to her CNA.  From what I have observed, along with providing child care for her two year old, the CNA's mother is the primary caregiver.  Grandpa, doing childcare, while grandma tends to the two elders, one of them being my beloved mother.

Things changed after the caregiver spoke to one of the RN's that owns the Case Management Agency.  The CMA is supposed to monitor the caregivers and provide advocacy to seniors within the Adult Foster Care System.  The caregiver, suddenly, and abruptly, became much less amenable after the RN asked her to come to her  office, where apparently, she wanted to personally, meet who I had finally chosen.  It was told to me as if it were a compliment, but the undertone said, "too picky," beware. 

The situation sent me in search of answers. Was requesting nightly assists unreasonable?

For instance, I think you will agree that nothing says, "Do not Disturb," like not providing a senior with a call bell. While my mother is afraid to ring her call bell, to be honest, I am too.  Previously, she paid dearly for the resentment it engendered in her last caregiver.   

Three days past and still no call bell for my poor mother.  I later found out it was against regulations for them not to provide one.  My mother is in s licensed Community Care Foster Home,  "qualified," to care for level II patients. On the books any way, CCFH are to provide 24 hour care; ostensibly this includes nightly assists, as well as bed checks every two to three hours for the completely bedridden.  Since, unlike Nursing Homes, CCFHs are not monitored, it is anybodies guess, as to who amongst the caregivers actually holds themselves accountable.

When the caregivers finally purchased a bell, it was a thick piece of rope with a plastic bell that made no sound. Since my mother's previous home had closed, and was actually worse than this one, I went out and purchased a door bell for them from Home Depot.   None the less this meant my mother had no means of calling for help, so I stayed with her on he phone to monitor her.  

Trying to remain as good natured as possible while the new caregivers were seemingly setting precedents, was hard enough, but things came to a head when my mother, predictably got sick because of the amount of stress being at the mercy of the mercenary clan of caregivers would cause someone half her age.

To better illustrate how this works, the caregivers all have Air conditioning in their rooms and sleep with their doors closed.  Neither my mother nor the other elder have AC, and the home is located in a area of Hawaii, that is arid and gets really, hot during the Summer time.  My mother's room at least has an AC unit, but it is unplugged and not included.  Ok fine.  

The problem is that It does not seem likely that they always make nightly rounds, as often as they claim either.  Call bell in  place, very concerned about her well being,  I once again stayed with her on the phone over night and monitored her.  I could hear her coughing and coughing through out the night, particularly at around 2AM.  No one heard, because no one came with cough medicine.  I called to her to ring her bell but there was no reply.  The following night, I requested they leave the medicine at her bedside table.

When the flu symptoms did not subside, I took my mom to see her primary care physician. As much as I would like to forego antibiotics, it is just too difficult for her immune system to rebound from the mercenary tactics of the caregiving community, coupled with my outrage at their ability to seemingly, act with impunity.

Here I am a thousand and one things to do, shifting the rage to the page, knowing, deep down love will prevail.  Love will prevail. Love will prevail.  I must stop adding to my mother's stress in the meantime. 

Veronica91, it was your "when in Rome..." that haunted me. I am native Hawaiian, and kupuna are aloha in the Hawaiian culture.  When did this become Rome?

It is too convoluted to go into full details, but I am sure this gives you a fair idea of what I am up against. I called the States Ombudsman, because the Case Management Agencies bias had taken caregivers willing to do the best job possible and seemingly, encouraged the apathy that I was trying to apprehend.  It was as I feared switching agencies would not help because they are all in fact in cahoots.  It was true that they also have been known to to black list kupuna who make waves, and unless their family had a home to take them to this meant ending up in one of Hawaii's, State run Nursing Homes, even when they do not require that level of care.  It seems a cruel twist of fate that the  "caregiving" clan's monopoly game included holding the "get out of jail free," card so to speak.

A few years ago a Bill was quietly passed, lowering the requirements for the Primary Caregiver from CNA to NA. When even a CNA would be hard pressed to adequately deal with the complicated health issues many of our seniors face, how in the world did the Hawaii State Legislature justify such an action?

The recent imprisonment of a Foster Home, CNA, caregiver, found guilty of committing, Manslaughter in the death of an 88 year old kupuna or senior, Nona Mossman, entrusted to her care, really drives home how egregious lowering the qualifications was.  The caregiver placed tutu Nona, (tutu is grandmother in Hawaiian) in her father's care while she went to work for 10 hours a day.  Her father an NA, apparently, was not taught why it was mandatory to perform the basic duties of elder care.   

Obviously, greed and apathy were afoot, in the case, but I do not believe as caregivers, any of them really, grasped the degree to which they were responsible for kupuna Mossman's life.  Sadly, in all likelihood, because of the way they had likely, dehumanized her.  It is not to say that adequate medical training would have prevented them from dehumanizing her, but it would have increased the chances of her not being "accidentally," killed in service to that very greed. 

In terms of ethnicity, I have cousins through marriage who are of the same race as the caregiving demographic in question, but it is the difference between generations in the islands, and those who have only recently (relatively speaking) obtained US citizenship.  What I object to is the fact that they have formed an enclave and found a nice little niche as "caregivers" for the most vulnerable amongst us, essentially, they are trafficking in kupuna.   

The agreement as it stands with my mother's new caregivers is that when my mother is feeling dizzy or otherwise challenged she will call for assistance.  Hopefully, the bell I provided will work when it is most needed.

Recommendation on bells anyone? Perhaps the Liberty Bell.
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A single caregiver in their own home needs to have a good nights sleep as much as anyone else if they are to do a good job of caregiving during the day. Preventing an elder from being incontinent during the night and laying in a wet diaper is good practice. I would have no problem with someone doing that for me personally.

Being afraid to ring for assistance is a totally different issue and most likely related to the previous abuse your mother experienced.

Dealing with a different ethnic group is something you probably need to learn more about and maybe learn at least a few words of their language. you don't actually have to converse just a few words of greeting will make them feel liked and valued because you have made the effort to reach out.

There are abusive caregivers all over the world and loved ones afraid to even tell family about how they are treated. It is not right but it happens which is why caregivers have to be vigilant supervising their loved ones care.

It can be outright physical or more subtle. Being made to wait too long for pain medication or not getting a dinner tray in your room till the kitchen is closed and having to settle for a sandwich.

I have heard stories of patients being pinched under their arms to get them to get out of a chair faster. the bruises don't show there. Of course there is the old chestnut of soiled beds not being changed for hours.

My advice would be to try and befriend the caregiver, after all she is doing a difficult job. You may not like her and misunderstand her culture but a small gift now and then might go a long way to getting things changed rather than inciting the whole community to close ranks against you.

Not the way things should be handled in an ideal world but "when in Rome............"
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It doesn't really matter what topic you put things under.

Long posts are fine, but they ARE easier to read if you break them up into paragraphs.

I can see that your mom, given her medical and psychiatric history, is both prone to misinterpreting the actions of others.

I might suggest that it would be useful for you not to fall into that. I think a simple " I'll look into that" and being sympathetic to your mom's conditions and being supportive of her are the way to go here.

Caregivers have hard jobs and are not well compensated.  The fact that there is an ethnic group willing to take on this arduous and underpaid work is a good thing, no?  As for N.A's vs CNA'S it seems as though that is the qualification for running an adult foster care home, which by its definition is for elders with less complex medical issues than those requiring nursing home care. Perhaps with her comorbidities, she requires a higher level of care.  If your mother requires CNA'S at all times, she should be in  NH.

It is a good thing for your mom to get an unbroken night's sleep. That is the aim here, and I might suggest that if you were looking after at home, you'd want the same for yourself.

We have several adult children on this forum who are being driven stark staring mad by being awakened by their elderly parents all night long.

Restricting post dinner fluids and toileting right before bed are normal practise, both for frail elders and little kids.

I don't see this as abuse at all.
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Aloha all, hope no one is put off by the lengthy answers. I suppose part of what I am sharing would be better addressed under the topic of abuse. I have held this bottled up for so long, it is like opening a flood gate. Thanks again for your feedback.
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Wow thanks everyone for the support. Yes I am in Hawaii, gladimhere. Foster homes are different from care homes in that they, supposedly, provide a higher level of care. My mother is 83. She had a stroke back in 2010. She was the victim of 13 years of horrendous, domestic violence. Unfortunately, she was diagnosed with schizophrenia and this places her at the additional disadvantage of being easily discredited by caregivers. The psychiatric medication she takes cannot be titrated, (cut back) without adverse side affects, including the inability to stabilize mood. The dosage she was given 10 years ago is likely to high for an 83, year old which has resulted in a loss of motor coordination skills. My mother has severe post traumatic stress disorder that likely would have driven anyone crazy. It was legal to beat your wife in the state of Hawaii, until 1970, and my mother was treated like her husband's property. To now watch while she is similarly treated like property only in a very different capacity is truly, painful. I am going to look into changing her prognosis to PTSD, because I believe her current diagnosis engenders prejudice. In the state of Hawaii, unlike Oregon or Washington, I cannot preform in the same capacity as the caregivers the State is willing to hire to provide her care. Unfortunately, a few years ago state lawmakers saw fit to lower the qualification for Foster caregiver from Certified Nursing Assistant to Nursing Aid, because most of the caregivers are not fluent in english. This is not to say, they are nurses in their country of origin; in which case, of course, the language barrier would be less of a divide. These are people, who likely would not get paid as much in another occupation or even as NAs employed by an agency.  Given the added bonus of working from their own home, without any outside supervision, and I am left grappling for ways to best communicate, so they will care from their hearts, rather than their pocketbooks.  Hope that long answer makes sense.  It is 2:15AM in Hawaii, and I wish my mother were with me.  
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Mymama what is the age of your mom? What ailments have her in a care home? Are foster homes the same as care homes? Are you also in Hawaii?
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Thanks Barb. Yes, I would like my mother to ring for her caregiver. The previous one was so mean and unkind that she made my mother feel as though she were not worth the toilet tissue the caregiver provided. I finally, got my mother to confess that she was abusing her after she witnessed the caregiver physically, harming the other client. Fate would have it that the caregiver ended up in ICU with an enlarged heart before I pursued legal action. Her home subsequently closed due to her health problems. Previously, any concerns I voiced, only led to retaliation through either indifference or subtle harassment and/or rudeness. My mother is a survivor of domestic violence, which complicates matters in that abusive or mean behavior will almost always put her into survival, "must be good," mode. Given her inherent vulnerability, due to a stroke, and the side affects of her medication, all I asked the caregiver to do was to reassure her that it is "ok to ring for assistance in the middle of the night when going to the bathroom if she is dizzy."  The caregiver replied, that she had to check on her clients twice a night anyway, (she has one other) and would do so, when my mother rang for assistance. Waking my mother at 11PM, (did not know it was standard practice) serve to likely, affirm that she expects her to go at the caregiver's convenience. Being that the vast majority of caregivers, and the case management agency, charged by the State of Hawaii's, Department of Health to provide supervision, are all from the same community, it seems incumbent upon us to be sensitive to their culture.  Especially, since no conflict of interests within the caregiving system has been cited or addressed thus far.  The problem is this community is very sensitive and takes offense, very easily.  It is stressful having to now tippy toe around and find ways of getting my mother the care she deserves without offending the caregiver.  So thanks a million for sharing your experience in Brooklyn.
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What would you like to see happen?

Would you like your mother to ring for the caregiver? My mom doesn't remember how to do that, so she is on a toileting schedule throughout the day. She is taken to the toilet before she is readied for bed. I'm not sure why you object to that; it seems to be pretty standard practice.
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Ok I am new to this forum and not sure how it works.  This is in response to Countrymouse.  Thank you for the prompt reply.  To clarify, the problem is, the aforementioned bias toward caregivers in the state of Hawaii, based on both the caregivers and their governing body, the Case Management Agencies, all belonging to the same very clannish demographic or community.  Believe it or not, when I previously complained about the errant caregiver to the Case Management Agency, they were unabashedly, biased toward the caregiver.  I was told that the caregiver needed more hugs, and that my mother was confused and I was seen as overbearing.  This obvious bias toward the caregiver has resulted in fear and confusion over what is appropriate. My mother will not ring for assistance because this new foster caregiver is part of the same demographic group, as the previous one with all the seeming advantages. Does that make sense? The caregiver stated that my mother would not ring her bell and wake the caregiver. Therefore waking her at 11PM, I told her would seem like further evidence that she expects my mother to go to the bathroom at her convenience.  The caregivers in Foster Care are required to look in on their clients at least twice during the night.  She told my mother to ring for her and she would make it the time that she had to check in on the other client.  Unfortunately,  my mother does not believe her.  I asked that she just reassure my mother that it is ok to ring her bell for assistance, and that when my mother is dizzy, she would request assistance.   The previous caregiver has made both my mother and I fearful, especially given that the new one belongs to the same, very clannish community.  Thanks again, Countrymouse. By the way are you a caregiver?
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Mymama, in an ideal world your mother would be free to drink whenever she's thirsty, and would feel free to wake in the night and call her caregiver for assistance with going to the bathroom, as many times as necessary. Of course.

But your mother's situation falls short of the ideal in several ways.

The new caregiver wakes your mother at 11pm and helps her to transfer. This means that both she *and your mother* are less likely to have broken nights. It also solves the problem that your mother is reluctant to call for help, having been very inappropriately scolded by a previous caregiver - whom, by the way, I hope you kicked hard all the way out of the front door.

It sounds to me as if the new caregiver is simply looking for practical routines that work well for both her and your mother. As long as she is also making it very clear to your mother that the 11pm transfer is not her 'last chance', and your mother mustn't worry about calling her during the night, I'm not sure what more you would like the caregiver to be doing?
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