How do we address concerns of live-in caregiver not watching mom as needed?

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Mom has dementia, is mobile, needs 24 hr supervision, plus help w daily activities. She is mobile, though, so when she wakes in the morning, can get up and move around. We have had cameras at the house since when mom was on her own, and I am able to access them, so can see if, for instance, she is getting up a lot during the night, and what she does. A couple of times now I have seen that she is up and moving around her room, but the carer is not attending her. One day this was for at least an hour, one day she did go downstairs without the caregiver's knowledge. She is able to do the stairs, but has had difficulties in the past (which the carer knows), and shouldn't be on the steps by herself. There is a gate in the hallway to prevent going downstairs, so she has either figured it out or it was left unlocked. My question is how to address this with the aide, as I only know this from seeing it on the camera when I have looked in the morning? I want to avoid the aide feeling like I am spying on her, but I am concerned about mom's safety.

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Your post reminded me of a clause I saw in a private duty contract for a company I was evaluating. It provided that the client (us) acknowledge and agree not to use audio or video recording in the house w/o first notifying the company and caregivers assigned.

I wondered if that would motivate the caregivers to be on their guard and provide better service, or just make them uncomfortable.

Not relevant to this post, but interesting as well: the same company required authorization AND RELEASE of the company so it could obtain credit reports and "other credit related information" as it felt necessary.

Release from what? From inability to maintain security of confidential information? From liability from hacks?

I was tempted to tell them that I require a Dun & Bradstreet report on all potential care providers, and further advise that I also require a release clause for what I might do with that information.

It also included an exclusivity clause. We would have to agree to deal with the company exclusively re the employees, and not to deal directly with the employees. It's unclear how we could "not deal directly" with people who were hired to provide caregiving.

Maybe we'd have to have Star Trek communicators so we could call the company if we wanted to say "hello" or "good bye" to the company's workers.

I think I'm going to call some other companies and ask for copies of their contracts. It's sometimes amusing to see what they come up with. Might provide me with some "lighter" moments.

And apologies for hijacking the thread, but the video camera consideration reminded me of how one company might respond, as well as the fact that it's aware that caregiver cams are being used.
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Did you have any kind of work scope, or list of activities for the caregiver to perform when she was hired? If not, I think it's time for one.

To avoid being critical or confrontational, you might suggest a sit-down with the caregiver and discuss what she might see as issues of concern, and share yours as well, w/o revealing that you have hidden cameras, kind of like a periodic evaluation of your mother's status, what's changed, what hasn't, what needs to be done.

You could also test her by asking her if your mother is going down stairs by herself. If she answers in the negative, you at least know that she wasn't watching when it happened. You might mention that your mother casually told you "the other day" that she went downstairs alone, if that's within the dementia range of conversation - so it would seem natural that your mother just might mention this to you.

Something else you might be able to do is put bells on the gate, like those cow bells that bystanders ring during downhill Olympic competition. No one could miss hearing one of those being rung, and it would alert the caregiver to the fact that your mother's on the move at the stairs. Figure out a way to secure it so it can't be removed, but put it on the upstairs side of the gate so your mother doesn't bend over the gate trying to remove it.

I believe but am not sure that there are also pressure sensors that could be alert mechanisms, but I'm not sure how you could make them stationary unless you put them under a rug (which wouldn't be a good idea at all).

The other option is a more commercial one, like those exit sensors in stores to determine if someone is leaving with something not paid for. But you'd need to have a matching coded device that your mother would carry at all times, so that's not really practical.

I think a solution might be a strip across the top of the stairs to activate when stepped on, but, again, I'm not sure of the technology or how to accomplish that.

But do work out a list of activities you expect the aide to perform so she's on board with your concerns.
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SunnyGirl1, she is hired privately, and no, not the only caregiver.
JessieBelle, I don't expect her to be on top of mom every moment, that would drive everyone crazy. Going down the stairs - early ish - around 7 or 7:30 am, so not unreasonable. I'm trying to figure out how to question this. Expectations are that she is up when my mom gets up, we have a monitor that chimes when mom is getting around her bedroom, also the aide uses the camera monitor to see during the night if the chime sounds, whether mom is just rolling over in bed, or if up and about and needs assistance. I am not thinking of using the camera as evidence, but it has alerted me to concerns about supervision. Writing this I am realizing no easy way to address this, if the aide is not prepared to watch in the morning, I need to put safety first. Also, my mom will be starting to go to a day program (5 days, 9-3) soon, so I know there will be enough down time for the aide to get her own things done.
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Is anything bad happening? I am a live-in daughter. I don't spend a lot of time with my mother. That would be like being in total prison. However, I am usually very aware of what she is doing because I can hear her. I am not with her right now, but I know she is in the kitchen and just delivered a load of laundry onto the back porch to be washed. Many times we are "watching" with our ears. Being right there with someone for 24 hours every day would be torture for everyone involved.

If the caregiver is being negligent, like sitting when help is really needed, it is another thing. Not hearing her go down the stairs was a concern. Was it early and the caregiver sleeping? You should question about that, but not be surprised if the caregiver quits soon.
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I'd first consult with an attorney in your jurisdiction to get advice on the legality of the cameras inside the home. I'd make that my top priority.

Is the aid hired through an agency? If she's not specifically trained to provide care for those with dementia, it may that she is just not qualified for that position. She may just not be aware that an adult with dementia has to be supervised constantly and safety measures for their protection are a top priority. Is she the only inhome caregiver? If so, maybe, she needs some help.
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