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I have a 93-year-old patient that I care for. I have been her caregiver for over a year. She uses a walker and has shown early signs of dementia. At the same time she is very sharp. She likes to go out and do things that aren’t really necessary. How do I learn to say no? She has gotten very hard to deal with. It makes for a very frustrating working environment,If you say no to her. my resources are very thin. I don’t have a lot of money and patience to waste on things that quite frankly don’t matter. She wants to go out and buy things like dresses and shoes and she has no reason to waste money like that.

If it's her money then it should bother you. If it's an issue of using your car, then simple tell her that you cannot use your car to take her places and she will have fork up money for cab rides. Also, use a schedule of activities calendar to plan all outings ahead of time and set return times.
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Beatty Mar 3, 2024
My LO has some Aides that use their own car for transport & some that do not. (Not sure if because their car is unsuitable eg too high to get into, they don't want the extra paperwork or maybe due to incontinence risk..) They are not required to give a reason.

If they agree to the shift & it includes transport it is agreed beforehand. They will arrange or escort by taxi instead (client pays).
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One man's "useless thing" is another man's "heart's delight".

If you yourself are unable to drive your senior places other than required shopping and appointments, simply let your senior know this.
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I don't feel, even with being paid mileage, that its your job to drive her 30 miles to shop using your car. That puts wear and tear on YOUR car. A car you need for work. I think you have a right to limit how many miles you are willing to go when its your car. Taking her locally for shopping and Dr visits I too would not worry about the mileage. If she needs to go to a Dr appt out of town, u charge for that gas. What everyone needs to realize is that 67 a mile does not really cover the wear and tear on ur car. So putting a limit on how far you are willing to drive IS up to you. And wanting to go somewhere just before your shift is up and running over your shift, you have a right to say no that you need to leave in time because you have a daughter to pick up.

I too was a single mother with a small daughter. I was living pay to pay. I had just enough money before payday to buy enough meat/cheese an 2 rolls for lunch for next 2 days. When I went to get my stuff for the second day, it was gone bag and all. Everyone thought it was funny someone stole my lunch. Not me, I had no money.

So you put those boundaries up. Yes, I can do this, nope will not be able to do that. Remind ur employer its your car. A car you cannot afford to replace.
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Kryor9815 Mar 3, 2024
Thank you! You get it! It’s very hard for me. One whole check goes to my rent. I have a very tight limited budget with my food and gas. I can’t afford to buy myself lunch when she wants to go out to eat. She never offers to buy my food either and I wouldn’t want her to. I took her out once and almost got in a car accident. We also had one incident at a store, where a woman almost dragged her with her cart. People are rude and always in a rush. I don’t feel safe, taking her out besides the gas and mileage part.
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I would stop those last minute outing requests because this is a lot of wear and tear on you and on your car.

I had a client that got mad because I wouldn't use my ID to get more items for her from a food pantry. After that, she made my life a living hell and started accusing me of things i didn't do in her home. Then she had a complete meltdown with her CSW worker. The CSW worker was angry at me and said that we were a bad match. I told her that everything was fine until I said no to a request of getting more food from the pantry. I was following the company's integrity policy that we don't do special favors outside of our established care plan. We have care plans to follow. Anything extra falls on us. This is where we open up Pandora's Box of problems for ourselves.
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We both need better paying jobs. I would start charging for mileage on your car and make limited trips. Making ice cream runs at 5:00pm would be a no no. These agencies promise these perks but we are responsible for car repairs with limited money. It sounds like you work for a home care agency and not home health care. There is a difference.

In my case, I have problems with clients cancelling their services with me if I don't adhere to their rules. My clients like to leave their home health aides in their home while they run the streets to visit with neighbors and go to church. The agency I work with is okay with it even though we are suppose to be with client at all times. If a client goes out and falls, the first thing they are going to do is blame the aide. If something gets misplaced in their home, guess who gets accused of stealing even though they may find the item and don't tell the agency.
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Kryor9815 Mar 2, 2024
I’ve gotten accused of stealing multiple times. she is always saying something is missing or she can’t find an item. Even though there’s cameras in every inch of the house. If I tell her no to an outing, she gets an attitude and makes sure the rest of my shift is unbearable. I’ll come in next day and everything is fine. Only to be hit with an outing request late in the afternoon when my shift ends at 6:30.
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The bigger question is - do you need a better paying job?

Your child will grow, as will your expenses. Would you like to explore other paid jobs or study options towards a better paying job in the future?
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Client 'care'. It can include many things. Can include outings & shopping - this is socialisation.

But it needs to be 1. Safe 2. Agreed 3. Fairly paid for

Is the issue that the client cannot REASON you are an employee? Is expecting you *her friend* to take he out & buy cakes etc?

The bottom line is you are an employee. As such you are paid for your time. Being paid for travel costs is fair & reasonable.

Is this a direct employ from the 93yo client? Or through an agency or relative?

Who pays you?

If minute mileage calculations are not understood with the person who pays you.. Could you strike a new deal for a fair but increased hourly rate instead?
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Kryor9815 Mar 2, 2024
The issue is pay for mileage and gas. In the beginning it wasn’t a big deal. The stores she frequents are close by. It’s when she asks to go places that are 10-30 miles out. It’s also the expectations. She will wait until late in afternoon and because she’s feeling like going to get cupcakes or ice cream. I’m not her only care giver. She also has a family member who takes her on weekends.

I take the brunt of it all. Every one passes the buck onto me. Without caring how I may feel about things, agency included. I feel like there is no set schedule and it’s just whenever she feels like it. I’m not getting paid extra to do these tasks. She has a problem with paying the agency mileage. I’m looking for help with a strategy to combat all these issues I’m
having with her. No one is helping me, everyone is enabling her behavior. Hoping I can get advice on here. Thank you for your reply.
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Yes kryro, that's my problem to is I worry about my mother getting knocked down in convenience stores, because everyone is in a hurry to get back to work, specially in the morning.

Id say take her out do things with her but absolutely don't let her push you to far. Ya gotta put up boundaries. I tell mom, only to stops today. Or only in the am not pm. They don't like boundaries but that's just too bad.
As sounds like it's important that she gets out, but don't let her make you feel bad if on occasions your just having an off day , but remember how good it is for her to get out
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Is the 93 year old competent and the employer, or does she have a POA? If she has a POA, discuss it with the POA. If they approve and want a certain number of trips out, then thats what they want you to do......
Ask them the parameters, eg after a certain number of hours out do they want you to coax her back home etc.
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If your client is pleasant to work with and just like to junk shop go for it. I would gladly trade your client for one of my former clients who liked to yell and cuss at me. Some people like to shop. It sounds like a fun client. She is 93 and if this is what makes her happy, and she is spending her own money, it's okay. Now, if she is trying to make a big ticket purchase, you want to call her POA on this one.

I had a client that got to a point that she only wanted to take buses while on these shopping sprees. I tagged along. However, one day while on one of her shopping sprees in Walmart, she kept walking from one end of the store to the next and back. She had weird shopping habits. It got to be more strained because she walked like a snail while crossing the street. People drive crazy here in DC and she was out in the middle of a large intersection when the light was about to change. We can't tell them anything because they will call the office on us and report us. Anyway, that Walmart trip did it for me. Of course, I ended up taking all of these bags on the bus that were heavy. It was the worst trip ever. She hit the food bank one day and wanted me to use my ID to get extra food for her. I didn't do it. Finally, she asked for more juice and another dozen of eggs. Again, I was stuck with carrying bags of stuff while we hopped buses.

I didn't mind the shopping earlier during the case, but something towards the end of our client relationship seemed off with this lady. Later she developed a paranoia towards me and when I showed up for my shift, refused to open the door. She got to a point like she didn't want it to appear that I was her aide and didn't want me to sit next to her on the bus. I had no problems wearing my regular clothing to blend in, but the company wanted us to be in full uniform.

The pay sucks. I get it. Sometimes, it feels like we are not being paid for the work that we should be doing and that is actual patient care. Now companies want us to burn our gas to transport patients to doctor's appointments, outings and other activities that we did not do in the early days of home care because it was not mandated back then. Now it has become more or less a social event for them. Home Health Care still sticks with the rule of not driving a client so we are protected by that rule. It's too much of a liability. All I can say is make sure you have commercial insurance if you are using your car for any activity dealing with these clients, and let them know how far you are willing to travel. If they are mid range dementia and prone to sundowning, my answer is no to the agency. It is too much of a liability.
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Kryor9815 Mar 2, 2024
She is a lovely woman, I do actually enjoy working for her. Recently she has been exhibiting signs of early stage dementia. I worry about her safety at times. We went on a trip to Costco and she almost fell due to a customer running into her walker. Ever since then I get high anxiety taking her any place.

My issue is that I feel I am getting taken advantage of. My company does provide mileage but she made plenty of comments stating she doesn’t want to pay mileage. In the beginning, I didn’t mind because the places she wanted to go were only about her neighborhood. Which is less than a mile. I never take any money from her for gas or report my mileage I’m using my gas and running my car into the ground taking her to all of these places. She seems to get in moods where she wants to do whatever she feels at a certain time. There are no set days it’s whenever she feels like going out! I really feel like I am getting manipulated and used of all of my resources. I have a young daughter and gas prices are very high. She always wants to go out to eat and I don’t have money to pay for my own food. This is where the problems lie.


I don’t mind the grocery store trips and doctors and dental visits. Those are important.That’s not an issue at all! It’s when on a random Tuesday at 5 pm she gets a hankering for cheesecake in a mall or to exchange her shoes. That’s when I have a problem with it. There’s no structure and I feel as if I’m her personal driver not a caregiver. I’m also not getting any extra pay for doing these things. I feel like I’m getting taken advantage of.
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That's how my mother bought her ring to marry Elvis. She was sure it was going to happen and watched at the window for him every day.

Her home caregiver took mom out most days to shop because that's what mom liked to do. Caregiver didn't bat an eyelash when mom chose the ring and paid for it with her credit card. Mom started wearing it right away.

I noticed and asked about it because it's a flashy and heavy pave' crystal ring, and I wondered why she thought she had to have it. Mom said very seriously, "Because it's the only proper way to to do it." I thought about insisting that they return the ring, but decided that since mom was getting so much enjoyment out of it, she might as well wear it. She did.

I still have the ring. It's nothing I'd ever wear, but every time I see it, I think of mom and Elvis, and I smile.
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Anxietynacy Mar 2, 2024
That's adorable
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My Mom and her 104-yr old sister love watching funny animal videos on YouTube shorts, IG and TikTok. They could watch those for hours...
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Laptop, Library.
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If she is paying you, and her desired activity is safe and reasonable, then I don't see why you don't go along. Are you worried she's spending "too much" money? Maybe offer to take her to thrift shops or flea markets instead. But I agree you don't need to judge what she chooses to do with her money.

At 93 she's losing her ability to participate in activities that she did when younger. My Mom is 94 and she's got osteoarthritis all over so even though she attempts to garden and do housework, it is far more difficult with each passing month. She can still drive well and enjoys going grocery and clothes shopping (more like browsing, doesn't buy much but likes to check stuff out in person).

Does your client have a PoA? If not, then maybe this is topic worth broaching with her. She needs to know that if she doesn't have one assigned, the county will eventually become her guardian and they will call all the shots. She may want to consider making certain decisions while she's still in control, like moving to a continuum care community where she'll get everything she needs in one place. If she's still in her home and thinks she'll be there till "the end" without a PoA... that's magical thinking.
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This is utterly not your business. What is "useless" in your opinion is your own subjective opinion.

Your reason for not allowing this woman to do the activities are completely irrelevant unless she is in danger either to herself or others--that is to say "incompetent under the law". Then it is the business of her POA or guardian, not yours.
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Kryor9815 Mar 2, 2024
She is a lovely woman, I do actually enjoy working for her. Recently she has been exhibiting signs of early stage dementia. I worry about her safety at times. We went on a trip to Costco and she almost fell due to a customer running into her walker. Ever since then I get high anxiety taking her any place. 

My issue is that I feel I am getting taken advantage of. My company does provide mileage but she made plenty of comments stating she doesn’t want to pay mileage. In the beginning, I didn’t mind because the places she wanted to go were only about her neighborhood. Which is less than a mile. I never take any money from her for gas or report my mileage I’m using my gas and running my car into the ground taking her to all of these places. She seems to get in moods where she wants to do whatever she feels at a certain time. There are no set days it’s whenever she feels like going out! I really feel like I am getting manipulated and used of all of my resources. I have a young daughter and gas prices are very high. She always wants to go out to eat and I don’t have money to pay for my own food. This is where the problems lie.


I don’t mind the grocery store trips and doctors and dental visits. Those are important.That’s not an issue at all! It’s when on a random Tuesday at 5 pm she gets a hankering for cheesecake in a mall or to exchange her shoes. That’s when I have a problem with it. There’s no structure and I feel as if I’m her personal driver not a caregiver. I’m also not getting any extra pay for doing these things. I feel like I’m getting taken advantage of.
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When I worked Elder Care, my client loved that I was at her beck and call and she also would shop every day I was with her. It was HER money, not mine, and my JOB was to take care of her and do what she wanted.

She LOVED being 'independent' enough so that she could shop for her grandkids and have presents carefully wrapped--something she had lost the ability to do.

She also wanted to eat lunch out almost every 'working day'.

I was being PAID to be her 'independence'. Her family was so happy that SHE was happy, it worked out.

Nothing she loved more than 'sample day' at Costco.

This was a really ironic dynamic for me as I really don't like 'window shopping' as a rule, and my family found it amusing that I was essentially being forced to shop--a Lot.

My only concern for you is that YOU are the one paying. We had very strict rules about the CG stepping over the line and buying things for their clients.

If she's spending her own money, then there's not really a problem. Except, as you pointed out, you'll have all that junk to get rid of at some point in time.
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That is my mom!!! I take her to dollar general she will spend 100 on needless stuff, every day if I would let her. My brother handles her money, I ask him is this ok, he says sure, I'm pretty sure it's his money she is spending, I spend my gas, by myself and her lunch, and she will spend an hour just in a drug store, so out of boardom I spend money on things I don't need. This has slowed down since a back injury, but I can tell she is getting itchy, always expects me to take her more and more and I find myself praying for a snow day, like I did when I was in middle school. Then we always have to stop at are local convenience store for her to spend more. And I get really frustrated because she can't get around well. I know the getting out for her is great, socially and physically. The girls at the stores are good to her. Sometimes I get see eyes roll when she opens a check book.
Now that her back is getting better I'm really struggling with knowing that it's going to start again! And she never seems to appreciate the cost , time, and work it causes, not to mention the stuff that is collecting, that someday will be my job to get rid of!
It's been so frustrating, I can imagine how harder it is if it's a paid caregiver job.
I do really think it helps keep her aging less fast, but I'm definitely ordering the books on Alzheimer's that was suggested.
Sorry for the long winded vent
I just know it really helps her, and really it's all she has so I keep doing it
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lkdrymom Mar 2, 2024
I remember once when I was out of work my father thought that meant more time to for me to take him places. I flat out told him I couldn't afford the gas. I did not ask him to chip in, I just stated a fact and he was so offended that I 'implied' he should chip in for gas. Seriously this was all for him and he got huffy that I didn't want to waste gas money on him. The crazy thing is, if one of my kids took him some place he automatically gave them $10 for gas. Start asking for gas money and if she wants to go to lunch...she is buying for both of you. If she starts to complain, tell her you can't afford the outing.
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Is the 93 year old client the one that is paying you, the one that hired you?
If so she is your employer and you do what she asks AS LONG AS IT IS SAFE.
If someone else hired you or is paying you then you discuss your concerns with your employer.

You say you don't have a lot of money to waste on things that quite frankly don't matter. (I am leaving your lack of patience out of this for now)
Are the items she shops for come out of your pocket? If not then it is not a waste of YOUR money.
Now if you are footing the bill for these outing and NOT getting reimbursed that is a different matter.


Getting back to your lack of patience.
Being a caregiver to anyone particularly a person that may have dementia requires patience.
If this is something you lack it might be time to find another line of work or another client that is less demanding.

You are an an autonomous being you can say NO at anytime.
The catch is, you are an employee and generally when the employer asks the employee to do something the task is carried out.
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funkygrandma59 Mar 2, 2024
Preach it Grandma1954!
And I totally agree.
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Is she paying for your gas to take her out on these errands? If not, ask her to contribute to your gas fund.

I wouldn’t say anything to her about buying clothing or accessories. If she can afford them, let her enjoy shopping.

She may be bored or needs some type of stimulation in her life. Find things that she likes and encourage her to do a variety of activities.

The senior centers offer all kinds of activities.
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Ask yourself if it's your concern what this woman wastes money on? Or what constitutes "things that don't matter"? If they matter to her, they matter. Your resources should not be used on her. Gas expenses should be reimbursed and she should pay for ALL of her own items.

Select an afternoon or two you'll take her out to do things she wants to do, and remind her that is the schedule and no more outings will take place. Such is the nature of dementia that they can get belligerent if they don't get their way. Distract her with snacks, activities and other things that keep her mind off of what she really wants. Realize that suffering from dementia means your client is hyper focused now on precisely what she wants all the time.....which may come off as being "sharp" when it's more of an obsessive/compulsive kind of thinking pattern. Distraction can help.

Pick up a copy of the book Understanding the Dementia Experience by Jennifer Ghent-Fuller on Amazon so you can learn about dementia and how to deal with your client most effectively.

Good luck.
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Anxietynacy Mar 2, 2024
I'm ordering that book today, thanks
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You have to speak with your employer. If you have to drive her then you should ask for driving compensation such as 60 cents per mile. Otherwise you do not take her anywhere. Do you have a contract? If not then insist on these details. Otherwise you just keep her safe in her home. Who is handling what she spends?
If your patient is your employer, then you should make an attempt to contact her family to keep them in the loop
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