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A new client has three caregivers already for her husband who is on the border of mid-stage ALZ. He sometimes does not remember the caregivers when they show up for the designated time. Then he sends them home. Up to now, her house has been a revolving door for caregivers and drivers who take him to men's day care. Now she wants to hire a male companion from my staff. Then she would have four caregivers during the five days of the week she is at work. If she hires my male companion, then it will be five caregivers.
Her husband does not like caregivers in the first place.
I am concerned that this couple may have a difficult time as his disease progresses because he has not "learned" that a caregiver can be a guide. Furthermore, he will not be accustomed to having caregivers around at a later stage of his disease if he is not used to them now.
IMO, four caregivers over a work week are too many. His wife will never quit work. She cares about him but does not want to come to grips with the need for caregiving. But that is another question.
So, based on your experience, what is a reasonable number of paid caregivers over five days for a situation that could go on for several years. I have my opinion. But I would prefer to hear your thoughts first. Thank you!

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My Dad has Caregivers and it has been a trial and error for setting time and personalities. What works best is having the same person Monday through Friday as long as it is a good match. Weekends it's a regular gal for Saturday, and on Sunday another regular gal. There is also a person for the evening shift. So basically 2 persons each day.

Really nice variety of Caregivers, all different ages, male and female. So a lot of new ears to hear all the old stories from the past :) What I like is the Agency emails me a weekly calendar with the time slots and who will be working that slot. One copy goes on Dad's refrigerator so help Dad know who is coming in the evening, it also helps the Caregivers to know who will be relieving them.

It took Dad a while to get use to a male Caregiver, he felt funny having some guy do the cooking, cleaning, and helping him go upstairs to get ready for the night.
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Personally, I'd be in favor of increasing the day care, if that is working well for him. That provides some stimulation in a basically calm atmosphere, and faces that become familiar over time. Going to his "club" may be more acceptable to him than what he might see as "babysitting" at home. What if he went every weekday, and had the same "caregiver/cook" every afternoon? Someone who could be presented to him "as the person who is going to get dinner started" -- that is, a helper to his wife, not to him. Might that be more palatable to him? Would you be able to supply such a person?

Eventually he may not function well in the day center and he will need more in-home care. I think I'd want to take full advantage of the "club" for him while it is suitable, and also to get him used to in-home care.

Of course, each person is unique. What is "gentle stimulation" for one person is overwhelming to another. I'm basing my comments on my experience with my husband. When he could no longer deal with the day program, we had a PCA -- the same one everyday. It was awesome.
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The wife is about 64. He is 75.
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I fully agree with Eyerishlass' suggestions. For someone with dementia, too many caregivers could just be confusing, especially if he's already having difficulty remembering the ones he's seen.

I think I'd focus on one or two, so he can (hopefully) gradually realize why they're there. I don't know if wearing a specific t-shirt or top might help him remember - it might be a visual clue, for example.

What concerns me as well is whether the caregivers are also the drivers who are taking him to day care, so he has 2 foci of confusion - the caregiver, then the day care. If there are separate drivers, that's a third level of confusion.

No wonder he doesn't to participate - that's just too many people involved.

I would suggest staying at home where he's comfortable, getting used to one or 2 caregivers, w/o going to daycare. Minimize the distractions.

If it's likely that the wife would continue working, I'm wondering what the age range of this couple is. If she's in her 80's or so, there may be a time when work isn't compatible with her own limitations.
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The ultimate goal is to get a regular set of familiar caregivers. Sometimes many caregivers need to be in and out in order for the wife to whittle down to just a few caregivers. I think 3 caregivers is reasonable. 2 would be better. 1 caregiver working 5 days a week would be perfect but that will be difficult to staff.

As far as the caregivers ringing the bell first thing in the morning and the husband sending them home, the wife may need to take a few days off work at first to be the buffer and to help get her husband acclimated to having people in the home.

If the husband needs to "learn" to accept a caregiver than I think someone needs to teach him to accept it. This is where the wife comes in.

I agree with you that 5 caregivers is too many. Too many faces, too many personalities, too much new energy in the house. But sometimes you have to go through numerous caregivers before you find those select few who stick. And I don't know how the husband reacts to them but maybe the caregivers can be advised on how to make it over the threshold and not get sent home. Do they need to hang back and let the husband have his space? Would soft-spoken caregivers be better suited to him than caregivers with outgoing and animated personalities? Does the husband have a favorite breakfast that the caregiver can whip up to get on his good side right off the bat?

It's not just about numbers. It's also about quality.
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