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Dad (99) has been taking care of Mom (97), and still thinks he can carry on. Mom is incontinent with dementia. He has been talking more, and getting forgetful. Forgets to take his medication, and give Mom hers. I live at a distance, and try to get down to help when I can. The Medicare nurse that comes in 3 times a week recommended a home health agency, and a consultant will be coming in tomorrow to talk about getting help. I am Medical POA, but was told Dad is of sound mind so I can't go over his head. Dad has fired caretakers, because he believes he is doing great, and blames Mom for getting rid of caretakers due to her yelling at them, but it's him. He is in denial of his frankness, and thinks asking for help is a sign of weakness for this WW2 vet. Anyway, the nurse recommended that if we hire a caretaker, we get cameras installed. Now, I am concerned because Mom and Dad are so vulnerable, and I am sick thinking someone could abuse them. Do background checks show enough about the caretaker? I have sent out pleas to friends in the neighborhood about anyone they know who does caretaking to no avail. Any suggestions on good caretaking agencies?

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I'm seeing so many post here about doing background checks..which is a good thing...but just want to remind everyone, not to generate more concern and paranoia...but not having a record is just not ever going to be 100% for sure...someone's past doesn't mean they won't do something in the future; and sometimes it is really a tough circumstance. In all my years working in the field there is nothing more hurtful and worse than a caring in-home caregiver being falsely accused as is most often the case. The wages are low and to have to put up with that...it's also very hard to prove, and sometimes it can be a family member who has access or who is playing. We had one time where something of value was in a box in a dresser drawer worn only on "special" occasions...so it was months before the client noticed...and by then the caregiver had resigned. Another time someone awkwardly shared their concerns...but we learned that the family had put the "jewels" in a sack under the sink in a powder room, and oh yeah, a plumber had been in, and oh yes...there had been many visitors during the grieving period...
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Hiring outside help via agency was initially only 1 hour 3x/week, bumped up to 5x/week, but didn't last because of mom, not them. She refused to let them in. We had hoped to increase help as needed, to allow her to remain in her condo. Nope.

We had already started with a timed pill-dispenser (recommended by the nurse who did the initial eval.) Despite having audible and visual reminders from that, she would sometimes not take them. Hired help was mainly to check on her, make sure she took her meds and whatever you want to do for the remainder of the hour (she really didn't need much help at that time.)

We also had cameras installed - before hiring of aides, more to check in on her as we are too far to check in daily, and to ensure unscrupulous people did not gain access! One outside, one just inside covering entry and part of kitchen and later one in the basement. MOSTLY these were to keep tabs on her, but came in handy when bringing in outsiders. Surprisingly the admin staff told us NOT to tell the aides we had cameras - probably that way they couldn't find ways to circumvent recording?

Certainly anything valuable or vulnerable paperwork (think papers that might have personal information on it) should be removed or secured before hiring anyone.

You have been told dad "is of sound mind"... so who exactly told you that? Has anyone actually tested him, more than just the mini-mental exam or a few questions in the doctor's office? Many who are in the earlier stages of dementia can "perform" well in front of doctors or others. They are not there all the time and may not be familiar with the person's capabilities previously, so they may not see the declines that you see. Becoming more forgetful is definitely a sign that more testing is needed. Any way to get that done without telling dad what it is? Forgetting the meds for himself and mom can lead to more issues! But that can be a combination of forgetfulness AND losing awareness of day/time, also a cognitive decline. Is he also repeating himself? If so, he needs to have a REAL cognitive test. The Medicare nurse may be able to perform this test. It does need to be more comprehensive than just the mini-mental exam.

It also, regardless of whether your POA becomes active or not, to get help in if dad refuses to let them in will be the big challenge. ANYONE, documented cognitive decline or not, can refuse treatment/help.

Also, since you mention he is a WW2 vet, have you explored any VA assistance? They do provide funds/help with those who qualify - check with local VA office, they may be able to assist. Maybe if he knows the help is available, free and is coming from his service time, he might relent some.
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gdaughter Feb 6, 2019
good points about everything. Just to add that I am grateful now because having my bedroom locked means it can be a safe space for valuables, papers etc.
Also: in short, there were some concerns brewing about mom, cutting her slack because of her age (90+)...but the trip to visit my sister was what made the symptoms more apparent; I gave examples to the family practice MD with whom we had a great relationship. He was shocked because she had been so slick at the visits nothing seemed amiss, and they saw him regularly enough. The neurologist did not feel the need at age 95 or so to do any testing to confirm the obvious which he was able to ascertain with his years of experience simply sitting down and talking...it was so sincere and conversational that neither mom or dad was aware of him using his keen clinical skills to be able to generate an accurate diagnosis...or accurate enough. I know there are many who will say they should do scans etc...but to what end? At least imo, the family is still left to deal with the issues and behaviors regardless of what it is called, and at that point, the meds are more likely to not be of any benefit or cause side effects that would make for worse problems.
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Please do background checks for the caregivers. My late mother was cheated by some untrusting people until I found out about it and put a stop to it.
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Before you do anything, remove anything that is "valuable" so it can't be stolen. Also make sure l00% of the papers, etc. are in perfect order. This includes a Will, durable health care power of attorney, and a general power of attorney so that you are fully in charge of EVERYTHING. Prepare a list of rules - do's/don'ts and make sure you and the caretaker sign it in agreement. Do background checks. Consult an eldercare specialist for advice. Be very, very careful. I took care of an elderly person for 28 years while working full time. I hired two people in the beginning to take care of her and it turned into a time of hell until I fired them after catching them doing some horrible things. Eventually she had to go into a nursing home where fortunately she was very happy. As to the father who thinks he is fine, tell him he either makes YOU in charge or you walk and be prepared to do it - until he realizes he has no choice. How else can you protect him. Just DO it!
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Lizhappens Feb 4, 2019
Oh God bless you for 28 years and working full-time. I felt like I had my hands full with what I was doing.
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Oh wow you’re at the very beginning. I started in 2013 and ended in 2018 coming in as a newbie going out as a pro ( if someone you fire gives you a key chain it says you’re the number one boss and you’re still on friendly terms I think that qualifies.) I considered myself the house manager and a caregiver. I’m not the only one who’s going to give you advice here, so I’ll focus on hiring caregivers and Agencies.

Caregiver agencies. There are none that can guarantee their workers integrity no matter what they say. The 20/80 rule is here too. Only 20% are good enough, I’d say 5% are actually what you expect, 80% are not worth your time. I never hired anybody that I didn’t have an opportunity to meet and work with first. The agency I worked with was willing to pay for one hour for training at my house, and I added paying one hour of training too. That was so I could determine whether or not I wanted to hire them at all. In any case ———-

Nanny cams are a must. Remove all valuables from the house is a must. And tell them you have nanny cams. That will help weed out a bunch of undesirables right off the bat. Even still, I’ve had caregivers who interviewed well, then watched the cams & they actually turn the nanny cams away so that I couldn’t see them! Fired! I always used them in the beginning and I would let them know if I saw something I didn’t like. That way they knew I actually used the nanny cams. Later, i only spot checked or when I felt suspicious of something. They were very valuable, Cannot say enough good about nanny cams. Put one in every room that your family occupies on a regular basis and one in the kitchen. They do eat your food and may do things you don’t like that you will want to know. Leave them out in the open. Have them keep daily logs with name/time and read them. Be on site as much as possible. Randomly show up.

I prefer private caregivers, an agency as a backup. Less expensive. Hire someone who is hungry to work. They will be more reliable. I used craigslist. Gave the basics, vague about my location, no phone number at this point - you have too many to weed out, that I had nanny cams, that I had high standards, and my deal breakers for Immediate dismissal. good people want a good employer and trustworthy coworkers too. I would give a starting pay and mentioned there were fast increases for the right person. I asked for resumes at the interview, ahead of time was better,and i would not contact anyone who could not form a decent reply back to me. first I email, then call, then an initial face to face away from the home at a nearby fast food restaurant. I wrote notes during the interview. Paid $10 an hour for the 1st four hours. considered orientation training, a get to know you and me time. $13 an hour for two weeks $14 an hour for one month $15 an hour after that. Rates may have changed at this point but that’s not too bad to begin with. I did the training. Agencies would pay one hour and I would pay one hour for two hours of training with any of their staff. I also offered holiday pay for the five major holidays during the year. Including Thanksgiving eve and Christmas Eve. If you don’t you will never have any time off for them. You really have to treat it like a business. I bought them gifts for their birthdays, their anniversaries, snacks on Fridays, I spent a half hour at every shift change talking to them about their personal lives. As unreliable as some caregivers can be, they are also one of the least appreciated and don’t have much fun in their jobs. I remember jobs where we always had office parties and had special occasions to get together, etc. Caregivers don’t. They work their butts off and have to be polite to their clients and employers can forget that there are people too and they want to feel like they are a valuable employee. This is not a job because it’s all about the money. Anyway that’s my two cents and the longest post I’ve ever made on this website. And ALWAYS ALWAYS TRUST YOUR GUT!
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Lizhappens Feb 4, 2019
Lol. One more thing. Both private and agency caregivers callout a lot but less being private I think and also it’s easier to work with them to cover each other or to come in for additional shifts. With an agency that caregiver can call out on a regular basis because they know they will not be fired because they are one of the good ones. Then they wind up sending somebody as a replacement that you don’t know Or call you and tell you they don’t have anyone to cover at the last minute then what do you do? I don’t like that personally. Again it could happen with private too but you just have more to work with.
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Are there jobs that your dad is having trouble with? If so tell him you are going to hire someone to work with him on those areas. Then when the person has been there for a bit he may accept more help with mom, because they are there to “work” with him. Sometimes the way we word the idea can change the attitude.
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Saveme1 Feb 4, 2019
Thank you. Good idea! I will try this.
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I can so relate, and it is of course more scary for you, so stress no matter what you do. You don't mention finances. I'd try to hook in with a geriatric case manager who can make pop in visits when the caregiver is there...maybe she gets a key. For comfort, if you go ahead, I'd make sure to take the valuables, breakables and put them in a locked space or take them with you for safekeeping. I have learned the lesson the hard way about this as with my mom's dementia, now the wedding/engagement rings are missing, both of theirs...and god only knows where they are, though we think still in the house. Hope so. I think the majority of caregivers are decent...abuse is less likely than theft I'd guess, but still...there are other abuses like sitting on one's ass playing with phone and not doing anything helpful like cleaning etc. Your most important way to go is with getting guidance on a good agency. And you should connect with the local office on aging to see what they've heard though they won't be able to specifically recommend any particular one. One may have more experience/train better in re to dementia. MAKE SURE they have done both a BCI and FBI criminal background check, or find a place to do it on your own with applicant's consent if you opt to hire privately, unless it is clearly someone you know. Really you can't do more than that, and unfortunately, it is often the best any of us can do. A clean background doesn't mean someone won't do something in the future. These days, yes, cameras are an option. Maybe just the presence will keep trouble at bay and you more relaxed...but putting forth the effort ahead should help. Let your gut and intuition lead the way...definitely plan a trip to visit, and set up interviews for when you are there, even if at a coffee shop. Look at on-line reviews. Check out Next Door for their area. Sign up, ask the question. I've found everything from good restaurants to help with insurance and car-buying questions. Also, dad probably loves mom to the ends of the planet and is frightened...so focus on how the efforts will help both of them, but especially mom so that the meds are straight. PS, touchy subject, but to play it safe, make sure the checkbooks are all with you if you can. My dad is WWII as well, but at least he is agreeable...and I am at the same junction you are. I may use an agency I've heard does dementia training (HomeWatch), and/or I may scour care dot com to find a nursing student or someone with adequate experience. Good luck!
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I would consider a family member that your parents are already comfortable with & trust to help them & that would give you peace of mind knowing that your parents are given proper care. I've been taking care of my mom full time live in caregiver for the past 3 years. I work through a program offered by Public Partnerships LLC & there is a process of course & lots of paperwork to fill out to get everything set up & I'm very shocked this year at the amount of money I earned, I never thought of this type of job before & am now considering continuing working through this company. If this could be an option I'd like to make sure that you or family member are aware that respite hours are not just hours set aside to pay someone else & if the situation meets the requirements the person can use respite hours as I was not aware of this for a little over a year I really struggled but finally the care coordinator told me how to use respite hours & my check literally doubled every other week but I did use those hours up very quickly even though I was encouraged to only use 2 respite hours on top of the 5 attendant paid hours but I needed medical equipment to make my job easier so I used 4 respite hours a day on top of the 5 attendant paid hours & I made a little over $21,000 this year.
I know how hard it is to see your parents struggle & not know exactly how to help & my heart really goes out to you. I hope you find the best solution to help your parents & ease your worries.
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Saveme1 Feb 8, 2019
I would love to be able to do something like this, but Mom and Dad told my husband and me years ago they would not move closer to us, because they want to die in their home. Being they are in Florida, and I am in Colorado, I can only get down to help once a month. I have family and responsibilities here. My brother cannot help as he is battling prostate cancer that metastized to the bones. So, I am b ack to trying once again to convince Dad he needs help...other than me when I can get there, and will get a consulatation with an elder care advocate to help access the situation. I appreciate your input, and do wish we were closer.
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Call Visiting Angels head office or visit their website and they will re-route you to their agency nearest to you. At this point, even if relocating to an Assisted Living facility is still an option, daily supervision is still paramount. And there is no better place to start than with a reputable Home Care Agency.
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gdaughter Feb 4, 2019
No matter what agency is used, it all comes down to the particular caregiver(s). Some agencies are short staffed and will hire anyone...so you still need to be careful.
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Understand your plight. Whether or not he has been labeled of sound mind, you have to look at the safety of the issue. DPOAs act for the person and can be revoked at any time. Your parents need to be safe. Find a geriatrician and go with them for a checkup. Speak to the Dr before the visit about your concerns. They should understand and know how to handle concerns of this generation. Have them go for each other if they won’t go for themselves. Caregivers often die before the loved one due to stress. It takes a village to care for someone with dementia. Try and find a care manager to help them also. Good luck.
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If a Caregiver is from an Agency, They have already been Screened. However, Puttin gin a nanny Cam for your Own at Home Contentment is Fine as well.
If Mom and Dad don't Mind paying out of Pocket for Help, It might be worth the Ride at this Point. However, With a caregiver from an Agency, Mom and Dad will Be daily Monitored and any of their own Reports about their Physical and Mentality will be Reported as they see fit.
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IMO, its much like hiring a babysitter. No matter what you do, there's going to be some risk. I would definitely install cameras so you can check in from time to time. Make sure you do it securely so that the rest of the world doesn't watch your parents while snacking on popcorn. People do that.

I would try to make sure you get the same person all the time. Some agencies will send out whoever is available. So your parents might get a different person everytime. I think it's best if they have the same caregiver so they can build a relationship.
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If there is a Bayada Home Health Agency near you, contact them. We have found them to be reliable, caring and extremely knowledgeable. It is a good company...the CEO ... the son of the founder ... gave a huge sum of money to employees as bonuses this year. Have had no problems with them in AZ.
Good luck....but as countrymouse said, they are not a substitute for boots on the ground family and friends.
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Here is a link to Missouri's Family Care Registry and what they look for when someone enters the helping profession. Employees are screened either every 6 months or every year, I can't remember. I would imagine that most states have similar data bases.

https://health.mo.gov/safety/fcsr/backgrounds.php
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These friends in the neighbourhood... how close are they to your parents?

The HHA consultant should, if she's worth her salt, be able to answer even searching questions and set your mind at rest. Would it be possible for you to take part in the consultation through a telephone conference call or anything like that?

The reason I ask about the friends is that there isn't really any substitute for boots on the ground; and if possible it would be good to have someone keeping a close eye on this important new relationship just until it's bedded in. It would be quite a lot to ask, and the friend would need to have plenty of common sense and of course be welcome in the home, but you never know.

Your poor poppa. The thing is, it's not so much a sign of weakness as being forced to accept that change is on its way; which unfortunately, inevitably, it must be sooner or later. Keep stressing to him that the help and support are his best way of continuing care for your mother at home.

You must sometimes wonder what happens if God forbid anything happens to him, too.

Have you had a chance to look around at what alternative options there are in your parents' area?
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gdaughter Feb 4, 2019
Yes, that could be a good approach, a plan b, just in case something happens to you dad, then we need to have someone in our pocket to take care of mom...
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