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The woman I care for has been incredibly hostile to me since a recent medication change. I am afraid she will fire me before it gets straightened out (if it gets straightened out). We have only a verbal contract. I live with her 24/7. How and by whom is it decided at what point someone can't live alone? I worry for me and I worry for her. I don't know how to best protect both of us.

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It is usually decided by a close family member when someone can no longer live alone. How a family member decides a loved one can't live alone anymore is based on many factors: the loved one's health, is the person safe in their home, has the person become too much for a caregiver to handle and other personal reasons such as family dynamics, the health and well-being of the caregiver and dangerous behaviors brought about by dementia.

Did this woman hire you herself? What do you feel you need to protect her from?

Make sure you are being paid regularly and in full. There are too many accounts on this website of caregivers who never get paid because there is no employment contract and the patient is not lucid anymore and the family isn't concerned with the caregiver getting paid especially since the services have already been rendered and the caregiver is no longer needed because family has stepped into the picture and/or the patient is being placed in a facility.
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Is this an escalating situation? Do you work for an agency? If so, you need to go to your supervisor at the agency. Verbal contracts with people who are ill and have the potential of developing emotional issues as well is scary.

Does this women have no family to whom you are accountable? Who does her doctor communicate with? Can you inform the doctor (maybe via the family) that this medication is having serious side effects that are making caring for her nearly impossible? If you fear she will fire you, then you need to start reaseaching other options since you would lose both your home and employment. Better safe than sorry and all that.

If the two of you are truly alone in this, take it upon yourself to call her physician and inform them what’s happening. Seldom is there no alternative to a medication that is having such concerning side effects. And, as Eyerishlass writes, make sure she owes you no back wages.
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Thank you both for your responses. I was brought in by her children, who told her she was only going back home from rehab (after multiple strokes) if there was someone there with her, and they both want me there and will push for her to keep me. They asked the doctors there if she was able to make her own decisions/at what point she wasn't, and they said at this point, she could still make her own, which would have to be respected, even if they were bad decisions.

She has dementia. It is not going to get better. She gets up and can't tell what day it is and tries to take her meds twice, thinking after a short nap that it is the following day. I take care of her meds. She wouldn't starve on her own but cooking is a struggle for her at 90. She sometimes leaves things with heating elements/water/etc on. She has fallen. She cannot get dressed on her own. There is an issue of putting her dirty incontinence pads in the same basket as her food. She cannot drive.

Her daughter handles my pay and I have always been paid promptly and in full.  I am thankful for this.

We only recently started seeing a geriatric doctor but I was able to go with her and her children. I'll be on vacation when they go next but am keeping notes for them.  They both have a realistic picture of  their mother's condition.

They think she would ~survive~ without live-in, 24/7 care, but that it would be a struggle.
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