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PREPARING YOURSELF FOR HIRING CARE GIVERS When hiring an employee, even if that person works for an agency and claims to be bonded, contact every reference which he/she gives. Check the county court websites which list arrest, warrants and indictments alphabetically. Make sure any prospective new employee is not on that arrest, warrants or indictment list. Ask to see the prospective employee's CNA license. Do not acccept an excuse that the license was lost or stolen. If the prospective new employee states that he/she is licensed, check to be certain that the license is current -- call the state agency which licenses CNA's. Some states also list the names of licensed professionals on a website. If the individual claims to be licensed, but cannot produce a license for you to inspect, do not hire that individual no matter how experienced he/she claims to be. Talk to Adult Protective Services about how to recognize abuse. Often Adult Protective Services gives a list of convicted elder abusers to nursing services. Ask Adult Protective Services for that list. A care giver may be licensed, bonded and/or work for a home health agency. You cannot assume that licensing or bonding or working for an agency proves that the care giver is not an abuser. If you can afford some kind of monitoring system -- video, sound or both -- have it installed prior to the hiring of care givers, if possible. Photograph everything in the home, and let any prospective care giver know that you have done so. Remove any valuables before hiring the care givers. Leave small amounts of money around in unexpected places and check frequently to see that the money has not been removed. Act immediately if the money or other valuables are missing. Caller ID can be used to track incoming phone calls. Even though the care giver may have a cell phone, the absence of phone calls from family members may be an indication that something is wrong, that someone in the family is being manipulated and speaking privately to a care giver. Caution the prospective employee about bringing other medications into the home. Let the prospective employee know that if un-prescribed medications are being given to your loved one, you will call the police and the employee will be fired. Tell the prospective employee when he/she is hired that any abuse of your loved one will be prosecuted to the fullest extent of the law. Adult Protective Services has a mandate to assist you. Use their services and do not be afraid to call the police for their assistance. FAMILY HISTORY AND INTERACTING WITH OTHER FAMILY MEMBERS The care givers are not your friends; they are your employees. Do not tell your family stories to your care givers. These wonderful stories can be used to manipulate you, by giving the care giver insight into your character and values. Recognize that there are people who have no concern how wonderful and kind and special your loved one is, that there are people who will purposely hurt the defenseless. Keep family squabbles to yourself - there will be disagreements over the course of care that a loved one is receiving. Those disagreements can be used to separate the family and hide what is being done to your loved one. Never stop talking to your siblings, no matter how difficult it becomes. Find some friend or family member to mediate for you if necessary. MANAGING THE CAREGIVING STAFF Never give or lend money to a care giver. It is inappropriate for an employee to ask for your financial help, no matter what reason is given. Limit the value of gifts given on birthdays and holidays. Remember these individuals are your employees. By allowing your employees to become friends, you add substantial risk for the patient. It is easier to overlook a friend's behavior than an employee's behavior. Always keep a distance between the care givers and yourself. This is, perhaps, the most critical suggestion. It does not mean that you are unkind to your employees. It means that you recognize that your knowledge of the care giver is limited, that you have little first hand knowledge about them. Make unexpected visits to the home, varying the times and days that you, other relatives and friends, come to the home. Do not allow the care giver to schedule visitation times for nursing services; the nursing service should make unexpected visits. By allowing the care giver to schedule visitation times, he/she can prepare both herself and the patient to make the best presentation, a presentation that may not be normal. Do not allow a care giver to re-arrange the home for his or her convenience. It may be a sign that the care giver is attempting to take over the home and the power which belongs to the family alone. Be cautious about allowing a care giver to bring household and other supplies to the home. The home belongs to the patient(s) and supplies should be provided by you. Bringing supplies, making herself/himself seem indispensible, may be a way for the care giver to detract attention from what he/she is doing. In addition, it puts you in debt to the care giver. Do not put one care giver in charge of the other care givers; it gives too much power to a non-family individual. You are the one in charge; never relinquish even part of your authority to anyone outside your family. A care giver who complains often about the other employees or family members is trying to confuse you, trying to keep you from suspecting him/her for the problems that you may be encountering. A constantly complaining care giver should be removed from the home. Even though a medication schedule is available to the care giver, you cannot be certain that the medications are being given as prescribed. Check to make sure the schedule has not been changed. Look at the medication box and watch for symptoms that the medications are not being given as instructed, for example, excessive sleepiness or frequent urination at inappropriate times. When ordering medications, have the medications delivered to your own home, if you do not share a home with your loved one. Provide only limited amounts of medications to your loved one's home at a time. Strictly control the amount and the types of medications that are available to the care giver. Many prescription services will deliver prescriptions in amounts needed for 90 days. Never leave the entire three month supply of medication in your loved one's home. When a care giver asks for supplies, make sure the supplies are genuinely needed. By asking for or ordering more supplies than are needed, an employee is stealing from you, even if that employee does not remove the items from the home. An abuser will look for ways of exercising their power, defeating you in little ways, gaining more and more power, until all the power belongs to the abuser. Keep in contact with outside care givers such as nursing services which visit the ill and disabled, questioning the service about what the visiting nurses and social workers have seen. Often the nursing service leaves a report in the home. Do not assume that the nursing service will contact you if there is a problem. Insist on a weekly personal report either over the phone or in person with you, the primary care giver. If possible, have the report mailed to your own home. If the care giver does not touch the patient in a loving manner when you are present and/or is unwilling to be touched, that person is not a care giver. That individual may have personality traits which are dangerous to your loved one. Loving people do not mind being touched, even if their ethnicity or race is different from your own. Do not assume that another care giver will relate to you improper care of your loved one. Most people are afraid of "blowing the whistle". Do not trust a care giver implicitly, assuming that he/she is telling the truth. Trust should not be given just because a person presents herself as trustworthy. Check out the stories you are told. Anyone who lies even about something little should be fired immediately. Any employee who repeatedly seeks your pity about their past or present life condition cannot be trusted. He or she is seeking to manipulate you. It is very easy for good and caring people to be manipulated. If a care giver tells you that hospice is needed, that your loved one is failing, question the reasons the care giver believes that to be so. Privately question the other care givers, if any, to gather information from them. Most important, talk to the patient's physician. Never just dismiss the care giver's assertion. You must never underestimate a care giver's knowledge, motives, intelligence, resourcefullness or the power which he/she has at her disposal. Never believe that you are smarter or better educated than the care giver. In all liklihood there are some areas in which the care giver is much more educated than you are. PERSONAL CARE OF THE LOVED ONE Do not make the mistake of trying to protect your loved one's dignity by being out of the room when he/she is being bathed or having a diaper changed. Familiarize yourself with the proper procedures for bathing and frequently watch the procedure being done. Never allow your loved one to be totally uncovered when being bathed. If you see an improper procedure from someone who claims to be licensed and/or experienced, that technique is being used to humiliate the patient. Immediately fire that employee! Do not assume that teaching the care giver the proper procedure will change the improper behavior. The behavior may be changed while you are present, but it will revert to the humiliating technique when you are absent. The presence of bed sores on a patient is an important indication of lack of care. Find out about the causes and the prevention of bed sores. Excuses by the care giver should never be acceptable. You must be very pro-active on this issue, firing the care giver if the issue is not resolved quickly. Check the patient's teeth daily. If the teeth are dirty, it is a sign that the patient is not receiving proper care. Do not accept excuses. Look in the patient's mouth for signs of thrush, a fungal disease. Proper mouth care is important and necessary or the patient will not be able to swallow comfortably and will stop eating. When conditions are puzzling, like a patient sleeping more than he/she should, or losing weight, though adequate food is provided by you, always suspect the care giver. Never just assume that the patient is failing or that his/her disease is getting worse. The patient's health may be deteriorating, but the reason for the decline could be the care giver. The care giver may have stopped feeding the patient or may be giving medications that were not prescribed for the patient. Do not assume that the doctor your loved one visits will routinely look for elder abuse. It is not common practice unless the doctor sees bruising or broken bones. The medical profession often considers paid care givers to be colleagues; colleagues motives and activities are seldom questioned by other medical professionals. The medical profession assumes that when an order of care is given, the order will be followed, particularly by individuals working in the healing professions. When the patient returns to the doctor in worse condition than at a previous visit, the doctor assumes the elderly patient is dying, that his/her body is failing. Expect to be told by the doctor that you are in denial when you argue with him/her about the patient's worsening condition. Be persistent. Though you may be unfamiliar with medical terms, you know more about the patient's life history than the doctor does; the doctor sees the patient for only a few minutes per visit. If something seems wrong about the patient's worsening condition, it usually is. Looking for bruises, expecting bruises to tell you if the loved one is being abused, is not enough. There are many ways to abuse which leave no marks and are just as threatening to the patient's health and well-being -- withdrawing food and/or medicine, ugly, demeaning words, changing medication schedules, refusal to assist an individual in and out of the car or to the bathroom, improper bathing procedures, improper mouth care, excessive urinary padding -- all are means of abusing your loved one. FURTHER SUGGESTIONS Remember that elderly folks are afraid to talk about the abuse. They are easily controlled by an abuser. Learn to watch for signs of behavior change. A person with dementia cannot tell you what is happening, for he/she often cannot find the words to relate what he/she has experienced. However, his behavior will show you, if you are attentive to changes in his behavior. A person who raises his/her arms in defense when you approach is a person who is being struck by another. Learn these physical signals and respond to them at once! When an elderly person, who has always been kind to you, begins to attack you verbally or physically, but talks sweetly to the care giver, fire the care giver. The elderly individual may be trying to "soften up" the care giver, hoping that the abuse, which he/she is receiving, will stop. Schedule private time with the loved one. Do not allow a care giver to sit in on private conversations. The care giver is not a member of your family. It is not necessary to make the care giver feel that he/she is part of the family. The presence of the abusing care giver threatens the elderly, keeping the elderly individual from speaking about what has been happening to him/her. Return to the top of the page.