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It's Time to Speak Up! Three Tools to Promote Self-Advocacy in Senior Home Care | Fedelta Home Care, Seattle WA

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March 24, 2020

It's Time to Speak Up! Three Tools to Promote Self-Advocacy in Senior Home Care

Choosing an in-home caregiver is an intensely personal choice for seniors and care advocates whose goals are to maintain a standard of living and independence in the home for as long as possible. In-home caregivers provide seniors with a new-found sense of freedom from the burdens of housework and personal care that prevent them from enjoying preferred activities. They also satisfy the need for social interaction which provides physical and mental health benefits. Despite the assistance of advocates, it can still be challenging to express needs and objections to caregivers and clinical staff. Relying on others for healing or the activities of daily living, can feel intimidating, impolite, or seem ungrateful to voice objections. Accepting help can also be a sensitive subject for those who are used to being self-reliant.  So, how to promote self-advocacy in seniors?

Senior Home Care Self Advocacy

#1.  Use generational cues to help anticipate behavior. 

While a senior might assume others will see them as elderly or debilitated, in-home caregivers will recognize that each person has a wealth of experiences that include families, careers, children, and personal accomplishments. Regardless of the limits of age or infirmity, they are still the same vital people they have always been to themselves if no one else. They are also the product of the experiences that shaped their generations. Members of the Silent Generation, (1928-1945), and the Baby Boomer Generation, (1946-1964), might not express their needs or comply with care, but for different reasons. Those born before 1945 were raised to respect authority and avoid conflict while Baby Boomers are commonly known for their rebelliousness and self-reliance. In other words, sometimes clients are polite even when they are unhappy with the service or caregiver because they are afraid not to be while others are resistant to care because of the change it represents to their independence. No matter which group of clients and patients are the recipients of in-home care, caring for them will mean that caregivers need to understand generational differences to communicate effectively. Silent Generation seniors may need to be approached with open-ended questions while Baby Boomers may want a more direct approach. The bottom line is that seniors deserve to be treated like adults.

#2.  Prepare for a successful in-home care experience.

The best way to help patients advocate for themselves is to set expectations and help them prepare their homes. Social workers should make referrals to professional health care advocates before discharge to protect the interests of seniors who have no available support system. Here are some guidelines to prepare seniors for having strangers in their home.

• Unless empowered legally, explain to the senior that the advocate or family member will be present only for support.

• Prepare copies of the medical power of attorney, do-not-resuscitate order (DNR), or any other advanced directives.

• Discuss that caregivers are not guests in the home. They provide a service and will expect to hear feedback. 

• Explain what caregivers should not do. For example, caregivers should not refer to clients using endearments, share personal problems, ask for money, keep a house key, sleep on the job, use their cell phone, bring family members to the home, borrow personal items, or expect gifts.

• Create a plan for counting, storing and taking medications.

• Take inventory of valuables and secure money, documents, jewelry, etc.

• Secure firearms or any other weapons. Home care agencies will discontinue services if weapons are unsecured or in the open.

• Ask the agency to assign no more than three caregivers for the duration of services so the caregiver only needs to adapt to a few new people in their lives.

• Purchase household supplies that the caregiver may need.

• Make a list of contacts, ailments, likes and dislikes that can be shared with the caregiver.

• Create a tool for those who avoid conflict that has suggestions for starting conversations about care.

• Emphasize specific ways having a caregiver will promote self-reliance rather than diminish it.

# 3.  Make Room for the Senior to Self-Advocate.

During the Assessment, senior advocates and family members should support self-advocacy by resisting the temptation to speak on behalf of the senior or explain what they say. Allow the exchange to flow naturally with the clinician or intake coordinator. Setting the example for the caregiver shows that the senior is the authority on their needs and that they have the final word. Only help when prompted by the senior.

Families and advocates can also encourage the senior to use the lists they made to guide discussions, answer questions, and help them remember everything that is most important to them. This builds a comfort level with their new contact so that future communications become easier. For those who have memory care or limited verbal abilities, remember to involve them in the discussion by asking simple yes or no questions to verify their understanding and agreement.

The best in-home care agencies will check in with the senior on a periodic basis to verify that they are happy with services, but seniors should not feel that they must wait to offer feedback. Encourage them to establish a routine with their caregiver at the beginning of the shift so they agree how the time will be spent and are less likely to be in a situation where services are unsatisfactory. 

Touch base with the senior daily at the outset of services, then reduce to a few times a week once the senior verbalizes that they are comfortable with their caregivers. If they express concerns, offer them options for self-advocacy first (i.e., speaking to the Case Manager, addressing the problem with the caregiver during the next shift, or contacting a supervisor) before offering to contacting the agency yourself. Advocates and family members should be sure to get the senior’s permission first, so they feel safe in expressing concerns.

Here is a tool to help seniors express concerns:

What to do if my Caregiver…

Self-Advocacy Strategies

…is late or misses their shift?

Contact the care agency office and report the late or missed shift to the supervisor. Ask the office to fill the shift with another caregiver with whom you are familiar.

…doesn’t complete their tasks or is lazy?

Humans sometimes make mistakes. Remind the caregiver that the task is part of the care plan. If they spend the shift watching television, sleeping, or using their cell phone, contact the agency and discuss the problem with a supervisor.

…refuses to perform tasks the way I like?

Not everyone will provide services in the same way that we might do for ourselves. Explain how and why you like to have a task performed your way and ask them to follow that plan next time. If they don’t adapt their methods, contact the agency for help.

…uses my things without permission?

Report the incident to the agency and ask for the shift to be staffed with a different care provider going forward.

…is abusive or angry?

Ask the caregiver to leave the home immediately. Depending on the incident, it’s possible that you may need to contact emergency services, law enforcement, the agency, and/or your senior advocate once the caregiver is safely away from you.

…brings family members to work?

Contact the agency to report that the caregiver brought a family member or friend to your home.

…uses endearments when speaking with me?

Remind the caregiver that you prefer to be addressed by your name only. If they continue to use endearments that make you feel uncomfortable, contact the agency.

Social workers and family members can promote self-advocacy among seniors in a few ways. Understanding the generational cues, connecting them with professional senior care advocates, helping them set up their homes, and stepping back to allow their voices to be heard are effective strategies. Self-advocacy is also helped by establishing a routine during visits that incorporates senior and caregiver agreement about how time will be spent. Finally, the best in-home care agencies value self-advocacy and will partner with you to assure your patient always has a voice in their care.

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