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Caregiver’s Toolbox Ep. 25 “Managing Expectations – Caregiver Downtime”

Ryan McEniff:

Welcome to the Caregivers’ Toolbox. Tools for everyday caregiving. On this podcast, we give education and information on topics related to senior healthcare. This podcast is brought to you by Minute Women Home Care, a home health agency located in Lexington, Massachusetts. My name’s Ryan McEniff, and let’s get into it.

Ryan McEniff:

Hello, everybody. And welcome to another episode of The Caregiver’s Toolbox, tools for everyday caregiving. We give you information and education on senior caregiving topics. My name is Ryan McEniff. I’m with Janet, and today we’re going to finalize our four-part episode. What ended up becoming a four-part episode. We thought it was only going to be three. But we got talking so much on managing expectations. And this is really going to be coming from an idea of downtime. And a couple other subjects about cleaning and about transportation. And what we want to talk about is the realistic expectation about downtime with a caregiver. In other episodes, I’ve mentioned how I got into this, where my mom got cancer and we needed 24-hour home care. And we eventually needed hospice, unfortunately. And I got that crash course of experience of what this is all like, which is generally how most people get this. Is a crash course experience.

Ryan McEniff:

And so one of the things I noticed was with my mom, when you’re on radiation and chemotherapy, there is a lot of downtime. She’s sleeping a lot. She was sleeping probably 12 to 14 hours a day. At night, and then during the day, right? So you had caregivers that were available, ready to go, but didn’t really have any work to get done. And so what we’re talking about is when there’s this downtime, there can be this expectation that the caregiver has to be on their feet at all times, working, doing something that to pay for their hourly services. And unfortunately, as much as both Janet and I completely understand where somebody’s coming from, because I get it. You’re paying X amount of dollars. You want to be getting something from this. It doesn’t work that way in home healthcare. The reason why it doesn’t work this way in home healthcare.

Ryan McEniff:

For example, if you somebody to clean your whole house while your loved one is sleeping. If they’re upstairs vacuuming and your loved one goes, “I don’t want, I just need to go to the bathroom real quick. I’ll be in and out of that bathroom,” before the caregiver knows what’s going on and then falls and hurts themselves. We’ve just defeated the purpose of having one-on-one care in your home. Now that doesn’t mean that a little bit of cleaning can’t be done, but you’re not going to be washing all the windows and dusting all the baseboards and cleaning out the gutters. And though that might sound funny to some of our listeners, we get those requests. Like why isn’t this happening at all times? So, Janet, what are your opinions on that downtime with cleaning and things like that?

Janet:

Well, I think, the general guidance that we give the caregivers, which I think is reasonable, is any mess you make, you clean up. So if you’re preparing a meal, you clean up. If you’re doing an activity with someone, it could even be puzzle. It could be whatever, straighten things back up. In addition to that, anything that’s involved in the personal care. You want to make sure the bathroom’s cleaned up. The expectation is to make the bed, to do things like that. As far as doing some laundry, we’re all accustomed to doing laundry. But back to your point, you have to figure out how are you doing laundry so that you’re not in the basement when Mrs. Smith, who thinks she’s fine and doesn’t need her walker, decides she’s going to leave it behind and walk into the bathroom. So you have to take those things into consideration.

Janet:

And you also may have someone who, for part of the time, they’re a major fall risk. They should not get out of that chair without supervision. But while they’re in their chair, they’re reading the book. And maybe they’re going to read a book for a couple hours. What is the caregiver to do during that time? So we encourage them to, if they’re someone who reads a book or they do certain tasks, we discuss that with the family and this is, is it okay if they do that? Many of our caregivers are taking online courses, and it’s acceptable to the family that they’re going to sit there on the couch and do some homework while Mrs. Smith is reading their book. So you kind of work it through that way.

Ryan McEniff:

Yeah. And that doesn’t… That’s not to say that making a meal, folding clothes, doing laundry, cleaning up after any messes that are made, aren’t going to get done. They absolutely are. But there’s only so many tasks that need to get done. If somebody is going to be reading in a book all day or watching TV for six hours, then there’s only so much a home health aide can do in that timeframe to eat up those six hours. So it can be frustrating to clients. And like I said, understandably, that they come in and they see a caregiver’s reading, or they see a caregiver’s writing or knitting or whatever it might be. But also you need to remember that you’re paying for a person to be ready at any moment to care for your loved one. And that is the primary goal of our caregivers is to keep somebody safe.

Ryan McEniff:

And so anytime that they are away, and this is a perfect segue into doing chores for people or outside of the house chores, I mean, like going grocery shopping. Any time that they’re away is time where your loved one is susceptible to getting injured and having nobody around to provide them any assistance or prevent that injury. So one of the things that people like us to do, and we absolutely don’t have a problem doing it, is to go do the grocery shopping, go to the fast food joint to get them some food or whatever it might be. Go to the library to drop off books, pick up more books. And you can speak more to this, Janet, but we’re happy to do that. But also that takes time. And that takes time away from the house where you’re looking after somebody, wouldn’t you say?

Janet:

Yeah, and I think it’s not uncommon that we either forget that it takes a certain amount of time to do things. And often older people, they lose the concept of time. That’s a very normal thing. So they think that the person has been gone for, oh my gosh, three hours. And you find out that it was 45 minutes, which still seemed too long. But then you look at the list of where they went and you’re… So you have to kind of work with them on that. And there are ways to do that. And we keep lists and show them what we did and all, but that’s an expectation that that is tough.

Janet:

And also, think of when you try and run errands on a Saturday. And how you’re running in a bunch of different places. You don’t know if the person in front of you at McDonald’s is going to want to order 300 Happy Meals. When Mrs. Smith wants a corn muffin or something from there, they’re going to wait until it’s their turn in line. It might take longer. So you have to deal with some of that. And I think also, where errands are involved, you do have to think safety. If the person has either a fall risk, you don’t have to have dementia to be unsafe. You can be perfectly sharp, but stubborn and a fall risk. So is their judgment going to keep them safe while you’re gone? Sometimes you take the person with us if that’s appropriate.

Ryan McEniff:

Absolutely. I mean, just because they’re supposed to use the walker everywhere, the caregiver might be there to enforce that rule. But sometimes they don’t when they’re alone, and they say, “I don’t need this stupid walker.” And then all of a sudden, that’s when the trouble comes.

Janet:

That is one of the number one things. I can’t count the number of times I can walk in a house where someone is either left the walker in the other room, or they’re dragging it behind them. And because of the age of most of these people, I say, “Ginger Rogers never goes anywhere without Fred Astaire. You need the two to dance.” And you just remind them and remind them. And they’re thinking back when they could dance the night away, what do they need a walker for? I’ll just go across the room.

Ryan McEniff:

And a personal example of this is, I remember when my aunt and uncle who are older, they’re at retirement age or over retirement age now. They’ve been retired for a while. Anyways, they first retired, and they went out and they started doing chores during the day. And when in conversation, they were like, “It’s so busy out in the middle of the day. There’s so much traffic going on. Where are all these people working? Why aren’t they working? What is going on? I figured there’d be like three trucks going down the road. And then that would be it. And I’m sitting in 20 minutes of traffic to get half a mile down 95.” And I go, “Yeah, it’s busy. People are driving around going, whatever they’re doing.” But their concept was like, the roads were going to be empty in the middle of the day.

Ryan McEniff:

And the roads are not empty in the middle of the day. They are congested in the middle of the day. And it wasn’t them, but that can easily be translated into somebody that’s saying, “Oh, go down and get me a burger somewhere real quick.” And what he’s taken so long, it’s been 30 minutes to get this burger. It’s a mile away. Let’s go. There’s no traffic going on right now. Well, guess what, there is traffic. And I didn’t think there was that much of it. You know what I mean? So.

Janet:

So my parents, I went through the same thing when they said, “I can’t believe how many trucks there are.” Well, businesses don’t generally have deliveries on the weekend. So you’ve got the big trucks, the little trucks, the UPS truck-

Ryan McEniff:

At two in the morning.

Janet:

The bread truck, the milk truck, they’re everywhere. And they’re often not the most patient drivers, because they got to be somewhere on time. So you got to, and school buses. You don’t see school buses on the weekend. And if you’re behind one of those on a back road, I mean, I commute through some farm country. And man, if you’re on the wrong side of the bus, it’s just going to take you that much longer. And that happens in the morning, and smack at two in the afternoon when they get out.

Ryan McEniff:

Absolutely. Well, it can be at different times, because the elementaries, the middles and the high schools all get out at different times. So you have three sets of buses in the morning and at night. So obviously in examples of that downtime and trying to eat up some of that downtime, but the pros and cons of it. And managing the expectation, which is our theme through these past four podcasts of, there is going to be downtime. There is things that you can do during that downtime, but if there’s a lot of it, you need to be prepared to see a caregiver sitting and reading. Or sitting and knitting or whatever they might be doing.

Ryan McEniff:

But obviously that would not excuse somebody for not getting their tasks done. They needs to get done. Don’t get me wrong about that. If the dishes are dirty and the laundry’s not folded, and the bed’s not made, and there’s still leftover crumbs from making a meal the night before-

Janet:

They’re not doing their job.

Ryan McEniff:

They’re not doing their job. Absolutely. It’s not a license to just lounge around all day, put the La-Z-Boy back and flick on ESPN and just watch the day away. There’s still things that need to be done. But some people can get really upset when they feel that a caregiver has too much downtime. And unfortunately, that can be part of the job, just like it was when my mom was sick.

Janet:

Right. And you’re thinking you’re spending this money. And what I like to compare it to in a way is when someone is in the hospital, there is not a doctor, a nurse or somebody at that person’s bedside every minute. And you’re paying dearly for every second that you’re in the hospital.

Ryan McEniff:

Because they’re available if you need them.

Janet:

But maybe they’re there for an infection or something, and people would be there. But right now, there’s nobody in a room. And it’s not just because they’re sleeping. And you’re paying for that. It’s the safety issue.

Ryan McEniff:

So, we will wrap this podcast up and this theme up. If you have any question or comments, please reach out to us. And thank you very much for listening to the Caregivers’ Toolbox, tools for everyday caregiving. Our podcast come out on a weekly basis. Janet, thank you for joining me. And we will be back. Thanks. Have a good day.

Ryan McEniff:

Thank you for listening to the Caregivers’ Toolbox podcast, which is brought to you by Minute Women Home Care Services located in Lexington, Massachusetts. Call us at 1-844-BEST-CARE if you have caregiving questions or needs. For comments regarding the podcast, find us on Twitter. Our handle is @mwhomecare. Thanks again, and we look forward to hearing from you.

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