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5 common issues with in-home caregivers and how to tactfully address them

A great in-home caregiver is worth her weight in gold. She can help a senior with cognitive or physical challenges age in place in the home he or she loves, rather than moving to a nursing home or assisted living facility. She provides companionship for her client and peace of mind for family members. But the very personal nature of the caregiver-client relationship means that when problems arise — and they almost always do, as in any employer-employee relationship — it can be tricky to handle them.

“When my partner Harold was sick, I hired several home aides to help him in shifts,” says Joan W., of Westfield, New Jersey. “They were all great, but things would occasionally come up that were a problem. For example, we had a flood in the basement, and I asked the aide to help me out with that while Harold was resting, but she resisted.”

Making expectations as clear as possible from day one is key, but when things go off track, you can work them out. Here are a few common issues that come up with in-home caregivers and how to handle them.

Problem #1: She’s always showing up late.

We’ve all been stuck in traffic, slept through the alarm or couldn’t find the keys as we were running out the door. So a late start once in a while is forgivable. But if your caregiver is consistently showing up late — especially if you need her to arrive before you can leave for work — it’s time to consider whether she’s truly committed to the job.

“If she’s a really valued caregiver, I would be a little more tolerant of this and sit down and tell her she’s doing a great job, but it is dangerous for the senior to be left home alone even for 15 minutes, so she needs to leave a few minutes earlier each morning,” says Wendy Wells-Chanampa, a dementia care expert and founder of Senior Resource Consultants in Naples, Florida.

You might even consider including expectations about punctuality in a written contract with the caregiver, suggests Amanda Lambert, a geriatric care manager in Salt Lake City, Utah, and co-author of “Aging with Care: Your Guide to Hiring and Managing Caregivers at Home.”

“Put it in writing rather than just verbally telling her, so there are no misunderstandings,” she says.

Problem #2: He spends too much time on the phone.

Your boss wouldn’t be pleased if you were scrolling through Instagram during an important work meeting, so it’s perfectly reasonable to expect your home aide to put down the phone when he is caring for your loved one.

“Of course you want her to have a phone for emergencies, and she may need to check in with her own children or parents during the day, but there should be clear guidelines,” says Wells-Chanampa.

You can say, “Dad really needs 100 percent of your attention, so please limit non-urgent phone calls to when he’s napping.” If you live in a different town or state, this can admittedly be difficult to monitor, says Wells-Chanampa, who suggests dropping in unannounced when you can to see if the aide is complying with the rules.

Problem #3: The aide gets frustrated or angry with difficult behavior.

If your loved one is suffering from dementia, there can be changes in behavior that are a challenge to the home aide: A senior with dementia may become more aggressive, refuse to eat, resist bathing or accuse the aide of stealing. This would be a good time to consult with a geriatric care manager to see if you need to step up to another level of care or hire a new aide with more experience in dementia care (and a more patient demeanor). If you want to continue with the same caregiver, meet with her one-on-one to discuss the challenges and see if she is willing to go through additional training.

“Call the Alzheimer’s Association, or search online for a dementia training expert and offer to pay for a training session so she can learn new strategies,” says Wells-Chanampa.

Problem #4: He isn’t providing the stimulation you want.

You may have visions of your mom’s caregiver taking her for walks, playing Scrabble with her and providing endless hours of stimulating conversation and care. In reality, they may be spending hours every day watching the Home Shopping Network together. This may simply be a matter of unclear expectations, says Lambert.

Her solution: Write up a plan of care, which outlines exactly which tasks you expect the aide to do each day. The plan might include: Go for a 20-minute walk three times a week; bring mom to a book talk at the library once a week; listen to music and go through photo albums every afternoon to stimulate memory.

“The plan of care is a flexible document, which can be changed as needed, but it gives the caregiver a clear guideline of what’s expected,” Lambert says.

Problem #5: She doesn’t communicate well.

Whether you live down the block or across the country, you want to keep updated on your loved one’s daily progress, whether there are any changes in physical or mental status or any issues that need to be addressed. But at the end of the day, your caregiver may just be too exhausted to let you know. So make it easy for her.

“I ask the caregiver to text me at the end of every shift, just a sentence or two about any problems that arose that day, or a list of what activities they did,” says Wells-Chanampa. “And I always validate her by texting back a thank you.”

Lambert adds that regular communication should be included in your plan of care — and if you live too far away to check in regularly, consider hiring a geriatric care manager to keep on top of things and report back to you.