When a person starts a new position as a caregiver for a senior, their role is more than just a job for the person they are helping to look after and his or her loved ones. No matter the level of care they are hired to provide, caregivers and aids are helping to bring companionship and support to someone who needs it — and that is priceless.
But with this job comes immense responsibility and trust that is built between the older adult, the caregiver and the employer (usually someone from the senior’s family). And as many will unfortunately learn, mistakes happen that can cost you the job. These common missteps can be as well-intentioned as becoming too close and crossing boundaries to life-threatening like embellishing when it comes to your experience.
Marguerite Rossi, a retired geriatric nurse practitioner, experienced a range of caregiver mistakes before taking over her 99-year-old father-in-law’s care three years ago. The issues ranged from generational clashes to more complicated problems like an employee not being flexible as the senior’s abilities deteriorate. “As an elderly person’s care needs change, there might be a need for a different skill set,” she says.
Even if you have the experience a family is looking for, you could be susceptible to common pitfalls between seniors and caregivers as you work together. Here, experts help us break down common on-the-job mistakes that caregivers make and how to fix them before they cause serious harm or cost you a job.
Common caregiving mistakes and how to address them
Getting the job isn’t the hardest part. Once you nail the interview and start working, ensure you continue to build a strong relationship with your employer by avoiding these common caregiving mistakes.
1. Mistake: Being late to work
One common mistake is being continually late and trying to cover it up but not acknowledging it or mismarking time sheets but you will eventually get caught, explains Winifred Carson-Smith, a board-level healthcare lawyer who specializes in the home health arena and consultant who also is a caregiver for her parents. In the “old-fashioned honor system,” the guardian or senior you are caring for will eventually take notice and bring this up. If you are coming in to relieve another aide and are continually late, that aide will report you.
“Aides tend to forget that if something happens to the client during that period when they are supposed to be there and they are not, they are responsible,” she added. “Aides need to be properly trained to know their responsibilities and change their conduct.”
How to fix it: Start by reflecting on why it is that you’re always running late and immediately address those issues. Then, in addition to curbing your tardiness, if you’ve been misleading on timesheets for the family, she suggests informing your superior and requesting to amend them. “But, if it is a chronic, long-standing problem, expect termination,” she adds.
“I also urge caregivers to keep their sense of humor as this is a very good tactic to diffuse difficult and awkward situations. It works in most cases if it’s used respectfully and with good intentions.”
—Marguerite Rossi, retired geriatric nurse practitioner
2. Mistake: Lacking awareness of the generational divide between caregiver and their client
Caring for the very old, in their 90s, can present very different challenges than caring for someone in their 70s and 80s, explains Rossi. “Younger caregivers might struggle with this, but it’s crucial for them to try to understand that perspective,” she says. “If they don’t get it, that can lead to friction and conflict, which impacts the delivery of care.”
An example of this occurs frequently with her father-in-law, who was raised during the Great Depressions. “For him, everything is associated with its monetary impact, which is very different from today’s millennial world,” she says.
He is constantly turning out the lights around his house in an effort to preserve electricity and therefore save money, and then his caregiver promptly turns them back on. “The way she sees it, we need all the lights on so he can see where he’s going and doesn’t fall,” she says. “Similarly, when he sees his caregiver standing with the refrigerator open for too long, or sitting idly while he is paying her by the hour, he sees it as costing him money.” Although it seems trivial, this irritates her father-in-law, and often leads to huge clashes between him and his caregiver.
How to fix it: Caregivers must become aware of these “sticking points” and find ways to make the situation work so that their client is appeased but not put at risk. They must learn to, for lack of better expression, “read the room,” and make an effort to understand the perspective of the person they are caring for.
“Always strive for compromises that won’t impact the safety and well-being of the client,” she says. “I also urge caregivers to keep their sense of humor as this is a very good tactic to diffuse difficult and awkward situations. It works in most cases if it’s used respectfully and with good intentions.”
You don’t want to be dismissive or appear to be making fun of them, but it helps to keep things light and can be a tool to help distract them from something that isn’t as important.
3. Mistake: Not reporting changes in behavior
Aides often see changes in a senior’s mental or physical condition long before they are evident to the family or general public. For example, they will know if there’s been a change in the patient’s eating, memory, or if he or she isn’t getting out of bed every day. Although most report changes in condition, Carson-Smith says that some feel if the change is not related to the patient’s diagnosed conditions, they shouldn’t mention it. “They tend to forget they are auxiliary medical professionals,” she says. “They have affirmative responsibilities to report changed physical and mental conditions, whether or not such is related to their existing diagnosis.”
How to fix it: If you haven’t already been doing so, Carson-Smith recommends taking these steps as soon as possible: Call the nurse managing the patient’s care, request a meeting and amend the aide reports to reflect the client’s changed conditions.
4. Mistake: Not following safety policies
Whether laid out by the agency you work for or your employer, chances are specific safety procedures will be in place to protect both you and the individual you’re caring for. “It’s always essential for staff to follow safety policies, especially regarding personal protective equipment in times of a global pandemic,” says Raymond Dacillo, Director of Operations at C-Care Health Services. “If someone is not following protocol, it has to be brought to their attention that they are endangering themselves and the client’s family.”
How to fix it: Be proactive with taking refresher courses and continuing to review safety handbooks. Having frequent and easy access to these procedures ensures that they will stay fresh in your mind and allows the caregiver to “review information on the fly,” explains Dacillo. “It is also crucial to mention to the staff that it is always best to inform your reporting managers if they spot someone not following protocols, as this will allow them to take the appropriate next steps.”
“Everyone should be working towards the same goal for the benefit of the elder person.”
—Marguerite Rossi, retired geriatric nurse practitioner
5. Mistake: Not being on the same page as family when it comes to the senior’s care plan
If the caregiver’s agenda isn’t aligned with their employer’s priorities, this can very quickly lead to problems while caring for an older patient. “Everyone should be working towards the same goal for the benefit of the elder person,” says Rossi. “For example, an employer might feel it’s very important that their elder person is getting every possible form of stimulation, whereas another family might be prioritizing safety. If you’re at odds about what the goals are and who’s in charge, the patient is not going to get what he or she really needs.”
How to fix it: Caregivers need to be flexible and touch base with employers as time goes on, because the plan of care that was initially laid out will likely change with the senior’s health and be willing to adjust.
Rossi has experienced this with her father-in-law: When they first hired his current caregiver, he was much more physically active and mentally appropriate. But in the last year, he’s experienced tremendous cognitive decline due to a progressive dementia, yet his caregiver approaches his care in the same way as when she started working with him.
“We have had to counsel her not to insist on correcting him or try to over-explain things to him, but she has a hard time comprehending his cognitive impairments and therefore how her care should evolve to be more effective,” she says. “Unfortunately, she continues to push food on him when he insists he isn’t hungry; it almost always leads to a bathroom accident, which makes him angry and embarrassed.” The caregiver feels she is doing her job when he eats, because she equates that with good nutrition but Rossi feels she’s missing the cues that her FIL is more upset by the excessive eating and resultant bathroom mishaps and instead will eat when he is hungry.
The key way to avoid this friction is by practicing “adaptive care.” “It might be worthwhile for the employer to have a regular meeting with the caregiver and together reassess where the client is at, and then adjust the priorities for care,” she says. “By working collaboratively with the employer, the caregiver will hopefully feel that their observations and ideas are respected and appreciated, it’s a mutually agreed-upon care plan rather than one person’s agenda, and the client reaps the benefits.”
6. Mistake: Overpromising on your skill set
Embellishing when it comes to your skills or experience can have life-threatening consequences. For example, claiming you have expertise in transferring patients who need assistance or a solid understanding of dietary restrictions like pureed food when you don’t have that experience or can’t execute these tasks safely and correctly. “Poor transfer skills can result in falls and misunderstandings can lead to swallowing and can result in aspiration pneumonia,” says Iris Waichler, a licensed clinical social worker and author of Role Reversal: How to Take Care of Yourself and Your Aging Parents.
How to fix it: Home health care aides Waichler hired made both of these missteps. It resulted in multiple hospitalizations for him and she had to fire his caregiver. “This was in spite of the fact that we clearly explained his care needs,” she says. “I have professional expertise in caregiving and still ended up with problems that endangered my father’s health and well being.”
If you lied about your experience, you need to be upfront about it. However, if it is a question of not knowing if you are doing something the way your employer would prefer, offer to have them observe to ensure everyone is on the same page. She also suggests people have a planned session to discuss how things are going early so that any clear adjustments or precautions can be made to help ensure care is being managed at an appropriate agreed upon level.
7. Mistake: Making ethical violations
Caregivers need to strike a balance between the medical care they provide and their relationship with the client. But many aides end up treating their clients like family to get them to work with them and comply with plans of care. This often crosses what should be professional boundaries, leaving clients with the belief there is a friendship, forgetting the susceptibility of clients to affection and attention.
“Those who care and retain boundaries are the exception, which is why many professionals advise rotating aides,” says Carson-Smith. “Aides need to understand where care begins and ends as the client is placed in your care for better outcomes not friendship.” The problem with friendships is that they often lead to loans and gifts, flexible hours and inappropriate intrusion into the patient’s personal affairs.
How to fix it: In addition to establishing new boundaries, she suggests that aids request ethics support from their supervisors and additional training. Aides should also report any gifts or loans between caregiver and client. “Should patients ask aides to intervene in family matters, that should be reported as well,” she says. “And, if all else fails, aides can and should request transfers if they feel they and the client have become too close.”
“If the caregiver is too occupied on their phone, they are clearly not being attentive enough to the client.”
—Marguerite Rossi, retired geriatric nurse practitioner
8. Mistake: Being on your cell phone too much
“With every caregiver I’ve worked with, it seems they were always on their phone too much, and it’s a distraction from their task at hand,” says Rossi. “If the caregiver is too occupied on their phone, they are clearly not being attentive enough to the client.”
How to fix it: The best way to preempt or end conflict over cell phone use is to be up front and ask about it. If you find out that the older adult you’re caring for or their loved one who hired you isn’t comfortable with it, have an open conversation about why you may need to keep it out and ways to compromise. “The caregiver should understand that the client might get irritated by cell phone use. Again, it comes back to the generational divide — many elderly people are typically not very tech-savvy,” she says.
And if having your cell phone out is a must, look for ways to make it less offensive to the client. “For example, one of our aides must keep her cell phone nearby as she has a young son and must be reachable, but she made it a positive thing,” she notes. “She gave my father-in-law her AirPods and let him listen to music on her phone so that he became less suspicious of the device, and let him use them to make a call to one of his daughters so he could hear her better — small changes like this can go a long way.”
The bottom line
Caring for someone else is an essential job that shouldn’t be taken lightly. And for many families who aren entrusting you with their loved one, there simply isn’t room for repeated errors.
