Bringing Care Home: The Dos and Don'ts of Hiring a Caregiver for Your Loved One with Dementia

Buzz Burbank  0:04  
An iRonick Media production visit us at i-r-o-n-i-c-k media.com.

Noma Kaz  0:12  
how care is activities of daily living? What does that mean dressing bathing toileting, companionship, meal preparation, transferring, helping them shower activities, cognitive activities, driving to appointments. Those are the the activities that a caregiver can complete and perform anything outside of that that could ultimately cause harm is excluded.

Barbara Hament  0:44  
Hello, and welcome to Season Two of dementia discussions. I'd like to thank you for being patient with me during my hiatus. What I've recently learned is that this community continues to listen to episodes of dementia discussions. And so I'm thrilled to be back and to bring you new content from professionals and new caregiver stories this season. episodes will air every second Tuesday of the month, I welcome you to listen in. If you'd like to share your caregiving story with me, I'd love to hear it. Please call me at 310-362-8232 or email me at dementia discussions.net.

I'm so thrilled to have our next guest. She is the co founder along with her partner her work partner Sherry litt of lifeline companion services, which has been in Los Angeles for many years since 2005. So without further ado, Noma Kaz, welcome to the show. It's great to have you here this morning. 

Noma Kaz  1:57  
Thanks so much, Barbara. I'm really happy to be part of this podcast. And thank you for the invitation. 

Barbara Hament  2:03  
Absolutely. So I know that you've been out there educating families for years and years and working as a support group leader at Leazes care connection. So you have Gosh, many years of experience with families. And so I would love to kind of just pick your brain about your work and kind of helping seniors along the way. Because we know, like, here in the business, we talk about aging in place, right? That's kind of our catchphrase, which really means staying home. Most people want to stay home with care. And you're you're an expert on bringing care into the home. I kind of think of like a tipping point where people

Speaker 1  2:55  
there's someone in the home who has a diagnosis right of Alzheimer's disease or dementia of some sort, Parkinson's disease, some sort of health issue that's, that's happening. And then oftentimes, there's a spouse, a neighbor, an adult child, someone who's offering the care, you know, they're kind of humming along, right for however many years, and there comes a tipping point, the place where the care becomes too difficult to earn is too stressful, overwhelming. Right? All these things that we hear when families call us. And you and I are kind of in the business of like keeping people where they are safely. I would love to just kind of pick your brain about that. Like at the beginning, when people call you. What's happening. What do you find this kind of going on? 

Noma Kaz  3:57  
Well, let me let me just give you a statistic or it's kind of an overview of caring for somebody, a loved one, who now needs some oversight because of, as you said, or either have a dedicated disease that has been diagnosed, or just because the aging process often requires that you have a little bit of assistance what used to be natural and easy and and just just a day to day living activity becomes much more strange or difficult. But statistically, family caregivers who are dedicated to caring for a loved one over long periods of time, because of the stress will also often died before those that are are actually being cared for. Because there's no release on a day to day basis. So that's that's kind of where we come in, to definitely remove that burden of, of stress from families not to say that they're not still attentive.

And they're still loving and they're still there. But the day to day, I often say your role in this family is to be a husband or a wife, or or or daughter or son, your role is not to be the quote unquote caregiver, the person who has to deal with the day to day changes in moods and behaviors and frustrations and, and family dynamics. So that's kind of where our company was born 18 years ago, trying to find a way to help families. So what we do just a brief overview, we are a homecare agency, and our job is to identify the right caregiver to come into the home who can deal with who has experiencing, working with with an individual with a particular condition. And I say that because it's very important to identify the condition, because not all conditions are the same. Not all skill sets are the same. So what we do is we we look at this skill set, we look at the overall experience, we look at the personality, we look at the family dynamic, and of course, the client and what they need on a day to day basis. But not everybody goes through an agency, there are other options for getting a reliever or some care by part at the time. And I think it's important to do a little bit of homework even before you get to that point to where you have to make some decisions. What's going to happen with mom, I noticed that she's can't drive anymore, or I don't trust her home alone. She's forgetting simple things. And she's asking questions repetitively, but she's fine. There's always, but she's really fine. And she says she doesn't need anybody. But I'm there, you know, I have to go there almost every day, I have to call her all the time, I have to remind her to take the pills, it's just starting to really stress me out, you can say, I have my family in my activities. And, and I just can't do it. 24/7. So start to educate yourself, be prepared, what kind of options are out there for for families and for individuals who who need some assistance. So let me start with the obvious, having somebody come into the house home a few days or hours a week, just to help with some housekeeping and you can hire somebody, maybe you hire a qualified person, a family member, maybe a housekeeper who needs to come in maybe an additional day a week and just kind of take care of the home and do some shopping. But then it gets it starts to get a little bit more the requirements are greater. So you can hire somebody on a more regular basis. You can look at daycare centers, which will allow you to have some some respite, while your loved one is at taking classes at a daycare center and and lunches served and they're around other people. That's the possibility. Then there is the assisted living community where perhaps meals are provided. And there's some activities that have provided and perhaps an option. But you know, the first and foremost place that most people wanted, you know, aged places at home. 

Barbara Hament  8:32  
The situation that you brought up is so common, where there's a housekeeper that's been there for many years, and they start to become the caregiver by suddenly they're outside of their skill set by finding themselves really providing a lot of care for a person at home.

Sure you get a lot of calls

Noma Kaz  8:57  
it it is dangerous in the long term, because they are not trained. 

Barbara Hament  9:01  
Right, right. And then there's situations where a neighbor steps in and helps out or a good friend steps in and starts to help out. I'm sure you've heard many situate many, right? many situations like that. And you're right, the care over time becomes more and more and kind of out of like you said like out of their league, people start to become uncomfortable with all the things that need to be done. 

Noma Kaz  9:27  
Right. Well, there are red flags that start to go out at that point. Because if somebody that you may know and trust says I have a friend of a friend who my gardener has his wife can can help and bring somebody in and the West can't make it that day or is is not available on the schedule that they wanted. She will bring in a friend of hers and maybe that friend doesn't really have have the experience. So you leave yourself open to really a plethora of people that are coming and going into your home. And that's what we don't want. So, so let's go to the positive side, and how do you find the right caregiver, either through an agency who will do the day to day reviews, and we'll, we'll identify the caregivers based on their skill set their experience, their background, they check if there's any kind of a criminal record, if there's any kind of issues with financial issues where the potential caregiver has been in and out of debt, which is, again, a red flag, because it could impact how they present themselves to the family. So the agency will go through all of the checks and balances that need to be checked off, before even presenting something to you. The another option would be to go to what's considered a registry registry is a caregiving registry. It's kind of like a nursing registry. But this is for non medical caregivers. And the registry is supposed to do some of that background checking. They don't always they're more like a staffing agency, which means that they advertise for people to to work in the home, and they gather up the names, and they present the person to you and you get to do the interviewing. And you become the employer. Even though the registry, you pay the registry of fee, you're doing some background work and presenting the candidates to you.

Barbara Hament  11:48  
like a care.com. Right? care.com?

Noma Kaz  11:51  
Well, that that's, that's third way to go direct to a internet site. So on an internet site, you're not paying a third person, a third party for bringing it to you, necessarily, you just going on site. And it says that there was an ad in the in the newspaper, caregiver looking for an assignment.

So you can go online and choose somebody and then your job is to bring them in to interview them. And again, I'd say you're the employer, and we'll get we'll get into that in a minute to tell you what it means to be an employer. So let's just pick one of those scenarios, you've got the agency, you've got the registry, and you've got direct to hire.

So you have somebody coming into your home, they seem nice. Other than first appearance, and whether you feel a connection to the person who walks into the home is that's important. What are the questions? What are you looking for, and the type of person you want to hire for your loved one, there's probably five elements that are very, very important, which are very difficult to determine, in the first meet patients is number one, is this is this person patient. They're important in the home to the patient, because often the client is demanding sometimes that they're not responsive, sometimes they are not compliant. Sometimes the questions are asked over and over again, start to get annoyed. So are they patient? Are they compassionate? It's easy to see that somebody is needs help. But how do you represent that compassion to the person that you're working for? Are you attentive, worst case scenario, caregiver comes in, they're on the phone, constantly. They're taking breaks, they're leaving the home, when they should not be leaving the home. They're in and out. Because the client may very easily say, oh, that's fine. You need to run an errand. I'll be okay. So it's tend to dependability it goes along with all of that. Do you show up when you're supposed to show up and trustworthy? Usually, there's there's important papers around the home. There could be money left around the home, do not take advantage of something that may be looking very valuable and and ask if you can take it home with you. So those are the things that are important. But you can't tell that in the first interview. None of that comes out. Turn. What is important is to ask the questions. The question is, how long have you been caring for someone with my mother, father, husband, wife, condition? What is your experience working with somebody? How do you respond when they are behaving in a non compliant way.

What happens if my mom doesn't want to take a shower, but she needs one desperately? How to handle that? These are? These are questions that we want to ask, have you ever charted? What does that mean? Do you write down on a day to day basis? What goes on in the home? So that I know how mom's been, and I can come in? And I can kind of read the Daily Log? And are you observance? Or is there a change in behavior? Are they more aggressive? Are they non-communicative? Do you find that mom is forgetting more? And more lately? Is she having some physical changes that that you now notice? Like, is she breathing? Is her breathing becoming more labored? Is she sleeping a lot? So this is all part of the care. That includes not just helping them dress and helping them with meals, or reminding them that there's time to take their medication or to to hydrate a little bit more. So there's a lot that goes on to bringing somebody into the home.  It is not a babysitting job.

Barbara Hament  16:17  
Yeah, absolutely. No, it is not a babysitting job. And this comes up so often, right? You just touched on so many things that color, but about this, what happens day to day, because if someone is sleepy, well, perhaps a medication was given that no one knows medicine for agitation was given. And that's why they're sleepy. But if it's not written down, nobody knows that. you're ready to give them medication for constipation, but they've pooped already, but no one knows that. So if it's not written down, like no information has been transferred. So I mean, you're touching on really important things, it's so important to kind of document what happens during the day, simply, right? Just pick up a simple notebook, at the grocery store, right, and just start writing what's happening during the day. So that the family knows the fear of hiring shifts of care, the next shift knows absolutely. So that behaviors make sense things start to make sense in your mind. 

Noma Kaz  17:20  
They challenge, I think, with all of this is when you do hire on your own, is how can you verify all these things, that it's only going to come out in time, and you have to keep a close watch for the short term to make sure that it's happening, a very important thing is making sure that the communication is clear. So many of our wonderful caregivers are multilingual. And English is not always their first language, that can be communication lapses or or at not as complete as you want them to be. So that's very important to choose somebody who, who you feel can really communicate on a good level. Another. This is important, since most elderly clients at some point, there's some hearing loss. It's not just a loss of hearing, but it is an indistinguishable way to interpret certain sounds, and certain pitches and accents. So if you bring a lovely person who may have they have an accent, that your mom or dad has difficulty understanding, you're going to have a it's going to be much more frustrating for them. And you may not get the clear picture. Because again, there's there's those issues. It's process. And that's what I think I want everybody to know, we've been doing it for 18 years, and I probably interviewed 1000s of applicants. And I know that sounds like a lot. But it's true. People come and they they come into our office, we sit them down, they have to fill out a form. And we have a very frank conversation with them. What is the most difficult case you've ever had? Why do you do this? What makes you angry? What kind of responsibilities do you have, that might interfere with the schedule that we need? So that what kind of additional care might be caregivers might be needed on a team because of your schedule? So that's it's kind of an endless interview. Again, it's very much a process.

Barbara Hament  19:42  
I would imagine you kind of get to know as an agency, you get to know your pool of caregivers over time. And so you can really start to plug in appropriate caregivers where they're needed as people stay with you over the years. 

Noma Kaz  20:01  
We have some caregivers who have been with us for 10 years, we have other caregivers who we just started working with that may have been with us for a month. And they turned out to be extraordinary. There's a certain amount of experience that I think that suits us well in the interview process, because we've done it so many 1000s of times that you can, can kind of see some red flags. And so so those are not the people that we offer employment to. Again, it's about the person who needs the care. So let me also go through a couple of changes in behaviors that we have seen over the years with different conditions that have to be addressed. Alzheimer's, dementia, and Alzheimer's is one of the one of the branches of dementia, many years ago before this became first and foremost and foremost, as someone aged, they'd say, Oh, he's becoming a little senile. We took that as, as the reason that some of these behaviors change. And the diagnosis have not been very clear to say, Well, what does that actually mean? So there's different kinds of dementia and and they present themselves differently.

Yeah, Alzheimer's, Louis body dementia, which is very different. There's...

Barbara Hament  21:30  
 frontal temporal dementia. 

Noma Kaz  21:32  
Yes, thank you.

There is there's vascular dementia, it's broad, knowing what the process is going to be going forward, the diagnosis for that kind of dementia, and what to anticipate and know what your timeline is going forward, you have to be able to have somebody who inpired who can step up, as things start to change, as became a structural change. So skill set, and ability to really work with somebody whose condition is going to be exacerbated over time, because it's just the condition, important. Parkinson's, knowing what signs to look for, when somebody is a Parkinson's patient, they have motor skill changes, that can be significant. Making sure you shadow them, so that when they're walking that they don't lose their balance, even though it at any point, sometimes you don't even see it coming because of that. So understanding what what is shadowing. How do you do it? Is it okay to allow the client to make the decision whether or not a shadowed, because often the client wants to be independent, and they will insist that they're fine. And it only takes a moment.

Barbara Hament  22:55  
Only take so long to lose their balance or right. Yeah.

Noma Kaz  22:59  
Brett? Yeah, 

Barbara Hament  23:01  
giving someone their autonomy and their independence yet being there to help them in case they need help. Yes, difficult. 

Noma Kaz  23:09  
And there's an art there's actually an art to doing it. So 

Barbara Hament  23:13  
tell us about that.

Noma Kaz  23:15  
Well, the art of persuasion, you have to earn somebody's trust, in order for them to believe that what you're doing is the right thing. That does take time, it takes some listening, it takes a little bit of definitely patience. But there has to be something in common that you both relate to that each you trust each other. So trust is a big part of the caregiving process. And it ensures that the client is going to stay safer. And it helps the caregiver complete the the tasks that that needs to be done, or the kind of care that the client needs at that moment. There's other conditions, some could be congestive heart failure, somebody may have chronic congestive heart failure. How do you know when things are changing? This again, you look for the signs. And what we do in our agency is we educate our caregivers on an ongoing basis. So not only do they have their hands on experience prior to coming to us or having worked with us, but yearly as an agency that we're licensed with the state we have a certain responsibility and a requirement to keep up that education. Whether it's it's video training, where we bring in a Geriatric Care Manager like ourselves, to come in and help manage the care and help the caregiver work with the client in a in a more effective way. We have people who maybe are not dealing with a chronic condition but maybe a temporary

condition, hip replacements, it's the most important thing with an elderly person who's just had a hip replacement is to make sure they don't fall, right. Because that that could be a life changing that should that happen so, and the proper way to help them stand in the proper way to help them date and the proper way to help them. Exercise makes them change. So it's it's a, it's a very broad, it's a very broad level of care, that we sometimes that I think the community at large doesn't recognize just how skilled you have to be to be a good caregiver. And to ensure your loved one is safe. 

Barbara Hament  25:50  
right. Like you think, Oh, I'll I can take care of my husband after his surgery, or I can take care of my mom, I'll just take a week or two off and take care of my mom after her surgery, do you find that families call you or adult children call us or spouses calling whoever it is calls you. And that the hip surgery kind of gives them an excuse for care? like, it's easier to bring in care when there's something like that happening? 

Noma Kaz  26:20  
Yes, it often kind of translated into maybe extending it a little bit longer. And to the point where the client who is 85 years old, and he's just had a hip replaced. And prior to that was just fine. And realizing after the fact that maybe getting back to her life as she knew it is not going to be the same. So there's a certain comfort and having had someone in there to help them through the recovery and maybe stay on a little bit longer. And who knows what that turns into. Yeah, it's a good entree into into maybe the future. I'll give you an example. I had a client several years back, she was very independent. She's healthy, never sick a day in her life. She was driving and had a slight accident. Small accident, not quite sure. What caused it. There was not another car involved. So it was obviously some something she had done to damage the car. And I think she she got some minor cuts and abrasions. And her daughter, she was single hurt. She was a widow. And her daughter said, you know, you need to drive her active and you need a driver, you can do them longer. How about if we maybe have somebody kind of like a roommate almost stay with you and she can drive you around. And while she's there, maybe you know help you go shopping and do some cooking around the house.

Well, it turned out that this person who was in the home that we provided, was actually very skilled. She had worked with us before. And we knew what her qualifications were.

So she stayed, she stayed with her. And after about seven years of being there. The client really did not have any major medical issues. They were they stay together for seven years. And she loved it because she never felt allowed. She had her driver, she became a friend. She still was our employee. So there was no responsibility to the family whatsoever. We we have full control over her, her work. And one day our client went to bed, and she passed away in bed

without a day of being sick. But this relationship lasted seven years, seven years. And it was a relationship built on companionship, and friendship and safety. And so not every person who has a caregiver who has somebody in their life to make sure that they're they're safe is in dire medical distress.

There's there's many scenarios out there but you have to be able to choose the right person who fits. 

Barbara Hament  29:35  
and you're talking like, that's such a great example of how it's easier to bring in someone with the label of driver rather than caregiver. Rather than, oh, you need help. We all want to be independent. No one really wants to help we all feel like we can do it on our own. We can do everything on our own. But we all really do need help, right? So I think calling it a driver calling the caregiver, a personal assistant or however you want to bring them or whatever label you want to use to bring a person in as a okay. I mean, she needed to drive her. But it sounds like she also needed a companion probably to help her with cooking, maybe a little straightening up, kind of morphs and to other stuff, even though they're just there to, quote unquote, drive. Yeah.

Noma Kaz  30:34  
Exactly. But the skill, the skill set, was there separate and apart from that, because had things changed in the home, that caregiver would not have needed to be replaced? She she had the skills because we made sure she did. So I think that's that's, again, an important part of the process. Who do you hire?

Barbara Hament  30:56  
Yeah, no question that going through an agency is a safer way to go. The caregiver is not the employee of the person doing the hiring. So the caregivers, are your employees, the liability is off the family, you're taking full responsibility for this employee, you're completely liable. They're a W two employee with you. 

Noma Kaz  31:24  
Correct.

Barbara Hament  31:25  
Right. And 

Noma Kaz  31:26  
and what does that what does that mean to the family? So So here's this other side of the coin. When making the decision, a consideration we're making the decision do I go private, I go through an agency do I go through a registry under every every circumstance unless you go through an agency where the agency is the actual employer, and as you said, they they are on their payroll and the taxes are taken out. And we provide social security to them and unemployment. And we also offer them health insurance, which is a requirement. So separate and apart from that, should the caregiver get injured on the job. And the injury can be something as simple as tweaking their back because they lifted help to the client, or the client started to lose their balance, and they caught them. And so that caregiver will now need some medical care. If you were hired privately, the caregiver could very well go directly to the client and say, I need you to pay for this, I can't work, my back is hurting. I don't have medical insurance. I don't have unemployment insurance and don't have workers comp insurance. Who's going to who's going to pay for this. And that would be you. There are many attorneys out there who have been waiting for the opportunity to get involved in that kind of a situation.

But the most concerning part of of hiring independently, is that there are certain laws as being an employer that have to be followed, whether it's an agency or whether you're an independent employer. And that has to do with the amount of money you pay your, your your person and what is considered overtime after nine hours. And it doesn't matter that the amount that you have to pay them at least the required minimum. Plus any time after that it's an hour is this time and a half. So if somebody works 12 hours, you have to pay them three hours of a one and a half times what you pay them for the first nine hours. In some circumstances, if they sleep over, you have to pay them time and a half for when they're sleeping.

Very important. So here is the issue. The caregiver feels very close to the family, the client, they stay with them a long time. They've been living in for periods of time where they've been doing extra favors over a period of time, and the client passes away. The connection with the caregiver and the client is now ended. But the responsibility on the estate of the client is still there. Should there be a lawsuit of unpaid wages of underpaid wages,

an issue that may have arisen during the time they were there. And So therein lies the problem. Those lawsuits are very expensive, and they can be in the hundreds of 1000s of dollars because they go back four years of working for. So does that happen every time? No but it does happen a lot unless they are the employee of a

A business of an agency of a qualified agency that is licensed, you take on that responsibility. So it's the monies that are saved by going direct, doesn't always serve the family at the end. So it's it can be an issue. 

Barbara Hament  35:17  
And I think that they're in lies why people don't go through an agency, right? Because it's so much more expensive. Hourly. That's the rubs. So, right, when we talk about going through an agency or paying probably, you know, you could probably find someone on nextdoor.com, or the I don't know how, like how caribou.com works, but probably for $25 an hour, let's say. And here in LA, the agency rate is probably least 36,37, 38 $40. Minimum, let's say. so.

Noma Kaz  35:57  
Yeah,

Barbara Hament  35:58  
 those people will take issue with that expense going in.

Noma Kaz  36:03  
 just a bit of insight that we've learned over the years that 25% of our clients have long term care insurance, that long term care insurance, which was purchased, probably when they turned 50, or 60. Suit, it has has been a tremendous godsend to the home care. And generally, there's a savings of they get reimbursed up to $60,000 a month on these policies. It's a huge benefit. We encourage anybody who is approaching retirement or leave a little before to consider that it nobody ever expects to get old and needing it. But a lot of our clients will use it if they have gotten some kind of chronic disease at the age of 60. And the care is required, or they're in an accident, and they have a long recovery. So it's really interesting, I will tell you a quick story, and then talking about out how young people are and what it means to have long term care insurance. When COVID first started our business we were considered first responders. So our agency stayed open the entire time, everybody worked, we stayed open care what's continued in the homes with with precaution. And in the very, very beginning, even before it got to the point of where people were aware of of how things are going to go the direction it's gonna go. I had gotten a referral about a gentleman who was the round zero patient in Southern California. Wow. He had, he was in the hospital in Burbank, for two months, with a 1% chance of survival. He was 5052 years old 1%. And he survived.

Barbara Hament  38:03  
Wow.

Noma Kaz  38:04  
He survived and he became our client. And we worked with and he had long term care insurance,

Barbara Hament  38:12  
never expecting to trigger it 

Noma Kaz  38:14  
never expecting. We were with him for about six months. During his recovery. He actually had some extremity amputations because of the disease and not having any medications and all of his everything shut down. Every one of his organs had shut down, isn't it was a miracle. But today, he is three years later. And as a matter of fact, he just did an interview, a TV interview, had gone back to the hospital three years later to visit with his with his entire team who saved his life. He was very appreciative to our agency for helping him get through the recovery period. And again, it didn't cost him a dime. Because he had that long term care insurance. So I say just just it's a little bit of information just to your listeners. It's a good consideration. 

Barbara Hament  39:15  
Oh, absolutely. Yes. If you're a senior who has long term care insurance, thank goodness, you were the thinking ahead, you were looking at down the road and right, yeah, and you bought it and if you're younger and listening, if you have an opportunity to buy Long Term Care Insurance, absolutely do. 

Noma Kaz  39:33  
I always I always compare it to earthquake insurance. I've been playing earthquake insurance for many, many, many years as a homeowner, I'm sure everybody you have as well. And chances are we will need it but it's good to have. 

Barbara Hament  39:47  
So just going back a little bit you would you were touching on questions to ask the caregiver kind of right and wrong questions to ask. And so I wanted to just ask you Are there questions as an employee that are not allowed to ask a potential caregiver? Are there...

Noma Kaz  40:07  
Yes 

Barbara Hament  40:07  
...other things that are off limits? Okay, so what are those? 

Noma Kaz  40:12  
you can no longer ask if they have a criminal record. You cannot you cannot ask anything about actually about their family. That's personal. There are certain questions that you cannot ask about their religious beliefs. There's it all has to do with everything. That's personnel to them. That would be a limitation to being hired. So those are off that those are off the table. Absolutely off the table.

the questions that you can ask is about their scale, about the clients that they've worked with to get referrals. who they are. And if we can contact them on their behalf to get a do a background check. You can ask them what their schooling is, you can ask them what their experiences. But it's, you're quite limited as to what you can ask them. 

Barbara Hament  41:16  
And you can bring up scenarios, like you were saying before, if my husband needs a shower, that refuses to shower, how would you handle that? So you can kind of bring up scenarios? 

Noma Kaz  41:30  
Have you... what was your most difficult client? And and why what was that client difficult? And how did you handle it? Have you ever worked with somebody who has dementia? Who has Alzheimer's gene of the difference? Have you had any formal training? For example, some caregivers are CNA, their certified health aides? So that means they've got to school in the school that to become a caregiver to get certified and health aide. They will teach them how to lift how to transfer how to shower, those kinds of physical care responsibilities and techniques. So you can ask them about that. You can ask them for a verification that they've completed the course. And if they have, you can ask them what their what their internship was, like, going through the course.

So having a CNA is always a positive it well, it's not a requirement to be a caregiver. It's just an extra leg up to getting the the basics directly from from schooling and working in a facility for about six weeks to get their their training. 

Barbara Hament  42:52  
So is there a difference between a CNA and a certified health...? 

Noma Kaz  42:58  
a CNA is a certified nursing aide and an HHA as a home health aide. And they're very similar. 

Barbara Hament  43:07  
okay. Can they dispense medication? 

Noma Kaz  43:10  
No. And let's address that. a non medical caregiver cannot have any invasive activities. So for example, they should not take they shouldn't cannot give a shot. They can should not be testing glucose, because that can be an issue that then no longer properly cared for. Although things are getting better with diabetes, because the testing is now becoming less invasive. But shots are not are not allowed. They can't do a wound care. So let's say your client falls, and they've scraped their arm terribly and it's bleeding. They should not be caring for that wound, because it could be impounded infected. medication, it must be organized to a family member or a pharmacy. The caregiver can do a medication reminders, so they go to their tray and Monday, see Monday morning pills have already been in there. So they remind a client that it's time to take their pills, they can take it out and give them to client but they can't take it directly from bottles. So there's no issue with under or over prescribing or or ingesting any of the medications. That's where the error comes in. And that's that's really a very big concern really is medication. Too much or too little of any medication is really very serious. What else can they not do? Oh, what we encourage or discourage actually is a caregiver who does things like a pedicure.

Very important not to do that. There's a lot of issues that happen with improper sterilization.

If you're clipping a nail, it can become infected, always referred to going to a medical professional to do that. So these are the these are the issues. 

Barbara Hament  45:11  
Are they allowed to do hands? Are they allowed to do manicures? 

Noma Kaz  45:14  
I haven't really... Yes, we haven't come across that too often. But it doesn't seem to be the same issue. So I'm sure there's something that I I may have forgotten that is in there, but there are... anything that could ultimately cause infection, or harm, or reverse a treatment that's going on by lack of medication or doubling it, it's very concerning, it really is. Oh, there's some others actually, now that I think about it, sometimes somebody will be be sent home with a catheter, and they cannot touch the the line at all. Often, they can just change a bad if under the guise of a home health nurse. They're trained to do that, but they can't touch anything that touches the skin. Nothing that touches the skin. 

Barbara Hament  46:09  
So if you're sent home with like a port and to say site or infusions... 

Noma Kaz  46:17  
They cannot... No, no, no more feeding tubes cannot. So how care is activities of daily living? What does that mean dressing bathing toileting, companionship, meal preparation, transferring, helping them shower activities, cognitive activities, driving to appointments, those are the the activities that a caregiver can complete and perform anything outside of that that could ultimately cause harm is excluded.

Barbara Hament  46:53  
Good to know. So we touched on showering a little and since that's such a huge issue and dementia, I know I hear it all the time with my clients. I'm sure you do, too. But are there any tips that you'd teach your pool of caregivers for bathing?

Noma Kaz  47:09  
Often the resistance comes from dementia patients and clients who who are experiencing that generally, other clients are well aware of that it's almost always Spanish. So again, it's about being creative, and maybe helping them do some some sponge baths in the interim, and work together and make it into a game. The caregiver, again has to have the trust of the client and the client, the trust of the caregiver in order to do that. But it needs to be a fun activity, rather than a requirement. And also to redirect. So that was somebody with with dementia, if they get fixated on something saying I don't want to go you just redirect them to think about something else. And maybe eventually, you go ahead and you head it to the bathroom or... it's a process. It is a process. Yeah. 

Barbara Hament  48:09  
I had talked to one client and her caregiver brings a full change of clothes. Because she actually stands up in the shower. Right with her client while she's showering her. Yeah, so yeah, I mean, I would say but they could bring a bathing suit..? 

Noma Kaz  48:29  
sometimes you can bring a stuffed animal with your client if they've got late stage dimension and ask them if they've washed their their special stuffed animal needs a bath, can you take, can you help them take a bath? And so creative... There's some creative ways to do that. Yeah, it's an art. 

Barbara Hament  48:48  
It is an art. Yes. Warming up the bathroom. Making it appealing. Maybe some soft light some music, some aromatherapy anything you can do.

Noma Kaz  49:02  
anything you can do. 

Barbara Hament  49:03  
Yeah. All right. What about like care spouses trying to get in the shower with their loved ones and kind of dancing or you know...

making it fun. Absolutely. Or putting like a wet towel like a hand towel that you wet with warm water and putting it over their, like their front. Some people don't feel so exposed so vulnerable.

Noma Kaz  49:31  
 Right. 

Barbara Hament  49:32  
Otherwise you're naked in water and just feels... no... becomes a scary place. 

Noma Kaz  49:38  
Absolutely. Absolutely. Yeah. 

Barbara Hament  49:40  
Lots of a gripping mats. Bars to hold, grab bars to hold on to. Yeah, 

Noma Kaz  49:47  
you always get the... and we go back to that same conversation about hiring somebody who has experience with that particular condition, because not everybody can just walk into a client's home who has dementia and as is non compliant in certain areas, and just do their job takes a very special person with a lot of Alzheimer's skill? And how do you find that? 

Barbara Hament  50:14  
Yeah, I mean, I just heard one agency that actually, they just have bath aides. 

Noma Kaz  50:20  
Yes. 

Barbara Hament  50:20  
Such... Do you guys have that? 

Noma Kaz  50:22  
We don't we don't do it. But I have heard that as well. And that's their expertise. 

Barbara Hament  50:29  
Right. Yeah.

Noma Kaz  50:32  
I would assume that that's something that you deal with on a regular basis as well, Barbara, probably one of the top of your list. It is so important, because what you want to do is you want to limit the potential of a urinary tract infection that comes from not being clean enough and not having showered. And so there is I'm sure you talk about the urinary tract infections and how dangerous they are to seniors, which they are very dangerous and can cause, you know, tremendous decline in their overall health. 

Barbara Hament  51:10  
Right. Absolutely. Yes, no question about it. So let's see anything else we wanted to cover? While we're... 

Noma Kaz  51:22  
Well, I think maybe just just to sum it up, do a little bit of homework in advance of, of a situation that becomes critical. And I think that's, that's really very important. Have a plan.

Barbara Hament  51:37  
Yeah. You're right. I mean, we kind of touched on, like, what leads people to bring care into the home. And then the, the sort of what I call the formal ways of bringing a caregiver on, which is through an agency like yours, or the informal ways, right through "nextdoor", care.com, your church, your temple, your neighbor, your friend, those sorts of informal ways of bringing someone on board, and then really, whoever you bring on board, making sure you have some, like safety measures in place, so that, you know, kind of who you're bringing into your home. And what's happening. 

Noma Kaz  52:23  
Absolutely, that in to go over the five points again, for your listeners, patience, compassion, attentiveness, dependability, trustworthiness,

that that defines the, the almost the character of of the person, you're going to be hiring, separate and apart from the scale skill without the first five is not necessarily the answer to having somebody there for a loved one. And the first five without the skill is not very, is not very effective, either. So I think that just just know that you want somebody who's going to take as good care of your loved one as you would, if you had the time if you had the training. And that's it. It's a process and take your time, if you can take your time. Don't rush into hiring anybody, just because you're out of time. Because that could be more detrimental than waiting a little bit longer. And stay in touch, stay connected. As a family member, check in on a regular basis, check your finances, make sure that the finances are separate and apart from anything that that whoever you hire, either independently or through an agency that everything is kept separate and apart, that this is really about caring for a loved one and not about what's necessarily going on. You know, don't don't don't allow them to get into the

inner circle of the family. Just take care of the, of your client. 

Barbara Hament  54:00  
Really good point. Yeah. And we didn't touch on that. But yes, absolutely. Kind of removing all the papers that are around the house, credit card statements, bank statements, checkbooks, putting those away valuables putting those away, no matter where you're hiring from. Those sorts of things should be out of sight.

Noma Kaz  54:20  
But we never expect there to be a problem. Sometimes it's life. And sometimes problems happen.

Barbara Hament  54:28  
Yeah, and thankfully, agencies like yours have insurance for those sorts of problems. 

Noma Kaz  54:33  
We do. We do. I'm very proud of the fact that we've never had to pay a claim in 18 years, but we try and, and offset anything like that happening, and making sure that our clients take a little bit of responsibility along with it because it's good practice. It's kind of like locking your car. 

Barbara Hament  54:53  
You're right, absolutely. 

Noma Kaz  54:54  
Or your front  door. 

Barbara Hament  54:56  
Yes

Noma Kaz  54:56  
you don't anticipate anybody's gonna be stealing it or but you never know.

Barbara Hament  55:02  
Well, Noma, thank you so much for being here today. I appreciate all your your years of experience your wisdom and expertise. You've given us valuable insights, which I so appreciate. So thank you. 

Noma Kaz  55:18  
Well, it was my pleasure, I'm happy to end just as an aside for what you do, you're such an important part of the team that helps us do our job. And while we provide the care and the oversight, you get into the big picture of the dynamics of what's going on in the home, and the families and, and you help manage the agencies that that do work with you and and who are caring, and you're a much higher level of oversight. And we're very grateful to have colleagues like yourselves to be able to trust our clients with and to have a reciprocal relationship. But it does take a village and we can't do ours without you. And certainly, we can't do ours without you. So I so appreciate you. Thank you so much, Barbara. Absolutely. Thank you.

Barbara Hament  56:18  
Thank you for joining us today on another episode of dementia discussions. If you're a caregiver or know someone who's a caregiver that would like to be a guest on the show, please call me at 31036 to 8232 or go to dementia discussions.net. Forward slash contact and let me know I would love to have you remember that you can follow dementia discussions on Apple podcasts, Spotify, Google podcasts, and many more. If you listen on Apple podcasts, it would mean a lot if you would leave me a review. For any other information about this podcast please visit me at dementia discussions.net and please share this podcast with someone you know if you think it may help. Thanks again for listening. And I'll see you here again next time on dementia discussions.

Transcribed by https://otter.ai