Conflicts with family members have to do with the expense of all these caregivers. The long distance family member would like for mom to go home immediately with Medicare paid physical therapy; the nearby family member is willing to wait until mother regains full function. As her care manager I would like to see a doctor's order stepping up PT not necessarily waiting until her Feb 3rd return visit. Client has been athletic all her life, is highly motivated, and ready to step up the program but because of dementia and her past athleticism, she thinks she can do more than she is able to right now, often attempting to get out of bed at night to walk to the bathroom by herself and doesn't think she needs all this help. She needs supervision. Because the nearby family member works, he is not able to supervise days.
Recent problem is that daytime caregiver not giving GCM daily report even though it has been requested of her. She is an excellent and responsible caregiver but is lacking in communication skills with client, family, and care manager. When this dementia client has an Alzheimer's related behavior issue she calls the GCM to intercede instead of using her training to redirect the client. For example, in the past she and the cient's former roommate were openly critical of the night time caregiver's alleged snoring problem. Whether or not the evening caregiver has a snoring issue is a moot point since the long distance family member relies on this caregiver's expertise and good communication skills for peace of mind.
When the roommate went home we expected the issue to be resolved. However, it resurfaced when I was called by the daytime caregiver, not about the client's issue with dinner, but to discuss the snoring problem. I decided to stop by the rehab center personally. On my way into the building I passed the caregiver on her way out and she began berating me about "what I should do or shouldn't do". It has become apparent to me that the daytime caregiver is the problem. It has become apparent that this alleged snoring problem is manufactured to assure her position as caregiver when the client goes home. When interviewing the client, I found no other issue but the dinner issue which will be resolved today.
So, is this recurring problem manufactured by the daytime caregiver bordering on elder abuse? My client has a very sweet nature and because of her dementia, highly suggestable. If someone puts an idea in her head, she repeats it and accepts it as her own. I have worked with this client for the past two years and understand this willingness to please.
I have interviewed the night time caregiver about her side of this issue. She keeps nightly progress notes as to their conversations and night time activities. She calls at 7:00 am to give me a detailed report at the end of her shift daily and is highly professional in meeting her patient's needs.
Caregivers often have their own hidden agenda and are adept at doing whatever necessary to lock-in their position when a client returns home. My goal is to keep my client in the rehab with PT and OT until she is quite ready to return to her former functional status. Regardless of everyone else's agenda, a geriatric care manager functions as an advocate for the client. When a caregiver plants seeds in a dementia client's mind to generate suspicious behavior against another caregiver, this is seen by me as elder abuse. I welcome your comments.
olga@agooddaughter.com
Certainly one of those gray areas where the client or situation is being manipulated by the caregiver. But is it abusive? It's impossible to get inside the caregivers head to understand their motivation or intent. Again not sure about that and not sure how APS would see it. But at the very least it's time to find a new day time caregiver. Instead of making a referral and spending my time spinning my wheels with APS, I would focus on replacing the caregiver. My hunch is that gray area is going to come in to focus real quick when you try to replace that caregiver. These caregiver relationships are always tricky. Good luck. Keep us posted.
ReplyDeleteThank you. In my gut I knew that was the right thing to do as well. Great comment.
ReplyDeleteOlga
Olga,
ReplyDeleteBased on my past experience, from a Law Enforcement point of view, you would have an extremely difficult time proving Elder Abuse in a Court of Law. APS probably will not see it as Abuse either.
You always have the option of "consulting" with APS and/or Law Enforcement if you need or want to.
I agree with the above poster, replace the caregiver as needed and focus, as you have been doing, on what is best for the Client.
Thank you Pete,
ReplyDeleteI always value your comments.
As always,
Olga