I am writing to share a recent experience with all of you, partly to help me process the event, and partly because this sort of occurrence makes me consider just how vulnerable our clients are, and how important it is to have multiple layers of back-up and protection for them.
A home health aide who has been the weekday anchor for a 104-year-old, non-ambulatory, non-verbal client of mine, suddenly had a psychiatric emergency while on the job. The aide became completely non-verbal, with bizarre, slightly agitated behavior. She was still trying to care for the client, but was unable to. The only family we could reach was a 70-year-old son who had arrived to live with his mother from their home country only 2 weeks ago. He was unaware of any psychiatric history. We called 911 for her, and she was hospitalized.
The only reason I found out about it as quickly as I did was because of the unusual circumstance that the client's 70-year-old son, who lives in another part of their enormous apartment, also has a home health aide for himself. It was the second aide who spotted the bizarre behavior, and called me for help. If not for that circumstance, I wouldn't have heard about it possibly until the evening aide arrived.
This woman has been been the anchor, 5 days per week, for almost a year for my client. She has been extraordinarily competent, cheerful and reliable. She had 7 years of solid references from an agency for almost 20 years.
I will certainly have this incident in the back of mind any time from now on that I formulate a care plan, especially with any clients who are unable to call for help on their own. I would be interested to hear any of your responses, whether you've had any experience like this, or what systems you have in place that would provide a prompt notification if something like this was to happen with one of your clients.
olga@agooddaughter.com
Families and clients usually ask in the initial interview/assessment for just one care provider, which is understandable, but as the owner of an in-home care agency, which does criminal reference checks and careful reference checks, I have learned through the years that it is always wise to have more than one care provider in each situation. In this case you were fortunate to have a care provider nearby. This could also be accomplished by a second shift or at least two care providers scheduled through the week with one client. This is tricky because clients might prefer one care provider over another and ask for only one person for continuity, but I explain that we need a second familiar face in the event one person is ill or has a family emergency. More than that though, we find that each care provider bring different gifts and perceptions to the situation ~ and they keep track of each other. There is an unspoken sense of accountability. I never advise one care provider move into a home with a client although I am often asked to do so. After a honeymoon period, I have noticed that care providers often slide into thinking that they "know best" and with time there is a power struggle. We have all seen cases where this has worked, but in my experience I have seen many more cases of "undue influence" and abuse. I think of it as a system of checks and balances.
ReplyDeleteThis reminded me of a long distance challenge another client's daughter was facing. This particular situation will further illustrate why long distance family members need an extra pair of eyes and ears when depending on very independent caregivers who might be at risk of having a psychotic episode on the job and are unable to care for an elderly vulnerable client. What happens to the client if there is no nearby care manager available as an emergency on-call person who can mitigate the problem and quickly put in place contingencies. These situations do happen. Care managers plan ahead are are prepared to step in as needed.
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