The importance of continuity of care
Continuity of care is an important quality metric in elderly care. But getting a professional home attendant to work with a senior for a long period is not always feasible. When there are changes of home attendants, transitioning to a new or a short-term substitute caregiver can be stressful for the familial caregivers and the senior.
“My husband and I have been familial caregivers to my mother-in law who lives with dementia and also undergoes treatment for cancer. We have been reliant on professional caregivers to support my mother-in law on a daily basis since the past 3 years,” says a client of Life Circle, a home nursing care provider.
“Uninterrupted support by professional caregivers from Life Circle has been our biggest blessing. In the first year, we faced many challenges like retaining a caregiver for a reasonable period of time, coping with challenging behaviour in a dementia patient and utilizing the services of professional caregivers in the best way,” she goes on to add.
“Our journey as familial caregivers is filled with ups and downs. We have devised several coping mechanisms which have worked for us over the last 3 years. It prepares us to face the period of changeover of a caregiver in a better way,” says she.
Understanding the patient
Here are helpful tips that the familial caregiver shares with Life Circle:
- Do not assume that caregivers understand the senior, their illness and their needs. There are things about the senior that only you can tell them as family members. I therefore have a long list that I talk about in the first few days, for e.g.
- My mother-in law likes slightly warm water for bathing ; it should not be too warm.
- I let them know my expectations – that the bathroom should not smell foul; the bathroom should be dry at all times.
- Talk to caregivers about how to handle challenging behaviour of seniors with conditions like Alzheimer’s disease and dementia. Don’t assume the caregiver would be familiar with the behavioural manifestations of the disease. Talk with them about it on the first day itself. Read online resources and speak with doctors about how to cope with difficult situations.
- Share the tricks that you may have learnt of in the journey as a caregiver. Make a list and keep adding to it. Share it with the caregiver on her first day. It’ll help her feel more confident about handling the senior. For e.g.,
- Sometimes, my mother-in-law does not understand how to swallow liquids and food. She can hold food in her mouth for a very long time without swallowing it. If you prompt her to speak something, she is likely to swallow her food first.
- Another trick is offering her yet another morsel of food or water. This also reminds her to swallow the previous morsel.
- Be specific about how much water you want your senior to drink in a day and how much food you want them to eat. If they refuse to eat, let the caregiver know what alternative supplements or drinks can be given.
- Make charts
- First of all, print a medicine chart and paste it on a wall or cupboard in the patient’s room. The medicine chart should list out the medicine name, the dosage to be administered and the time of the day. If caregivers can’t read the medicine names well, use colour codes.
- Next, prepare a timetable for the caregivers to follow. For the first 2-3 days, let them know that you are particular about the timetable being followed. Ensure that they stick to time as much as possible. Allow caregivers sufficient rest and “me time”.
- Print all important phone numbers that caregivers can refer to in case of an emergency. Stick this information next to the medicine chart and timetable.
- Spend the first 1 or 2 days supervising caregiver and set expectations. If the first two days are managed well, sailing through the remaining days is rather smooth.
- All seniors should be engaged in meaningful activities of their choice and caregivers can shoulder this responsibility. Include specific activities in the daily timetable and ensure that caregivers adhere to it as much as possible.
- Dedicate time every day for exercise. All seniors irrespective of their condition should exercise in some way or the other. Bedridden seniors benefit from passive movement exercises suggested by a physiotherapist. Massage can also help. Again, set expectations on the first day. Video record the exercise regimen on your mobile and new caregivers in the future can use this recording.
- In case, the senior uses wheelchair or walker, ensure that the caregiver knows how to use it too. If not, explain it.
- I have a miscellaneous list of things relevant to my home which I talk about on the caregiver’s first day, for e.g., how to use the geyser, how to use the microwave, how to use the water filter, how to use the air conditioner. Most new caregivers have not used appliances that are common in urban homes.
First time caregivers
If you are engaging a caregiver for the first time, talk to Life Circle’s nurse manager about the following aspects related to the patient. The nurse manager will frame a Personalized Care Plan based on these aspects:
- Patient’s condition
- Activities of Daily living
- Mobility assistance – use of wheelchair / walker
- Toileting needs
- Physiotherapy and exercise
- Engaging the senior in meaningful activities
- Managing medication
- Nutrition and diet
- Challenges that the caregiver may face because of the patient’s condition
Nurse Managers at Life Circle are expected to train the caregiver if she is not skilled in performing any of the activities in the care plan.
“In the initial days as familial caregivers, changeover between caregivers stressed us out. Now, we’ve learned how to deal with it. It’s a journey of learning and coping,” says the client ending on a positive note.
We invite our readers to reach out to us and share their stories so that we could share them for the benefit of other families who are in similar situations. You can contact me if you would like to share your care-giving experience with senior friends or their families.
About the author
Madhumita is a familial caregiver to her mother-in-law who lives with dementia and a full-time mom of a bubbly 3-year-old. She meets and interacts with Life Circle’s clients to understand various aspects of Geriatric care and care needs with the aim of serving our clients in a better way.