Starting private duty care services for clients with dementia diagnoses, especially with Alzheimer’s disease, is all about personal connection and trust.
Dementia clients usually do not recognize a new caregiver at the door and as a result, they refuse to let the aide into the house.Over time the client becomes more familiar and trusting of a new person but repeated exposure is essential.
Therefore, overcoming the hurdle of getting in the house is essential when the client is home alone. The aide can be refused by the client for a week or more and I have seen families give up on keeping their loved ones with dementia at home.
As a client manager, I work as a bridge to get the aide through the doorway and into the house. My task starts before the contract signing when I visit to assess the client’s needs and their personal traits. Once the contract is signed and I have an aide who is a good personality match and has the right dementia training and experience, I will bring the aide over to the home for an introduction. The aide is then able to judge whether they want to take on this particular client.
During the aide introduction, I strive to have the most responsible or the local adult child onsite. If the adult children are working or no one is in town, I ask the daughter or son to call in by phone and confirm that the parent can trust me. I then continue to verbally connect myself to that adult child over the rest of the visit by saying that I know their child(ren) and have been asked to stop by. I continue restating this connection over subsequent visits and tell the aide to do so as well.
During the introductory visit, the aide and I will spend time with the client getting to know each other. Often the client’s memory about themselves is poor and I will review information gathered in a life history document during the contract signing. Hopefully on the next day, I will come again with the aide but stay for just a short while and will continue escorting the aide into the home for a couple more days if needed. I judge to see how welcoming our client is becoming. I will try to have the aide scheduled for several days in a row whether they want daily care or not. Repetition is needed. The schedule usually drops back to the desired 2-3 times a week on the following week. If the client is willing to have the aide come back into the house with little hesitation, I encourage the aide to come a day by themselves. An experienced aide is very much needed in this phase. A good aide will greet the client at the door and start reminding the client of the activities that they did together on the previous visit. If necessary, I will take a photo of the aide and the client together so that the aide can use it to rekindle the client’s memory of their being together.
Sometimes, when client lives with a spouse or adult child, they refuse aide care because they feel well taken care of and have no need for strangers. This type of situation is a tougher challenge. I recommend that the aide start by transporting the client and letting a friendship develop. Soon the concern about a stranger in the house vanishes and the spouse or adult child can leave easily. To gain trust, all the aide’s attention should rests on the client. Dementia clients can become jealous of the opposite sex receiving attention from their spouses at certain stages. Sometimes when transportation is not necessary, the client may need to meet a “distant” cousin of their cleaning lady or family friend. The bimonthly cleaner or friend would need to come in and make the introduction. The aide will then continue to associate herself with the maid and then care can be delivered under the disguise of cleaning and cooking.