Happy Scents

I was a Caregiver/Certified Nursing Assistant (CNA) for ten years here in USA. There are different types such as private duty, quality life specialist/dementia care specialist, home health aide, patient care technician, and agency caregiver. I have had experienced all of them except patient care technician. The different settings include home (most ideal), hospital, assisted living, nursing home, agency, home healthcare and adult daycare centers. It is by far the longest I have stayed in one profession. When I acquired my CNA certification, I really thought it will be a stepping stone to be a nurse. It stirred me to a different path.

Caregiving is helping the elderly with activities of daily living (ADL) and instrumental activities of daily living (IADL). Activities of daily living (self-care) are bathing, shaving, changing clothes, toileting and etc. Instrumental activities of daily living are cooking, cleaning, managing finances, transportation and etc. It requires companionship (no assist-minimum assist) to lifting dead weight (maximum assist) and giving total care depending on client’s health condition and prognosis.

It can be live-in and to go. Live-in is when you live with the client/clients for specific days ( 2-5 days) in their home, assisted living and group homes provided they give you your own room and allocate food for you. You will be the all-around help of the elderly/client. Mostly caregiving jobs in all settings offers “to go” means hourly and shifting. You can get paid every hour and go home daily.

Dealing with the Elderly

Respect and restoring dignity-The older populations have a lot of histories, wisdom, stories and experiences to tell. They were respected in their previous careers as a police officer, army nurse, secretary, professor, banker, designer, priest, business owners and more before they retired. Few distinguished people I am honored to have worked for. They have their own character, culture lifestyle, attitude, hobbies and way of life but respect is necessary regardless of their condition and disease. Older generations have been independent for so long that relying for someone for basic self-care is very hard for them.

I have a client who had diarrhea. She made a mess in her bathroom. She apologized profusely. I look her in the eye and said, “Its not you but your condition. I’m here to clean you up and restore your dignity.” She smiled and say, “Thank you!” Treat them like an adult, and it goes a long way.

Trustworthy– Most of my private duty clients, they let me in their homes with all of their belongings. I have seen the finest antique collections, jewelries, checks, big condo in downtown Chicago overlooking Navy Pier, and houses in upscale suburbs neighborhood. I even drive luxury car of my client for her doctor appointments and groceries. You need to be trustworthy and not steal because its elder abuse and you can get penalize. The only way to get private clients as well through word of mouth when you have no record of stealing and taking advantage of the elderly.

Companionship/listening-The older generations crave for companionship, and good conversations. They are alone and living separately from their family members mostly by choice because they have been independent for so long. Needless to say, they admit that they long for someone to talk to or even listen to what they have to say especially my widow clients. They miss their spouses and companion for many years. I can attest that elderly has full of wisdom through life experiences, victory over many struggles, resiliency and strength against trials and tribulations.

I have one client she was the director of Rush sleep/dream pathology and I learned a lot just for how many days I took care of her because she had right knee replacement surgery. She gave me a book of dream interpretations that she authored.

Offering redirection techniques– Most memory care residents have dementia or comorbidity of physical illness or mental illness as well. Dementia is a degenerative brain disorder. It is a wide spectrum that includes Alzheimer’s disease, vascular, lewd body, frontotemporal and mixed dementia. The residents may or may not be communicative depending on the stage (severity) and the part of the brain is/are affected by the disease. You have to have a bag of tricks to deal with them. The aggression, melt down, irritability or behavior issues that affect them, but they can’t express verbally.

Redirection means controlling temperature (too cold “A/C” or too hot “heater”), offer healthy food (facial cues of hunger and thirst), ask simple/ direct question (avoid confusion). Take them for a walk because Vitamin D helps with mood and brain functioning or do an activity they love doing.

A resident who used to be a designer/seamstress, we give her magazines and ask her to critic the clothes they wear. The activity aid brought a sewing machine and let her do pillowcases. Simple activities that mean a lot to her. She was excited, eager and happy to do her part.

Living on their own reality– people with dementia often remember long term memory more than short term memory but not all. Sometimes all memories fade away until losing their capacity to walk, eat and talk. Families and healthcare professionals should treat them where they are right now in terms of mobility and cognitive abilities.

One resident who goes back to when he was a child. He was looking for his parents and very aggressive to go out of the side exit doors. He was sundowning. We (caregivers) try to stop him by talking to him (reorienting him) but he gets more agitated and combative. He was hurting everybody even his arm (bloody) forcing his way out by banging in the door and wall. I learned from his family member that we should tell him that his parents are out of town for work and they will pick him up tomorrow in the facility. He remembers when he was a child. The reality is the moment where they are in at that particular time and place. Going against it will bring more agitation, confusion and aggressive behaviors.

We have a 100-year-old resident who always stands up with a walker while eating dinner in a dining room area. She said her school bus was waiting for her. I will walk with her in the bus stop (reception desk) and let them announce that the last school bus left for the day so we can go back to the dining room and called her parents so they can pick her up. I told her to eat and wait for them.

Another resident will always wants to get to the airport and in the plane because he said he will have a business meeting (used to be a businessman) soon. He was very anxious and try to walk so fast (walker) but he was a fall risk. We have to print a plane ticket to show him and calm him down. We print plane ticket late during the night, and the business meeting is scheduled for tomorrow. We show him the plane ticket, his calendar of schedule and clock so he will sit down and wait until he falls asleep.

Lifting Techniques– carrying and lifting heavy weight takes a toll on your body especially lower back. Most caregivers not everybody has had lower back problems. Use of gait belt, proper ergonomics and posture are a must. I learned stand, pivot and turn with a wheelchair if transferring clients from bed to chair and vice versa. Use transfer aids such as bed rails, hoyer lift, sit-to-stand lift, transferring board/sheet to help maximum assist residents/clients but use with caution or ask help with your co-workers. But sometimes all the proper lifting techniques goes out of the window especially if a client and resident starting to fall.

They always say fall with them in a manner that you still protect them and yourself. It is easier said than done. If a resident is bedbound, make sure you clean them up in bed, bed needs to be elevated by your waist level with bed rails up (for safety and turning) , put depends on, pants (better loose and with garter), socks and shoes and put top when you sit them up. Well I just reiterated is dressing technique at the last part not lifting but it goes side by side on efficiently dressing and getting your residents ready to go.

Dealing with healthcare providers– I used to work at memory care and every doctor’s visit maybe appointment or emergency, the caregiver on the floor should come with the resident. They staff the same person on the floor for consistency of care and to know residents well. I work there long enough as well to know every floor and residents from 1st to 4th floor from early to end stage of dementia. Healthcare providers will rely on you for getting the information and communicating with the residents especially if there are non-communicative or has aggressive behaviors.

I deal with nurses, doctors, PT, OT and many more in hospital and home health for my private clients. I am their primary source of informations, for relying diagnosis and care to the family, discharge instructions, home exercise and so on and so forth. I have important documents such as DNR. A client’s family rely on me so much that sometimes they want me to decide in the procedure that has to be done in the event that my client has having stroke. I always look at what’s best for the client, give my opinion and let the family decide. Sometimes they will make you the power of attorney (POA) for healthcare. It is such a big responsibility.

Dealing with family dynamics– There were different family dynamics from those family members who wants quality care for their parents/grandparents to those families who were forced to visit. Families who have type A personalities even if you do everything you can’t please them. On the other hand, you have to deal with the families who don’t care but they are there for inheritance. Dealing with them and answering their questions regarding their loved ones and families. Dealing with the families at the end of life care were the hardest emotionally and mentally especially if their family member are in hospice. Finding right words to say or just be there to listen through grieving period.