Although hiring a home caregiver to aid in the care of a loved one can be a tremendously positive experience, a common set of issues occasionally arise. Awareness of these issues before they arise can help the family, the caregiver and the Agency deal with them effectively.

Stranger in the house

While many families recognize the value of the skills of the home caregiver, there is occasionally a reaction to the constant presence of a non-family member in the home. Since most people feel their home is some type of sanctuary, having a non-family, member about the house can be disconcerting.

This normal feeling usually subsides over time as the family and the client grow accustomed to the caregiver, and the caregiver comes to know the needs of the client and the ways of the family. Only rarely does this issue cause a long-term problem

The client resists care from the caregiver

While the vast majority of clients welcome the help of a caregiver, occasionally, especially in the case of clients at the early stages of Alzheimer's disease, the client will resist or shy away from an unfamiliar caregiver. This can be difficult for the family to accept since it calls into question their judgment in retaining a caregiver.

Like the stranger in the house issue above, this usually dissipates over time. In fact, often the introduction of a third party - e.g. the non-family member caregiver creates less agitation on the part of the client.

Professional boundaries break down between the caregiver and the family.

As contrasted with the previous issues, in this instance the caregiver is in a way "adopted" by the client's family. The family may begin to bestow gifts on the caregiver or treat them as members of the family.

This is a difficult situation since in many ways the caregiver does become part of the family unit. Care must be taken by both the Caregiver and the family to keep appropriate professional boundaries while preserving the caring relationship.

The Caregiver and family push boundaries of allowable care

It is natural that as the client becomes frailer, both the caregiver and the family wish to provide more intensive care. Sometimes there is a temptation for the caregiver, encouraged by the family, to step over the bounds of what the caregiver is legally able to do. An example is that caregivers are not allowed to dispense medications to clients in many areas in the country.

When this situation arises it is best to speak to the caregiver's supervisor and establish clear guidelines as to what is permitted and what is not.

The family desires to fire the Agency and retain the Caregiver

Once a caregiver settles into a routine with a family and a client, occasionally to try and save money, the Family will attempt to fire the agency and retain the caregiver. The agency will have made a large investment in establishing a successful relationship with the family, caregiver and client. To protect their investment, agencies structure a fee to be paid by the client or family, if they wish to directly employee the caregiver. Families considering this should be fully aware of the fee, as well as the responsibilities they will assume.

When these situations arise, it is best to bring the Care Manager into the discussion to allow for appropriate protection of the client, the family and the caregiver.


Sexual acting out

Often for clients with Dementia, sexual boundaries break down. Occasionally, a client may approach the caregiver in an inappropriate way. Caregivers and families should be trained to deal with this situation by re-directing the client's attention.

In most cases the issues outlined above do not arise. It is useful however to be aware of what the issues are, and know what to do about them should they arise.