The Role of the Caregiver
A caregiver is a family member or close friend who has taken responsibility for the physical and emotional needs – and sometimes the financial affairs – of a person who cannot entirely care for him or herself because of advanced age, illness, dementia, or disability.
A caregiver can also be someone that the family hires to provide care and/or to assist the primary caregiver.
Caregivers may have a range of responsibilities from attending to a person's physical needs, including preparing meals and helping the person bathe and dress, to logistical tasks such as driving the person to the doctor, buying groceries, and keeping the home clean.
In the United States, approximately 80 percent of long-term care for the elderly and disabled is done in the home by a family member or close friend. It is estimated that over 44 million people in the U.S. serve as unpaid caregivers. The value of that unpaid care is estimated at $375 billion a year.
Care can be given for a short time as someone recovers from surgery or a broken leg or for a longer period of time for someone who has an illness like Parkinson's or Alzheimer's disease. The average length of time someone is a caregiver is about 4 years, though this can be shorter or longer depending on the situation.
The role of a caregiver can be extremely difficult. Caregivers often feel overwhelmed, resentful, and even depressed. Therefore, learning good self-care and reaching out for support are essential for caregivers. In the best of circumstances, taking care of a loved one can be rewarding and meaningful, as well as challenging.
Caregiving by the Family
A family caregiver is someone who attends to the needs of a relative or close friend on an ongoing basis, usually without pay.
Most family caregivers are not healthcare professionals, but they talk to healthcare professionals on behalf of their loved ones, arrange appointments, provide rides to and from doctors' offices, stay informed about their loved one's condition, and ensure that their loved one receives appropriate medical care.
The family caregiver also assumes responsibility for their loved one's nonmedical day-to-day needs.
Choosing the family caregiver
When a family member becomes chronically ill or disabled, or an aging relative reaches a stage where he or she needs help with basic needs, other family members often must decide together who will become the person's primary caretaker.
Usually, if a spouse becomes ill or infirm, the able-bodied partner will assume caretaking duties. But with an unmarried relative or elderly parent(s), the process of "electing" a caregiver can be delicate and complex.
There are many factors to weigh. One adult child or relative may live close by. Another may have a spare bedroom. One may have more free time than the rest, and another may have more financial resources. All these considerations (and others) are important, but it is most essential that a caretaker:
- Is willing to do the job (not pressured into it for the convenience of others).
- Is emotionally and practically prepared to accept the responsibility of caretaking.
- Has the intelligence and ability to provide the necessary care.
Hiring a Caregiver
Types of caregivers
Numerous types of hired caregivers can provide a wide range of services. These include:
- Personal care assistant/companion. This type of caregiver performs chores such as meal preparation, housecleaning, and grocery shopping, while also offering company and conversation. Some personal care assistants offer help with dressing, bathing, and toileting if necessary. This type of caregiver need not be certified or licensed.
- Certified nursing assistant (CNA) or home health aide. This type of caregiver provides assistance with daily activities such as toileting and bathing, dressing, and personal hygiene, while also monitoring the health of the person cared for. CNAs and home health aides are trained to check vital signs such as pulse and blood pressure, provide bedside care (including turning and positioning a person in bed), remind a person when to take medication, perform nonsterile wound care, and sometimes guide a person through range-of-motion exercises or help a person to walk around.
- Licensed nurse. In addition to the care that a CNA or health aide provides, a registered nurse (RN), licensed vocational nurse (LVN), or licensed practical nurse (LPN) performs specialized medical services such as managing medical equipment and sterile wound care. Nurses also monitor a person's vital signs on an ongoing basis. Normally, a nurse is hired as a caregiver only if a person is bed-bound or very ill and the person's family does not want to move their loved one to a nursing home or other facility.
- Rehabilitative therapists. A physical therapist (PT), occupational therapist (OT), or speech therapist (ST) works with stroke and injury survivors and people with debilitating disease to help them regain motor and communication skills. This type of caregiver provides services in short sessions of 1 to 2 hours, guiding a person through various exercises and movements. A rehabilitative therapist may also teach the family and other caregivers about bed mobility, techniques for safe transfers, and the safe use of equipment such as walkers. A rehabilitative therapist does not care for people in their home for extended time periods.
Hiring the right caregiver
Choosing someone from outside the family to be a caretaker requires careful planning.
The first step is to create a list of the chores and responsibilities the caretaker will have to perform. Does your loved one need dressing, toileting, bathing, hygiene care, or walking assistance? Does your loved one need someone to make sure they take their medications as prescribed each day? Do you need someone with medical qualifications, such as a registered nurse, or will an unskilled assistant be able to meet your loved one's needs?
Once you have made an inventory of services needed, you can create a job description. If you expect to keep a caregiver for a long time, you may also want to draw up a job contract, including wages, hours, and duties.
Hiring a caregiver can be more complicated than it seems. Be sure to check what your legal responsibilities are regarding Social Security and taxes, limits to hours and minimum wage laws, and other benefits such as paid time off. California is in the process of considering a domestic workers rights bill, and these laws could also be changing. Several links are listed below. Your local library or senior center may also offer helpful resources, such as the Nolo Press book, Working with Independent Contractors, which includes a chapter on hiring household workers and family members.
AB 889 (Ammiano and Perez):http://www.aroundthecapitol.com/Bills/AB_889/20112012/#
Federal Administration on Aging resource site: http://www.eldercare.gov/Eldercare.NET/Public/Index.aspx
National Council on Aging: www.benefitscheckup.org
Friends, neighbors, healthcare professionals, church groups, or colleagues may be able to recommend a caregiver, or you can hire one from a licensed agency with a pool of qualified applicants who are bonded and insured.
Prospective caregivers should be able to provide good references, including previous employers. You should check these references thoroughly.
When interviewing prospective caregivers, have more than one family member or close friend present so you can compare impressions afterward.
Listen to your instincts. Does the prospective caregiver seem responsible and able to communicate well? Will he or she get along with your loved one?
After hiring someone, have a trial period. Spend some time observing how the new caregiver treats your loved one and how comfortable your loved one is with the caregiver, as well as how responsibly the caregiver performs his or her duties.
At the very least, a good caregiver should:
- Be knowledgeable about your loved one's condition.
- Allow your loved one to be as independent as possible.
- Know what to do in an emergency.
- Communicate well with you and your loved one.
If you have an emergency medical condition, call 911 or go to the nearest hospital.
An emergency medical condition is any of the following:
(1) a medical condition that manifests itself by acute symptoms of sufficient severity (including severe pain) such that you could reasonably expect the absence of immediate medical attention to result in serious jeopardy to your health or body functions or organs; (2) active labor when there isn't enough time for safe transfer to a Plan hospital (or designated hospital) before delivery, or if transfer poses a threat to your (or your unborn child's) health and safety, or (3) a mental disorder that manifests itself by acute symptoms of sufficient severity such that either you are an immediate danger to yourself or others, or you are not immediately able to provide for, or use, food, shelter, or clothing, due to the mental disorder.
This information is not intended to diagnose health problems or to take the place of specific medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.