Sunday, August 18, 2019

Confessions of a Caregiver: Accepting Help is as Tough as Finding It

Certainly I don’t need help.

Robert goes to a Day Program while I work so that’s already more help than some of the other 40 million caregivers get. I feel fortunate I have this great resource.

Almost 11 years ago when I started caring for Robert he could walk unassisted and get dressed by himself. He needed help with medications, time management, toileting, and making safe and healthy decisions (like not wearing urine soaked clothes that had dried overnight).  

The decline has been slow and steady but brutal. It is hard to see a steep decline when living it day to day but sometimes it hits me just how significant of a decline it has been.

Robert and Aunt Evelyn
After each bout of pneumonia or the onset of Parkinsonism or the relentless, ongoing seizure clusters, Richard and I picked up the slack with the tasks Robert can no longer manage. Dressing has gone from picking out his clothes and prompting him to pull up his socks to completely dressing him. Walking unassisted transitioned to using a wheelchair just for long distances to using it most of the time. Robert may use the walker at home but he can’t do so unassisted. We walk next to him so he doesn’t fall but he still does fall. Falling (or almost falling) means catching him or picking him up. 

All 210 pounds of him.

Robert has developed other health issues which require additional maintenance and medications to keep him as healthy as possible. I now brush his teeth to reduce the bacteria in his mouth so there’s less of a chance of pneumonia when he aspirates. We put the nebulizer mask on him twice a day to keep his lungs open and healthy. His medications have changed and increased so much that, for fun, I’d like to walk into a pharmaceutical school and take their final exam to see how I do. I may not get an “A” but I think I’d pass.

I have a strange idea of fun.

Incontinence has moved from urinary incontinence to occasional bowel incontinence. Robert’s memory is so inconsistent that sometimes I have to remind him which way to turn out of the bathroom to get to his bedroom or explain that it’s breakfast time and not time for a scoop of Rocky Road ice cream.

Still, I didn’t think we needed help. After all, there were two of us taking care of Robert. The bulk of the physical work fell to me since Richard has his own health issues but I was managing it okay – until I wasn’t.

My stroke last year was a wake-up call and I was determined to make changes. I immediately started walking regularly, taking medications to prevent another stroke and have greatly reduced my carb intake. For good measure, I feel even more guilt than usual when I cave to those sugary cravings. I do better about managing my stress and have no trouble saying “no” to doing too much for too many on any given day.

My longer term goals related to caregiving were to hire a housekeeper, take a respite and hire in-home care for Robert.

These goals took a little bit more work but I hired housekeepers, fired them after not showing or calling and promptly hired another company. I absolutely love this extra help and am grateful to be able to afford such a luxury. Richard and I took a respite within a few months of my stroke.

Two goals down; one to go.

I started my search for in-home care by posting an ad on NextDoor and, telling friends and family I was looking and calling several agencies. The referrals from friends were already working elsewhere, replies to the ads were minimal at best and the agencies either didn’t show up or were too expensive. (One rep came in and declined my offer to talk with Robert. She wanted to get straight to the services, their cost and even pulled out a contract. Um, thanks but no.) 

The other problem with agencies?  They only do medication “reminders.”  I’m sorry, but no amount of reminding is going to get Robert to take the correct medication. He needs to be handed a cup with two pills at a time and told to take the meds.

Even while looking, I was having trouble nailing down exactly what someone would do but decided a few hours a couple of days a week would be helpful.

One of the hardest parts of providing care to Robert is the constant interruptions and needs. He probably needs something every ten minutes. If it isn’t him asking for something, I am restocking supplies and medications, doing laundry, ordering more supplies and calling medical professionals and health agencies.

It would be nice to have a two hour break a few days a week but because it was proving to be so difficult to find care, my head started the excuses reel:

How can someone help me for just a few hours a week?  Will that really be helpful?  I mean, I can change him myself and let him watch Family Feud and have a few minutes to restock or do laundry or make calls.

Plus, what about our dog?  We have an older dog who doesn’t mind strangers but our “puppy” (who is actually pushing seven years old) takes a while to welcome people into his tribe. I wasn’t sure he would get used to someone.

Puppy and Oz
Other Brother asked me how my search was going and how he could help. I appreciated his offer to help pay for services but I refused to pay an exorbitant amount for a small amount of in home care – no matter whose money I was spending. Especially when Robert has the benefit of IHSS hours (which means we can hire a care provider using these hours and the state pays the person instead of us paying out of pocket).

I suppose that is one more excuse I was coming up with not to hire help but I really tried to find in-home care. It just was not working out – excuses or no excuses.

It became more difficult to find help than any benefit that I could gain even if I did find it. I told myself that all the other changes I had made after my stroke were enough. We were managing just fine, thank you very much.

Over the next several months, the decline in Robert’s mobility and health continued. There are more frequent bouts of pneumonia and his mobility takes a worse hit each time. The last bout of pneumonia really knocked him for a loop and he was in a Skilled Nursing Facility for a few weeks to get intensive physical therapy.

Not showering Robert. Not dressing him. Not sorting his medications. Not doing five loads of laundry a day (no joke). Not helping him stand or keeping him upright while he was walking.

This was nice. I really, really liked having a break from the physical part of caring for Robert.

We saw his mobility neurologist about a week after Robert returned home and she saw just how much trouble he was having even just adjusting himself in the wheelchair.

She looked at me and said, “You need to get in-home help. This is too much.”

I love this doctor. She cares for Robert but also cares about the impact caregiving has on me. She is smart and helpful and kind.

And she validated that what I am doing is a lot.

For some reason, I couldn’t do that for myself so let the reasons for not hiring in-home care pile up.

She told me she hired caregivers for her mom who has dementia and lives in an assisted living facility. She reminded me about She gave me a goal of finding a caregiver. Interview caregivers at Starbucks, she said. Find someone you like then bring them into your home.

She gave me the steps to find someone. Her words were what I needed to hear.

I told my best friend. I told Richard. I told Rachel. I told Other Brother. Rachel had been trying to convince me to get help on our nightly walks. My best friend told me she had been very close to calling Rachel and staging an intervention so I would get some help.

They all agreed we needed help. They knew all along. It just took me some time to see the benefit was worth the effort.

I renewed my efforts to find help. I placed another ad on and got several applicants this time. I took time off work and set up interviews at Starbucks. Some showed up, some were terrible, one was most likely impaired.

None were right.

I continued screening applicants. I did a phone interview and fell in love with someone but she had transportation issues. Then scheduling issues. It didn’t look like this would work out.

Then, a miracle happened.

My son-in-law saw a post on NextDoor from a woman who only wanted to work ten hours a week, was IHSS certified and lived a couple of miles away. He texted me her info and I immediately called her.

She was everything I had thought would be a perfect candidate: IHSS certified and she could work in the afternoons when Robert gets home from Day Program.

She even liked dogs.

Crazy Puppy
She came over and met Robert and Puppy. She loved Robert and didn’t run screaming from the barking Puppy.

I hired her on the spot.

Puppy barked at her the first day and Evelyn took it in stride. She gave him treats and Richard took him in the bedroom after a while so she could work with Robert. I showed Evelyn the routine for after Day Program and before we knew it, two hours had gone by.

Still, after the first day, I wasn’t sure if this was going to work. Puppy and Richard can’t stay in the bedroom for hours every day. Evelyn wanted someone who was mobile and Robert is, well, mostly mobile. I worried about that “mostly” part.

And Puppy.

I felt better after Day Two. Evelyn told me she wanted to do everything. She said I didn’t need to help her. She sweetly called me a mama bear (I can’t argue with her there). I went in the office and worked on a writing project. It was two hours of mostly uninterrupted time and it was glorious.

Puppy was even warming up to her.

By Day Three, we were calling her Auntie Evelyn and Puppy was comfortable enough to hang around her without barking.

Day Four Richard gave her a house key.

On Day Five, Richard had his first post-surgical appointment at the time Robert was due home and I wanted to attend with him. We weren’t sure if Evelyn and Puppy were ready to be alone together but Evelyn said she was ready. Puppy was ready too – he ran circles around her when she came in and then brought her a toy!

Mama Bear leaves them alone now; Auntie Evelyn and Robert watch Family Feud after she gets him into his pajamas and while she folds laundry. They laugh like old friends and are plotting how they can get on Family Feud together.

She is everything I wanted in a caregiver. It took a year but the effort to find help was worth it.