Trained Attendants for Home Care

Locate sources for trained attendants

The type of paid help to employ depends on multiple factors. Examples are availability, cost, the person’s needs, family comfort, and so on. Often, families use the term “nurse” for the helper they employ, though the helper is not a medically trained nurse. Types of arrangements that Mother Touch Services Provides:

• Using a maid/ ayah/ servant (part-time or full-time) after providing them some training.

• Using a part-time trained attendant for the day (a 8 hour shift, or a 12 hour shift).

• Using a part-time attendant for the night (typically a 12 hour shift).

• Using two part-time attendants, one for the day and one for the night.

• Using a full-time attendant who lives in the home.

• Using qualified nurses part-time in one or more shifts.

Many families look at the home help first, like a maid or ayah or servant. They may already have a home helper they know and trust. This home helper already knows and respects the person with dementia and so may be considerate and affectionate. The main problem here is that the family has to train the maid themselves. They have to explain dementia to the home help. They have to explain how to interact with the person and handle odd behavior. Home help have no medical knowledge. They may have seen persons with dementia symptoms being treated as unreasonable or “mental” in the society around them. So they may not believe that changed dementia behavior is because of a medical problem. The family may not know how to explain or convince.

Often, families use agencies or services that provide attendants for home care. These attendants may be trained to handle frail or elderly people. But they usually do not have sufficient training on dementia. Families usually need to train agency-supplied attendants for dementia care.

Most families opt for part-time or full time trained attendants from agencies. Some employ only a day-time part-time attendant and do the night-time caregiving themselves. Some families use two attendants, one for the day and another for the night. Others prefer a full-time live-in attendant.

Employing a full-time attendant means that the family has to provide meals and enough living space. This is a problem if the family lives in a small apartment, or if they do not have a cook. Most agencies say that attendants will not help in any housework. In families without servants and maids, the family then has to cook for the attendant. Often the attendant’s food habits and choices are not the same as that of the family. So the family has to make separate food that the attendant likes, or there is a risk that the attendant will be unhappy and will leave. Some families handle this by using a “dabba” service to get food the attendant likes.

A full-time attendant may not be able to handle all the work if the person with dementia needs attention day and night. There is also a problem in case this full-time attendant falls ill. When the attendant falls ill, the family has to take over all the dementia care work and also has to decide whether to send the unwell attendant away or to look after the attendant. If the attendant was sharing the room with the person with dementia, an infected attendant may pass the infection to the person. Also, when full-time attendants have to leave suddenly, such as for a personal emergency, the family has no alternate help till the agency can find a replacement.

Using part-time attendants (either single or two) is another option. This saves the family the additional work of cooking for the attendants. Part-time attendants are supposed to bring their meals and the family only has to give them tea and maybe snacks. No separate, private sleeping space is needed. The attendant spends the day (or night) with the person with dementia. Two attendants, one for the day and one for the night, is one arrangement many families use, Often, agencies agree that the attendant on duty will continue on the shift till the next shift’s attendant comes for work.

While deciding on whether to employ full-time or part-time attendants, look at the rest of your home helpers (maids, drivers, and cooks) to see if they can help if the attendant skips work.

One very important factor is how the dementia person adjusts to the arrangement. They may not be able to adjust if the day and night attendants are different. This is especially true if the two attendants have different ways of helping.

You also need to decide whether you need male attendants or female attendants. Female attendants are used if the person who needs care is a woman. But for men who need care, families may use female attendants or male attendants. In homes where most family members are women, the family feels more comfortable and safe if the attendant is also female. But there are also other things to consider. For example, can the female attendant do the physical work required? Can she lift and turn the person with dementia? If the person who needs care is a man, is the man’s behavior towards the female attendant alright? In some forms of dementia, persons become aggressive and abusive and may behave in socially unacceptable ways. They may make lewd comments, grab, or try to kiss. In such cases, using a female attendant could be a problem.

While looking at the overall costs of the options, do consider food and other living costs for full-time attendants.

Very few people with dementia need a qualified nurse as a caregiver. A trained attendant with basic medical knowledge is enough for most of the care work. Employing a qualified nurse for home care is very costly. Also, qualified nurses would find the day’s work boring and a waste of their skills. In case there is an occasional injection or some other medical procedure to be done, families can ask a home nursing agency or nearby polyclinic to send a qualified nurse for that work. If the person with dementia needs proper nursing care for some days, families can use a qualified nurse for those periods of severe illness.

Trained attendants (part-time or full-time) and nurses are usually employed through agencies. Some families employ attendants directly instead of getting them through agencies because it costs less. However, this private and direct arrangement becomes a problem if the attendant does not come on one day. If the attendant is being supplied by an agency, the agency is supposed to send a replacement.

Agencies bill the family for the work. They pay the attendant a salary after deducting their commission. Commissions agencies take vary widely. They may be as low as 500 rupees a month or as high as 50% or more of what they charge the family. The agencies are supposed to ensure that the attendants are “trained” and “reliable.” But they don’t treat this as a contractual obligation. The quality of agencies and the attendants they supply varies widely. Agencies and attendants often overstate their experience to get a job.

Agencies are supposed to send substitute attendants when the assigned attendants go on leave. Some agencies do so. But many agencies ask the families to “adjust” for a few days. Some agencies keep expressing their inability to provide attendants, but they do not refund the deposit given to them. It is advisable to check the reputation of the agency. Ask others who have used that agency for some care work, even if that wasn’t dementia care.