When Is It Time for Home Healthcare?

Intro: Welcome to Dementia Matters, a podcast created by the Wisconsin Alzheimer's Disease Research Center. It's our goal to humanize Alzheimer's research so that our community, our patients, our participants, and anyone else interested can get a better understanding of the work that's happening to fight back against this disease. My name is Nathaniel Chin, and I'm a geriatric memory clinic physician at the University of Wisconsin. I'm also the family member of someone living with dementia. I'll be serving as your host for this podcast and asking the questions I believe are in the minds of many in our community. Thanks for joining us.

Chin: Today, I'm with Marion Chapin the training and outreach coordinator for Senior Helpers, a home health care agency in Madison Wisconsin. Marion has been working in home care for over 40 years and even worked as a live-in caregiver for her own parents. We're very excited to welcome Marion Chapin to Dementia Matters. To begin, I was wondering if you could define home health care and the services that are offered.

Chapin: What I tell people is home health care is keep them at home as safely as we can, as long as we can, because, in the end, everybody wants to be home. Home is a familiar place. It's a safe place, It's where they feel the most comfortable. On top of that, home health care is bringing in someone with the ability to do what they need done for them, either showering or meal preparation and then socialization, because they tend to isolate. So, we want to make sure they get some type of socialization which will include some activities—some type of exercise in some way.

Chin: So, you offer, really, a broad range of services?

Chapin: Mm-hmm.

Chin: Would you say that home health care provides a certain level of caregiver training to the families?

Chapin: Yes, if something's not working for them maybe reframing how can we help them do this better. Caregivers, spousal or children, tend to get stressed out because it can be 24/7 on duty with that person. So, teaching them some basic things of how to approach somebody different—how to rephrase things differently.

Chin: So, in addition to providing care for the loved one, you're also really providing the education needed from the caregiver.

Chapin: Mm-hmm.

Chin: So, what are five signs you may need home health care services?

Chapin: One of the things is where are they physically—are they able to do their self-care? Are they changing their clothes? Are they showering? Are they brushing their teeth? The things that we would always do every day—are they doing those things? Another thing—are they losing weight? That means they're not eating well. They may think they've eaten, or maybe they've forgotten how to prepare something, or they're not getting to the grocery store—things like that. Also, if a family member is coming in from out of town, and they're seeing disconnect notices or late payment things on the table with all the bills piling up, that's a good indication that they're not able to process that they need to do these things. So, that's a pretty good red flag, too. Another thing is isolation. Are they isolating themselves? Why are they isolating? Have they decided that they can't fit into a group setting anymore—they're making too many mistakes? Maybe when they go out they're getting lost and not sure where they were going to go—where it's just too hard to make that whole transition of leaving the home and going somewhere; it's easier to stay home. Also, paranoia is really a good indication. They’re telling family members that somebody's stealing their money or someone's coming in at night and taking things—where, in essence, they're hiding them, but they've forgotten they've hidden them, so they're thinking somebody is coming in and stealing. Paranoia is really a good indication to us that there's something bigger happening. Also, what's going on with a spouse or the main caregiver? Are they having health issues, and then you definitely need to have some type of care come in, because if that person gets ill and ends up in the hospital, then you've got the person with dementia—doesn't have a caregiver then, and, so, then you've got two people in crisis instead of just one.

Chin: A question that comes up a lot in my clinic from the caregivers is: what if the person who needs the help doesn't like the hired caregiver coming in? What do we do in that situation?

Chapin: Then what they do is they call us and we try to figure out what it is they don't like. Is it that they didn't fold the sheets right? That's something that can be coached, and we can say to the caregiver that we've sent in—this is how you need to fold the sheets. If it's a definite personality conflict, then we pull that caregiver, and we try another one. They're not stuck with that caregiver.

Chin: That's important to know, because I feel like a lot of people are under the impression—all right this was the one shot I had. It didn't work out, yep, but you're willing to work with them and find the right person to work with the person. Is there anything else that you feel is important for the community to know when discussing home health care services or help for a caregiver? You have such experience in this community and in being a home health care service provider—anything you want to leave us with?

Chapin: I think the saddest thing we hear is: I should have called you a whole lot earlier. The sooner we get in there and develop that relationship, we develop a trust then, and it's so much easier to continue and build upon that. Maybe we're in there once a week or once every other week, and they get used to that and building upon that as they start to decline and need more—then it's easier to increase services. It's difficult to come in when things are already really stressful and everybody's exhausted and angry. It's really hard to develop a trust at that point

Chin: Well said. Well, thank you, Marion, for joining us at Dementia Matters. We hope to have you again in the future.

Credits: Dementia Matters is brought to you by the Wisconsin Alzheimer's Disease Research Center. The Wisconsin Alzheimer's Disease Research Center combines academic, clinical, and research expertise from the University of Wisconsin School of Medicine and Public Health, and the geriatric research education and clinical center of the William S. Middleton Memorial Veterans Hospital in Madison, Wisconsin. It receives funding from private, university, state, and national sources, including a grant from the National Institutes of Health for Alzheimer's Disease Centers. This episode was produced by Rebecca Wasieleski and recorded and edited by Alex Wehrli. Our musical jingle is "Cases to Rest," by Blue Dot Sessions. Check out our website at adrc.wisc.edu. You can also follow us on Twitter and Facebook. If you have any questions or comments, email us at dementiamatters@medicine.wisc.edu. Thanks for listening.