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5 Qualities of Caregiving Excellence
3/14/2013
Relationships can be tested to the limit when there is a caregiver and care recipient within a family relationship. In a paid caregiving position there are those who have something special within them and those who are just interested in a paycheck.
By Angil Tarach RN, GCM is a nationally known eldercare expert, best-selling author, advocate, speaker and consultant with over 30 years in geriatric care and advocacy.  She writes on issues in aging and eldercare and is a writer for continuing education courses for Pedagogy Inc.


Relationships can be tested to the limit when there is a caregiver and care recipient within a family relationship. In a paid caregiving position there are those who have something special within them and those who are just interested in a paycheck.  I have met, observed, and trained hundreds of caregivers and as healthcare manager , we are always striving to hire the excellent caregiver’s with that something special, rather than someone just looking for a job. It is much easier to control what type of caregiver’s we employee than changing a less than satisfactory caregiving situation.

Everyone isn’t suited to provide care in a family situation or as a paid position. So what are the characteristics that an excellent caregiver has? I believe there are 5 core qualities an excellent caregiver possesses.
 
1. EMPATHY

Empathy is the #1 core characteristic of an excellent caregiver. I often question if this is inherent or something which can be learned?  I tend to believe it’s mostly inherent with a big mix of environment. There are varying degrees of empathy. Some can empathize more than others. If you can totally put yourself in the place of who you are caring for, you will do nothing but provide excellent care.

The question is always how would I want to be treated and taken care of under these circumstances? If that is the core basis for how you provide care you will provide caring, compassionate, and dignified care with a great attitude.

2. DEPENDABILITY

A person who is in need of care has lost some degree of independence and needs to be able to depend on the person or people providing assistance to them. Losing independence is very difficult for most people. Imagine being unable to obtain your own meal, bathe yourself, get dressed, or go to the bathroom independently. Imagine the feelings involved when you lose that independence and have to ask for help. Imagine having no one to count on when you need them.

It is difficult enough for a person to lose independence without having the added burden of finding someone reliable to help them. When you provide care, it is crucial that you are dependable. So many vulnerable seniors’ lives depend on the assistance and care of another to remain as healthy as possible, safe, and happy.  As care providers it is our responsibility to make sure we do not leave those we care for in an unsafe or unsatisfactory situation.

3. PATIENCE

Most adult care recipients are elderly. As we age our bodies no longer move the way they used to. Add an injury, or physical illness and movement is more difficult, slower and may even be painful. Parts of our patient’s body’s may not work at all, following a stroke, or with diseases such as Parkinson’s or ALS. With brain disease, such as Alzheimer’s there is memory loss, and loss of the ability to process information and follow direction.   These are some of the examples that would cause someone to move slowly, respond slowly or repeat conversations. It takes a patient person to provide care when the person we are assisting cannot move as quickly as we can or we’d like them to.

I often see caregivers contribute to loss of independence because of impatience. We are in a hurried society and typically spend our lives in a fast pace. It can be difficult to slow down to the pace of the person we are caring for, but it is crucial to excellent caregiving. A good rule is to allow a person to do as much as they can for themselves, and to avoid doing things for a person they can do for themselves. Doing too much contributes to the loss of physical abilities and increased dependence. It can also damage the dignity of a person, which damages their mental health and quality of life.  If you spend time talking to your patients about receiving care the vast majority will tell you they don’t want to be a burden.  As care providers, we should never contribute to our patients feeling like a burden.

Give the care recipient ample time to comfortably be assisted with their activities of daily living (ADL’s), and to complete as many tasks as possible on their own. If you aren’t patient, you will end up providing more care, not less. Use the time to slow down your hurried life and enjoy the process of caregiving, and the person you are caring for.  Socialize and help make them feel important, cared for and valued.  Your empathy will increase as you learn more about the people you care for also.

Persons with memory loss will repeat questions, and comments. This can be enough to test anyone’s patience when you’ve heard the same question 30 times that day. Here again, empathy is needed. EVERY single time a person with dementia asks a question, they truly believe it is the very first time they have asked it. You MUST respond as if it’s the first time you heard the question.

I cringe when I hear a caregiver tell a care recipient with dementia, “I just told you”, or “don’t you remember?” This vulnerable person affected by this horrible disease truly doesn’t remember you just told them, and they honestly cannot remember. These responses typically come with a frustrated tone of voice, and sometimes anger. Again, empathy counts! Imagine asking someone a question for the very first time, and they respond in an angry voice and scowl.  How would you feel?  Rather than getting to this point of frustration become a pro at redirection!

Sometimes redirection can take a while to begin working because dementia can cause someone to get fixated on something, but the better you get at it, the less your patience will be tested. Direct the care recipient towards something they enjoy, or change the conversation to a joyful time earlier in their life. Photo albums, taking a walk, or offering a healthy snack are usually helpful in redirection.

If the care recipient is angry, and uncooperative, give them space and a bit of time. If they are not in danger of hurting themselves or others remove yourself from the situation. Give everyone time to breathe and calm down. Wait 15 or 20 minutes and reproach in a calm and loving manner. If the source of the frustration is a task that can be put off -- put it off. If it’s something that needs to take place as soon as possible, like changing an incontinence brief, try a different approach.   Always approach a person with memory loss in a slow and soothing manner.  Fast moves, loud speech, and trying to move a person before they are ready will cause anxiety, fear, and can result in aggression that will ultimately delay whatever you are trying to accomplish anyway.

4. STRENGTH

As I mentioned above, caregiving can be very difficult. Whether you are paid or unpaid there will be days and times when you feel like you are at your limit.  You may be having a bad day yourself, the care recipient may be having a bad day, or you are just burned out. Times like these call for strength.

You must be strong enough to recognize when you are in need of time off, when you need to adjust care, and when you need to dig deep within yourself for patience.

Caregiver’s seem to be in a frequent battle with the outside world regarding advocacy and fighting for services, or through red tape of insurance, or the healthcare bureaucracy. It takes a lot of patience and strength to advocate for your care recipient.  It’s important to recognize this in family members too.  They are often having a more difficult time than their loved one and need our understanding.

Recognize what your weaknesses are and when to get additional assistance. If you get frustrated and exhausted it will not only affect you, but it contributes to the person you’re caring for feeling like a burden, and everyone loses.  Take time off, get additional assistance, and again take time to put yourself in a place of empathy focusing on what it’s like to receive care.
 
Caregiving is not for sissies!

5. FLEXIBILITY

Caregivers have to be some of the most flexible people I know. Things can change in an instant when you are caring for someone.

Family members can be called home from work, needing to get their loved one to the doctor, or hospital. The health situation can fluctuate, and personality and behavior can change on the drop of a dime causing a change in plans, or schedule.

Paid caregivers can lose a client to a hospital admission or discharge, have to stay on their shift longer because of a fall or a health crisis, or get a new patient at the last minute. There are constant schedule changes, and patient changes. You must be open to change because whether you like change or not, it will happen.

People who value strict schedules and sticking to a routine have a lot of difficulty in the caregiving role. I have spent my career knowing that as soon as I have my day planned out something is sure to change and I will have to tend to whatever has become the priority. Caregiving is best for people who can adapt quickly, and accept change easily.

There are other qualities and characteristics I could talk about, but I believe those stem from the core 5. The characteristic of having a kind and gentle personality stems from empathy and patience. Obtaining the best healthcare possible is a result of empathy and strength. Keeping the care recipient safe comes from empathy, dependability and strength. Every situation and every caregiving moment spent will require empathy.

Whether you are providing care now or will be in the future, you have to ask yourself if you are able to put yourself in the shoes of the person, or people you care for. That requires you to be judgment free of them and their situation, and have the ability to understand what it must feel like to be on the receiving end of care.

If the person has advanced Alzheimer’s, think about what it would be like when they were healthy, and then started to realize they couldn’t remember things, or lost their way. Understand how it felt to receive the diagnosis of Alzheimer’s, knowing there is no cure and your abilities will diminish. Think about what it would be like to have a stranger bathe or dress you.  Think about knowing that one day your life will be totally out of your control and in the hands of those who will care for you.  There is an enormous amount of fear that comes with an Alzheimer’s diagnosis.  Be a person your patient feels safe and cared for with.

If you can do those things, you will always provide care that is of the best quality possible. If you cannot, I recommend alternative care for a family member or another choice of career.

Care recipients deserve no less than the best we have to offer!

Angil Tarach-Ritchey’s shares and experience she had as a nurse’s aide in 1977 that changed the way she provided care, in her best-selling book, “Behind the Old Face: Aging in America and the Coming Elder Boom”. Learn more about her work at The Elder Boom™ Foundation
Click the book for more information and a look inside the books





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