Ask the Expert: Taking Care and Keeping Promises

by Amy Natt, MS, CMC, CSA

Q: I promised my husband that I would keep him home, but I am not comfortable bringing a caregiver into my home. What options do I have now that he needs more help than I can give him?

A: This is a great question, as so many people promise loved ones that they will keep them home and care for them. These promises are made with the best of intentions, to provide peace of mind to someone we love. The problem is, when a person needs more care than you can give them, other supports must be put in place, or it can become unsafe or (unintentionally) neglectful. Most of us, if asked where we want to spend our final days, would respond “at home”. However, we do not always consider the type of care we might need, the duration of that care, the skill of caregiver needed and the cost that might be attached. The cost is not just financial; it can be emotional and mental stress as well. These can quickly take a toll on even the best caregivers. 

When more care is needed, bringing a caregiver into the home is one option. It may be a paid caregiver, family member or volunteer. It still means that someone will be in your space. There are things you can do to increase your comfort level. Get to know the caregiver outside of the home first, through outings, lunches etc. Always make sure background checks, reference checks and other verifications of credentials have been completed. You might also consider having them in designated areas of the home and preserving some space as private for yourself. If you are worried about valuables, lock them up and don’t leave things like money or jewelry laying around. Trust your gut; if you have a bad feeling about someone, move on to another option. Once you establish a comfort level and routine, you may feel better about having that person in your home. 

Some families place nanny cameras or some type of monitor in the home, so that you can keep an eye on your husband and caregiver when you are not in the room with them. You would want to discuss this with them, to ensure no privacy issues are created. They typically work best in general activity areas, avoiding those areas where personal care may take place. 

Another option would be to utilize an adult day program. Your husband may be able to attend an adult day program during the day and be home at night, giving you a break. If you have family and friends who are able to help and supplement your role as caregiver this may be an option to provide you with short breaks. They might also be willing to be at the house while a caregiver is there, so you feel more comfortable going out. 

There are circumstances that would make it difficult to keep him home, and those should be realistically considered as well. If he requires skilled or heavy care, a facility may be the best option to get him the care he needs. If he is bed bound and no longer mobile, he can quickly develop skin issues if the correct equipment and care is not implemented. There may also be safety issues. If he has memory impairment and is at risk to wander, or demonstrates aggressive behaviors, it may not be safe to keep him home. Cost can also be a determining factor. If you decide to bring in paid caregivers and make that adjustment, there will most likely be an out of pocket expense that exceeds the cost of facility care. This may not be realistic or practical for an extended period of time.

Remember that your promise to him was made when you were able to provide the care he needed. We have no way of knowing what the future will bring. Do your best for as long as you can and as long is practical, but do not let those words become a deterrent to ensuring he has the best care. If you are not comfortable having a caregiver in your home, securing a room in a facility may be the better option. You can set it up to be very “home-like” and continue to provide daily support to him. The important thing is that you care for him to the best of your ability, that he is safe and loved. That may or may not be in your current home. The situation needs to work for both of you, so do your best and give yourself permission to make a different choice if necessary for the greater good.

Readers may send questions to Amy Natt, an Aging Life Care ProfessionalTM, certified senior advisor and CEO of Aging Outreach Services. She can be reached at amyn@agingoutreachservices.com .