Live-In Home Care: How best to manage food appropriations – Part 2.

Food appropriations combined with meal preparation is often one of the most challenging aspects of live-in home care for both the care recipient and the caregiver – not to mention for other individuals or family members involved in the process. 

To adequately cover what can be considered a broad topic with many parts, we created a Three Part Series which will be distributed into separate emails:

• Part 1: Introduction to Food Appropriations 
• Part 2: Assessing Needs and Making Preparations
• Part 3: Implementing Policies and Procedures

Part 2: Assessing Needs and Making Preparations
Once a family has determined the best method for handling food appropriations with their live-in caregiver, the next step would be for them to go to the home of the family member needing care to help facilitate preparations. More often than not this care recipient has been hospitalized and might be recovering in rehab for some time. It is not uncommon for this person to have been having a little difficulty managing before this decision was made for them to have care. Additionally, many elders are from a very frugal generation. Waste not want not! They do not like to throw away food or waste food. If you wait until mom or dad comes home this might create a high anxiety situation. If the caregiver winds up being the one to reorganize the food stock this typically creates even more tension. Time is of the essence. Get over there first!

The care recipient’s kitchen might need a real “going through” and cleaning prior to them coming home. Some families opt to leave this for the caregiver to sort out thinking they will be the one cooking, so the caregiver will likely want to set things up their own way. But this is a common mistake. If a caregiver arrives at a house with nothing but expired canned goods in the cabinets and a fridge full of old condiments and questionable foods, it is a very awkward situation. The best thing to do is give everything a good clean, discard all the expired and spoiled food items in order to begin fresh. Put an order of new groceries in the house for both the care recipient and the caregiver. This will save families from having to run around on the day live-in services begin. The new caregiver will be able to see, based on what is available in the house, what mom or dad typically eats and how their home is typically stocked. This will also help the caregiver get started in regards to maintaining shopping lists for the household. This way everybody starts off on confident ground.

After a kitchen is cleaned and stocked with adequate food supplies, families are encouraged to review some safety measures in the kitchen. Some recommendations include:

• Maintain appliances in working order and ascertain ability to operate them. 
• Ascertain ability to manipulate sink faucets with hot water temperature settings reduced. 
• Make sure electrical cords are not dangling near water. 
• Ascertain ability to open/close refrigerator, freezer, stove door and cabinets. 
• Ascertain ability to reach dishes, pots, utensils and outlets. 
• Store sharp objects safely away. 
• Keep flammables away from the stove area. 
• Remove small non-food items that could be swallowed. 
• Cover stove burners, remove knobs/shut-off valves and install auto-pilots when needed. 
• Unplug or put away kitchen appliances not in use. 
• Disconnect or camouflage garbage disposals.

Another issue that typically makes families nervous is…..what does my caregiver like to eat? This is a very good question. Obvious to everyone involved is the cultural differences. The humanity involved in the live-in home care business is what makes it so challenging. First, we have families with their own cultures and way of eating. Now we are bringing in the caregiver who in most cases has immigrated to the United States from another country with altogether different eating patterns and a cuisine completely unfamiliar to us with polar opposite cooking methods and flavors. It is enough to make anyone nervous! But it is really not as daunting as it seems. Although cuisines are different, typically caregivers do well starting out as long as some pretty basic items are in the home. Once you get to know your caregiver you will also get to know what he or she will need. But for now as long as you have a large bag of rice, some meat proteins, fresh vegetables and fruits in the house, maybe some fruit juices and tea and a couple gallons of bottled water most families are good to go. These items may appear to be things that will cost more but it is important to note that caregivers come from countries that do not typically use convenience foods and processed foods like we Americans do. They cook from scratch using simple methods like boiling and baking. When they come to the United States and try to eat these processed foods they become ill before long because their bodies are not accustomed to them. This actually, more often than not, turns out to be a good thing for care recipients. Care recipients will likely enjoy more home cooked food than they previously had which will be good for their health!

Families also often worry about how the caregiver will be able to cook for their loved one. This is a challenge! When caregivers go to school and obtain their Home Health Aide license, the schools do not spend time teaching caregivers how to cook. They will glaze over the appliances in a typical home and show them enough about using them to provide basic safety in using the appliances. The schools will also spend some time talking about basic nutrition but that’s it. Caregivers learn about cooking for American seniors mostly by doing it. This is the true reality in the live-in home care industry. Some caregivers are better than others in the kitchen. Caregivers can create basic meals for their care recipients but they cannot be expected to create gourmet meals. There are caregivers who are excellent cooks and the majority can create some tasty basic meals; however, families should expect the latter and think of the matter as a work in progress at start of service.
 
At Boardwalk Homecare, our Case Managers can provide some help to any caregiver struggling in the kitchen. We have some written training materials to help our caregivers understand the basic American diet. We also help with typical American recipes as well to help caregivers please their care recipient’s palate as well as to encourage healthful eating. Families can also help by offering some ideas to their caregiver about the foods their loved one typically enjoys. In most cases, sharing family recipes and using meal preparation as a shared activity between the care recipient and the caregiver will have a very positive result. A little time spent showing caregivers what meals your loved one enjoys and how best to prepare them can go a long way.

While it is not a component of this Three Part series, we strongly recommend families and their caregivers are very clear on any care recipient dietary restrictions. While Boardwalk Homecare’s field nurse supervisors discuss this with our clients, families and caregivers will need to make sure they understand recommended meal preparation as it relates to various conditions including: Arthitis, Diabetes, High Blood Pressure, Irritable Bowel Syndrom (IBS), Acid Reflux, etc.

In conclusion to Part 2, it is important for families to make preparations at home prior to their loved one returning home and setting up live-in home care services. Readying the kitchen in terms of basic cleaning and fresh food supplies for both the care recipient and the caregiver is a good start. Additionally, families are encouraged to go over safety measures with their caregivers as well as provide input on how best to prepare meals for their loved one to ensure their nutrition and well-being.  

Live-In Home Care: How best to manage food appropriations – Part 1

Food appropriations combined with meal preparation is often one of the most challenging aspects of live-in home care for both the care recipient and the caregiver – not to mention for other individuals or family members involved in the process. 

To adequately cover what can be considered a broad topic with many parts, we created a Three Part Series which will be distributed into separate emails:

• Part 1: Introduction to Food Appropriations 
• Part 2: Assessing Needs and Making Preparations
• Part 3: Implementing Policies and Procedures

Part 1: Introduction to Food Appropriations
For any family exploring live-in home care options, a good measure of time should be spent explaining the industry wide custom of care recipients providing food for their caregiver. At Boardwalk Homecare, our Case Managers further discuss the parameters in place to create fair expectations on both sides - a concept that sounds so simple! But many times families are so incredibly overwhelmed trying to set things up properly that they instinctively triage all of the information coming at them into ‘must do now’ and ‘will deal with as soon as we can breathe’ categories. Unfortunately, this seemingly benign topic often takes a back seat but can wind up causing problems rather quickly. Because food is a basic need for both the care recipient and the caregiver, it really can set things off on a bad foot if this topic is not taken seriously within the live-in service arrangement.

Since most of our readers will best understand the vantage point of the family on this subject, we do want to spend some time explaining the caregiver’s perspective and Boardwalk Homecare’s typical response when food issues occur. This will shed some light on what a caregiver goes through on a live-in case and also on how we typically get a handle on this topic prior to it becoming a difficult situation.

Unless you personally know a live-in caregiver, it is difficult to imagine what we are about to explain. Unfortunately the humanity of the caregiver sometimes gets lost in the shuffle of dealing with everything else. When navigating the new territory of bringing in care for mom or dad, the focus is on their interest – as it should be! It becomes very difficult to juggle protecting a loved one’s happiness and well-being while also considering this new person in the mix. For families that decide to hire a licensed home care agency, it is obvious to conclude that if one caregiver does not work out, they can always switch to another. Easy...right? Not so much.

There are some issues, such as the food appropriations and meal preparation, we are discussing now that can become a very unpleasant theme if not addressed. The same problems will likely occur time and time again…..regardless of caregiver….regardless of agency. The core of the problem needs to be rectified in order to make it better. The alternative is likely a parade of new caregivers which will cause a lot more strife than simply acknowledging the basics and accepting them as necessary.

Choosing to be a live-in caregiver is a very humble way to make a living. We can tell you from our experience that although the object of working is to make a living, accepting this type of work goes much deeper. Unless you have an inner calling pulling you towards this type of work, it would be impossible to thrive doing it on a long-term basis. Live-in caregivers endure the hardship of being away from their families and the outside world for weeks or months at a time. They live and work in the same place, without having a definitive end of their work day nor escape from their environment. They subsist all of this out of a well packed bag from home when they accept a new case. This contains all the creature comforts they can muster to get through to the next visit home. But of course it is impossible to haul everything. Food is perishable not to mention it can be heavy and bulky. 

This is why the industry custom has always been for families to provide food appropriations for their live-in caregiver. When a caregiver comes to work in a home that either has not been set up properly with food (including food for the care recipient) or where families for some reason cannot get behind the idea of having to feed the caregiver, it can be extremely distressing. The first few weeks in working with a new family, the caregiver spends time trying to gain trust and build rapport as well as learn about the intricacies and nuances of this new care recipient they are now responsible for. It is a very sensitive time. Not a time to make waves, not a time to complain.

Regardless of whether the live-in caregiver was hired privately or through a licensed home care agency, we often we run into families who have had a negative past experience in relation to food appropriations. A common compliant is when caregivers take advantage of the family’s generosity. Families have told us stories about demanding caregivers who expect families to purchase extensive amounts of food or very expensive items that otherwise would not normally be purchased in the household.

In the end, this sort of ‘bad apple greed’ leaves families feeling taken advantage of and we are sensitive to how common this problem can be. This is why at Boardwalk Homecare our Case Managers go over our guidelines for families and caregivers to follow so there is no leeway in expectation on the caregiver’s end. Families also get a concise explanation of what their responsibility is so they begin on a sure footing as well.

As an alternative to purchasing food for their live-in caregiver, Boardwalk Homecare also provides a second option for our families. This alternate option adds a modest ‘food stipend’ to the daily cost-of-service which is then transferred into the caregiver’s paycheck. This option excludes families from having to be responsible for the caregiver’s food at all. In these situations, the caregiver will either bring in all of their own food for the month or shop with their own money.

In conclusion to Part 1, it is essential for families to decide on how they would prefer to handle the food obligation before they set up live-in home care services. Each situation is unique. Through discussion it usually becomes apparent rather quickly which option (family provides the food or pays a daily stipend) will be the best route to begin.