Live-In Home Care: Acceptance of Care

People have a tendency to delay long-term care decisions until absolutely necessary. Naturally, we can all understand how an individual of declining functionality might have difficulty facing the reality of waning independence. The concept of live-in home care, in which a stranger is entrusted to live and care for someone in their home, can be challenging and it is often avoided due to the individual’s denial of their need for care.  

While it is very common for elders to disagree with family members on their need for live-in home care, it is just as common for elders to refuse assistance from caregivers once service has started for a number of reasons. The primary obstacles to acceptance of live-in home care include:

• Fear of losing their independence
• Alarm about the cost of live-in home care
• Distress of having a stranger live in their home
• Conflict around other cultural backgrounds and/or language barriers 

It is important for families to understand that a care recipient may have these feelings no matter how compassionate, caring, attentive and competent the caregiver may be. Some ways in which we have seen success in helping a care recipient overcome their anxieties include:

• Explain that assistance in one area may provide them with independence in another area
• Explain that the caregiver is there to provide a break for other family members directly involved with providing care to help avoid ‘caregiver burnout’
• Reinforce the advice of their medical professionals (e.g. physician, rehab facility, etc.) that live-in home care is necessary in maintaining their health, safety, and independence even if it is for the short-term
• Refer to any friends, neighbors or relatives who have had a good experience
• Get the care recipient to open up about their own fears or discomfort with live-in home care and explain what measures will be taken or support included to overcome those objections 

A family meeting is a good way to launch a cooperative effort for care of a loved one. As a forum for sharing information, feelings and thoughts on the best way to set up live-in home care, it can also improve communication and cooperation as it relates to the care recipient, caregiver and other family members.
Be very clear about the purpose of the family meeting and about the topics to be discussed. Expect there to be some differences of opinion. It may be helpful to provide everyone with a checklist of items ahead of time. These might include:

• How much and what kind of care is needed?
• What tasks and routines will be assigned to the caregiver?
• Are there any special instructions in handling these tasks?
• What involvement is expected of other family members?
• Will there be a need for a fill-in caregiver for scheduled breaks or will family members provide gap coverage?
• Which family member will be listed as a single-point-of-contact for the caregiver and the home care provider?
• Which family members will be listed as emergency contacts?
• Who will be responsible for handling the medication setup?
• Who will be responsible for grocery shopping, running errands or taking the care recipient to doctor appointments?
• Which family member will take the responsibility of maintaining contact with the physician or skilled nurse?
• Which family member will be responsible for purchasing medical equipment or making arrangements to modify parts of the home if needed?
• Who will handle the finances?

The process of implementing live-in home care successfully takes a good amount of effort so families should expect to provide ongoing encouragement and to help target the causes of a care recipient’s opposition prior to the start of service. Being proactive to ‘solve the solvable problems’ will be a key ingredient in helping gain the acceptance of a caregiver when they offer a lending hand.