In the book What Are Old People For?, the author, William H. Thomas, MD (2014, p. 246-247), believes that the problems facing those who care for elders in the workforce are many. He states that current research indicates caregivers need the following:
Advanced training
Permanent assignment
Involvement in decision making
Self-managed work teams
Better pay.
I do not think these are in any particular order, although the first two would give more benefit to the client and therefore should result in higher wages and more consistency. Advanced training should include behavioral aspects of illness and dementia. In fact, behavioral health training is lacking in home health providers according to Scott Herman, CEO of Elara Caring, a Texas-based organization providing home health care, home care, and hospice (Famakinwa, 2019). Behavioral health can include emotions, mental illness, addiction, and dementia. Training for in-home caregivers should include the identification of depression, behavioral strategies to address agitation, and the emotional components of dementia as well as medication management.
The caregiver working with your family member should become an expert in caring for them. The care staff learns what works, what doesn’t, changes strategies based on progression and mood for the day, adapts to issues with ease and positivity, and becomes a beacon of support for the client’s primary caregiver. In doing so, the process feeds the passion or calling the carer feels to be helpful despite all the extraneous issues and challenges such service brings. One item of importance this list ignores: recognition.
As part of my license renewal as an associate psychologist, I am required to obtain continuing education hours every year. In addition to annual ethics hours, I also earn credits pertaining to cultural diversity. According to the state board, cultural diversity can include age, disability, etc. This year, I supplemented my hours on dementia and ethics with a course in positive psychology. I wanted to see in what areas theories overlapped the symptoms and course of dementia. I was particularly struck by a 2004 study by Sivanathan, Arnold, Turner and Barling (2004). The study’s results pertained to ways to increase employee well-being. The four psychological processes of transformational leadership that improved employee personal satisfaction were:
Promoting efficacy
Bolstering trust in management
Fostering the employee’s belief that they are doing meaningful work (and are valuable to the organization)
Increasing sense of belonging within the organization.
The first process, promoting efficacy, can be accomplished by training the caregiver on universal skills used with all clients such as safety precautions, lifting and transferring, talking with the client rather than around/about him or her, the various types of dementia and associated behaviors and challenges, bathing and personal care accommodations and variances based on physical capability of the client, how to respond in an emergency, etc.
The second leadership process, bolstering trust in management, has more to do with communication and being available to address issues and questions when they arise. The study referenced above stated trust lowers an employee’s anxiety and fear which in turn can enhance job efficacy.
The third leadership practice, fostering the belief that the employee is valued, and the fourth, increasing a sense of belonging in the company, both result in many positive benefits for the organization itself. In two studies (Harter, Schmidt, & Hayes, 2002; Harter et al., 2003), it was found that company profit, consistency of attendance on the job, and customer satisfaction all improved if an employee felt valued by management.
Sources:
Famakinwa J. Elara Caring CEO: Home health providers often ‘ill-equipped’ to tackle behavioral health. Home Health Care News, May 28, 2019. Retrieved from https://homehealthcarenews.com.
Ferrell, BA, Ferrell BR, Rivera L. Pain in cognitively impaired nursing home patients. J Pain Symptom Manage 1995; 10:591-8.
Harter JK, Schmidt FL, Hayes TL. Business-unit-level relationship between employee satisfaction, employee engagement, and business outcomes: a metanalysis. Journal of Applied Psychology, 2002;87(2):268.
Harter JK, Schmidt FL, Keyes CLM. Well-being in the workplace and its relationship to business outcomes: A review of the Gallup studies.
In CLM Keyes & J. Haidt (Eds)), Flourishing: Positive psychology and the life well-lived (p. 205-224). American Psychological Association.
Sivanathan N, Arnold K, Turner N, Barling J. (2004). Positive psychology in practice. Leading Well: Transformational Leadership and Well- Being, Hoboken, NJ, John Wiley and Sons Inc.
Smith AF, Vallance H, Slater RM. Shorter preoperative fluid fasts reduce postoperative emesis. British Medical Journal, 1997; 314(7092):1486.
Thomas WH. (2014). What Are Old People For? How Elders Will Save the World. Acton, Massachusetts, VanderWyk & Burnham.
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