As a health professional caring for my elderly parent, I have been welcoming of our Government Strategy to support care of senior citizens at home as long as possible. To do this, our Government contracts agencies, paying them to provide the support care for the elderly and provide back-up relief for us primary unpaid care-givers. This is much appreciated, even if an hour at a time, it enables primary care-givers like me to continue employment. Each client requiring care has their needs individually assessed before the agency is contacted.
As time has progress, I have found that there appears to be no Agency Community support-care provider that specialises in Dementia care. I have been shocked by the lack of training the agency workers have and find the workers are task orientated, becoming lax with time or wanting to socialize with me rather than be the professional care-giver providing the relief I require. The people are lovely, just lack training and understanding which I believe is the contracted Agency's responsibility. I end up giving training!
The medication responsibility appears to be put in the hands of a mixed up, time disorientated dementia sufferer, rather than the Agency take responsibility for this. Examples and points are:
- Mother, like a lot of elderly persons, has glaucoma and requires nightly eye drops to prevent blindness.
- The Agency workers, who settle her for the night, are not allowed to administer the eye drops, when my shift work prevents me being available! Even if willing and able, they are not permitted to by the Agency.
- My concern then is that the client therefore misses out if living alone and unable to manage. This is a quality of life issue! My father (now deceased) who lived in a Residential home also missed out! How many Residential clients are also in this position I wonder?
- Mother has been on warfarin which had different doses each day to keep her INR levels therapeutic. Important for someone who has multi-infarct dementia and Atrial Fibrillation.
- The provider Agency workers are not allowed to administer the medication (get it out of the bottle). This can be overcome by being put in a blister pack, but is not ideal as it frequently changes with the INR level, making it difficult getting her pack resorted often. When in Residential respite care, she was being given it on an empty stomach against medical instructions!
- Mother is now on Pradaxa (Dabigatran), being one of the first in NZ to go on it because of her atrial fibrillation and multi infarct dementia. The issue with Pradaxa is that it cannot be put in a blister pack or be left out ready because it immediate deteriorates with exposure to moisture in the air. It is in a special moisture proof child-lock capped bottle. That is the only way available in NZ at present.
- The support carer is not allowed (by their Agency) to open the Pradaxa bottle and take one capsule out for mother. She needs to take one with breakfast and one with her evening meal. She has arthritic hands and struggles to open the bottle, let alone get one capsule out without spilling them all over the floor!
- I find it amazing that the Agency doesn't tell us this until the need arises. I found a worker got Mother to administer her medication herself, then another reports finding mother with five capsules in her glasses case, mother's faulty reasoning in case she forgot to take one! Mother couldn't cope with the responsibility, it made her anxious and obsessed about taking her pills. How many was she taking? We had to put the bottle out of sight and reach!
- How does that assist elderly at home have a quality of life? The Agency putting the medication responsibility on the client with poor memory and poor co-ordination/ eye-sight/ arthritic hands puts the client living at home in danger as far as I am concerned.
- I think the Government needs to require any agency applying for the contract to be qualified in dementia level care and have training standards for their workers. Of course they will need to pay better.
- Or professional support-carers can form a body to maintain standards i.e. practising certificate and contract individually to provide the care required. Cutting out the bureaucracy will probably save money and give the worker more in hand.
- I require a worker that ;
- is ethical, respectful and compassionate toward the elderly and not condescending.
- is professional enough not to take away my precious time out, respecting my needs also.
- does their job intelligently, guided by their instructions and not by the person with dementia who is time disorientated and has it wrong.
- is trained in dementia care and in safe practice with handling prescribed medicines.
Is it the administration difficulties of Dabigatran (similar to the above example) the cause of deaths and not the medication itself??
