Wednesday, August 26, 2009

Hiring Caregivers: “Who’s For My Mother?”

How Green Was My Valley, a movie from 1941, is a painful movie for me to watch. It’s about conflicts in a Welsh mining town that also tear apart a Welsh mining family. Whenever there’s a mining accident, the call goes out for rescuers who will go down in the damaged mine and work to save the miners trapped there. The call for help begins “Who is for” and then the names of the trapped miners are called out. At a pivotal moment in the film, a collapse of the mine traps the patriarch of the family and the call resounds, “Who is for Gwilym Morgan and the others?” An unlikely person, the minister of the town, joins the group of miners who descend the elevator into the mines.

This week I’m in upstate New York, hiring caregivers for my mother who, like the miners, is trapped as well – trapped by her Alzheimer’s and by a recent minor stroke. But like the miners still alive in the mine, she’s still there. Many people might not take the time to see this, but we want caregivers who will. My job is to stand at the elevator to the mine and call out “Who’s for My Mom?”

Yesterday, we interviewed two possible caregivers, and one was clearly for my Mom and one wasn’t, and the contrast was so stark that they could be used as case studies in hiring careproviders.

I was anxious and concerned because this job of hiring is usually done by my sister Nancy who has worked in the health care field. I talked with Freddie, my Mom’s primary caregiver, about how the interview should be structured. Then I called Nancy and we created some questions to ask. Here’s what Nancy and Freddie already knew – when you start asking questions, the person’s answers will reveal the nature of their caregiving approaches. With the right questions, I would have no trouble recognizing someone with a personal touch and someone with an institutional approach. We don’t want Mom to be seen as an invalid, but as a person with qualities and a personality that are still alive down in the mine. We don’t want her impediments to be seen as a problem that has to be solved (like feeding her), but as a process of uncovering her skills that has to be respected (she can feed herself, even if it takes awhile).

I began by explaining that my father feels the home is the best place for my Mom and his daughters agree and are supporting him in that. I described our goals for my mother – not just to keep her at home, but to keep her active, for her to have a viable life and to keep her mind active. What we want, I said, is a personal touch.

Here are the questions I asked:
1) Tell me how you got into caregiving. What are your skills, your background, and your past jobs?
2) How would you break up a day so that it would be stimulating for my mother?
3) How do you sense, when someone has trouble communicating, what they really want?
4) What’s the toughest personal care experience that you have had?
5) What do you find rewarding?
6) And because my parents live in an area that can get 200 inches of snow in the winter: have you driven in the winter?

If someone has worked in a nursing home, I was to ask, What’s the difference between caregiving in the home and caregiving in the nursing home. What are the advantages of each?

At some point, both Freddie and I realized the first person was giving answers that focused on the negative, didn’t provide personal statements about what mattered to her about caregiving, and seemed to have many other priorities. In response to the “toughest personal care experience” the first person said it was the death of someone she had just been hired to care for. She had cared for him on Friday, he died on Tuesday. The answer seemed so flat. The second person described working for a retired schoolteacher with Alzheimers who was extremely nasty to the caregivers, and how hard that was, but she knew it was because of the disease and that helped her in caretaking. She gave us so much more information: From her we learned how she interacts with difficult situations and that she does not blame the individual for being trapped in the mine.

The first person did give one heart-stopping answer. First she described the conveniences of working in a nursing home “there are aides, there is the medicine you need, there’s hospital beds” – all of which reminded us that her training was to view my mother as an invalid, or an almost invalid. Then she said, “at home, your whole life is still with you, even if you can’t recognize it.”

We were sitting in a room that has on the wall a poster-size photo of my parents on their wedding day. I faced it. “Who’s for my mother?” I thought. “Who’s for my mother? That’s the answer I need to know. Who’s for this specific person, with this specific life, here?”

I knew that the second person had given good answers, because Freddie asked her more in-depth follow-up questions than the first. Later, Freddie explained, “If I can feel a personal trust, a personal desire, and a personal interest, I am going to ask more. If a person doesn’t have those, you are just going to come in and do the motions and not go beyond them.” But, I already recognized those qualities too. The questions did their job.

In the second interview, the excitement and care and interest in my mother was so intense and wonderful. She asked questions about who Mom is and has been, and I knew from this that she was someone was who would not hesitate to rescue trapped miners.

I wanted to hug the second person as she left and I did; I was so thrilled to feel her commitment to caring for this wonderful person, my mother. I knew that she was willing to join us in the elevator in the mineshaft, as we called out the most important question of all: “Who’s for my mother?”