Demystifying Home Care

Editor’s Note: The following essay began as a guest post for OpenPlacement, a company that links seniors and their families with providers of senior housing and home care services. In writing this piece, I’ve relied on my experiences as a professional caregiver, but the views expressed are my own, not those of my employer, and I did not receive any compensation for the essay. The client in the story, Mrs. Josie Delancey, is not a real person, but the issues underlying her fictional character are drawn from real life. — MAB

Woman Sitting by the Window (detail) by Tivadar Kosztka Csontváry

Woman Sitting by the Window (detail) by Tivadar Kosztka Csontváry, via Wikimedia Commons.

Every few months, I find myself standing on the doorstep of a new client, ringing the doorbell.

Who will she be? I wonder, this new member of the community of elders whom I meet in my work as a certified nursing assistant and companion to elders.

What family photographs will I see on her walls, what medicines on the table by her bed?

Will I have the skills she needs? Will she accept help from me, a person she’s never met?

Looking back on these moments of mystery on the doorstep, I’m struck by how high the stakes are when we try to help frail and vulnerable people as they grow older. When a family calls my agency to ask about home care, chances are this is just one step in a long journey. Perhaps their mom is struggling to cope at home with illness or injury. Perhaps their World-War-II-veteran husband has escalating memory problems that trigger agitation or even rage. Even in more fortunate circumstances, asking an elderly person to consider home care is a big step.

My hope in this essay is to demystify home-care by telling you something about it from my point of view as a practitioner with eight years of experience in the field. This work is by its very nature private, yet as the baby-boomer generation ages, there will be more and more elders who need the assistance of direct-care workers in order to live safely at home. That’s why I write about my experiences — taking care, of course, to preserve client confidentiality by changing any identifying details about my clients and their families.

Client Story: Mrs. Josie Delancey

Suppose you are an adult daughter named Alicia, and I’m here to help your mother, Mrs. Josie Delancey. You and your mother have met with my agency’s staff to discuss her situation. At age 85, Mrs. Delancey has been living alone in your family home since your dad died five years ago. But lately you and your three siblings have seen a big decline in her health. She was hospitalized twice in the past year, once with pneumonia and more recently with a fractured wrist. Her arthritis makes it difficult for her to stand up from a seated position. She’s no longer able to drive, and has become increasingly sad and listless. Her once-immaculate house fills up each week with discarded newspapers and used cat-food cans. She’s been losing weight and needs help with using the toilet as well as cooking, cleaning, medication reminders, and rides to the grocery store.

As you can see in this scenario, you and your mother have already given us lots of information that will help me do a good job. My supervisor has worked with you to set up a care plan that specifies what tasks your mother does independently, where she needs a little help, and where she needs substantial assistance.

Home Care Map

Indeed, since my agency uses secure email and web-based documentation tools, the information flows quickly and easily between the family and the client, agency supervisors, and caregivers like me in the field. Today, as I meet your mother and set about making her breakfast, I have a mental Home Care Map in my head that will grow and change with each visit.

Home Care Map for Mrs. Josie Delancey

Client Home Care Map

Tools of Support

Included in my mental Home Care Map is a list of intangible Tools of Support. It’s been my experience that the emotional support a caregiver can offer is just as important as the assistance we provide our elderly clients in the activities of daily living. As caregivers, we need both strong arms and kind smiles. When clients or family members resist care, or when something about our presence triggers some negative response from a client, we need to be able to work with the situation as tactfully as possible.

I remember visiting a friend of mine who was under hospice care, years ago, before I embarked on my career as a caregiver. I noticed that the hospice caregiver would help my friend get situated on the toilet and then wait outside the bathroom, with the door barely ajar. It was a small detail, but my sense was that in respecting my friend’s privacy at this vulnerable moment, the caregiver was supporting her independence and autonomy.

Appreciating Family Caregivers

Finally, I would like to express my appreciation for the family caregivers with whom I have worked over the years. A couple of years ago, I worked with a family caring for their 82-year-old father. He loved baseball, so for Father’s Day his son bought him a tablet device with a link on the home page to the Baseball Hall of Fame website. He especially loved the online exhibit, Picturing America’s Pastime. Looking at the pictures and telling stories about games he remembered gave this elderly man hours of enjoyment. I’ll always remember the thoughtfulness of the son’s gift and the joy it gave his father.

About the Author

Mary Ann Barton is a certified nursing assistant, elder companion and blogger who writes about health, healing, and caregiving for elders, their family members, and their paid and volunteer care partners. She finds joy in singing and is writing a book about finding rest and renewal as we care for others. See more by clicking here.

The Biology of Fleshly Pleasure


Purple paisley stretching out from yellow ground, by Mary Ann Barton. Inspired by Zentangle: 06/25/2012

Purple Paisley Stretching Out from Yellow Ground by Mary Ann Barton

Dear Readers,

Awhile ago I published a poem about love and sex called Today Love Asks Questions. While the poem was inspired by a real moment of intimacy and happiness in my marriage, it wasn’t at all explicit, or even erotic, since I’m an old-fashioned and somewhat reticent woman. After all, the last time I wrote about sex for publication was an article about a sex therapy conference for the newsletter of a women’s health clinic thirty years ago.

Still, the topic of sensuality and bodily pleasure remains relevant and interesting to me. As my doctor said to me a few years ago, “Sex is a quality of life issue no matter how long a life we have.”

Plus, in doing research for my recent conversation with my urogynecologist about surgery for pelvic floor problems, I learned that sexual activity and orgasm can have a beneficial impact on a woman’s physical health. (See, for example, Pelvic Floor Health for Women by Ellen Braatz, PT and Erin Alft, PT.)

As a professional elder-care provider who writes about aging and caregiving, I’m aware that sexuality and sensuality are extremely sensitive topics. I’m not sure how to approach this area of human experience, or even what I think about aging and sex. I just think that as I grow older and move closer to the end of my earthly journey, I’m becoming more aware of how much I treasure all the pleasures of the body.  The biology of fleshly pleasure is such a gift, such a remarkable thing in itself and such a remarkable element of an intimate relationship. I have an anticipatory nostalgia for the expansive silliness of playful interaction with a loving partner: the jokes we tell each other, the stories we remember about how we met, the pet names we murmur in the middle of the night.

Sex and love aren’t always delicious, of course. Sometimes, in our lives, there’s tragedy and betrayal, or tragedy and pain, or tragedy and loss, or just plain tragedy. But the pleasure-and-happiness part of sex is still important.

What do you think? Is it possible to write about aging and sex without awakening the Internet trolls? Will my spam-filters be working overtime at WordPress this week? I hope not!

In any case, I trust that many of you will enjoy a chance to think deeply about aging and the fundamental pleasures of sex. Let me know how we can keep this topic in mind in ways that respect the boundaries of privacy — our own, and that of others — while acknowledging that the biology of fleshly pleasure is a fascinating part of our common inheritance.


Mary Ann

PS: My poem “Today Love Asks Questions” appears below.

Today Love Asks Questions: A Prose Poem by Mary Ann Barton

Image credit: Koekkentrappestor (Kitchen Stairs) by Kristian Zahrtmann, 1908, via Wikimedia Commons.






Dementia Communication Strategies (INFOGRAPHIC) by Alyssa Chan

Editor’s Note: The following post was originally published by OpenPlacement, a California healthcare company. I’m sharing it here because I like the focus on finding positive ways to communicate with people affected by Alzheimer’s disease and other dementias. — MAB

It is critical to have dementia communication strategies. Because dementia gradually diminishes a person’s ability to communicate properly, it can become very difficult and complex. This requires patience, understanding and good listening skills. Below are a few suggestions in an infographic that we created on how to overcome that barrier between you and the person with dementia.

Please share this infographic if you found it [helpful]. In addition, make sure to check out and share our previous infographics with the latest featuring tips on Healthy Aging.

Dementia Communication Strategies (INFOGRAPHIC)

Dementia Communication Strategies:

  • Some signs of dementia progression affecting communication – using familiar words repeatedly, inventing new words to describe familiar objects, easily losing his or her train of thought, reverting back to a native language, having difficulty organizing words logically, and speaking less often.
  • Suggestions on communication:
    • Identify yourself and call the person by their name.
    • Offer comfort and reassurance.
    • Avoid criticizing, correction, or arguing.
    • Help with unfamiliar words.
    • Turn questions into answers.
    • Turn negatives into positives.
    • Give visual cues.
  • Most importantly be patient – It is important to keep calm and talk about the communication issues you are having. By questioning or arguing, this will cause unnecessary frustration and stress and will possibly heighten the level of agitation for the person with dementia.

Visit these sites we used to create this graphic for more information: Alzheimer’s Association and AARP.

– Alyssa Chan

You Might Also Enjoy…  Dementia Greetings: How to Say Hello to Someone with Alzheimer’s Disease


Thanks for Responding to the Survey for Rest, the Book

May 11, 2014

Dear Readers,

Last week I asked if you would help me write my book about caregiving, Rest, by taking a word-association survey (Want to Help Me Write My Book?).

Many of you took the survey. I am so grateful for your responses. Click on the REST Survey #1 to take it now. Feel free to take it more than once, as some of you have done.

Brilliant, springboard, resilience, woof, idleness, forgiveness, hunger, satisfaction. Why are these eight words important for a book about caregiving?

The words seem chosen arbitrarily, as if I’d opened a big dictionary eight times at random and stabbed down with my finger on the page. Which is true, in a way. I was following my intuition. Your associations to these eight words, I told myself, would be a resource for me in my writing, even though I didn’t know why.

Yet reading your responses, I know so much more about the gut-level process of writing this book for you. Your willingness to read my words has been such a gift to me. Your words, responding to mine, are another gift: sweet, soft, hard, unexpected. Brilliant. Together, we will make a gift that neither of us can make alone.

Only connect,” writes E.M. Forster in Howards End.  “Only connect the prose and the passion, and both will be exalted, and human love will be seen at its height.”

Caring for others can bring us closer to them and closer to each other, even in the raw hardships of illness and frailty.

“My father and mother-in-law died this winter within weeks of each other,” writes meditation teacher Kate Wheeler in her blog post, The Dying Season. “I have been imagining us as orphaned little kids holding hands by an open grave, trying to carve out a little piece of happiness for ourselves as we transit through this life.”

I’m in transit through this life, too.

I’m writing this book because I think that life is precious, rough, raw, and whole.

I’m writing this book because lately it has dawned on me that my pelvic-floor problem is getting worse, and surgery is in my future.

I’m writing this book because Elana Miller, the young doctor who wrote When in Doubt, Write the Truth, has a new post about her life with cancer called Loss. In this essay, Elana hits the ball of truth so hard that I’m still reeling from the blow.

Thank you for being there.

All the best,

Mary Ann

PS: Will you take the survey? Click on the REST Survey #1. Thanks! And Happy Mothers Day.

Want to Help Me Write My Book?

May 5, 2014

Dear Readers,

Want to help me write my book?

Mary Ann Barton, September 2012

Mary Ann Barton. Photo by Wendy Wolfberg.

Rest is a book of readings about finding rest and renewal as we care for others.

The poems and stories I’m writing for Rest are relatively easy to compose. How not to love a character, Grandmother Cellist, who appears suddenly before me as I gaze at a favorite painting on my widescreen computer monitor. I imagine her playing music after dinner with her grandchildren, drawing her bow in an exquisite arc of notes. I imagine their music as a balm of sound that reaches the kitchen worker toiling downstairs and the new mother resting, exhausted, upstairs in bed.

However, these evocations of happiness — of joy, beauty, comfort, and intimate family connections — aren’t just aesthetic considerations for me.

Increasingly, as I read about recent scientific studies of the structure and function of the brain, I’m coming to see poems, songs, and paintings as tools that we can use in structured ways to help ourselves become calmer and more resilient, even in the midst of hard times.

I first started thinking about art, happiness, and healing two years ago, when I took a course called Taking in the Good taught by neuropsychologist Rick Hanson, Ph.D.

“You can use your mind to change your brain,” Hanson told us, in ways that “change your mind for the better.” Simply by paying attention to small moments of positive experience, Hanson says, we can, over time, strengthen the circuits of the brain that promote “contentment, calm, and confidence.” *

I wish I could write a brilliant essay for you that explains how modern neuroscience, ancient contemplative practices, classic European paintings, and my blog have helped me cope with the hardships of aging and caregiving. I’ve tried to do it, but I’m just not there yet.

Here’s where you come in.

I Want to Know What Brings You Joy

What brings you joy today? What are those small moments of relief that raise your spirits or ease your pain?

I’m talking about specific sights, sounds, tastes, smells. Touches. Textures. Heat. Cold. Flame. Glances. Words spoken and understood. Movement. Stillness. Silliness. Pratfalls. Puns. Wiggles. Giggles. Barks. Purrs.

So how do we do this?

Let’s start with a survey. I’ll give you eight words, and you give me eight associations. You could give me just one word, or describe a complex image. Tell me something you remember. Something you want. Something you’d forgotten. It doesn’t have to have anything to do with joy. But it has to be specific.

REST Survey #1: Eight Words, Eight Associations.

Take this survey any number of times. Forward it to your friends. Link to it on your Facebook page. Post it on your blog. And if nothing comes to mind for a word, just write “Nothing today.”

Writing is a mystery. Who knows where these words will take us!

All the best,
Mary Ann

PS: I chose the eight words in this survey for their somewhat mysterious importance to me as a writer, so they may not seem to relate to the topic of this post, which is about sources of joy in our lives. Please know that whatever you write will be received with gratitude.

* Hanson, Rick, Hardwiring Happiness: The New Brain Science of Contentment, Calm, and Confidence. New York: Harmony Books, 2013.