Challenges of Caring for More than Just Your Patient…


Taken From Trade Article
Date: April 1, 2017 •

In home care – or as some prefer to classify them – Attendant Care environments, the subject of the care is often one, (1) person. In some cases, that subject is a juvenile.

While special challenges impact all care environments, there are areas of concern in this one that no responsible care provider can ignore. When you are serving a child, it is urgent that care providers have the humble cooperation of the parents and siblings to truly impact the life of the person being cared for.

In cases of catastrophic injury this becomes especially important. In our company, we have encountered negative family dynamics of various types.

In the last 1990’s we served an elderly female in Southfield Michigan. We quickly learned that the family dynamic will impact the care delivered. Our client was in her late 80’s and lived with her daughter and the daughter’s family. At first, things were normal. Then staff was told to eat in the laundry room away from the family and we started noticing the laundry contained more than Granny’s clothing. This was a Medicaid waiver case and our instructions were to serve Granny only.
There were recommended exercises for Granny made by a visiting physical therapist our staff was to assist with, and the family would do so when we were not present. The family never bothered to assist and would interrupt our staff when we were doing so asking for more attention to housekeeping.

We brought it up and the laundry situation did not change. Before long, we dropped the case. Not long after that, the Medicaid waiver agent closed the case altogether. Let’s face it, in-home assistance is a partnership between the provider and all occupants and when that is not the case, everyone suffers.

ChallengesWhat if you are serving a juvenile, perhaps a child injured in a serious accident. The care is heavy lifting as you must assist the child to acclimate to the challenges of growth, both mentally and physically. Perhaps you are not present 24/7 and must rely upon the cooperation of family to make the Treatment Plan effective. Perhaps you must rely upon family for everything from documenting their activity to medication administration when agency personnel are not present, all while parents have a history of ignoring the child and the child’s circumstances.

ChallengesUnfortunately, in far too many instances, the level of cooperation needed to assure consistent care is simply not present.  Some – at least on the surface – give the impression that their child’s injuries represent nothing more than in increase in income for the household.  As sad as that sounds to hear, it is a reality.  We have also seen situations where one parent is somewhat engaged while the other parent is narcissistically wrapped only into self.

What can you do to ensure the child receives the best care and attention they deserve while balancing their troubling circumstances?  Here are a few tips:

  1. Put things in writing: Whatever you decide to ask the family to assist with, place in a simplistic memo with never more than 2 or 3 items.  Ensure these tasks are assigned for specific days.  Then add a box wherein they can place a checkmark or note indicating an item has been completed.  Avoid naming them “tasks as assignments” or you could come across as dictating to them which would be interpreted as demeaning.  Life is all about perception.

To get the most out of people you must come to where they are.



Complementary Item Yes No Comments
Observe how long child is awake after last medication XX

48 minutes

Observe walking straight 50-100 feet to note if there is a dependency on one side of body.


2.  Monitor Your Expectations: Generally, you are not dealing with medical or rehabilitative professionals.  You must remember this to temper your expectations.  To that end, remember that when reviewing the documentation from the home in the presence of responsible family members, avoid unflattering or derogatory remarks.  If you do not, they may give up and stop providing even this limited support.

Challenges3.  Do Not Impose Personal Standards: You may observe patterns in communication, cleanliness, orderliness or even society norms that relate to morality that are far different than what you deem acceptable.  In these instances, you must train yourself to re-focus on the needs of the child and how you can heighten the effectiveness of the care and attention you are delivering.

4.  Avoid Irresponsible Judgments: There will be situations where the spiritual and life aspirations of the family do not match yours as an organization or as a care provider. Members of the immediate family may traffic in verbal filth and for the most part, simply are not as attentive as you think they should be.

At the end of the day you must remember that their approach to life is not your focus, except when it directly creates a basis for harm to the child and/or interferes with the success of your services.  Nothing is wrong with suggestions for improvement, but barring child abuse as defined by your state government, your focus is strictly working to create the most therapeutic atmosphere for the child as possible.  This will often mean you are working around the negative aspects of the at-home atmosphere.

Just remember, not to allow these circumstances to cause you to become bitter or resentful.  The world is a big place and you will constantly run into “not so ideal” circumstances.

Let’s give our best without forgetting what our main focus must be.


Another Blog Post by Direct Care Training & Resource Center, Inc,

Photos used are for the purpose of complementing the printed page.  They are not meant to imply an endorsement by or affiliation with any individual or entity and may belong to their respective copyright holders.



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