Working with Potentially Aggressive Alzheimer’s Clients

August 18, 2014

Concerns for Senior Home Caregivers Working with Alzheimer’s Clients: Training and Preparation, Dangers and Liability

A recent California Supreme Court decision determined that clients with Alzheimer’s disease are not liable for injuries they cause to paid in-home caregivers.

This case involves a woman who had Alzheimer’s disease and her husband, who hired a caregiver through an agency to care for the client at home through 2005. The caregiver had a history of working with patients with this diagnosis. The caregiver was told that the client was prone to biting, kicking, and scratching.

Three years after the caregiver began providing services to her, the client bumped against her from behind while she was washing a large knife and reached into the kitchen sink, which caused the knife to cut the caregiver’s wrist. The caregiver lost sensation in several fingers and her thumb, and had persistent pain in her hand and wrist. The caregiver received workers’ compensation benefits, but also sued for negligence and battery. The husband and wife are now deceased, but the insurance company that provided their homeowner’s insurance has been defending against the caregiver’s claims.

The basis for the Court’s decision is that in-home caregivers who work with clients with Alzheimer’s disease should know that the disease commonly causes physical aggression and agitation, especially in its advanced stages. According to the Court, it is, therefore, inappropriate to allow caregivers who suffer injuries to sue their employers. With regard to this point, the Court stated that “it is a settled principle that those hired to manage a hazardous condition may not sue their clients for injuries caused by the very risks they were retained to confront.”

Other courts deciding on similar situations in institutional settings had already come to similar conclusions. This does not preclude future lawsuits by caregivers who aren’t warned in advance that clients may be violent or when injuries are unrelated to common symptoms of dementia. This was a California decision, but likely to inform courts in other states as similar cases come before them.

Regardless of the legalities, no family wants to see their loved one harm someone and caregivers obviously wish to avoid injury.

Tips for families of a loved one with dementia:

Be honest with caregivers/agencies about your loved one’s status, needs and possible concerns.
Explain possible triggers and solutions that have worked for you.
Get a thorough assessment with recommendations for the type of care and support needed.
Keep the lines of communication open: share information if you notice changes in your loved one, talk to their doctors about concerns, ask the agency or your geriatric care manager to communicate regularly with you and give a summary of care.
Make sure any home care agency or other care provider prepares an individualized care plan. Ask about the training the agency provides, the experience of the caregivers and how the agency supports and helps the caregivers deal with difficult situations.
Use licensed home care agencies that provide worker’s compensation insurance for employees.

Tips for Alzheimer’s caregivers:

Seek extra training and information about Alzheimer’s disease.
Get to know the client: ask the family and your agency to provide information on the client’s habits and preferences, things that tend to trigger behaviors and coping techniques that have worked.
Share your knowledge and ideas with the care team. For individuals with dementia, especially those who act out, a consistent care team is important. Having a set of caregivers with personal knowledge of the client provides consistency, keeps caregivers from burning out and potentially offers different perspectives/solutions.
Learn behavior-management techniques such as redirection and calming activities. Be sure to maintain routine, ensure the client gets sufficient rest and food/drink, medicines are given properly and the client is comfortable (unusual acting out may be a sign of pain or infection, so contact your agency if you notice changes so that the family and/or care manager can get possible causes assessed).
No matter your experience/expertise, it is important to have an agency that supports you. Do they provide a detailed careplan? Who can you count on for support/talk to about concerns? Does the agency have someone who will make a home visit with you and offer ideas for problem-solving?

Call EasyLiving at 727-447-5845 for experienced caregivers to provide memory care/dementia support. If you are a caregiver who would like to work for a super supportive agency, check out our home care careers page!