When it comes time to hire a caregiver or to train a family member to assist in the basic care of your parents or in-laws, whether or not they have professional nursing or other caregiver training, you will need to devote some time and attention to training them to care for your elders.

If your parents or in-laws have an agenda of their own regarding their care, you may have all of the best intentions and plans and still fail. Accepting the fact that they need some assistance may be the furthest thing from their minds despite the fact that they are no longer capable of living alone or without some sort of daily assistance. Getting them to accept help may be next to impossible; their agenda may be to live with you or only have you provide care for them. To these ends, they may sabotage all of your best efforts.

They may not even consciously realize they have an agenda or are resistant to accepting help. Even if they are willing to accept help, they may have some very different ideas about the type of help they want or are willing to accept. It is important to discuss this openly and as honestly as possible. It may be that you will have to introduce a caregiver in very small steps. Most people, however needy they may be, don't want a stranger in their home. Aside from fears that they may be taken advantage of or have things stolen, there is also the natural social grace of feeling they must entertain the person. If they are having difficulty taking care of themselves, they certainly don't feel up to entertaining someone else. Home health-care nurses and other home-health professionals meet this form of resistance on a regular basis; it becomes an issue of convincing the patient that this is a professional visit to assist with the patient's care because she isn't feeling her best.

Any caregiver is going to need specific training in how to care for your parents or in-laws. If the caregivers come from an agency, there will be restrictions on what they can and cannot do according to their scope of practice. To dispense medications, for instance, you have to hire an LPN or RN if using an agency. If you are hiring privately, you can train anyone in how to dispense medications specifically to your loved ones. If the medications are complicated or require some form of judgment such as how much pain medication to dispense at one time, you may want to hire someone with nursing experience.

Similarly, caregivers from an agency cannot perform any form of wound care or similar procedures unless they are an LPN or RN. However, again, hiring privately allows you or the home-health nurse to instruct the new caregiver in how to perform the procedure.

You should also demonstrate and have the caregiver demonstrate back any specific care instructions you provide. If your parent needs assistance in transferring in and out of the bed, bathtub, or shower, or on and off the toilet, you should demonstrate and have them show you how she will do this. Make sure you have been instructed in proper body mechanics and that the caregiver understands these principles as well. A back injury is preventable, and you don't need a disabled caregiver!

Discuss your expectations openly and all instructions for care. Ask questions to ensure the caregiver understands the expectations the time schedule, and pay. Leave written instructions in a notebook for reinforcement and reference. You might use a notebook for communication purposes — for you to leave new information or instructions and for the caregiver to leave you notes as well. Explain the way your parents expects things to be done and what times they want such things as meals and bathing. Is there a certain way to do the laundry? Do towels get folded into quarters or thirds? Are there specific recipes your parents like? What about TV programs they watch without interruptions?

Have a backup plan. Anticipate problems and be prepared for what to do if and when the caregiver doesn't show up or needs a day off without any warning. Try to cover all of the special needs and wants and pet peeves to avoid issues. Make sure the caregiver gets the best chance possible.