Annette was paying extra to the skilled nursing facility to have an aide be with her mother, Penelope, one-on-one for five hours every day.

Marjory, one of the nurses, said, “The aide who’s with her during the week, Gabriela, is so good with your mom!  She’s very calm, and your mom is content.  Sometimes I go into her room unannounced and Gabriela is always quietly talking with your mother, helping her look through her photo albums, things like that.”

 “So it’s really working out,” Annette said, relieved.

“Yes,” Marjory said, and started laughing.  “One day your mother was in a really bad mood.  She was short and snippy with everyone, refusing to go to meals, yelling at anyone who tried to get near her.  We couldn’t figure it out.  She’s usually so pleasant.  We started working backwards, asking, ‘Did something happen today?  Did she get hurt or upset by something?  Is she sick?’  And finally we realized, ‘Oh, Gabriela wasn’t here!’  And the aide who was with your mother was just in her face all the time: ‘Do you want to do this?  Do you want to do that?  Come over here and do X.  Stop doing that.’  It drove your mother crazy.  We had to call down [to the scheduling department] and say, ‘You know that aide you sent today?  Don’t ever send her again!’  And they agreed.”

The next day, Annette spent time with Penelope and Gabriela.  Penelope was smiling and laughing.  When Annette asked Gabriela questions about herself, Penelope would jump in, trying to give answers about her own life.  Even though it was hard to understand her, she was clearly having a good time. 

When they all looked at a photo album, Gabriela said, “Usually, she will tell me about the people in the pictures.”

On Saturday, the weekend aide, Allison, was surprised at how cheery Penelope was.

“It’s because you’re here, because she has a family member here,” she said to Annette. “Why, she’s actually smiling and talking.  Usually, I can’t get any more out of her than ‘Yes,’ or ‘No.’  She never smiles.”

Annette realized, “If she won’t talk or smile when she’s with Allison but does with Gabriela, I need to ask the schedulers find someone besides Allison for the weekend.”

If you are paying for one-on-one care, it’s reasonable to try to make sure that the patient is very comfortable with the caregiver.  A paid companion or aide should help ease the patient’s path through the day – not be a source of distress.