Table 2.

Older Adults or Their Families Were the Gatekeepers to Paid Caregiver Communication With the Health Care Team

Communication about acute health needs
Cognitively intact older adults
Older adult 2	“I was vomiting and I had been vomiting the day before when [my paid caregiver] left. And I wouldn’t go to the hospital. So she left and she went home because I’m grown. She can’t make me go.”
Paid caregiver 8	“The other [paid caregiver] called me around midnight because [the older adult’s nose] was still bleeding she couldn’t control it. And [the older adult] was not going to the hospital. I got on the phone with [the older adult] and screamed at her that she was going to the hospital or else she was going to bleed to death. That scared her, so she agreed to go to the hospital. So that is when [the other paid caregiver] called 911.”
Cognitively impaired older adults
Paid caregiver 4	“I defer medical decisions to [the son.] Based on my observation I would call him if I think something is not right, and then he will have the final say. If it’s an emergency I know to call 911, but if it’s something I would call [the son] and then he would make the final call. Whatever he says goes.”
Proxy 10	“[The paid caregivers] will check her if her feet are swollen, so they are very aware of all these little signs and they will tell me…. And [the paid caregiver] knows her, I mean she takes care of her. She cleans her, so she notices. And she has been telling me, “At night she her feet are swollen” so I said, ‘Next week we are seeing the doctor.”
Communication about general health needs
Cognitively intact older adults
Paid caregiver 7	“Oh, I get involved a lot with my clients. If they accept. Because there are clients that don’t like someone to go in with them the doctor, but that they stay outside. There are people that don’t like anyone to come in. But I get very involved with her, because she has given me her confidence and permission for me to be there.”
Older adult 3	Interviewer: “Do [the paid caregivers] ever talk to the doctor?” Interviewee “They stay in the waiting room. I’m capable of that. Believe me. All the people put me down because my speech is slurred but my brain matter is still working very, very well.”
Cognitively impaired older adults
Paid Caregiver 4	“Usually I don’t contact her doctor directly. I always go through [the son]. I feel I stop there, that’s my boundary… I have spoken to [the doctor] directly along with [the son] before, but from the way [the son] said it wasn’t a written rule, but I sense that I have to tell [the son]. He never said it, but I remember in the beginning whenever we go to see [the doctor] he would go in with her. So I give them that space.”
Proxy 5	Interviewer: “Do they ever speak to doctors or nurses directly?” Interviewee: “No, I don’t usually let it go that far.”