Caregiver Manual

A basic guideline for family and

volunteers providing care and
support to older people
Table of contents

Who is this guide for?

Section 1: Guide for the organisers, managers or trainers of volunteer

caregivers

Section 2: Guide for caregiving for older people with care needs

• Assisting with mobility

• Assisting with instrumental activities of daily life

• Assisting with social connection and relationships

• Assisting with health promoting behaviours

• Assisting with personal care

Using bookmarks
 Healthy ageing

Healthy ageing is about maximising the ability of everyone to enjoy wellbeing in later
life and to continue to do the things that matter to them. This includes, things like:

• meeting our basic needs

• learning, growing and making decisions

• being mobile (getting around)

• building and maintaining relationships

• and contributing to families, communities and societies.

A person’s ability to enjoy healthy ageing is influenced by their physical and mental
abilities, the environments in which they live, and how these two things interact.

Physical and mental abilities include things like our ability to walk, think, see, hear
and remember. As we age, these can be affected by things like diseases, injuries or
general age-related changes.

Our environment is made up of all the elements of our home, our community and
our broader society. It includes the built environment, people and relationships,
attitudes and values we and others around us hold, and the systems and services
that support us throughout our lives.

For many people in later life, care and support can play a key role in achieving
healthy ageing by helping to maximise physical and mental abilities, the
environments in which we live, and how these elements interact.

Who provides care and support?

Care and support activities

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The goal of care and support is to promote healthy ageing and to ensure that an
individual with care and support needs can maintain the best possible quality of life, with
the greatest possible degree of independence, autonomy, participation, personal
fulfilment and human dignity. Care and support activities are therefore varied and can
take place in different settings. What is delivered will depend on the individual’s needs
and wishes, as well as what is available in their environments. However, some common
activities that are delivered as part of care and support include:

• psycho-social support to enable individuals to remain physically and mentally

active and engaged in their communities

• measures to help with the basic activities necessary for daily life (often
called ‘activities of daily living’) and activities that support independent living
(often called ‘instrumental activities of daily living’) (see box below)

• clinical care to help manage infections or long-term conditions.

Activities of Daily Living (ADLs) and Instrumental

Activities of Daily Living (IADLs)

ADLs can be described as the basic activities necessary for daily life, such as bathing
or showering, dressing, eating, getting in or out of bed or chairs, using the toilet, and
getting around inside the home

IADLs can be described as activities that facilitate independent living, such as using
the telephone, taking medications, managing money, shopping for groceries,
preparing meals and getting around outside the home.

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Source: ADB/HelpAge caregiver training course

This this manual is for caregivers who may provide a range of services but will mainly
support with ADL/IADL and psycho-social elements of care. In relation to clinical care, they
may support with referrals, counter-referrals, medication, self-care education, nutrition and
rehabilitation, as requested and supported by health staff.

In addition to these activities, support is often needed to help the person with care needs
and their caregiver to identify and access services that help promote healthy ageing,
including accessing assistive devices and technologies that are available, and to
communicate and coordinate between different service providers.

In addition to support for the person with care needs, activities should also consider the
health and wellbeing of family and friends providing care and what a volunteer can do to
support them in their role.

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Putting the person at the centre of care and
support
Care and support should always begin from the perspective of the person with care needs
and focus on enabling them to live the life they want, to the best of their abilities. This
means ensuring everything from the planning through to the delivery of care and support
is person-centred.

There is no set way to deliver person-centred care and support because it is about the
individual. But some important elements include:

• The person with care needs, the caregiver and their family and household members
working together to design a care and support plan based on the needs,
preferences and goals of the individual with care needs

• All those involved in care provision supporting the person with care needs to have
the knowledge, skills, motivation and confidence to manage their own health and
wellbeing as much as possible

• Promoting good communication and coordination between all those involved in a

person’s care so everyone is working together to achieve the goals important to the
person with care needs

• Delivering care that promotes the independence, dignity and human rights of the
person with care needs (see section below)

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Safeguarding a person’s dignity and rights
Everybody is born free and equal in dignity and human rights, and this does not change
as we age. The rights of the person with care needs and the person delivering care (the
caregiver) must always be recognised, respected and promoted in the planning and
delivery of care and support.

These rights include, but are not limited to:

• The right to dignity

• The right to autonomy

• The right to independence

• The right to choice

• The right to control

• The right to participation

• The right to information

• The right to privacy and confidentiality

• The right to equality and non-discrimination

• The right to justice and redress

• The right to freedom from violence, abuse and neglect

Some people’s care and support needs can put them at increased risk of experiencing
rights violations, including violence, abuse and neglect. People with mental or cognitive
health issues, including dementia, can be especially at risk. It is the duty of those with
management and oversight responsibility for volunteer caregivers to ensure the person
with care needs and those providing care are safe. It is important they know and
understand their rights and how they should be promoted and protected, and that they
know what they should do if they think their safety or their rights may be at risk –
including being familiar with any local measures in place for reporting elder abuse.

Who provides care and support?

In most of the world, families are the main providers of support for older people with care
needs. But changes in the amount and type of care older people need, and less family

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being available for giving support because of smaller family sizes and children moving
away from home, mean that the there is a greater need for help from outside the family.

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Characteristics of a good caregiver
The most important thing about being a good caregiver is respecting the dignity and
independence of the person you are providing care for and being committed to
supporting them to do what they value. To support someone else well, it is also
important that you look after yourself. You need to make sure you have the knowledge
and confidence to deliver care, and that you take steps to maintain your own health
and wellbeing.

Some additional characteristics of a good caregiver include:

• Being friendly, kind, compassionate, patient

• Treating others with respect

• Having integrity and being reliable

• Being flexible and resilient when faced with challenges

• Being committed to providing good care and willing to learn new skills

• Having a sense of humour and ability to make the best out of a situation

• Taking initiative and being enthusiastic

• Having good interpersonal and communication skills

• Knowing how to remain calm or to take a break when frustrated

• Being able to be discreet and to maintain confidentiality

Putting the person you support at the centre of

the care you provide
Care and support should always begin with the person you are providing care for and
focus on enabling them to live the life they want, to the best of their abilities. This is
sometimes referred to as ‘person-centred care’. Delivering person-centred care means
respecting the person as an individual and ensuring that they have a voice and can
make choices and decision for themselves about the care and support they receive. It
means doing things with them and not doing things to them. It also means seeing the
person you are caring for as a whole person, not as a series of health conditions, care
needs or disabilities. We are all unique and it is important that you respect the
different views, identities, needs and wants of the person you are supporting, and do
what you can to provide the care they want that responds to their individual needs.

Consider for example, you are supporting an older woman who is 73 years old. She
lives with her daughter, son-in-law and their three kids. She used to farm and sell fruit
and vegetables at a local market, along with woven baskets she had been taught to
make, but she no longer works because of arthritis in her hands and in her knees. Her

Guide for caregiving for older people with care needs │ Page 2/9
faith is important to her and she enjoys singing. She has hearing impairment, diabetes
and depression. She needs support to leave her house because it is difficult for her to
walk long distances and she lives far from the centre of the village.

Am I delivering person
-centred care?

Caregivers can assess whether they are practising

-centred
person
care by
asking themselves the following questions
:

 Does my behaviour and the mannerIin

amwhich
communicating show that
I respect and value this person?

 Am I treating this person as a unique individual with a history and a range of

strengths and needs?

 Am I making a serious attempt to see my actions from the perspective of

the person I aming
tryto help? How might this person interpret what I am
doing?

 Does my behaviour and interactions help this person feel confident and
supported?

 Is the support I’m delivering meeting the needs, preferences and the goals
identified by the individual?

 Am I promoting the person’s independence and supporting them to make

their own decisions?

Source: Adapted from WHO (2015) World Report on Ageing and Health.

Good communication between you and the

person you are providing care for
key part of delivering good care is practising good communication. As a first step, it is
important to understand the communication needs of the person you are providing
support to. For example, do they have any difficulty with seeing, hearing or speaking?
Good communication is also about respect. It means being aware of what you are
saying and how you are saying it, as well as actively listening. Some things to keep in
mind include:

• What words you choose

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 • The tone of your voice and the speed and delivery of your speech

• Your attitude – avoid speaking to the person you’re providing care for in the way
you might speak to a young child or as though you know better than they do
what they need. Treat them with dignity and respect. Recognise their right to
have their own opinions, ideas, preferences and to make their own decisions
and choices about their care for themselves, with support if necessary

• Your non-verbal behaviour and body language – your body posture, gestures,
facial expressions, and eye movements

• How the person you are communicating with is feeling, paying attention to their
nonverbal behaviour and body language

• Giving the person time to say what they want to and listening with empathy and
respect, showing that you take the thoughts and feelings of the person you are
speaking to seriously

• Not getting distracted – focus on the person and what they are telling you

• Do not interrupt the person, wait until they have finished speaking before taking
a pause and reflecting on what’s been said

• Repeating or paraphrasing what the person you are speaking to has said to
check that you have heard and understood them correctly

• Responding appropriately – take time to think about your response before

speaking

Additional tips for communicating with people with

dementia

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Dementia can affect communication in different ways and how it does so will depend
on the individual. The rules for general communication outlined here are also relevant
to people with dementia. Some additional considerations include:

• Gaining the attention of the person you are speaking to in a respectful

manner. You may want to lightly touch them on the shoulder, or take their
hand

• Asking or telling the person one thing at a time.

• Using simple language and keeping sentences short. Avoid long and
complicated sentences, focus on one subject at a time.

• When needed, change from open-ended to closed-ended questions that can

be answered with YES or NO.

• Recognising and responding appropriately to challenging behaviour,

considering what might be causing the person to behave in the way they are,
thinking about how they might be feeling and finding strategies together to
respond at times like these.

Safeguarding dignity and rights

As a caregiver, you should take time to understand the rights of the person you are
providing care for. These are considered in the box on ‘our rights’. It is important to
make sure that the care that you provide respects and promotes these rights. If you
ever think that the safety of the person you are caring for or their rights may be at
risk, whether from family or community members, within support services or from
health workers or caregivers, you should raise your concern with a health professional,
with the police or with the relevant authority in the place you live. It is also important
that you are aware of your own behaviour. If you start to feel exhausted,
overwhelmed, frustrated or impatient and you are concerned that your behaviour
towards the person you are caring for could become abusive or neglectful, always ask
for support.

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 Our rights

Our human rights include but are not limited to:

 The right to dignity

 The right to autonomy
 The right to independence
 The right to choice
 The right to control

 The right to participation

 The right to information
 The right to privacy and confidentiality
 The right to equality and non- discrimination
 The right to justice and redress
 The right to freedom from violence, abuse and neglect

Looking after yourself

As outlined above, looking after yourself is vital both for your own wellbeing and the
wellbeing of the person you are providing care for. As a first step, you should make
sure that your family and friends, and any relevant health professionals, know you are
a caregiver. You should also check whether any local organisations or the local
authority offer any training or support.

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 Assisting with mobility

Why is it important to stay as mobile as possible?

• reducing the risk of developing several health conditions, including coronary
heart disease, stroke, diabetes, some types of cancer, obesity, arthritis,
depression, and dementia, including Alzheimer’s disease
• helping to manage existing health conditions
• Improving our mood, increasing our self-esteem, increasing our confidence and
energy, and relieving stress.

How can I assist a person with their mobility?

You may need to help a person with:
• walking
• turning and moving in their bed
• moving from their bed to a chair  standing up from a sitting position
• physical exercise.

Assisting with personal care Page 1/2

Important tips to keep yourself safe while

assisting someone to move
Whenever you are assisting someone to move, you should consider these guidelines to
protect yourself from injury:

• Keep your head, neck and spine in a line and your neck and back as straight as
you are able

• Bend with your hips and knees rather than forward from your back and use the
muscles in your legs to lift or pull
│
• Do not twist your body when carrying or supporting someone

• Seek help if you need

• Lifting Techniques

• Some general guidelines to follow when you lift or move a person include:

• Keep your head and neck in proper alignment with your spine; your head, neck,
and back should be as straight as possible.

• Maintain the natural curve of your spine; bend with your hips and knees, rather
than from your back.

• Avoid twisting your body when carrying a person.

• Always keep the person who is being moved close to your body.

• Keep your feet shoulder-width apart to maintain your balance.

• Use the muscles in your legs to lift and/or pull.

• If the person is uncooperative, too heavy, or in an awkward position, get help.

│
Helping someone to move in and out of bed
If the person you are caring for is unable to get out of bed, turning them and
changing their position frequently is important to prevent pressure sores and to aid
blood circulation.

Assisting with mobility

Moving in and out of bed

Who might need help with moving in and out of bed?

Some older people might need your help with moving in or getting out of bed. Those
who may need more assistance include people:

• who are less mobile or have mobility related impairments affecting muscle
strength, coordination, reflexes, and balance;
• who have certain health conditions, for example, heart disease, low blood
pressure;
• with vision problems;
• with dementia, which can affect reflexes and awareness of surroundings, and
may lead to confusion about the time of day and when to get up;
• who have mental health conditions, including depression and anxiety.

Moving in and out of bed │ Page 1/9

 Looking after your own health and wellbeing – tips
for caregivers

It is important for you to consider your own physical health while

assisting those you care for with their mobility. Some things to
remember:

• Try not to lift or take someone’s whole weight by yourself

• Protect your back when moving someone - use the strength in your
legs, keeping your knees bent
• Stand with one foot in front of the other to increase your stability
• Avoid twisting or stooping;
• Move in the same direction that you are moving the person;
• Make sure to assess the person’s level of ability before assisting them
with mobility so you know the type and amount of help they will
need;
• Seek advice from a health worker, trained caregiver or supervisor in
the safest way to assist the person you are caring for, based on their
level of ability;
• Make a note of any challenges, changes in the person’s level of ability
or any signs of pressure sores and share these with a health worker,
trained caregiver or supervisor;
• Remember, there are people who can support you.

How to help someone move in and out of bed

Before assisting someone make sure you do the following:

• wash and dry your hands;

• ensure the area is free from slips, trips or falls hazards;
• ensure you are wearing sensible shoes;
• check there are no sharp objects like scissors or badges in your pockets;
• if necessary familiarise yourself with the person’s care plan and level of ability.

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 Special considerations for people with memory loss
and/or confusion

Dementia can affect a person’s physical mobility and behaviour. If you

are assisting someone with dementia or a person who is confused or
forgetful:

• speak calmly and clearly, explaining what you are doing and why
• reassure the person about what is happening;
• tell the person you are going to take their hand or touch them, before
doing so;
• if assisting them to get out of bed, explain what time of day it is and
why it is important to get up.

Turning someone in bed:

1. discuss what you will be doing with the person and get their consent, for
example, by asking, “shall we turn you now?”
2. if the person can turn themselves, ask them to do so and explain why;
3. if the person is not able to turn themselves, start by turning their head in the
direction you will be turning them (away from you);
4. if a second caregiver or family member can help, ask them to stand on the
other side of the bed;
5. cross the persons arms;
6. bend the person’s leg nearest to you so that their foot is close to their bottom,
or if this is not possible, cross their legs at their ankles;
7. place one hand on the person’s shoulder and the other on their hip. Gently
push the person over onto their side,
making sure in advance that they are not
too close to the edge of the bed;
8. if there is a second caregiver on the
other side of the bed, they can help
support the person by placing their hands
on the top shoulder and knee
9. if possible, place a cushion or pillow
behind the person’s back and between
their legs;

Moving in and out of bed │ Page 3/9

 10. support the person in this position, check how they are feeling and make sure
they are comfortable and feeling safe.
Note: A bed sheet can be used to help turn a heavier person in bed and may be useful
in other circumstances.

If you are turning a person on a low bed or mattress on the floor, you may have to
kneel on the floor or edge of the mattress. Try to use a sheet to help in this situation.

Sitting up in bed: using a slide sheet:

You can use a sheet to help you move someone higher in the bed and more into a
raised or seated position. The goal with this way of moving is to pull, not lift, the
person toward the head of the bed. This technique requires two people, so try to work
with another caregiver or family member.

1. Discuss what you will be doing with the person and get their consent, for
example, by asking, “would you like to sit up now?”
2. If the person can move themselves up the bed, ask them to do so.
3. If the person is not able to move themselves, start by placing a slide sheet
under them. Roll the person to one side (as described above), then place a half
rolled-up sheet, ideally made of a slippery material, against their back.
4. Roll the person onto the sheet and spread the sheet out flat underneath them.
5. Make sure the person’s head, shoulders, and hips are on the sheet
6. You and the other caregiver or family member helping you should stand on
opposite sides of the bed.
7. Grab the slide sheet at the person’s upper back and hips on the side of the bed
closest to you.
8. Put one foot forward as you prepare to move the person and put your weight
on your back leg.
9. On the count of three, move the person by shifting your weight to your front
leg and pulling the sheet toward the head of the bed.
10. You may need to do this more than once to get the person in the right position
11. If using a slide sheet, make sure to remove it when you are finished

If the person has some mobility and can help you, ask them to:

● bring their chin to their chest and bend their knees, keeping heels on the bed; ●
have the patient push with their heels while you pull up.

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Sitting up in bed: single caregiver through arm lift:

Note: Only do this lift if you can do so safely without injuring yourself. If the person is
larger than you and requires much effort, ask for another person to help you. Be sure
not to pull on arms or under arms as they are not able to easily bear weight.

1. discuss what you will be doing with the person and get their consent, for
example, by asking, “would you like to sit
up now?”
2. if the person can move themselves up the
bed, ask them to do so;
3. if the person is not able to move
themselves, position yourself behind the
person with one knee on the bed and the
other foot on the floor
4. put your arms under the person’s arms and
around their chest. You can ask the person
to fold their arms across their chest before
you do this;
5. ask the person to drop their head down
towards their chest;
6. agree with the person what you will say, for example, “ready, steady, lift”. Ask
the person to push up and back with their legs on “lift” while you pull up and
back;
7. when the person is in the right position, place cushions or pillows behind their
back to support them;
8. with this lift it is important not to grip too hard or exert too much pressure on
the person’s chest while moving them.

Getting out of bed to a chair:

1. discuss what you will be doing with the person and get their consent, for
example, by asking “are you ready to stand up?”
2. check the area around you to make sure there are no obstacles or trip hazards
and try to make sure you are wearing suitable shoes;
3. ask the person to turn their head in the direction in which you will be moving
them - to the side of the bed they will be sitting on;
4. ask the person to cross their arms over their chest or help them to do this
5. bend the person’s legs at the knees and move their knees to the side of the
bed they will be sitting on;

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 6. bring the person’s feet to the very edge of the bed, keeping their knees bent.
Their feet should overhang the side of the mattress;
7. gently roll the person on to their side;
8. stand close to the bed with legs apart, knees bent and back straight;
9. place your arm nearest the top of the bed around the person’s shoulders and
your other hand on their hip;
10. standing close to the person, push gently downwards on the hip and upwards
on the shoulder to move the person to a seated position on the edge of the
bed;
11. give the person a few minutes to rest and check they are feeling comfortable
and safe and are not dizzy;
12. position a chair at right angle and close to the bed;
13. make sure the person’s feet are flat on the floor;
14. squat in front of the person with your knees bent, feet apart and back straight.
Ask the person to put their arms around your waist;
15. agree on wording, like “ready, steady, lift” and make sure it is clear to you
both to move on the word “lift”. Stand upright, moving the person with you
and pivot towards the chair;
16. ease the person down into the chair;
17. check the person feels comfortable and safe.

Getting out of bed to standing (for more mobile people requiring support):

1. discuss what you will be doing with the person and get their consent, for
example, by asking “are you ready to stand up?”
2. check the area around you to make sure there are no obstacles or trip hazards
and try to make sure you are wearing suitable shoes;
3. remove the person’s bedding being careful to ensure their nightclothes are
covering them to ensure their dignity and privacy;
4. ask them to lie on their side at the edge of the bed facing outwards;
5. ask them to drop their feet and legs over the side of the bed, and push
themselves up with their hands until they’re sitting upright;
6. help them to put on slippers or shoes;
7. Sit on the bed next to them. Have their clothes or dressing gown ready if they
want to wear them once they’re standing;
8. put your arm nearest them around their waist;
9. make a fist with your other hand and ask the person to put the palm of their
hand that’s nearest you over the top of your fist. This is safer than holding

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 hands in the usual way. If your fingers are interlocked and you stumble, one or
both of you could be injured;
10. while you are sitting side by side, place your feet flat on the floor with one foot
slightly in front of the other;
11. agree on wording, like “ready, steady, stand” and make sure it is clear to you
both to move on the word “stand”. Pushing down through your heels and
gently rocking forward as you say “ready”, “steady” can make it easier to
stand. The person can use their free hand to push against the bed to help
them stand up;
12. when you’re both standing, pause for a moment. Check that the person is
feeling OK and wait until they are feeling steady before starting to walk;
13. if they feel unsteady, dizzy or weak, help them sit back down on the bed. See

When to see advice from a health care professional

It is important to understand what the person you are caring for can do, what support
they might need and how best to assist them. You should seek advice from a health
worker, trained caregiver or supervisor to:

• assess the person’s level of ability and agree a care plan that details the
support they want. This should include understanding any physical
injuries the person may have, including hip, knee and shoulder joints,
and whether they have had any recent surgery or medical treatment;
• ensure you are best equipped to assist the person to move in, or get out
of bed ensuring you and the person you are caring for are safe and not
putting your own health at risk;
• discuss any available equipment and aids that could help you and the
person you are caring for;
• share any observations you have of changes to the person’s level of
ability and general health and wellbeing;
• report any challenges or incidents, including any sign of pressure sores;
• get immediate medical help if the person falls while you are assisting
them to move and you are concerned they may be injured or you are
unable to move them

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Helping someone to stand
Being able to stand is important in our ability to stay mobile and active. It is also
crucial in helping us to stay independent and able to do everyday tasks for ourselves.
Standing from a sitting position is a functional exercise that strengthens leg, core and
back muscles, all muscles that are needed to increase mobility and independence and
improve balance. Even if someone is not able to stand without help, assisting them to
stand from a sitting position can still have great benefits.

It is important for you to protect your back and muscle from injury when assisting
someone to move. (See Assisting with mobility)

Assisting with mobility

Standing from a sitting

position
Who might need help in standing up from a
sitting position?
Some older people might need your help with standing from a sitting position. Those
who may need more assistance include people:

• who are less mobile or have mobility related impairments affecting muscle
strength, coordination, reflexes, and balance;
• with heart disease and/or high or low blood pressure;
• with diabetes, because of potential problems with their feet and legs
• with vision problems;
• recovering from an injury or surgery;
• with dementia, which can affect reflexes and awareness of surroundings.
Mental health conditions can also affect our motivation to stand and be active. Our
confidence and sense of control can also be affected by health issues and physical
disability, so taking it slowly and supporting the person you care for to do things in
their own time is important.

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 Looking after your own health and wellbeing – tips
for caregivers

It is important for you to consider your own physical health while

assisting those you care for with their mobility. Some things to
remember:

• Try not to lift or take someone’s whole weight by yourself. This is

particularly important if you are helping someone to stand up from a
low seated position, including from the ground;
• Protect your back - use the strength in your legs to help the person
to stand, keeping your knees bent;
• Stand with one foot in front of the other to increase your stability;
• Avoid twisting or stooping;
• Move in the same direction that you are moving the person;
• Make sure to assess the person’s level of ability before assisting them
with mobility, so you know the type and amount of help they will
need;
• Seek advice from a health worker, trained caregiver or supervisor in
the safest way to assist the person you are caring for, based on their
level of ability;
• Do not blame yourself if the person struggles or if they fall trying to
stand on their own;
• Make a note of any challenges, changes in the person’s level of ability
or any falls and share these with a health worker, trained caregiver or
supervisor;
• Remember, there are people who can support you.

How can I help someone stand up from a sitting

position?
Standing from a chair:
1. discuss with the person what you will be doing and get their consent, for
example, by asking “shall we stand up now?”

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 2. if the person normally uses a walking aid such as a cane or walker, prepare
this in advance of standing up;
3. check the area around you to make sure there are no obstacles or trip
hazards, and try to make sure you are wearing suitable shoes;
4. ask the person to try and shuffle their bottom to the edge of the chair, taking
care they don't shuffle too far forward. They should transfer their weight from
one buttock to the other, gradually moving forward;
5. when they are sitting at the edge of the seat, they might be able to push on
the arms of the chair to stand;
6. if the chair doesn't have arms or the person is sitting on a bench, and you
need to help them, stand close to the person. Take care to bend your knees
and keep your back straight. Put your arm that’s nearest to the person around
their waist. Make a fist with your other hand. Ask the person to put the palm of
their hand that’s nearest you over your fist;

7. agree on wording with the person, like “ready, steady, stand” or counting “1,
2, 3”. Make sure you both know to move on the word “stand” or the number 3;
8. push down through your heels and gently rock forward as you say “ready” and
“steady”, as this can make it easier for the person to stand;
9. the person can push with their hands, the hand that is on yours and their free
hand, which can push against the chair to help them stand up;
10. when you are both standing, pause. Check how the person is feeling and wait
until they are feeling steady before starting to walk or move further;
11. if the person feels unsteady, dizzy or weak, help them sit back down on the
chair;
12. try to give reassurance throughout the process if you think it is needed.

Managing personal finances │ Page 3/4

Note: if the person is sitting on the ground, you may find it useful to add a few steps to
move from sitting on the ground to sitting on a chair before standing. Assist them to
kneel and then ask them to lean their head and arms forward onto a chair or bed while
you place a stool or cushion under their bottom. Then assist them to come into a
seated position on the stool or cushion. If needed you can repeat again to help them
sit on a chair or bed. Once sitting upright, you can follow the above steps. )

Sitting down on to a chair:

1. discuss with the person what you will be doing and get their consent, for
example, by asking “shall we sit down now?”
2. check the area around you to make sure there are no obstacles or trip hazards
and try to make sure you are wearing suitable shoes;
3. ask the person if the chair is close enough to them;
4. stand close to the person. Put your arm that’s nearest them around their waist;
5. make a fist with your other hand and ask the person to place the palm of their
hand that’s nearest you over the top of your fist;
6. guide the person to a position where they can feel the seat against the back of
their legs. Support them as they sit down;
7. if possible, use a chair with arms and encourage the person to hold the arms
while lowering themselves down;
8. if you are assisting someone with a visual impairment, using touch is
important. Help the person to take hold of the chair so they know exactly
where it is in relation to themselves. With this help they may be able to sit
down with little assistance from you.

Managing personal finances │ Page 4/4

 Special considerations for people with memory loss
and/or confusion

Dementia can affect a person’s physical mobility and behaviour. If you

are assisting someone with dementia or a person who is confused or
forgetful:

• speak calmly and clearly, explaining what you are doing and why;
• reassure the person about what is happening;
• tell the person you are going to take their hand or touch them,
before doing so.

Whether the person you are caring for has significant mobility challenges and
needs a lot of support to move around their home, or they are physically able, but
they gain confidence through having someone accompany them on walks outside,
there are things you can do as a carer to help.

Who might need assistance with walking?

Older people in need of care may face a range of different challenges with walking.
Those who may need your help include people who:

• Are less mobile or have mobility related impairments affecting muscle strength,
coordination, reflexes, and balance.
• Are rehabilitating after health events, surgeries, or treatment, for example,
after having a stroke, hip or knee surgery or a period of illness with time spent
in bed.
• Have diabetes.
• Have vision or hearing problems.
• Have mental health conditions affecting their confidence, motivation, and ability
to leave the house, for example, depression and anxiety.
• Have dementia or are experiencing confusion and memory loss.

Managing personal finances │ Page 5/4

 Looking after your own health and wellbeing – tips
for caregivers

It is important for you to consider your own physical health and mental
health while assisting those you care for with their mobility.

Some things to remember:

• When helping someone to walk try not to take someone’s whole

weight by yourself.
• Protect your back when helping someone to walk - avoid stooping
and take any weight with your legs and not your back.
• Make sure to assess the person’s level of ability before assisting them
to walk so you know the type and amount of help, they will need.
• Seek advice from a health worker, trained caregiver, or supervisor in
the safest way to assist the person you are caring for, based on their
level of ability.
• Make a note of any challenges, changes in the person’s level of ability
and share these with a health worker, trained caregiver, or
supervisor.
• Walking is good for your physical and mental health too. Make time
for breaks and go for a walk in the fresh air.
• Remember, there are people who can support you.

Walking with someone with problems with their vision

• Ask the person what help they would like, for example, whether they want to
take your arm while walking.
• If walking around the home check for hazards and obstacles on the floor.
• Do not move objects or furniture without asking the person first.
• Do not leave doors ajar, close them or open them fully.
• Use accurate and specific language when giving directions. For example, “the
door is on your left”, rather than “the door is over there.”

Managing personal finances │ Page 6/4

 • Try to avoid noisy situations if you need to give directions and instructions.
• In a dangerous situation say “STOP” rather than “LOOK OUT.”
• Describe the surroundings and obstacles in their pathway (remember to look up
as well as down). Warn of the presence of over-hangs such as kitchen
cupboards, jutting side mirrors of cars, or trees.

Walking with someone with diabetes

Walking can be a helpful way for people with diabetes to stay active. It can have
positive effects for controlling blood sugar levels, managing weight, and fighting
fatigue. If the person you are caring for has type 2 diabetes you should consider the
following while supporting them to walk:

• Encourage them to check with their health workers before starting to walk if this
is a new form of exercise.
• Make sure the person plans their sugar intake and any medication carefully
around a walk.
• If the person injects insulin into their legs, they should avoid walking after this,
because exercising the leg muscles can affect the rate at which insulin is
absorbed.
• Encourage the person to check their blood sugar level 15 minutes before
walking and 1 hour after finishing. If there's a big difference, encourage them to
discuss with their health worker.
• The person should not go for a walk if their blood sugar is unusually high
• Make sure you or the person carries glucose with you.
• Get advice from a health worker, trained caregiver, or supervisor to make sure
you know what to do if the person’s blood sugar levels drop (a hypoglycaemic
episode).

fessional

Managing personal finances │ Page 7/4

How can I help the person I care for to prepare
their meals?
When you are caring for an older person, you might need to help them to prepare
their meals. Cultural and religious beliefs influence what people eat. When you are
responsible for preparing and feeding meals to an older person, talk with them (and
their family members) to find out:

• Which foods do they like, any foods that they dislike?

• What foods are forbidden or inappropriate?
• Do they have any allergies or foods they must avoid for medical reasons?
• What times of day do they prefer to eat? Some people like to eat more at
midday and have a small meal in the evening to avoid indigestion.

Assisting with instrumental activities of daily life

Preparing meals
This is also an opportunity to share nutrition information. It can be helpful to support
them to prepare meal plans for the week ahead, but many families will decide what to
cook depending on what is available in the market.

Managing personal finances │ Page 8/4

Pay attention to food hygiene
It is especially important to pay attention to hygiene when preparing food because
food-borne illnesses can be severe in older people. Always wash your hands before
preparing food, and between handling raw meats and other foods.

Avoid exposure to the smoke from cookin

If you are cooking on a wood or other biomass stove, try

to reduce the older person’s exposure to the smoke.

Choose healthy cooking methods

The method of cooking can make a difference to the nutritional value of food.

• .

Managing medicines
What can I do to help the person I care for to manage their
medicines?
Firstly, ask them about their medicines and whether they have any problems with
them. Don’t tell them what to do, but ask for their opinions and ideas about how to
manage any medicine-related problems.

Keep a record
Next, make a list of the medicines they take, the reason or condition that the medicine
is for, and side effects to watch out for. Many older people remember which medicines
they take by the colour and shape of the tablets or capsules.

Taking or giving medication at the right time

Ask the older person how they remember to take their medicines each day

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Before giving any medications, you should wash and dry your hands. You
need to check:

• the name of the medicine;

• the correct dose and time to give the medicine;
• that the older person has not taken the medicine already;
• the expiry date of the medicine;
• that the elder is not allergic to the medicine

Never force the person you are caring for to take their medicine.

If they don’t want to take their medicine, talk with them calmly about the reasons.

Managing personal finances │ Page 10/4

 • communication, trust, and autonomy improve when older people keep their
own health record;
• older people rarely lose their health record and remember to bring it with them
to consultations.
• the patient, their caregiver and their health care providers give preventive
health strategies more attention;
• the record makes it easier for the person to make decisions with their
caregivers about their own health;
• it improves continuity of health care, for example, avoiding unnecessary

Supporting people with vision or hearing

problems
If the person you support has problems with their vision or hearing and you notice
that this is affecting their relationships and how people communicate with them,
consider offering the following advice to friends and family members:

Vision
When speaking with someone with vision problems:

• identify yourself - do not assume the person will recognise you by your voice;
• speak naturally and clearly, loss of eyesight does not mean loss of hearing
• continue to use body language, this will affect the tone of your voice and give a
lot of extra information to the person you are talking with;
• use everyday language, don’t avoid words like “see” or “look” or talking about
everyday activities such as watching TV or videos;
• name the person when introducing yourself or when directing conversation to
them in a group situation;
• never channel conversation through a third person. Always talk to the person
directly;
• in a group situation, introduce the other people present;
• tell the person if you are leaving a room;
• use accurate and specific language when giving directions. For example, “the
door is on your left”, rather than “the door is over there”
• relax, speak naturally and be yourself.

Nutrition │ Page 1/7

Hearing
When speaking with someone with hearing problems:

• make sure you have face-to-face contact with the person you are talking to;
• get their attention before you start speaking, maybe by waving or tapping them
on the arm;
• speak clearly but not too slowly. Do not exaggerate your lip movements;
• use natural facial expressions and gestures;
• do not shout;
• if someone does not understand what you have said, do not keep repeating it.
Try saying it in a different way instead;
• find a suitable place to talk, with good lighting and away from noise and
distractions;
• check the person you are talking with is following you during the conversation;
• if the person lip reads, do not cover your mouth with your hands or clothing.

Assisting with social connections and relationships

Preventing and addressing

neglect and abuse
What is abuse and neglect?
Violence, abuse and neglect of older people is a serious problem around the world.
Around 1 in 6 people aged 60 and over report experiencing some form of abuse in the
previous year.

Abuse is defined as any knowing, intentional,

or negligent act by a caregiver or any other
person that causes harm or a serious risk of
harm to a vulnerable adult.
Neglect occurs when those responsible fail to
provide food, shelter, health care, protection
or emotional support.

Nutrition │ Page 2/7

 Types of abuse Types of behaviours

Physical abuse Assault, hitting, slapping, pushing, misuse of

medication, restraint, inappropriate physical
sanctions.

Sexual abuse Rape, indecent exposure, sexual harassment,

inappropriate looking or touching, sexual teasing, or
innuendo, sexual photography, subjection to
pornography or witnessing sexual acts, indecent
exposure and sexual assault or sexual acts to which
the adult has not consented or was pressured into
consenting.

Financial or material Theft, fraud or exploitation, pressure regarding wills,

abuse property, or inheritance, misuse of property,
possessions or benefits.

Domestic violence and Psychological, physical, sexual, financial, emotional

abuse abuse, ‘honour’ based violence.

Discriminatory abuse Including forms of harassment, slurs or similar

treatment: because of race, gender and gender
identity, age, disability, sexual orientation or religion.

Modern organisational Including neglect and poor care practice within an

institution or specific care setting such as a hospital
abuse or care home, or in relation to care provided in one’s
own home. This may range from one off incidents to
ongoing ill-treatment. It can be through neglect or
poor practice because of the structure, policies and
processes within an organisation.

Self-neglect This covers a wide range of behaviour: neglecting to

care for one’s personal hygiene, health or
surroundings, and behaviour such as hoarding.

Psychological abuse Including emotional abuse, threats of harm or

abandonment, deprivation of contact, humiliation,
blaming, controlling, intimidation, coercion,
harassment, verbal abuse, cyber bullying, isolation

Nutrition │ Page 3/7

 or unreasonable and unjustified withdrawal of
services or support.

What can I do to help prevent or manage

violence, abuse and neglect?
As a caregiver you have a responsibility to look after yourself to make sure you do not
become abusive or neglectful towards the person you are caring for. You must also be
vigilant to any signs of abuse or neglect being experienced by the person. If you see
or suspect anything, it is important you know what to do.

Recognising signs of violence, abuse or neglect

Recognising and identifying abuse are the first steps in being able to support the
person you are caring for. There are several signs that might indicate abuse:

• physical abuse: bruises, pressure marks, repeated accidental injuries, anxious

behaviour when someone approaches;
• psychological abuse: unexplained withdrawal from normal activities, insomnia,
fear of people, a sudden change in alertness or in appetite, unusual depression;
• sexual abuse: anxious behaviour when getting undressed or being touched,
genital bruising or bleeding, torn or stained underclothing;
• financial abuse: sudden changes in bank account or banking practice, including
unexplained withdrawals of large sums of money, sudden inability to pay bills;
• neglect: unusual weight loss, malnutrition, unsanitary living conditions, lack of
social control.

If you see any signs of abuse you should consider:

● talking to the person, carefully ask how any injuries occurred;

• make sure you talk in private, without an accompanying family member
present;
• if you are concerned that talking to the person directly may cause trouble for
him/her, then it is sensible to discuss the issue with your supervisor;
• if the person you are supporting tells you they have been or are being abused,
ask them exactly what happened;
• you should also ask the person about when the abuse happened and what else
was going on at the time. Was anything unusual happening in the person’s
daily life, or that of their family member or the person that they say has abused
them?
• try to understand the broader family situation. Has anything changed?

Nutrition │ Page 4/7

Responding to reports or signs of violence, abuse and neglect
It is important that you try and respond in the best possible way if the person you are
caring for tells you that they have experienced abuse:

• stay calm and try not to show shock;

• listen very carefully;
• be sympathetic;
• be aware of the possibility that medical evidence might be needed;
• reassure the person that they have done a good thing in telling you and that
you will treat the information seriously;
• make clear to the person that the situation is not their fault;
• If your role as a caregiver is managed through an organisation and you have a
supervisor, inform the person that you must tell your supervisor what they have
told you, and that with their consent, your supervisor will contact the
appropriate authorities and/or the police. Do not promise to keep the
information secret;
• write down what the person tells you, be factual, date and sign your name
• if you are worried about any imminent danger to the person you are supporting,
take immediate action. In situations of acute danger, the police must be called;
• in every case where there is a suspicion of violence or abuse, your supervisor or
manager should be informed, and further action agreed.

Reporting instances of violence, abuse and neglect

If you suspect violence, abuse or neglect of the person you are supporting, or they or
someone else reports an incident to you, report this to the most relevant person or
authority.

Why is good nutrition important for older

people?
The food we eat makes a difference to our health and well-being

Some health problems that can result from a poor diet are:

• Anaemia (thin blood)

• Obesity
• Diabetes

Nutrition │ Page 5/7

 Assisting with health promoting behaviours

N utrition

• High blood pressure

• Heart disease
• Stroke
• Arthritis
• Weak bones
• Some forms of cancers
• Eye problems
• Weak immunity
• Constipation
Sometimes older people do not drink enough liquids to stay well hydrated.
Dehydration is when the body loses more liquid than it takes in.

. Dehydration can result in seizures, heat cramps, low blood volume, and even kidney
failure and coma.

What can I do to help to prevent nutritional

problems?
Encourage the person you are caring for to eat a variety of locally available,
nutritious foods, chosen from all of the five food groups below:

[Link] – important for energy

• Rice
• Maize
• Wheat
• Oats
• Millet
• Barley

Nutrition │ Page 6/7

 • Potatoes
2. Protein – important for maintaining muscles and repair

• Pulses such as beans, lentils, chickpeas

• Fish
• Meat and chicken
• Eggs
• Cheese
• Nuts, including peanuts (ground nuts)
3. Fats – important for energy and some vitamins

• Oil, such as canola oil, olive oil and coconut oil

• Butter
• Suet (animal fats)
• Margarine
4. Micronutrients (vitamins and minerals) essential for immunity, preventing anaemia,
and bone strength

• Fruits
• Vegetables
• Dairy foods
• Eggs

5. Fibre – important for gut health

• Fruits
• Vegetables
• Whole grains
• Wholemeal bread
• Dried peas, beans, and lentils

Nutrition │ Page 7/7

In general, older people need to eat some protein with every meal. Regularly eating fish can
reduce the risk of heart disease, stroke, dementia, and vision loss. Plenty of vegetables and
fruit will provide fibre and micronutrients.

If the older person is underweight and has a small appetite it is helpful for them to eat more
energy-dense food. Encourage them by making the meal a pleasant occasion.

If the older person is having difficulty chewing, assist them to visit the dentist.

Encourage physical activity, which improves appetite and strengthens muscles.

Assisting with health promoting behaviours

│
 Preventing and
managing falls
Falls most often result from a combination of factors. Older people are at a higher risk of
falls if they have:

• Hazards in their local environment such as poor

lighting, slippery paths or floors, poorly fitting
shoes, or things on the ground like floor mats or
rugs, cords or objects like toys.
• Poor vision and/ or hearing problems.
• Dementia, which causes reduced awareness of
surroundings and slows reflexes.
• Heart disease and high and low blood pressure,
which affect blood flow to the brain and cause
dizziness and loss of balance.
• Diabetes, can causes a decreased sensation in the feet; and increases the risk of
foot infections. Treatment of diabetes can also cause low blood sugar dizziness and
falls.
• Taking medicines which cause drowsiness.
• Reduced muscle strength, coordination, reflexes, and poor balance due to lack of
mobility.

What can I do to help prevent falls?

Here are some key actions to prevent falls:
Encourage and support daily physical activities.

Include a variety of exercises which strengthen the body:

Make the home safer and more accessible.

• Keep the floor dry and clean.

• Put in brighter light bulbs, consider lighting at night between bedroom and toilet.
• Put up some handrails.
• Make sure the path to the toilet is clear, well lit, and arrange handrails if needed.
• Highlight steps or stairs by painting in contrasting colours.

│
 • Repair any uneven surfaces.

Arrange for a vision and hearing screening and seek treatment for vision and
hearing impairment.

Why is personal care important?

As we get older, or our physical and mental abilities start to decline, we may need
support with some personal aspects of our daily lives, including:

• Bathing and grooming;

• Dressing and undressing;

• Going to the toilet and managing incontinence ;

• Oral and dental care;

• Foot and nail care;

• and eating and drinking.

Because these are essential aspects of life, if someone needs assistance with them, it is
an important part of a caregiver’s role. Support with these types of tasks should be
provided with sensitivity and compassion. A caregiver should respect the person’s choice
and preferences, privacy and dignity. The type of personal care provided should be based
on the needs and abilities of the person being cared for. It is important that a caregiver
does not do too much. We should all continue to manage our own personal care for as
long as possible and keep doing whatever tasks we can to maintain our independence to
the greatest extent possible.

│
Why might someone need assistance with
toileting?
Older people may need help with getting to the toilet for several reasons. For
example, they may not be able to move around easily or memory loss or sight
impairment may be an issue. Osteoarthritis is usually worse in the early hours of the
morning when an older person may wake needing to pee. So it can be difficult for
them to get up and walk to the toilet. Painful joints, weak muscles or poor balance
may make it impossible to squat. Some older people have difficulty in undoing buttons
or a zip in order to pee.

Some types and locations of toilets may be more difficult for people to use. If the
latrine is outside, the pathway may be difficult to navigate, especially in the evening.
Some older people have to go to the field or the forest to pass urine and stools. Some
have an indoor cistern flush toilet with a seat or an indoor pour-flush pit latrine.

Assisting with personal care

Bathing and grooming

Managing our personal hygiene and cleanliness is important for both our health and
emotional wellbeing. If we start to struggle to be able to wash ourselves and find other
tasks such as brushing our hair and shaving challenging, it is important we have
someone to help us to do these tasks. Bathing and grooming are very intimate and
personal acts and having to ask for support can be challenging. As a caregiver, it is
important that you undertake these tasks in a way that ensures the privacy, modesty
and dignity of the person you are supporting is upheld and promoted.

Reasons bathing and grooming might become difficult

There could be several reasons why the person you are supporting is no longer taking
care of their own bathing and grooming. These include:

Assisting with personal care

Dressing and undressing │ Page 1/6

 Bathing and grooming
• experiencing or worrying about having pain while standing, bending or sitting;
• fearing slipping or falling over uneven bathroom floor or a wet floor in a
communal washing area;
• being concerned about discomfort or pain from water that is too hot or cold;
• finding it difficult to get into and out of a bathtub or shower particularly if there
is a step/s;
• finding it too difficult to walk to a communal washing area outside the home or
compound;
• being fearful of being harmed by other people using a communal washing area;
• forgetting about the need to bathe, or how to bathe and groom themselves.
This can be a particular challenge with people with dementia;
• having a fear of water and/or its sound. This can be a particular issue with
people who have dementia;
• lacking the motivation to bathe and groom themselves. This can be a particular
issue with people with mental health conditions, such as depression and
anxiety, and could also be linked with loneliness and social isolation, as people
may not see a point in bathing and grooming if they are not seeing anyone else;
• finding bathing and grooming exhausting;
• being physically unable to do the tasks needed, for example because of
paralysis, weakness, pain or injury.

Dressing and undressing │ Page 2/6

Helping an older person to eat
The person you care for may need your help at mealtimes for several reasons.
Arthritis, a tremor, weakness from a stroke can make it difficult to cut up food and
take it to the mouth. Cognitive difficulties can also mean that an older person needs
help to eat.

For older people eating is often an important part of their lives and something they
look forward to doing. Providing them with tasty and interesting food will help to make
them happy. Ask them about which foods they enjoy, and if there are any foods or
flavorings that they dislike. Helping an older person to eat, or feeding them, is a
sensitive task. It is important to help them to feel that they still have some control,
and to be patient.

Assisting with personal care

Eat ing
• Ask them if they are ready to start eating. Eating meals is also a social activity.
Make it a calm and friendly time. The pleasure of eating increases when a meal
is shared.
• Help them to wash their hands before the meal. If they have dentures and they
are not in their mouth, ask them if they would like to use them. Ask them if they
would like to use the toilet before they eat. Wash your own hands before the
meal.
• If the person you care for is confined to bed
make sure that they are well supported with
a cushion, so that they can swallow food and
drink. A tray with legs to go over the bed is
very useful to help the person to be able to
see and reach their food
• Provide a waterproof cloth to protect their
clothing from food stains to maintain their
dignity.

Eating │ Page 1/4

 • If you need to feed them, try to sit at the same level. Give them small spoonsful
of food. Don’t rush them.

• In many cultures it is usual to eat with the fingers. If this is the case, offer the
elder a bowl of warm water and a hand towel to wash their hands before and
after the meal. If they cannot use their usual chopsticks or cutlery, offer ‘finger
foods’. Or cut up the food so that they can eat with a spoon. Make sure that the
pieces are small enough to prevent choking.
• Place the plate or bowl within easy reach and check whether they need help. If
the weather is cold, use a warm plate. Make sure that the food is not too hot.
• Make sure that they have a glass of water at mealtimes. If they cannot lift a
glass or cup, offer them a straw, or help them to drink small sips.
• If there is a danger of choking, try mashing the food, or providing a rich and
tasty soup.
• If they refuse the food, offer something different. If they continue to refuse food,
or to eat very little, arrange for them to see their health care provider.
• Provide a cloth or napkin so that they can wipe their mouth. Check their
appearance after the meal.
• If the older person has medications to take at mealtimes, remind them to take
them after the meal.
Special considerations for people with memory loss and/or confusion

Eating │ Page 2/4

• Dementia can be associated with eating problems. The older person
may eat smaller meals than when they were younger and lose weight.
People with dementia often have a change to their sense of taste.
They often prefer to have food with strong flavours.
• Mealtime can be a stressful time for both the older person and the
caregiver. Offering smaller meals more frequently, with familiar, tasty
foods that they like, can be helpful. Make sure not to serve the food
too hot.
• To help to remind the older person to eat, try to involve them in
preparing the meal, or putting the plates on the table. Eating with
family members gives an opportunity for the older person to see them
eating and copy them.
• Try to ensure that there is plenty of time for the older person to eat
their meal. Avoid distractions at mealtimes. Keep the table or tray
clear. A non-slip mat under the plate can be helpful.
• For some older people you might need to put the food in their hand, or
on their spoon, and guide it to their mouth. You might need to remind
them to open their mouth, or gently touch their lips with the spoon.
You might need to remind them to chew and to swallow. If the older
person says that they don’t want to eat, try offering the food again
later. Never force an elder to eat food that they do not want
• It may also be helpful to provide some nutritional supplements. Ask for
advice from the health care provider.

Eating │ Page 3/4

SS