This is the companion blog post to the podcast Getting the Best Care, The Insider’s Healthcare Podcast Season 2 Episode 2
Do you have a parent who is approaching 80 or even 90 years old? Have you been noticing that you loved one is starting to decline? It is natural to put things off until it is “absolutely necessary.” But too often that means waiting until a crisis or tragedy develops. This issue came up recently for one of my new clients. He realized that his aging mother was probably having trouble living on her own, but he knew she wanted to remain in her home. I wanted to give you all some tips to help to ease the transition when you are going from managing your own life to adding on the management of an aging parent’s life.
Start Early!
Start considering getting in-home care. Even if your parent doesn’t have serious medical issues, companion care can be a good way to start introducing caregivers into the routine. Companion care, although not cheap, is the most affordable type of in-home care. Companion care is appropriate for someone who is largely able to manage their own toileting and can move around fairly well without help. It is very helpful in those early stages when you may be dealing with Mild Cognitive Impairment (MCI). MCI is very common in people as they age past 80 years old. It is a form of memory loss, frequently short term memory is affected. This is when your parent asks why you haven’t called recently, and yet you actually spoke to them the day before. People with MCI do not have dementia, and in general are capable of living independently. But more complex tasks are a challenge. They may not be paying bills, or keeping the house organized, this is when it is good to consider getting companion care.
If you know that there is not a budget to afford in-home care, it is best to start planning very early. There is a federally funded Area on Aging Agency in most areas of the country (search it online). They have good resources that you may be able to use if you are on a very limited budget. But be forewarned, you may be put on a waiting list. So it is imperative that you not wait until you are in a crisis situation. There are also many senior services centers throughout the country, they too, often have access to free or low cost care programs. But again, becoming familiar with the programs and the staff at these agencies BEFORE you have your back against the wall needing help is the smart way to go.
Be aware that if things start to deteriorate in your loved one’s home, the state authorities may become involved. Having a government agency judging the situation can complicate things for you, and it can cause you to lose control over the plan. All it takes in many areas is for someone to call in a report of a senior citizen being in danger, and you will have a case opened with a state agency on aging or a private agency that has a contract with the state. These services are important because for many years, senior citizens had no specific protections, and many were living in terrible conditions, or were vulnerable to exploitation by family or strangers. Increasing awareness of these issues has lead to the creation of agencies that are charged with the welfare of senior citizens. While the services are valuable, it can be intrusive to a family that is trying to make a plan that is tailored to the goals and values of their loved one. So, that is why I recommend that you start very early to get help into your loved one’s home, even before a crisis develops.
Assuming that your parent is physically in fairly good shape without any debilitating health problems, but is experiencing problems maintaining their home, consider professional companion care. I recommend that you explore professional home care agencies in your area. Home Instead is a company that specializes in this sort of care, and also has the capability to provide more complex care as your loved one ages. There are dozens of home care agencies in most areas of the country. You may be tempted to call on someone in the neighborhood who “freelances” doing home care. I would caution you to consider these issues:
Do you want to be an employer?
What training does this neighborhood person have?
Who will handle problems or disputes that will likely come up?
Who will be the back up caregiver if the freelance person cannot come on short notice?
I have seen all of these situations in my own family as well as in my professional life. Having someone cancel at the last minute can throw your life into chaos. That is why I say that a professional agency is the easiest route. Having in home care is a fluid situation, complications will occur. But if you have a professional agency coordinating the care, you will likely have the option to get a last-minute substitute when one caregiver is sick or on vacation. And, if someone is not working out, you have more staff to chose from, all of whom have been vetted by the agency.
Even when an agency is coordinating the care, there will be last-minute changes. One caregiver may suddenly decide that she is not returning the next day. That means that a new person will be sent out. It is a good idea to try to have someone who is familiar with your parent to be present any time a new caregiver is coming. Having their routine disrupted can really cause confusion in the aging especially if they have MCI. So, it is best if you or someone else who your parent knows, can be present any time there is a change in caregivers.
Companion care can be for just a short period of time everyday. Even four hours a day can be a great help. It will ensure that your loved one is not alone all day. It is also a good way to monitor the situation in the home. If someone is consistently coming, they can alert you to any changes or concerns that appear. You are probably busy with your own family, work, and personal responsibilities-or perhaps you live a distance away. Having companion care may give you peace of mind that someone is keeping an eye on things.
Another tip I have is that you consider installing cameras. There are easy to install cameras that are to be monitored from your cell phone or tablet. The purpose of the cameras is safety, they are not meant to spy on people. I strongly encourage you to notify everyone who comes into the home that there are cameras present. And, of course, places them in areas that respect your parent’s privacy. Even if you have companion care, your loved one is likely to be spending a great deal of time alone. Having the cameras available to be able to do a visual check in can be helpful. We used cameras when my mother was in her 90’s and she lived with us with 24 hour care. Both my husband and I worked long hours (60+ hours a week). Having the cameras allowed us to check in and to see how she was interacting with the caregivers. But we were sure to let everyone know that the cameras were present.
The third tip is to consider a security system such as Simplisafe. Again, they are not complicated to install and you can customize the system to your needs. One of the best features is the keypad and sensor that you can install at each exterior door. That allows you to be notified if the door is opened. You might set the notifications to alert you if the door is opened in the middle of the night, for instance. Additionally, these systems allow you to remotely lock and unlock the doors. Imagine you are able to look at your phone and see that your parent’s front door is unlocked at 10 pm. You would be able to remotely lock the door without disturbing your loved one.
The final tip when you are starting to have to manage your aging parent’s affairs, is to get grocery delivery. There are several services in just about every neighborhood. Once you start an account you can go online, order and pay for the groceries and choose the time to have them delivered. That way you can be sure that someone (a caregiver or other family member) is present to receive the delivery. It is wonderful to not have to add another trip to the store to your unending list of things to do!
These are just a few of the tips that I give to my clients. This can be such a stressful time of change for you and for your parent. It is important to put systems into place that can help to ease the transition.
