Years ago the choice was simple, everyone chipped in to help. There was never a shortage of resources and parents lived with their children when they could no longer care for themselves. To assist in the matter, most women were stay-at-home Moms who took care of their children and parents. Those were the days when people had large families, a support system that all lived in the same city or town. Today, however, things have changed dramatically. We have stopped having the large families; if there are siblings, they frequently live far apart due to the strain of finding sufficient employment. Society has become mobile, here today, somewhere else tomorrow. So how do we care for our elderly? Off to a nursing home or assisted care living, the burden and responsibility has shifted to unrelated people to care for our elderly. It is no wonder we have lost respect for our elderly, out of sight out of mind. Old age was once thought of as the "Golden Years," but not any more. Nursing homes and assisted care living is extremely expensive. How do we plan for these costs with house payments, car expenses, college tuition, insurance fees and every day living costs? Long-term care policies only pay a fixed amount per year and have caps. So what are we to do? The bubble is going to burst at some point with the baby boomers approaching retirement age.
Doing the right thing for your Parents or elderly relatives can be daunting, demanding and stressful. The situation can be magnified if your parents have health issues e.g. Alzheimer's. My family was faced with this dilemma a year ago. My Mom's Alzheimer's was progressing and she lived in her house alone. Additionally, she lived on the East Coast, my brother in the Midwest and I in the West. We choose not to place her in a nursing home because she had severe sun-downing symptoms, i.e. paranoia, hallucinations, delusions. We were concerned that she would be highly medicated and confined to a wheel chair if placed in a facility. Our Mom has two good legs and enjoys walking and being active. Keeping an eye on her in a nursing environment would be challenging. Attention provided to patients is based on a facility's staff to patient ratio which is generally one staff member to many patients, mandated by law. Finding a good facility requires establishing a criteria checklist. Some factors to consider when searching for a facility are:
- Facility Reputation
- Pending Lawsuits, prior lawsuits
- References
- Certifications
- Site Inspection - Visual observation
- Are patients happy?
- Are patients clean, dressed appropriately for the temperature and weather?
- Does the staff know each patient's name?
- Noise Level?
- Facility cleanliness?
- Is temperature controlled within each patient's room?
- Security, Wander bracelets, anklets?
- Wheelchair access and handicap showers?
- Staff to patient ratio - What nursing level, i.e. RN, LPN, CNA per shift and how many?
- Does Facility offer future and on-going training for all staff members?
- Programs, Activities, Recreation, calendar of events for residents?
- Emergency procedures, working fire detectors and sprinkler system?
- Meals, Nutritionist on board, special diets for patients with food allergies or diabetes or other health issues?
- Price, Price increases how often, historically, how much advance notice?
- Furnished/Unfurnished?
If you decide to go the nursing facility route, make sure to visit your parent and facility on a regular basis to ensure your family member is being treated and cared for appropriately. Don't ever convey when you will be there to visit, show up at different times. Inquire immediately about any bruises, odor and request to see medication reports to review times administered. Visit with the nurse on duty to obtain daily information. If nursing home costs exceed available funds and you are over the Medicaid threshold, see if there are additional funds under Medicaid's Medically Needy Program. In some states, Medicaid will pay the difference between what you can pay and the facility's cost even if available funds exceed Medicaid's threshold.
If you are thinking about caring for your parent at home, your home will need many features similar to those found in a nursing environment i.e. safety features, shower accommodations, wheelchair/walker accessibility, door latches and i.d. bracelets for wanderers. A major difference for at home care is that you become the around-the-clock nurse, housekeeper and cook, 24/7. You will need the following skills and/or knowledge
- Lifting skills.
- Bathing/showering skills.
- Toilet cleaning skills.
- Dressing skills.
- Denture care skills, make sure to clean and remove while sleeping.
- Knowledge on administering medication timely with or without food, medication side effects.
- Food preparation skills, i.e. how to prepare appropriate balanced meals, soft foods for chewing and swallowing, no tough steak or sticky chewy candy.
- Provide mental and physical stimulation. Flash cards, puzzles, card games and walking are good activities. Ask them to write sentences and their name is a good memory exercise.
- CPR skills so you can recognize life threatening symptoms and be well prepared for the unexpected. Knowing what signs to look for with the elderly can be life saving when time may be of the essence, e.g. stroke signs.
- Calming skills when someone is confused and doesn't recognize you. Go with the flow and try not to get them upset, create a soothing story. My Mom wanted to know where her young children were; she thought my brother and I were still kids. Instead of explaining the truth, I said they were at their friend's home playing and they would be back later.
- Don't leave them alone.
My brother and I decided to keep my Mom at home with us. I took her for several months and established a good treatment plan with the assistance of several specialized doctors. My brother then took over the care of her at his home. His home is more suited for elderly care, i.e. minimum stairs, bedrooms and bathroom on main floor, large, wide hallways for walker access and our Mom was accepted into a clinical study research program with a major pharmaceutical company. The company is in the last year testing a new drug for Alzheimer's before going to market.
Caring for the elderly at home, there are common symptoms to be mindful of. Dehydration with the elderly is common. When you pinch skin on the back of their hand, it should snap right back in place, if it stays pinched together, they are dehydrated. Make sure they drink plenty of fluid, water is best. Another common feature with elderly people is that they tend to have dry skin. Assist them with moisturizing their skin with a hypoallergenic moisturizing lotion. Elderly people also tend to be colder since they move around less, keep a sweater, jacket or blanket handy. Elderly may have incontinence issues so keep a change of clothes, bed pads, wipes, etc. in a diaper/travel bag, be prepared at all times for the inevitable. Keep sunglasses and tissues in the car. Pack whatever is necessary to keep them comfortable, snacks and water is also a good idea if you are away from home for a long period. Elderly can be like children. You have to do all the thinking.
Taking care of the elderly can be emotionally and physically draining, make sure to give yourself a daily/weekly breaks, don't burn out the caregiver. There are many support groups that can assist with stress. There are nursing agencies that provide per diem nurses for $18 per hour and up. Your religious institution may have volunteer services which could provide you relief for free. There are also adult daycare centers sometimes run by your hospital or city. Social interaction is good for the elderly especially those with Alzheimer's. Ask friends and relatives if they could assist for a few hours a week. For additional resources, consult your doctor and city offices. Good luck with your decision. If you have any questions, please email me. Thank you, Kathryn Alexander. www.herocardsinc.com.
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