Planning care for an elderly parent is a difficult decision and one that many families confront, often with conflicting ideas, when their aging parent shows signs of decline. The only universal answer is, "It depends". There is no one answer that fits all. What does your parent want? If it's to stay in their own home, as is often the case, can you or other family members provide a safe environment and the necessary care to keep them there? Consider the costs to you, emotionally, as well as financially. Too often, a loving caregiver's health declines faster than the one they are caring for. If you are caring for your parent now or considering doing so, keep this in mind: you must recognize the stresses on you and your family; your spouse and children need you, too. Once your parent is gone, at some point they will be, will you still be there for your own family? Here are some things to consider and to discuss with other family members: siblings as well as your spouse and children.
1. What is your relationship with your parent? Are you or your parent often impatient, short-tempered, continually critical or demanding of each other? Or, are you caring for your parent now and exhausted?
2. Dementia posses challenges when wandering or other behaviors are beyond your control and are a risk to your parent and others. You can restrict their wandering by keeping outside doors locked as long as someone is with them, and it does not interfere with escape in case of fire or other disaster. You cannot lock them in a room or tie them down. Adult protective services will step in, as they should.
3. Does he or she require intimate personal care (injections, incontinence, bed sores, other wound care, etc) that goes beyond your ability to provide? Some people are able to remove themselves from the discomfort of those tasks and provide the care, no matter what. If that is not you, don't force it.
4. Fragile health requiring skilled nursing care is more difficult to manage at home, though not out of the question. If the doctor thinks your parent has less than 6 months to live, and you really want to keep them at home, you can engage the services of Hospice. They will provide the necessary skilled care wherever your parent is, whether it is at home or in a facility.
5. Social interaction with friends and family are important to all of us. For elderly people, who are limited in their ability to get out on their own, socializing with others where they live is important. If aging-in-place (remaining in their own home) means loneliness and isolation, then they are likely to decline more rapidly.
If any of the above applies, then hiring caregivers to provide in-home care or placing your parent in a care facility are your best options. There are numerous in home caregiver agencies. Hire a care manager to assess your situation and make recommendations. Assisted living residences are available, from homes in residential neighborhoods accommodating 5-6 individuals, to large multi-story complexes for many individuals and with many services. Some of them are sponsored by different faiths. Skilled nursing facilities, i.e., nursing homes, take individuals who, as the name suggests, need skilled nursing care. If your parent is transferred from an acute care hospital at the doctor's recommendation, then Medicare will cover the cost for up to the first 100 days. If you admit your parent from home, you must pay the bill.
I am a proponent for keeping a loved one at home whenever possible, if that's where they want to be. Trained caregivers are caring, nurturing people, and they are more removed emotionally, than you are. This distance enables them to manage the more difficult aspects of care while still treating them with respect, and hopefully humor. In my own experience (many others have reported this also), my father didn't listen to me, his "child", despite the fact that I was an elder care professional. He ignored me or often did the opposite when I made suggestions; but when his caregiver gave the same advice he would say, "good idea", and do it willingly. I stepped aside, supervising from a distance, and let it flow organically. When the time comes for you to make this difficult decision, discuss it with your parent, siblings - all of them, and your own family. If you can't all meet in person then have phone conferences, or email "conversations". Don't leave anyone out of the discussions - it will come back to bite you later if you do. If your parent isn't capable of making realistic decisions include them anyway. They need to feel included and know they have a voice in the matter.
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