by Steve Andriko
Those who find themselves in the “sandwich generation” are struggling with commitment to both younger and older family members who need their attention. This is your Silver Senior Alert about care for the elderly. Often the more significant challenge presents itself when senior family members have needs. While the catalyst to act on behalf of our younger loved ones appears rather obvious the same understanding of the time to intervene in senior affairs can be perplexing.
- How does one step up to parents to tell them that they need care?
- What are the care options? Are there any resources to help in this process?
- Finally, and perhaps the cause of the greatest angst, how are we going to pay for whatever care may be appropriate?
Silver Senior Alert – When Do My Loved Ones Need Senior Care?
When to take action to acquire care for the benefit of a senior loved one such as a parent, grandparent, or maybe even a spouse can be quite difficult to discern. The most obvious situation has been observed by most of you on the freeway. If you are driving by one of the electronic billboards citing “authorities searching for a missing elderly person” and that person is your loved one, it is definitely time to step up and get some assistance.
Situations short of that may be more complex in the determination process. If your loved ones present a danger to themselves or others then it is time to act on their behalf. Some issues may involve physical mobility and result in frequent falls or other physical mishaps. Or perhaps mom or dad cannot get around cleaning up, preparing meals, or dressing themself without help. Many times those circumstances are rather easily identified and addressed.
However, issues involving the mental state of your senior loved ones can be much more challenging to identify. How do you decide if certain behavior is merely old-age forgetfulness or dementia that can provide a ripe environment for a broad range of dangerous possibilities?
First let’s examine what is dementia. Dementia is a group of symptoms resulting from the death of brain cells due to a variety of conditions such as Alzheimer’s disease and others. Most often the person exhibits loss of memory, reasoning and planning ability, along with behavior modification. Of course we are all a little forgetful from time to time. This condition is more consistent. The first cognitive functionality to disappear is the ability to plan for the future and execute those plans.
As an example you set a date with your mother to pick her up at her place at 11AM on Friday to go to lunch. You arrive and she is not dressed and knows nothing about your lunch plans even if you discus the conversation you had when you made arrangements. Once is no big deal, but beware of this becoming a prevalent occurrence. Another indication of dementia involves discussion of loved ones that have passed away as though they were still alive.
The progression of dementia almost always claims memories in reverse chronological order from their formation. Thus your loved one knows that certain people exist in memory, but the dying event has been erased. In your loved one’s mind they are still with us. Behavior changes can also provide early warning. Is your loved one suddenly mean and short with you when that type of behavior has never been commonplace? You may have to trust your instinct regarding behavior issues. If you think it is abnormal, it likely is abnormal.
These warning signs are certainly not all-inclusive. Indeed they may not even present danger at that immediate moment. However, you do not want to stop by to visit mom and find her captured by the television while the stove is hot and a pan on the heated burner has all of its ingredients evaporated. Of course mom is unaware. Or perhaps dad has driven off in the car and it has been a few hours since he had contact with anyone (see the billboard discussion previously).
A common thread involving the warning signs involves personal observation. Parents are unlikely to voluntarily share their dementia related events with their children.
Now that you have decided to take action where do you turn? Seek professional clinical advice first. It is important to find a good geriatrician if your loved one is not currently under that level of physician care. Remember why you chose a pediatrician for your children. The special training and experience of a doctor who treats seniors is invaluable. Your family physician, insurance plan, or the internet may be available sources to find the right clinician.
The memory issue might be as simple as adverse medication interaction, or as extensive as Alzheimer’s disease. You need a professional opinion. Once the geriatrician has completed the appropriate evaluations, he will be able to provide ammunition to convince your loved one of the care necessary. After all, you can then explain, “The doctor says…”
So you have crossed the threshold of needing care. The next step is determining whether care should be provided in the home or outside of it. Even more variations loom beyond that basic decision. If you choose the in-home route then you can opt for personal care (you do it) or professional care (hire someone). If you provide personal care be careful to consider the physical and emotional commitment necessary. It may merely require you to drop by mom and dad’s house periodically to clean up or run errands.
On the other hand your senior loved one may require as much care as your child does. In that case it is a full-time commitment involving days, nights, and weekends regardless of your own needs or issues. It is very likely that you and your senior loved one will have to reside together maybe at their home or yours. If you decide that personal care is not for you, then you can select a professional care-giver.
At this point you also have options. You can contract for care through a licensed agency that employs bonded professionals that have been vetted and specially trained. Their hiring and supervisory procedures are rigorous. Otherwise you may find your own care-giver keeping in mind all of the criteria that you would include when selecting a sitter for your young ones plus a whole host of other considerations specific to your senior loved one’s need.
Once you have chosen the most appropriate person, you then must consider how much care is necessary. Again it could be as minimal as once or twice a week to help with basic chores of household living or as significant as 24-hour care services. You can feel free to blend your personal and professional care. Perhaps you have dad living with you, but you need a break periodically for personal events. If you choose to provide care on your own be aware that it is a physically, emotionally, and spiritually challenging task and you may not get the recognition that you deserve and may expect for your efforts.
By the way, there is even another option to consider for in-home care when specific medical attention is necessary. That service is called Home Health. Home Health providers can arrange for a skilled clinician (think “nurse”) to visit the residence of your loved one for specialized care. Several examples of this kind of care can be imagined such as post-surgical wound care or physical therapy. Many more medical services can be provided in the home. Remember, the geriatrician is an expert in the field. Therefore, ask him or her about all of your options. Agencies providing this type of care may also provide the non-medical care previously mentioned. You may be able to consolidate your options.
The second option is out-of-home care. Here once again you have two basic categories, full-time or part-time. Part-time care is generally provided in an Adult Day Care environment. This setting may be at a church or senior center. Check with your local community resources to find available options. Generally, community resources are available for active seniors without special care needs. You can also contract with a professional community for such services. A fee-for-service adult day care establishment will exercise the same process in vetting care-givers and will hold a state license.
Click here to read Silver Senior Alert Part 2– When Do My Loved Ones Need Senior Care?