WHEN DO I PLACE MY ELDERLY PARENT IN THE HANDS OF SENIOR CARE EXPERTS?


This 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 you 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.

Your Parent’s Caregiver: To Be – or Not To Be

 7 Points to Consider

When your elderly parent is no longer able to live alone safely and independently, and he or she wants to remain at home, a caregiver will be needed.  Deciding who that person should be and what their duties need to include, involves lengthy discussions, over time with family and much soul-searching. Include your parent, and maybe an eldercare health professional and an elder law attorney.

If you decide to be the caregiver consider these 7 points.

1. Relationship : Of course you love your parent, But do you enjoy being around each other and see eye-to-eye on things that matter? I loved my dad and we had many good times together, but we did not agree on many things, we were both stubborn, and he, as my dad, viewed me as the child – he thought he knew better.  Much of the time we were at loggerheads with one another. For that reason I hired the primary caregiver; and he and I spent quality time together.

2. Patience:  Can you to listen to and wait for your parent to respond at her own pace even if memory and/or judgment interfere?  It’s important to allow your loved one to do all of those self-care and daily tasks they are capable of, regardless of how long it takes them.  Only step in to help if they clearly cannot complete what they are attempting to do, or if time is critical.  If you take over tasks they are able to do, you are fostering their dependence on you and you are taking away their sense of self-respect.

3. Nurturing: can you help with bathing, toileting, dressing or whatever other intimate care is required without judgment, resentment, or being turned off?  It is important to maintain your respect for the person your parent is regardless of their capabilities.

4. Your own lifestyle: do you currently have a job? Can you afford to lose an income and benefits to take on a caregiver job with neither income nor benefits?  Do you have a family who needs you? Consider what it will do to your relationship with your husband or kids/grand kids?

5. Did you choose to do it or did your siblings pick you?  You will harbor resentment if you let them talk you into it.  Be sure it’s your choice.  It is a hard job, both physically and emotionally, and though it may only be a few daytime hours to begin with, it could turn into a full time job or beyond – it could eventually require 24 hours a day, 7 days a week. 

6. Respectful: Can you treat your parent with respect, regardless of their state of mind or physical abilities, or lack thereof?  Though you may think she has reverted to child-like behaviors, she is not your child and she deserves your respect.  She will sense it and resent it if you treat her in a child-like manner.

7. Insist that your siblings participate in some way.  If one lives far away, can he or she be responsible for finances? Routine bills, property management and investments can be handled online.  Ones who live close can come in one or two days a week (at least a half a day) to give you time off.  You will need it and deserve it, as in any job, and it gives others a chance to see just what is involved in caring for your parent.  If additional funding is needed (groceries, incidentals, bills) be sure the expenses are shared by all.  Don’t spend down your own resources or make sacrifices that will later impact your long term care.

Helping one’s parent age with dignity at home is one of the most loving things you can do.  It has it rewards, but as the primary caregiver, it can impact your life with your siblings and your own family after your parent is gone.  Consider these 7 points and know that even if you hire a caregiver, whether full or part-time, you are providing your parent with the chance to age in place with love and dignity.

Read more about these and other eldercare issues in About this Book.

Gail McGonigle, author, Dad’s Home Alone, Caring For Your Elderly Parent.
Email me: gmcgonigle@att.net