- DR. MARION'S METHOD
- CAREGIVER TRAINING
15 Things You Can Do to Keep Mom and Dad at Home
U.S. News & World Report
Few people gleefully anticipate the task of caring for an aging parent—but plenty seem to deny that it's coming. Sooner or later, avoidance can thrust adult children into the caregiver role with a shotgun start. A parent's slip in the bathroom or a collision caused by a mistake in the driver's seat can precipitate a deluge of anguished decisions and rapid changes you're not ready to handle. Suddenly, you could be scrambling to locate account numbers to pay Mom's bills while she's in the hospital, tangling with her insurance company to figure out why coverage for an X-ray was denied, and consulting with your brother—who lives three states away—about getting Mom into an assisted-living facility. You grapple with guilt because your mother never wanted to move out of her home, but now her condition leaves little choice. As the drama plays out, you're also trying to stay afloat at work and look after your other dependents, the kids.
The first step toward avoiding such baptism by fire is to acknowledge you'll most likely take on caregiving responsibilities someday. According to the Family Caregiver Alliance, the number of "unpaid family caregivers" is set to reach 37 million by 2050, an 85 percent increase from the year 2000. You can help your parents stay happily independent as long as possible if you start those tough conversations now and do some thorough preparation. Here's a game plan.
The vast majority of senior citizens want to live out their days in their own homes—and without being a burden on their kids. Planning ahead greatly raises your odds of making it happen.
1. Consider hiring a pro. A knowledgeable, neutral professional can assist from the start, even when your parents are still living at home. Locate an expert through the National Association of Professional Geriatric Care Managers to help navigate everything from finding a companion service for Dad to identifying a mediator to help settle family differences over caregiving choices. "You may think you can handle it yourself, but you can't—not when you're so [emotionally] close to the situation," says Don Terrell of Ellensburg, Wash., who got help from a geriatric care manager later in the process when his family sought a facility for his mom, who has Alzheimer's disease. According to NAPGCM, an initial assessment runs $300 to $800, and services cost $80 to $200 per hour, depending on where they're needed.
2. Keep track with technology. Helping your parents remain in their home may be realistic but typically requires at least a few adjustments to keep them comfortable and safe. Savvy families are deploying products like QuietCare, which relies on strategically placed motion sensors, to keep tabs on their elders. Phyllis Baker's 80-year-old father lives alone outside Detroit, nearly five hours away from her home. But she needs only to check her iPhone to allay worries, she says, like "Has he gotten out of bed? Is he in the bathroom and never came out?" No cameras or microphones are involved, so her dad has privacy, and a secure website updates a status report every two hours. QuietCare calls immediately if anything is out of the ordinary. Inspired by her two sons, marines regularly deployed overseas, Baker is considering another tech boost: webcams for "virtual meals" together.
3. Remove booby traps. The National Association of Home Builders has certified aging-in-place specialists who can consult and make structural changes. Extras that you or a specialist might install, says Meri-K Appy of the Home Safety Council, include antiscald devices for showers and faucets (like H2O Stop, a new product) that protect older skin, which is quick to sustain serious burns; alternatively, set water heaters to "low" or at 120 degrees. Carbon monoxide detectors are recommended since elderly people are sensitive to even low concentrations of the deadly gas. Special smoke detectors with strobe lighting or a vibrate feature can wake them up when conventional devices wouldn't—new research suggests the latter are set at frequencies that many elderly people can't hear. Grab bars in the shower and near the toilet are usually a must, but their often ugly appearance isn't. Moen's new SecureMount options are an improvement on institutional-looking models, says Appy, and they don't require tearing down tiles.
4. Visit frequently. The time together matters, plus you'll have a better sense of whether they're safe, mentally sound, and in the best living situation, says Alexis Abramson, author of The Caregiver's Survival Handbook. Keep an eye out for subtle changes: Are the plants watered? Is unopened mail piling up? Do they have bruises suggesting they may have fallen? Enlist your family and your parents' trusted neighbors to check in.
5. Anticipate expenses. To help maintain your parents' independence and health, you'll very likely need to pay for a few services. The national average for a home healthcare aide to assist with hygiene and medication, say, is $19 per hour, according to a MetLife Mature Market Institute analysis. Think Medicare will pay? Not if they need the aide for a chronic condition, says Mary Lynn Pannen, president of NAPGCM. "I dispel this myth all the time." Adult day care averages $61 per day, according to MetLife. Lisa Midden got financial assistance for her 88-year-old dad through a Florida state Medicaid waiver and a local grant, but he must requalify each year. "Until we learned about these [benefits], everything was coming out of our pocket," says Midden, whose father lives with her and her husband in Orlando. A few afternoons at adult day care and several hours from a nurse's aide are covered each week, plus the Middens get 12 weekly hours of "respite care." Start with your local Area Agency on Aging.
It's now known that regular exercise can protect older people against disease and make them functionally younger by 10 or 15 years. Indeed, the American College of Sports Medicine and the American Heart Association have recently published exercise guidelines for seniors that call for several workouts a week. Some additional precautions:
6. Work with the pharmacy. "Poor medication management is the No. 1 reason for leaving an independent living situation and going into supervised care," says Elinor Ginzler, coauthor of Caring for Your Parents: The Complete AARP Guide. Your father may see five different specialists yet fill all prescriptions in one place, so his pharmacist could be the only provider with an eye on all his meds; befriend this point person. Since aging alters drug metabolism, ask about side effects your father should look for, including those that could arise if prescribed meds interact with any over-the-counter drugs or supplements he's taking. Most pharmacies can repackage pills that should be taken together in a "calendar card," an easy-to-use blister pack.
7. Get help behind the wheel. One of the messiest challenges for adult children and their parents to navigate is the driving question. Sometimes a few more years of safe driving are realistic—"if problems are caught early enough," says Dannielle Sherrets, manager of AAA's traffic safety research and analysis. AAA and AARP offer classes for "mature operators" that can yield car insurance discounts. AAA also has started CarFit, a program that invites seniors to bring their vehicles in for ergonomic adjustment; staff may recommend gadgets like mirror add-ons or tools to help arthritic wrists turn a key with less pain.
For parents, the idea of stopping can be daunting and depressing, and it can inspire the most vehement, stubborn refusal. But bodies stiffen, reaction time diminishes, and cognitive abilities may wane. When driving gets dangerously erratic, a serious talk about hanging up the keys becomes necessary. If met with resistance, enlist authorities like the parent's doctor or the DMV—flunking a vision or driving test won't get a license renewed. But resentment is sometimes unavoidable. Marion Somers's father kept deflecting her efforts to talk about his dwindling skills. Her concern for his safety—and that of others—eventually won out. Though it drew ire, "I sold his car for $1,700, and that became his transportation fund," says Somers, a gerontologist and author of Elder Care Made Easier.
8. Draw up the documents. All adults—but especially older ones—are advised to designate a healthcare power of attorney, also known as a healthcare proxy, which is the person to make healthcare decisions on your behalf if you're unable; create a living will, which (unlike a will that designates assets after death) details such things as the circumstances in which you wouldn't want a feeding tube to keep you alive; and consider talking to a doctor to decide if you want a do-not-resuscitate order, which instructs healthcare providers in the event the heart or lungs stop. A state-specific healthcare proxy and living will can be downloaded free from www.caringinfo.org. And a certified elder law attorney can help you fill them out correctly, says Lawrence Davidow, past president of the National Academy of Elder Law Attorneys. A common pitfall: A parent lists two children as proxies. In some states, including New York, that voids the document unless one child is listed as "primary" and the other as the alternate. Make copies of the completed documents and share with family, healthcare professionals, and even close friends. "The worst thing you can do is execute these and stick them in a drawer," says Ginzler.
Senior citizens are particularly vulnerable to financial distress once they're living on a fixed income and experiencing some cognitive decline. Here's how caretaking children can help:
9. Discuss the money. The World War II generation tends to guard financial information and independence, driving some proud seniors to foolhardy measures, says Kenneth Kamen, president of Mercadien Asset Management in Princeton, N.J., and an expert in retirement planning. An older woman he knows racked up $31,000 in credit-card debt before her family found out. It resulted from household expenses that were just beyond her fixed monthly income. "For some seniors, [debt's] the only way they're getting by," says Kamen. The financial details need to be teased out, he says, especially if you suspect your parent might need to lean on you. He recommends starting the money conversation with an advice-seeking approach: "Dad, Sue and I are thinking of buying long-term-care insurance. Did you and Mom do that?" If he shrugs you off, explain you're simply trying to plan your own finances and wonder if you might need to someday help pay for his care.
10. Add a caveat to the durable power of attorney. Another document to complete is a durable power of attorney, which names a person who will control Mom's finances if she can't. Technically, no one else has access to the financial records, so errors can go unnoticed, says Kim Hubbard, interim director of the elder abuse prevention program at the California advocacy group WISE Seniors. Moreover, she says, the majority of financial elder abuse is perpetrated by a relative—sometimes the one holding power of attorney. She recommends that seniors add a detailed paragraph that names a second person, be it a professional accountant or personal friend, who will take a look at bank statements monthly and do an in-depth analysis of all financial records yearly.
11. Find extra money. Financial tools like a reverse mortgage can improve seniors' cash flow, but Kamen suggests downsizing into an affordable, senior-friendly condo first. Your parents might be eligible for benefits that reduce their heating bills or take the edge off prescription drug costs, but it requires looking—and applying. "There are lots of programs out there to make ends meet," says Scott Parkin, a vice president at the National Council on Aging, "but it's rare that more than half the people who qualify actually use them." The council's benefitscheckup.org can direct people to assistance programs.
12. Protect against scams. Seniors are particularly vulnerable to telephone solicitations for phony investments, say, and to getting tricked into sharing their Social Security number. This year, officials reported a spate of deceptive sales of Medicare Advantage plans. It's a good idea to have parents get their credit report checked; all three issuing agencies—TransUnion, Experian, and Equifax—must provide a free annual report upon request. Starting this month, residents of all states can put a reversible "security freeze"—different from a fraud alert—on their credit report, which should block identity thieves from obtaining new lines of credit.
As the losses associated with aging mount, many seniors become isolated and are at risk of suffering from depression. Some ways to make sure they stay engaged with the world:
13. Get them involved. No longer managing the demands of child rearing or a career, many seniors have—for the first time—the opportunity to contribute the wisdom amassed over decades. Determined not to "wither up watching TV," Richard Williams, 71, spends three days each week tutoring middle schoolers in Port Arthur, Texas, through Experience Corps. "The best way to get uninvolved with yourself," says the widower, "is to get involved with someone who needs help." Research has linked participation in Experience Corps to boosts in cognitive and physical abilities and metabolism and to having a broader social network. Other organizations, like Senior Corps, arrange a variety of volunteer programs that include helping kids get immunized, counseling new business owners and teen parents, building houses, and more.
14. Find shared meals. Some seniors have difficulty with meal preparation or simply lose interest in food if they're feeling depressed. So-called congregate meals, which often take place at senior centers and may include transportation, provide a helping of the social interaction everyone needs. "For seniors tending toward depression, it can be a lifeline," says Ginzler of AARP. Such group meals and delivery services, like Meals on Wheels, can be found in their area on www.mealcall.org.
15. Keep them mobile. Surrendering the car keys—or losing a spouse who did all the driving—can bring about an emotionally devastating loss of independence, says gerontologist Somers. Keeping parents involved in the community may require creativity, especially if local public transit is lacking. The solution for Somers's dad before he died was a three-wheeled bicycle that got him around town—and offered a fitness benefit, too. "The stationary bike I gave him became a perfect place for him to hang clothes," she says. He used to put his dog in the three-wheeler's basket and get a kick out of all the waves from passersby.
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