General
One of the joys in living is being independent. As fully-functioning adults, we are able to pay our bills, grocery shop, clean our own homes, garden at leisure, and participate in activities that bring us pleasure. As we become older, we may lose the ability to care for ourselves, due to chronic arthritis or other conditions. We may not be able to answer the phone, we may not be able to climb stairs to get to the bedroom, and cutting the lawn and or tending to the garden may become difficult due to the inability to push the lawnmower or get down on our knees. Sometimes a little help is all that is needed in order to remain living independently.
In the past, care of the elderly typically fell to the extended family. Now, with smaller families, older adults living longer, and families living further apart, care of the elderly is not only falling to (often long-distance) family members, but also to independent caregivers, the state or charitable organizations.
Whether caring for an elderly family member or an elderly client, caregivers often have multiple challenges to overcome. As our needs and abilities change throughout the years, there are issues that may arise -- health challenges (physical and mental), housing concerns, transportation needs, financial issues, and end-of-life decision-making are some of these, and planning will be important.
Good Mental and Physical Health
Good mental and physical health is something we can easily take for granted until it begins to decline. Our memory may not be as adept due to the aging process, or we may have been diagnosed with memory issues due to Parkinson’s, Alzheimer’s or any one of a number of other diseases. Our ability to make adjustments can be exhausting, but also very empowering.
Housing
Housing may be one of the adjustments that are necessary. There are some things you can do to stay in your own home. Physical alterations, such as handles for getting in and out of the shower, non-slip flooring, a different telephone, or a lifeline emergency medical alert system may make it possible to stay in the home. Home health care may be another possibility for those faced with more challenges. When independent living is no longer an option for elders, there are several other housing options available. In Michigan, there are adult foster care homes, assisted living homes, adult day care centers, respite care, nursing homes, and other options. It’s extremely important to recognize that the cost of each facility is different, and methods of payment vary from place to place. In order to get specific financial information, contact the owner or admissions coordinator of the facility you are interested in.
Transportation
Because our transportation system is built for the average person’s sight and abilities, as we age, transportation issues will eventually arise. It is a difficult choice -– put yourself or others in jeopardy by driving unsafely, or give up the freedom and privilege of driving altogether. Although not being able to drive impacts our lives in a big way, by planning ahead, the transition can be less traumatic for us, and safer for those around us.
Financial Well-Being
Financial well-being is an important component to be addressed when making adjustments due to age, and especially if someone has a disease that will get worse over time. You can be more prepared by becoming familiar with any insurance you have that concerns illness and long term care. Government programs such as Medicare and Medicaid also have programs that you may want to learn about ahead of time.
End-of-Life Decisions
End-of-life decisions are never easy to make. It’s a discussion that all family members should be part of. Questions regarding end-of-life decisions should be made before a crisis arises. Designation of a medical patient advocate and implementing hospice care are two important issues that should be addressed.
- Designation of a patient advocate allows the chosen individual power to make medical treatment decisions, and personal care and custody decisions, when the patient is unable to make their own medical treatment decisions.
- Hospice is a type of care given to someone facing the last stages of a terminal illness. To be enrolled in hospice, a physician must write an order. Hospice includes palliative care (comfort care) and can be provided in various settings. Hospitals, a hospice facility, nursing homes, and the patient's own home are some of the environments that hospice care is given.
- Palliative care (comfort care) can help people coping with any stage of a disease, whether curable or incurable, and focuses on relieving and preventing the suffering of the patient.
- Caregivers needing a break from care giving may want to learn more about respite care. This allows an older adult to be placed in a temporary facility, so that the caregiver can attend to whatever needs they may have -- whether that be a much-needed vacation or dealing with other issues.
There are many issues concerning aging. When we were children, we were gaining control over things. Even though things were difficult because of our physical or mental limitations, things got better. Aging is part of the process of living. We get wisdom and experience -– yet are asked to give up independence. By doing research, planning ahead, and making small changes, we can try and maintain an equilibrium that we need in order to thrive.
Other Areas of Concern
Along with the aging process comes additional challenges such as memory loss, elder abuse, and hoarding.
- As people get older, some memory loss and forgetfulness is common. It doesn’t necessarily mean that they have Alzheimer’s disease. In the past, forgetfulness was called “senility.” Now that word has been replaced by the word “dementia.” Although Alzheimer’s disease is the most common form of dementia, dementia is a symptom that can be present in many other conditions. Some thyroid conditions or vitamin deficiencies can cause dementia. Learn more about Alzheimer’s disease and other diseases that can cause dementia by referring to the Alzheimer's Association.
- Elder abuse and neglect may consist of the following types: physical abuse, exploitation, violation of basic rights (opening mail, making phone calls), psychological abuse, self-neglect, sexual abuse, neglect and abandonment. It is important to be attentive to older adults who could be victims of abuse.
- Hoarding is a psychological disorder which causes a person to collect a large number of possessions. Hoarding is estimated to affect 1.4 million homes in the United States, and it is believed that only 10% of all the cases of hoarding gets the attention of public officials. Hoarding involves more than just hanging on to junk, and can become a health hazard for the one who suffers from the disorder, as well for as their families and the community.
Planning for elder care involves much more than just a few phone calls or emails. You will need to know the answers to specific questions when talking with family members, health care providers and others involved in the care of your loved one, especially in emergency situations. Below are questions to consider as you plan the care of your loved one. Try to involve others who will be able to take an active role.
Planning
What information do I need to gather? Who do I need to involve? Which family members and friends can take an active role in providing care? Who are the professionals (doctors, lawyers, financial institutions and advisors, etc.) that we need to contact? Who will take care of important things during a crisis, e.g. spouse or partner, pets, mail, bills, messages, plants and flowers, other outdoor maintenance?
Where do I find help? Ask for support and resources from the social work team at the hospital or the primary care physician's office, and see Elder Care Resources.
Long Distance Caregiving
Caring for a relative who is living in a different town or state than you can be a challenging and sometimes overwhelming experience. There are resources available to assist you with decision-making as you embark upon the journey of long distance caregiving. Expect to have several conversations over a period of time, as needs evolve.
U-M provides support programs through the Geriatrics Center including the Turner Senior Resource Center, Housing Bureau for Seniors, FASCCO (Faculty and Staff Counseling and Consultation Office) and OCWR (Office for Counseling and Workplace Resilience for Michigan Medicine employees). Even if your relative lives far away, these local resources provide an excellent source of education and support to help you know what to look for and what questions to ask.
Help Your Relative Accept Care
- Explain that you want the best for their health and comfort. Acknowledge and address any of their concerns.
- Treat them with respect and realize that they are ultimately in charge of their own care, unless they are unable to make decisions. Having a financial and medical power of attorney set up in advance makes it much easier to make decisions if your relative’s condition worsens.
Identify Caregiver Support
- Establish a relationship with your relative’s church, neighbors, and/or personal circle of friends. Collect phone numbers and/or email addresses for contacting them with your questions/concerns. Be sure they all have your contact information as well.
- Solicit help from other family members either through a regularly scheduled phone conference call or arrange for an in-person meeting which may involve travel for some. It may be helpful to have a professional lead the family meeting if one is available.
- If your relative has been admitted to the hospital, there may be social workers there who can assist you with planning.
Consider a Care Manager
If a close neighbor, family member or friend cannot be identified, and you need someone to help provide informal support and formal services to your relative, you may want to consider hiring a professional care manager. A care manager (also called a case manager) specializes in assessing and monitoring the needs of older adults. Names of care managers are available from the National Association of Professional Geriatric Care Managers.
When contacting a care manager, consider asking the following questions:
- What services are offered?
- What are the care managers’ professional credentials and licensing?
- How much experience does the care manager have in providing caregiving services? What type of services have they provided in the past?
- What are the fees associated with this service?
- Can a list of references with contact information be provided?
- Is the care manager available for emergencies?
Check-in Regularly
- This can be tailored to the person’s needs by considering how often visits may be required, taking turns with other friends/relatives when planning visits, or having someone who lives near your relative make regular visits.
- When visiting, assess their ability to provide self-care including preparing meals, access to healthcare appointments and medications, transportation, errands and chores, money management, social activities, and psychological health. Be aware that some medications can bring about unexpected changes in physical and mental health.
- Use phone calls as a way to check in regularly. If your relative has a hearing problem, arrange a specific time so your call is expected. If you don’t have time for long daily conversations, ask them to leave a short phone or email message daily to “let you know all is well.” Or, send them a quick message and await their reply.
- Listen for any changes in their interactions with you on the phone. Ask about how they are doing in order to assess whether any additional support will be needed.
- Schedule doctor appointments to coincide with your visits so you may become familiar with the doctor and his or her staff. Have your relative complete a HIPAA form (Health Insurance Portability and Accountability Act) with each of their physicians to authorize you to have access to their medical information.
Gather Information
- Keep track of personal information, insurance and medical information, medical providers’ names and contact information, legal and financial information, and more.
- Keep photocopies of important documents such as Social Security cards, health insurance cards, other insurance documents, a will or trust, advance directives or living wills for end-of-life wishes, and Durable Power of Attorney documents for health care and finances.
Locate Housing Options
- Most people want to stay in their homes as long as possible. There are many ways to make modifications to make the home safer. One source to contact is the National Association of Area Agencies on Aging. Their primary mission is to build the capacity of its members to help older persons and persons with disabilities live with dignity and choices in their homes and communities for as long as possible. The n4a administers the Eldercare Locator, a public service of the U.S. Administration on Aging or (800) 677-1116.
- Other options include adult foster care, independent living in a senior community, assisted living, memory care, and long term care in a nursing home or hospice. There are many national search databases that identify facilities by zip code such as the Eldercare Locator. This can provide a good place to start, however asking for referrals from others in the community is also a valuable way to find quality facilities.
- See other Elder Care Resources.
Connect with Local Resources
- Identify local friends, relatives, religious groups, or neighbors who can be trusted with a home key and help check in on your relative. Knowing someone who can be called upon in an emergency can help ease your concerns. Be careful not to over burden neighbors and friends, caregiving can be a very daunting task. Be sure to have a key made for yourself as well.
- Establish a list of local names and phone numbers for your relative’s physicians, dentist, landlord, utility companies, and others who may provide services. You may want to call periodically to see if there are any problems/concerns regarding payment.
- Consider setting up automatic deposits of Social Security and other income and automatic payments for monthly bills. You may want to consider setting up a joint pass through account to just pay bills. This is helpful if the older person is in the hospital or in rehabilitation for an extended period of time or if they have some cognitive limitations and are at risk of late payments or unpaid bills. Also share copies of a financial or medical power of attorney to enable a caregiver to discuss financial matters and the older person’s status with their healthcare providers.
- Connect with other groups such as organizations, clubs, and religious communities in which your relative participates. Ask if they have a network of volunteers that can assist you. Check to see if they have a local Meals on Wheels program.
- Consider hiring a non-medical home care agency to assist with meal preparation, companionship, and other basic needs such as bathing. Be sure to do your due diligence in screening the agency’s hiring (e.g. drug screening and criminal background checks) and supervising practices for their caregivers and be aware of their business practices (e.g. rates, minimum service hours etc.). You may also want to arrange for a house cleaning service once or twice a month.
- Consider setting up an emergency medical alert system that provides a way to request immediate help in the case of an emergency. One way to find options is to do a web search for medical alert systems. Be sure to ask about fees and 24/7 response time if requests for assistance are made.
- Check if local pharmacies or grocery stores will deliver. This is very important if your loved one should become homebound for an extended period of time.
- If they are in assisted living or a nursing home, be sure to establish a good working relationship with the staff. Check in with the staff on a regular basis to ask for their observations or input. You may want to have someone pay an unscheduled visit to check out how things are going. You need to be an advocate. Review the care plan and be sure your relative gets what they need. Participate in their care conferences in person or over a speaker phone. Make sure the staff knows your wishes. Do you want to be called before your relative goes to the emergency room or soon after? Do you want medication changes to be discussed with you prior to a change being made or afterwards?
- See Elder Care Resources.
Child and Family Care does not endorse or represent any information or resources listed as recommended by U-M.