THE FAMILY CONVERSATION #3

As people age in place, they often require more assistance to remain safe and comfortable in their homes. In some cases, your loved ones may need help getting around or taking care of daily chores. In other instances, caregivers may recognize that their parents or relatives need more substantial help, from warning signs such as:

• Withdrawal from social interactions
• Neglecting personal care or nutrition
• Signs of forgetfulness—for example, piles of unopened mail or unwashed laundry
• Mismanagement of monthly bills or odd purchases.

In-home care services can provide many different things, but generally, such services enable individuals with functional or physical limitations to remain safely in their own homes. They might be available for people who recovering from an injury or returning from hospitalization; those who are chronically ill or disabled; or those who are getting older and frail. Typically, home-care services fall into two broad categories:

• Non-medical supportive services. These care services may assistance with shopping and transportation; homemaking, such as meal preparation, cleaning, yard work and laundry; and custodial or personal care, such as bathing and getting dressed.
• Home health care services. These services may include some non-medical assistance—helping older adults with activities of daily living—but also involve care from health care professionals, such as licensed practical nurses, therapists, or home health aides. Most of these professionals work for home health agencies, hospitals, or public health departments licensed by the state.

Home care services may be provided short-term—for a few days or weeks—or long-term, over a period of many years. Some types of care and community services are free; other types you must pay for. But this type of care is usually less costly than care provided in an assisted living facility or nursing home, and it goes a long way toward lessening anxiety about the future for seniors and their family. Sometimes government programs or your health insurance will help cover the cost of certain home care services.

This is an opportunity for another kind of family conversation, sharing concerns, needs, and options with other family caregivers.

It’s not usual for your loved ones to resist help. It can be emotionally difficult for people to recognize new limitations; it means accepting a loss of independence. Add to that the anxiety
parents feel about being a burden to their family—and whether they’ll have enough money to cover expenses for professional caregiving assistance.

It’s important to respect the wishes of your loved ones and get their input. You may need several discussions to unearth sensitive issues. Compromise may be required; your loved one may agree to the major needs and accept help for other needs later. Priorities may change as circumstances change, either gradually or suddenly.

Here are some guidelines for planning and carrying out such conversations:

• Consider a “circle of care,” involving several family members, as well as a doctor, social worker, geriatric case manager and member of the clergy to help build trust and a sense of safety—for both your loved ones and you.
• Find ways to get other siblings involved— even if it makes sense to have one primary caregiver. Allow for different points of view. Listen to your other family members.
• Be careful not to make your parents feel infantilized or pushed into situations. If you think your loved ones can do something by themselves, let them. But if they could be harmed, don’t feel guilty about getting involved.
• Identify areas or care that require the most attention and suggest specific options. Make a list of all the needed tasks and create a plan that assigns who will be responsible for completing each task, as well as follow-up meetings to evaluate your plan and make necessary adjustments.

Here are four big issues likely to come up in the course of such conversations:

Driving. Nothing gives people a greater sense of independence than driving, but if a senior’s physical of cognitive skills become diminished, driving through hectic Long Island traffic may become a risky endeavor. If your parents are not ready to give up the keys, try to negotiate ways they can drive the car less frequently, perhaps only locally and in the daylight. (Several private local driving schools offer driving skills courses for seniors, and AARP also offers several useful programs, including Driver Safety Courses, “Carfit,” and “We Need to Talk.”)

Finances. If there’s no evidence of problems, it’s better for caregivers just to offer help — like balancing a checkbook or organizing documents, which may give a sense of the bigger financial picture. But keep your antennae up for hints of trouble, like the misplacing important papers or questionable spending (seniors are often targets of scams).

Home Safety. Review the steps outlined in Part II of this guide, assessing your loved ones’ home for fall prevention and overall safety. People can be slow to accept their physical limitations, so if caregivers see their parents having problems with gait or limb strength or has recently started using a walker or cane, it’s time to start the conversation—before some crisis occurs.

Health and Medications. If your parents seem healthy, there’s no need to intervene, but keep a watchful eye. Seniors may not fully understand their medical reports, or they could be withholding information because they don’t want you to worry. If family members observe any symptoms, or notice that a parent is mixing up medications, it’s time to step in.

Questions to Ask

When hiring a home health worker from an agency, consider these questions:

• Does the agency have a brochure describing services and costs?
• Does the agency have a current license to practice, if required by the state?
• Does the agency prepare a care plan for the patient, with input from the patient, his or her doctor, and family members?
• How closely do supervisors oversee care to ensure quality?
• How does the agency document that its services were completed?
• If the caregiver is sick or otherwise unavailable, what are the alternative arrangements?
• How are agency caregivers hired and trained?
• How does the agency screen prospective employees, including criminal background checks?
• Will the agency provide a list of references for its caregivers?
• Is there a sliding fee schedule based on ability to pay, and is financial assistance available to pay for services?
• Is the agency bonded and insured in case of injury or theft?
• What is the procedure for resolving problems, if they occur?

If you’re hiring home health care directly from an individual provider instead of an agency, it’s even more important to conduct a thorough screening, including an interview with the home health caregiver. Whichever way you choose to hire, spend time preparing the person who will provide care. Spend a day with the caregiver before the job formally begins to discuss what is involved in the daily routine—and put a daily care plan in writing. Inform the agency and caregiver (both verbally and in writing) of various factors affecting your loved ones’ care, such as:

• Health conditions, including illnesses and injuries
• Signs of an emergency medical situation
• General likes and dislikes
• Medication, including how and when each must be taken
• Need for dentures, eyeglasses, canes, walkers, hearing aids
• Allergies, special diets, or other nutritional needs
• Therapeutic exercises with detailed instructions

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