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Elder CareTips:
Mastering The Eldercare Maze™
December 1,
2005
Is Staying At Home
The Right Choice?
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We call it "care creep." In the beginning
it's almost unnoticeable as we make a quick trip to the
store or run by our elder's home to drop something off. It
expands to a regular weekend visit, then mid-week trips to
the doctor. Then you're making daily calls to be sure
medications are being taken and your elder is able to answer
the phone. You stop by every night on the way home.
Everyone wants to age at home. If we discount the woman who
for twenty years has detested the retirement location her
husband insisted on, or the couple who are bone tired of
taking care of the empty four-bedroom house they raised
their children in, this is the way most people feel.
But for most of us, even "successful" aging eventually
brings with it some loss of flexibility, some aches and
pains, perhaps vision and hearing changes. It gets harder to
do what needs to be done to stay at home without help. If
memory problems surface it's eventually downright dangerous
to live alone at home. If one spouse needs a great deal of
care, the other spouse can become exhausted and depressed,
and often dies before the more "disabled" spouse.
So, staying at home requires a great deal of thought and
preparation if it is to go well.
Caring for a parent at home can be the most expensive choice
of all the residential alternatives available. In a group
living situation (assisted living, personal care home, or
nursing home) an aide will take care of several people. His
or her salary is spread across all of them. At home, an aide
or companion is giving undivided attention to just one or
two people and there is no one with whom to share the cost.
This can get
expensive fairly quickly.
Once the amount of care needed at home grows to more than 5
or 6 hours a day it begins to be less expensive financially
to look for alternate living arrangements. Of course, this
is "only money." There are a lot of other benefits to
staying at home that have nothing to do with money. But if
money is tight, it can make staying at home difficult if not
impossible as time goes by.
The decision to stay at home should be a joint decision.
Ideally both the caregivers and the care recipient will talk
about what is and what isn't possible to do at home before
urgent needs arise. Unfortunately, we don't always have the
opportunity before an emergency crops up and decisions have
to be made in a hurry. Whether you have the chance to talk
it over ahead of time, or you're working against the clock,
the "thinking & talking" points below should help to clarify
whether staying
at home is the best decision.
Many families say they are willing to do "whatever it takes"
to keep an elder at home. Most often they make this decision
while caregiving is not overwhelmingly difficult. But as
time goes by and demands on their strength and time
increase, they find themselves stretched to the breaking
point - often before they see it coming. This is care creep,
and it's almost universal for those who are trying to take
care of aging loved
ones at home.
Few of us are in a position to leave our jobs and families
to take on complete responsibility for an elder's at-home
care. Eventually almost everyone has to turn to some kind of
outside help. If your elder is capable of understanding
this, and is willing to accept that staying at home will
eventually involve financial costs, then staying at home may
be an excellent choice.
If your elder isn't willing to consider at some point having
help from someone other than family, then remaining at home
will probably be immensely difficult for the long term.
The following checklist gives you some important things to
consider and talk over. Note that most of the items on this
list suggest that the older person must not only have the
funds, but must be willing to use them. He or she must also
be willing to accept the help. This is often the big barrier
that many older folks aren't willing to cross.
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_____ |
I understand that if my needs
increase I will probably have to pay for additional
help to stay at home. I understand the approximate
cost of this kind of help, I have the funds to pay for
it, and I am willing to use my money for the help I
will need to stay in my own home. |
|
_____ |
I have a close neighborhood support
system (other than a
family member) who I can call on in an emergency.
These people are at home during the day and are
willing to help. |
|
_____ |
My home is in good repair, and I
have working smoke
detectors. If not, I'm willing and able to get started
on making it so, or I'll hire someone who can do the
work. |
|
_____ |
I am not confused. I would know
what to do in an emergency. I would be physically able
to do it. If not, I would be willing and able to pay
the costs of having someone stay with me, and I would
be willing to accept someone other than a family
member. |
|
_____ |
I have not fallen more than once in
the past 3 months, or
I was able to get up by myself if it happened. If I
have fallen more frequently I understand that I
probably need someone with me when I walk. This may
not always be a family member, and I am willing to
accept help from others. |
|
_____ |
I can remember necessary daily
activities such as taking my medications and bathing,
or I am willing to accept assistance from someone who
comes in regularly to help me if I cannot do these
things. |
|
_____ |
My bedroom and bathroom are on the
ground floor. |
|
_____ |
I would be able to get around
indoors using a walker or a
wheelchair, or I can afford the necessary renovations.
There are no sunken rooms. Thresholds are not raised.
Doors are wide enough to pass through. |
|
_____ |
Indoor clutter is minimal, or I am
willing to clear out/rearrange my rooms. |
|
_____ |
I have an alternate source for
transportation if I should be
unable to drive, and I am willing to use it. |
|
_____ |
I can prepare nourishing meals and
clean up afterward, or
I am willing to accept (and pay for if necessary) help
with
my meals. |
|
_____ |
I can do light housework and
laundry, or I am willing to
accept and pay for help if necessary. |
|
_____ |
I have an extra bedroom where a
companion or aide
could spend the night. |
If you and your elder have not been able to
honestly say "Yes" to most of these items, then staying at
home for the duration will be extremely difficult,
especially on the elected caregiver. An elder who is too
"independent" to acknowledge that he or she may one day need
help will probably refuse the help when it is really needed.
This can put your care "creep" into caregiver overload and
burnout, as well as create an unsafe living situation.
If your elder does not have the funds to pay for necessary
renovations to his home or for extended care through the
day, this checklist will give you a better idea of when it
will be a good idea to start seriously considering your
alternatives.
Of course, if you're properly covering all your bases,
you'll be looking seriously at all your alternatives before
you make any decisions.
| Why is it that holidays
intended to bring people together are so stressful and
often unhealthy? Make a pact with yourself to enjoy
what's coming, tolerate the inevitable comments that rub
you the wrong way, and assume that every mode of
transportation currently in use will be running late.
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If you know anyone with kidney disease,
especially anyone who is on dialysis, you should know that
their medical regimen is nothing to mess around with.
Getting those medications may be more complicated now that
Part D is here. But there's help especially for renal
patients.
First, the social workers in dialysis
facilities have had special training to help their patients
find the right plan to cover their particular medications.
Make it a point to get together with that social worker as
soon as possible, because the line of people waiting to see
them is only going to get longer.
Second, there is a
website especially for those with kidney disease who are
faced with Part D. You'll find current information about how
to choose a kidney-friendly plan and get the most help
paying for your prescription drugs.
Going home for the holidays? If your elders
live "away," while you're there get a copy of their Yellow
Pages. Bring it home and keep it handy. The next time you
need a local resource for them, if you don't have an advisor
to call, you'll be able to "let your fingers do the
walking."
| Middle age is when you've
met so many people that every
new person you meet reminds you of someone else.
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