Decision Points: When Do You Call in Professional Caregiving Help and What Kind Do You Get?

For most of us, caregiving sneaks up gradually. We start helping our elders a little here and a little there. However, as illness and frailness of age drain vitality from our elders they need more care. This is when the adult child often has to make some touchy decisions.

There are, of course, times when sudden changes occur with an elder, as with a stroke. Even then, however, the elder is generally hospitalized and upon returning home, would qualify for some nursing care paid for by Medicare. However, when that care stops, the adult child in this situation is in the same predicament as the person who had caregiving sneak up on her.

Then, of course, there are people like me, who have multiple care receivers, each with different needs. Over the span of two decades, I cared for the varying needs of seven elders. In caring for them, I used many of the care options available at the time. Now, however, there are many more options, which is wonderful but can also be confusing.

Let's go with the sneak-up caregiving as an example for making care decsions, since that is a step by step process. First, your mom and dad need just a little help. You are the only adult child in town, so you are "it," so to speak. That's fine. You don't mind helping out with some chores around the house. You even run over and mow the lawn on the weekend. But then, Dad takes a tumble and breaks his arm. End of casual caregiving.

You have a job and family. Your mother is small and rather frail and can't handle your dad in this condition. Medicare pays for some nursing care out of the hospital, but nursing care is the least of the problems. The things Dad used to do around the house aren't getting done, and Mom is so upset she can't even cook a meal well, let alone get a grocery list made up. This is a good time to consider hiring an in-home agency for a few hours a day.

Yes, you'll still be very involved in care, but an in-home agency will send a person around to bathe your dad, help your mom with a grocery list and even take her for groceries. They will set up things for dinner and do some other chores. Your folks can afford this for awhile, so it works out okay.

But then, Mom starts acting funny. She gets lost when she's on her way to church. You find her hearing aid in a planter with the ivy. She thinks the in-home caregiver is stealing things. So, you take her to a doctor and she is diagnosed with third stage Alzheimer's disease. She gets some medication that helps with the paranoia, but your dad can't handle her all day long. Okay, now what? Adult day care could work well here.

Dad will continue to recover from his broken arm. He can get Mom off on the day care bus, then putter around the house and do what he needs to do. He can have some social time with his buddies, too, before Mom comes home. He can even have a nap, which he'll need, because she'll be up and down a lot at night.

Though still rare, there are a few night care options opening up now and I expect them to increase. People with Alzheimer's are often geared toward being active in the late after noon and they want to be up at night. So, for Dad and Mom's sake, if the day care center starts a night service it's worth looking into.