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.

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    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.


    Now, Dad is showing signs of fatigue and worry over the house. He doesn't get out with his friends and feels isolated. This may be the time to look toward assisted living. Some assisted living centers have memory care units, too, and that would ease the transition for Mom before she needs a nursing home. They could both be in the same center, but in different care units. Dad could see Mom often, but wouldn't be totally responsible for keeping her safe. He can be as social as he pleases, which is great for mental and physical health. He may want to join a card group or other activities. Meals are a snap. And there's no worry about the house.

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    He balks a bit, and grouses some about the change, but soon learns to enjoy having friends right there and not having to be totally responsible for Mom. Then, Dad develops type 2 diabetes, and needs medication for his heart. He gets a little fuzzy about his pills, so you hire an in-home care nurse to set up his medications at the AL. The same woman also takes care of some medical needs for Mom that don't fit into the assisted living contract.


    Then, Mom starts to rapidly go down hill and she also has more problems with her arthritis. She falls often and the assisted living center says they can't handle her anymore. She needs a nursing home. You, being on the ball all of this time, have toured homes and have her name (and Dad's) on the list of a very good one in the same town. You make the call, and within a week there is an open bed.  Mom moves. Dad stays at the assisted living center, as he's happy there, and you take him to see Mom often. And so it goes.


    Of course, the stages of care needed by an elder are not always this neatly arranged. But you get the general picture. All of these services can be useful at different times during your caregiving experience. You may go back and forth between care options, as people do, sometimes, improve for awhile. Also, they may hate having a stranger in their home, but enjoy (once they adjust) their "volunteer" time at the day care center.


    People sometimes need nursing home care right out of the hospital, but then can go to assisted living. This often happens if they already have a spouse in assisted living. If they don't, they may decide to stay at the nursing home, as moves from one place to another can be disorienting and if they've made friends, they want to keep it that way.


    You'll always be on your toes with these agencies. Check them out. Think ahead. Get references. Take tours, but also visit at times of the day when you aren't expected. This applies to home care, as well. Stop in and see Dad during "care" time, to get a feel for the dynamics.


    Whatever outside care help you choose, you are still the caregiver. You are your elders' advocate. You can only do so much alone, but you are part of the care team with each of these agencies. If any agency tries to shut you out, go elsewhere. Your elder needs you.


    Please take advantage of as many care options as you need so you can remain the caregiver who cares, not a burned out shell of your former self. Help is often the best option for the elder and the caregiver. Then, your care efforts can focus on the relationship, not on the nuts and bolts of daily living.


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Published On: July 02, 2009