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

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.

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.