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When mom and dad can't care for themselves

"Today" contributor Alan Kopit has advice for children faced with placing their elderly mother or father in a nursing home.
/ Source: TODAY

Deciding the kind of care needed for an aging parent can be an emotional and financial burden for adult children with families of their own. But when that time comes and for whatever reason your loved one can no longer live independently, are nursing homes the best answer or are there other alternatives? “Today” contributor and consumer lawyer Alan Kopit has some advice.

So many of us today find ourselves caring for our children and our parents at the same time.  You may find yourself “in the middle” simply because your parents are aging and can no longer do all that they did before or you might be thrust “in the middle” because of a medical emergency.  But whether you can consider the care your parents need without undue pressure, or whether a medical condition requires immediate action, you may need a roadmap to assess alternatives for your parents if living independently is no longer an option. 

Do your parents need help? 
Obviously with age, the ability of someone to care for themselves changes.  You may see changes in driving habits, in your parents’ ability to conduct activities of daily living, or in simply getting around the house. You may also notice changes in personal hygiene, speech, their ability to handle their finances, or to think clearly or remember basic things.  We all want to support our parents’ desire to live independently, even when we have concerns about their safety and well-being.  But there may come a time when you need to step in because their safety and the safety of others are at stake. 

Stepping in starts with an assessment, which is simply a full review of a person’s overall condition to determine his or her ability to remain safely independent.  There are tools available on line, through social service organizations, or with healthcare professionals that can assist with the personal assessment of your parents.

Assessing a parent’s need
An assessment is a comprehensive review of a person’s legal, physical, mental, environmental, social and financial condition, which helps to establish his or her ability to remain safely independent.  It identifies risks, and offers options for reducing them.  A successful assessment will result in a comprehensive plan for meeting needs and addressing problems, whether those needs are met at home, in an assisted living facility, or nursing home.  It is essential that your parents participate fully, if they are able to do so, in the discussion of options. 

It is important to discuss:

  • What your parents need to feel secure
  • Whether your parents are self-sufficient
  • If it becomes dangerous for them to live alone, where they would like to live.
  • You must also learn about their financial condition as this may dictate the type of care they can afford and that can be provided. 

Listing these issues is easy, but actually discussing them with a parent can be very difficult because of your parents’ fears about losing independence and facing a future with unknown consequences.  While it is possible for families to complete assessments on their own using standard checklists, there are also experienced professionals who can help.  Professionals will often be able to assist with communication issues as well, which in many ways can be the most difficult hurdles to overcome.

Alternatives if a parent cannot live safely alone
If an assessment shows that a parent cannot live alone, there are several alternatives:

Home Car
Most people want to stay in their homes or apartments as they always have.  While this is not always possible, there are services and support systems that may make this possible for the short or long-term.  Services include personal care attendants who can help with daily needs, and even a trained person who may come to your home to help with a special health problem.  In addition, there may be services outside the home that permit someone to still live at home but spend the day in an adult day care center, for example, where meals and activities are provided.

Assisted Living Facilities
Assisted living facilities are for people who need some help with daily living, but who want to live on their own as much as possible.  Assisted living is a step between living completely on your own and living in a nursing home.  These types of facilities may offer help with medication, may offer daily visits from trained personnel, may offer activities, may serve all of the meals, and help in an emergency with a trained staff on duty 24 hours a day.

Nursing Homes
Nursing homes are for people who need more nursing care than you would usually get at home (skilled nursing care).  A nursing home may be needed right after you leave a hospital following an illness or injury, or may be the best place for you to live as you age and cannot do much on your own.  In a nursing home there is nursing care 24 hours a day, and all meals and other needs are also provided.  The cost of these facilities can be quite expensive and that may dictate where and what type of nursing home you attend.  Consider the following issues when evaluating nursing homes:

Bed availability (is there a waiting list to be admitted or can one be admitted immediately?)Provision of services that the resident will need (are there special needs of          concern to this resident?)Affordability (can one meet the monthly rent and for how long?)Quality of the facility (what do you know about the living conditions at the nursing home?)Location (is the home located somewhere that is convenient for you or a loved one to visit often?)Continuing Care Communities.  In a continuing care community, you can move in while you are still healthy and active, and stay in the community for the rest of your life.  You will get the kind of care that you need as you age and your health changes.  Continuing care communities are like little towns with different kinds of housing.  There are apartments, small houses, assisted living homes, and nursing homes.  You live in the place that provides the care you need and move when necessary (and space is available). 

Selecting the appropriate facility
Whether someone is using home care, going to an assisted living facility, considering a nursing home, or going to a continuing care community, consider the following before making any of those decisions:

Use your senses
When you visit the facility, does it seem like a cheerful and pleasant place?  Do the residents appear happy and alert?  Are the rooms, hallways and meal tables clean?  Is the facility free from unpleasant smells?  Do the meals look appetizing?

Observe the staff
Does each shift have enough help to be able to care for the residents?  Does the staff appear to be enjoying their work?  How much training is given to the staff?  How does the staff assure family and resident participation in care planning meetings? 

Learn from other residents and their families
Does the facility respect the resident’s wishes about their schedule (for example, activities, bedtime, baths, meals)?  Is attention given to residents at night if they are awake and need help?  Do residents participate in care planning conferences?  Does the resident get outside for fresh air as much as he or she wants?  Who handles resident or family member concerns?

Family involvement
Is the family able to participate, speak up and raise concerns?  Does the family have an opportunity to attend care planning conferences on a regular basis?  Has the family been given an opportunity to get to know the staff and to help them understand the needs of the resident?

Document your evaluation
Be sure to document your reaction to various facilities so that you can “compare notes” after you have done an evaluation.  It may be difficult to remember all of the details if you haven’t taken good notes during the process as a great deal of information will be provided.  Go back for more information if you still have unanswered questions.

Help is available from professionals and other groupsGeriatric assessment centers exist in every community, and are comprised of healthcare professionals such as physicians, nurses, social workers, dieticians, physical and occupational therapists and others who can help to conduct comprehensive assessments if you have any questions.  They can also help you make decisions on what kind of facility is best for your parent.  There are also geriatric care managers who are healthcare professionals with aging-related expertise and a familiarity with services available.  They are especially useful for families who are assisting with care from a long distance. Also, consider these groups for more help:

National Association of Professional Geriatric Care Managers
Website:  www.caremanager.orgPhone: 520-881-8008

AARPWebsite: 800-424-3410

Family Caregiver AllianceWebsite:  www.caregiver.orgPhone: 415-434-3388

Eldercare Locator
Website:  www.eldercare.govPhone: 800-677-1116

National Council on AgingWebsite:  www.ncoa.orgPhone: 202-479-1200