From the category archives:

Home Care

Long Distance Caregiving: Tips to Managing Your Aging Parents’ Needs

by stephanie on February 15, 2010

Written by: Stephanie Erickson, MSW, PSW, LCSW 

As our parents age, it becomes harder and harder to feel secure that they are safe and healthy in their home.  This becomes even more difficult if we do not live nearby and are unable to “pop in” to make sure they are okay.  We are left to rely on their self-report of their situation. 

If our parents have memory problems, we wonder if they are accurately reporting what is happening.  We may also believe that they are minimizing their struggles for fear that they will be forced out of their home.  Even if our parents live in senior’s community, assisted residence or full care facility, we still worry if they are getting all the care and attention they need.

There are some things we can do from a distance to increase our full understanding of their situation, to improve the communication we have with them, and to manage the risks inherent in long distance (and close distance) caregiving.  All of these suggestions can be done via the internet and phone.

  1. Ask your parent to sign a consent to release information from all of their health care providers so that you can gather collateral information about their functioning.  Get a list of the names and phone numbers of these individuals.
  2. Encourage your parent to complete a power of attorney at all of their financial institutions so you can monitor their management of money.  Make sure to tell them that you do not plan on taking over; you just want to oversee to ensure they are not being taken advantage of by another and if they have questions, you can assist them. 
  3. Encourage your parent to draft a Mandate/Living Will/Durable Power of Attorney for Health Care so you have the legal authority to make decisions and manage their finances if they become unable to do so.
  4. Ask your parent to list all of their utility providers, their mortgage carrier, car insurance, etc. and account numbers and to give these facilities authorization to share information with you so if they are confused about their accounts, you can assist them.  (See our website for a complete list). 
  5. Arrange for automatic bill pay where applicable.
  6. Ask your parents for the location of all important documents (power of attorney, birth certificate, deeds, etc.). 
  7. Obtain LifeLine, Medic Alert, or another type of safety system so that your parent can access help if he/she falls or has another emergency.
  8. Obtain a list of individuals nearby who could stop by your parents’ home if you have an immediate concern (neighbor, friend, relative, etc.)
  9. Obtain a complete and updated list of all medications, prescribed and over-the-counter.
  10. During a visit to your parents, conduct a home safety assessment and make all necessary modifications to the home.  (See our website for a complete list of areas to observe).
  11. Prepare a list of private and community agencies that are available to make visits to your parents for future or immediate reference.
  12. If your parent is at a facility, get the names, phone numbers, and emails of at least two professional staff members (nurse, social worker, etc.) and make contact with them periodically to foster an on-going relationship.
  13. If you can afford it, arrange for a monthly visit from a social worker or nurse to monitor your parents’ safety and report back to you.  The money spent will be worth the peace of mind and may prevent major crises.
  14. Begin a journal of all of the above information, as well as on-going updates about your impressions of their functioning, including specific examples (i.e., my mom called me again to ask about her phone bill; I noticed she has lost weight since our last visit, etc.). 
  15. Monitor the following when you visit: Physical appearance and hygiene, medication administration habits, ambulation risks and falls, home cleanliness and organization, food acquisition and preparation, driving, memory loss, ability to express thoughts, social interaction or isolation, judgment, decision-making, etc.)

For further information and more detailed toolkits that outline each of the above areas in more detail, please refer to our website. http://www.ericksonresource.com/estore/

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Home Safety Checklist for Your Aging Parent

by stephanie on February 8, 2010

Written by: Stephanie Erickson, MSW, PSW, LCSW

It is very scary to know that our parents are living alone in their home as they begin to lose physical and cognitive functioning.  We want to respect their decision to remain autonomous at home for as long as possible so we search for ways to make this happen.  The following is a complete list of all of the areas in your home that present a danger to your parent or loved one, outlines the factors that increase risk and offers concrete suggestions to reduce the identified risks.

Emergency Preparation:

  1. Get the name of neighbor/friend/relative and phone number to contact in the case of an emergency and you are not able to get to your loved one’s home.
  2. Post your name and phone number next to every phone AND give this information to AT LEAST one neighbor/friend.
  3. Obtain the name of a community member, social worker, other professional to contact in the case of an emergency and/or regular updates.
  4. Give an extra key to a neighbor or friend, have an extra key for yourself, and hide one outside the home (if you feel comfortable) so someone can gain access to the home in an emergency.
  5. Register with Medic-Alert or LifeLine and get a bracelet for your parent so he/she can access help if there is a fall.  See our website under Resources for a link.
  6. Make sure all legal documents (power of attorney, mandates in the case of incapacity, etc. are updated and complete).

Risk Factors for a Fall:

  1. Over 75 years old
  2. Living alone
  3. Housebound
  4. Use of cane/walker
  5. Previous falls
  6. Acute illness, chronic conditions, tremors (neurological disorders)
  7. Multiple medications
  8. Cognitive impairment
  9. Vision and hearing problems
  10. Difficulty sitting/standing from a chair/bed
  11. Foot problems
  12. Alcohol/drug use
  13. Poor nutrition
  14. Balance/equilibrium problems

Bathroom Safety:

  1. Install grab bars in the bathtub or shower and by the toilet
  2. Use rubber mats in the bathtub or shower
  3. Use a shower chair or bench
  4. Take up floor mats when the bathtub or shower is not in use
  5. Install a raised toilet seat
  6. Remove tub and install a shower with a minimal step-up
  7. Place a chair in shower stall
  8. Use a telephone shower head

Kitchen Safety:

  1. Use automatic tea pot
  2. Remove rugs without a non-stick service
  3. Place frequently used pots and pans at waist level to minimize bending and stretching
  4. Use a microwave to reduce use of oven/stove
  5. Disconnect stove/oven fuses if there are memory impairments and it has been left turned on in the past

Outdoor Safety:

  1. Repair cracked sidewalks
  2. Install handrails on stairs and steps or install a ramp
  3. Trim shrubbery along the pathway to the home
  4. Install adequate lighting by doorways and along walkways leading to doors

Living Space Safety:

  1. Remove throw rugs, or tape down to secure
  2. Secure carpet edges
  3. Avoid visually distracting patterns on flooring/carpets
  4. Mark transitions from carpet to flooring with a different color paint/stripe
  5. Remove low furniture and chairs that are too low to get up/down
  6. Remove objects on the floor
  7. Reduce clutter
  8. Remove cords and wires on the floor
  9. Avoid floor wax or use nonskid wax
  10. Ensure the telephone can be reach while laying on the floor

Stair Safety:

  1. Install hand rails on both sides of staircases at elbow height
  2. Make sure an adult can wrap their hand completely around the handrail
  3. Attach them securely to walls or posts
  4. Secure carpet on treads of stairs
  5. Install light switches at the top/bottom of stairways
  6. Do not reduce lighting in stairways; in fact, increase the lighting
  7. Do not place rugs at the top/bottom of stairs
  8. Leave one hand free to hold the handrail when carrying objects
  9. Check lighting for adequate illumination at night, especially in the pathway to the bathroom and on stairs

General safety:

  1. Wear shoes or slippers that fit properly and have a non-slip sole
  2. Remove reading glasses when walking up/down stairs
  3. Install a telephone on every level of the home, especially in the bedroom, kitchen, and bathroom
  4. Install a bathroom on each floor
  5. Understand side-effects of medications, such as dizziness
  6. Avoid alcohol
  7. Avoid carrying large or heavy objects, such as laundry baskets
  8. Get up slowly from a sitting or laying position; sit on the side of the bed before rising
  9. Wear clothing with an elastic waistband for easy removal

For further information, please contact Erickson Resource Group at www.ericksonresource.com

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“I don’t need any help!” – Introducing Home Care to Resistant Parents

by stephanie on January 11, 2010

by: Stephanie Erickson, MSW, PSW, LCSW 

Every time you visit your parents, you notice that they are having more and more difficulty keeping the house clean.  They seem to be losing weight, and when you look in the refrigerator, you can see why. Clearly their nutritional needs are not being met.  You suggest they bring in private help a few days a week to help with the shopping, cooking and cleaning, but they will not even consider it.

Does this sound like your parents?

As a geriatric social worker, the question I get asked most often is, “Do you have any suggestions of how I can get someone in the home to help my parents?  They just won’t agree to help.”  Boy!  Do I wish I had a cookie cutter answer! 

In reality, there are so many different personality characteristics and past experiences that impact one’s openness and willingness to acknowledge deficits and accept help.  I cannot give you the guaranteed solution.

Below are some basic suggestions to assist you in introducing home care assistance.

  1. Lower your own expectations.  It is not realistic to expect that individuals who have been managing their own life from A to Z are going to welcome others taking over.  Understand that things will not change overnight.
  2. Acknowledge their fear.  Most seniors feel that once they accept help, even in the most minimal way, it is the “beginning of the end” for them.   This is scary and they want to prolong this first step for as long as possible.
  3. Introduce the topic slowly. Start by asking your parents some open ended questions, such as, “Tell me how you’re managing the housekeeping?”  Not, “Can you do the housekeeping?” – which will draw a quick “yes” and an abrupt end to the discussion.
  4. Start with housekeeping.  This is usually the least threatening type of help and the one most appreciated.  If your parent already has a housekeeper, how about suggesting that “large” chores are done by someone else, i.e., washing windows, and that you know of someone who is available and good.
  5. Give the gift of help.  Instead of presenting help as a “need”, give your parent a gift for the holidays, a birthday or anniversary.  You can frame it that your spouse/friend gave you the same thing (i.e., housekeeper for 3 months), and you found it so incredible, you wanted to share the joy.  You may find that they are relieved once the assistance begins.
  6. Qualifications.  Make sure that the housekeeper is a qualified nurse’s aide (attendant, caregiver) and able to assist with personal care (bathing, dressing, etc.), even though this service will not be introduced at this time.  Professionals will understand and expect that their introduction into the home may be about “housekeeping” for a period of time.  At least you know that this person has additional skills if needed in the future.
  7. Introducing housecleaning.  Ask your parent what tasks in which they could use help.  DO NOT decide for them.  Suggest large tasks such as window washing, floors, toilets…this may feel less threatening than imaging a stranger washing their clothes.  Once the housekeeper is there, she can offer additional tasks gently and at your parents’ pace.
  8. Building on existing housekeeping. When there is already a housekeeper in the home, ask if this person is available and willing to provide more help.  If they are, perhaps they could take some basic nurse’s aide courses to learn about assistance with transfers and bathing.  If not, this housekeeper could suggest a “friend” (the aide you find) to provide cleaning when she is out of town or busy.
  9. Introducing groceries and cooking.  Suggest the housekeeper start to phone your parents prior to her visit to state that she is running to the grocery store on the way to their house and would your parents like her to pick up a few things (milk, coffee, bread).  Presented in this fashion, it will not feel like your parents are in “need”, but are benefitting from a convenience.
    1. Slowly, this person can ask if they would like her to “run to the store” quickly at the end of her day.  Soon, she can suggest she bring them along to do the shopping themselves.
    2. One day, this person can show up with a bag of groceries, stating they have a “surprise” and cook a meal WITH your parents (if they want).  By this time, there should be a nice rapport and relationship, so this would be a fun activity to do as “friends.”  Again, this is not a “need”. 
    3. Over time, this could build into a weekly/daily activity.
  10. Introducing medication assistance.  Once this person is in the home, they can ask to assist your parents with minor organization, such as placing their medication and other supplies in one location.  Then, this person will have access to their medication and can slowly begin to monitor the medication to ensure it is being taken properly.
  11. It costs too much!  When/if your parents resist due to finances, there are a few ways to proceed. 
    1. You can pay yourself, if you have the money. 
    2. You can sit down with your parents and review their finances to reassure them that they have the funds.  Look into tax write off’s for home health support.
    3. If you have a banking power of attorney, you can make the payments directly so your parents do not have to see the bill.
    4. You can find low cost support through a community agency.
    5. You can arrange with the provider/aide that services rendered more often are at a reduced rate, making it more affordable to your parents.
    6. IF you have discussed “assisted living” environments in the past, you can compare costs.
    7. Be honest! You can talk about the risks that are currently in the home.  Are your parents willing to end up hospitalized and then placed in a facility?  Or, would they rather spend some money up front?  Not eating well is a risk that can lead to hospitalization and subsequently a medical evaluation that finds the person incapable of living autonomously.
    8. You can look at existing insurance policies to assess if there are funds available, or if the policy can be “cashed out” and used towards help.
  12. Following up.  When you ask your parents how this “housekeeping” is going, again, use open ended questions to encourage their verbalization of the benefits.  For example, “What did she do today?”  (Oh, how nice!)  “Are there ways she’s helping you that you didn’t expect?” (Oh, how nice).  If your parents do not want to “fess up” to all the things this person is doing, do not push it.  Does it really matter?  As long as they are getting what they need, you can find out from the aide/caregiver what she is doing straight from her!
  13. Discuss your concerns lovingly.  When you were a child, your parents encouraged you to make healthy and appropriate decisions.  You are honoring them by behaving in the same way, making good decisions for their health and safety.  Share this with them.
  14. Be honest.  Your parents will know if you are trying to “trick” them and this never works.  If you’re introducing someone through the existing housekeeper, make sure that the new person and the existing housekeeper meet ahead of time so when she is introduced to your parents, you can honestly say they know each other.  Or, if you give the gift of help, make sure you DO use it prior to honestly share what your experience was like.  Dishonesty will always backfire.

For more information or to obtain toolkits to assist in the organization or management of your loved one’s personal, health and financial affairs, visit my website at www.ericksonresource.com or contact me directly at stephanie@ericksonresource.com

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