Finding Home Care for a Senior Parent

Posted on December 9, 2012

The Right Way to Find Home Care for a Senior

An adult child who is caring for an aging parent may suddenly find that the job of caregiving is too much to handle. The senior parent, who is living at home, may abruptly need someone with them during longer periods of the day and night, or they may even require some skilled care intervention. This is when the search for home care begins.

Assessing the type of home care a senior parent needs
To determine the kind of home care that is essential for the senior, first observe the senior parent. Watch how they senior routine Activities of Daily Living (ADLs) such as bathing and dressing. Also, note any housekeeping or errands that are difficult for them to accomplish. Make a list of all of the areas in which they need help and if outside assistance would improve quality of llife.

The Family Caregiver Alliance offers these guidelines for assessing the home care needs of a senior and for indicating where the caregiver needs support:

  • By assessing each area, the adult child can begin to align support for each need. For example, a friend or neighbor may be able to cover some of the areas of need, or community services, such as Meals on Wheels, can offer aid with other care requirements. If the senior parent has medical needs or requires constant supervision, hiring a home care worker is a viable alternative.Personal Care: bathing, eating, dressing, toileting
  • Household Care: cooking, cleaning, laundry, shopping
  • Health Care: medication management, physician’s appointments, physical therapy
  • Emotional Care: companionship, meaningful activities, conversation

Sure-fire warning signs that a senior needs more help
It is suggested that if an adult child or caregiver notices certain warning signs, the senior probably requires assistance on a more regular basis. Some signs to look for are:

  • Spoiled food that doesn’t get thrown away
  • Missing important appointments
  • Difficulty with walking, balance and mobility
  • Uncertainty and confusion when performing once-familiar tasks
  • Forgetfulness
  • Unpleasant body odor or noticeable decline in grooming habits and personal care
  • Dirty house, extreme clutter and dirty laundry piling up
  • Stacks of unopened mail or an overflowing mailbox
  • Late payment notices, bounced checks and calls from bill collectors
  • Poor diet or weight loss
  • Loss of interest in hobbies and activities
  • Changes in mood or extreme mood swings
  • Forgetting to take medications – or taking more than the prescribed dosage
  • Diagnosis of dementia or early onset Alzheimer’s
  • Unexplained dents and scratches on a car

Where to start looking for home care
Once it is apparent that the senior needs a home care worker or a home health care worker to help them around the house, locating the appropriate individual may present a challenge. Begin by asking people and organizations in the community – friends, local clergy, geriatric care managers or hospitals – if they could recommend a home care worker or a reputable home care agency. Community and local government resources, such as the local Area Agency on Aging, can often give advice on many good options for in-home care.

Whether you’re planning to enlist the help of a home care services agency or hire a personal home health aide, knowing what questions to ask is key to receiving quality assistance. The Society of Certified Senior Advisors has a great list of questions to ask when choosing a home care provider. Click here to read the article.

Understanding what services are offered
Home health care workers provide in-home medically necessary services, such as administering medicine, while home care workers provide in-home, non-medical services such as preparing meals, assisting with hygiene and housekeeping. Either an agency or an independent provider can supply these kinds of services in a senior’s home.

A good assessment by a qualified senior services professional will help align appropriate services, and by not paying for aid that isn’t needed, this assessment can also help keep costs down.

Starting a conversation with a senior parent about home health care
Before approaching a parent to discuss bringing in a home health care worker, put yourself in their shoes. Think about what that senior is most frustrated about and be empathetic. Understanding the situation is extremely important in relating to the senior’s emotions, and timing is crucial in setting the stage. Choose a time when tensions are low and there is plenty of time for a discussion.

To make the conversation the most productive, focus on the senior’s safety and helping them maintain independence. Concentrate on why and how an in-home health care worker can actually make life easier and safer. The Society of Certified Senior Advisors has a comprehensive guide to creating a safe and functional home environment for your loved ones that includes recommendation for home safety changes for each room in the house, what equipment is covered by Medicare and tips for finding the right contractor.Click here to read it.

Jake Harwood, Ph.D., the former director of the University of Arizona’s Graduate Program in Gerontology and the author of Understanding Communication and Aging (2007, Sage Publications), offers tips to help family caregivers communicate with their aging parents on sensitive subjects.

  • Get started. Start observing the senior loved one and gather information carefully and thoughtfully. Don’t reach a conclusion from a single observation and decide unilaterally on the best solution. Base the conversation on multiple observations that are gathered with an open mind.
  • Talk it out. Approach the senior parent with a conversation. Discuss your observations and ask the senior for their opinion about what is going on. If the senior parent acknowledges the situation, ask for their opinion about what would be good solutions. If the senior parent doesn’t recognize a problem, use concrete examples to support the case.
  • Sooner is better. Talk sooner rather than later when a crisis has occurred. If the senior has poor eyesight or has trouble driving at night, begin to address those issues before a problem arises.
  • Maximize independence. Always try to move toward solutions that provide the maximum amount of independence for the older person. Look for answers that optimize strengths and compensate for problems. For instance, if your loved one needs assistance at home, look for tools that can help them maintain their strengths.

Recognize the senior’s right to make their own life choices, especially if a home care worker is coming to the house. The senior is likely to be more agreeable if their concerns or wishes are respected during the decision-making process. The sooner you begin conversations with an aging parent about how they can remain safe and maintain independence by using home care, the easier it will be to approach the topic over the long-term, before any major safety concerns are presented.

Submitted by Gabriela Brown, CSA
Constant Companions Home Care San Diego and SW Riverside

Content by Society of Certified Senior Adviors, Member

Estate Plans Help Seniors Keep Control

Posted on December 9, 2012

Estate Plans Help Seniors Keep Control

More than 70 percent of adult Americans do not have any form of an estate plan legally filed, according to Good Morning America financial contributor, Mellody Hobson. Yet, the process of setting up an estate plan is actually less complicated than one may think. Seniors come from a generation where it was inappropriate to discuss money and death, and therefore, many adult children may find that their parents do not have the appropriate paperwork in place to manage their estates. Or, the senior may not have formal paperwork because they feel that they will just hand down their belongings to their children so there is no need for it.

Becoming proactive toward estate planning
What happens to an estate without an estate plan 
Without an estate plan, decisions about an individual’s property, medical, and final arrangements will be made without input from the individual. Attending doctors or the hospital will make medical decisions, family members will decide on burial arrangements, and state law will dictate the distribution of assets. These considerations alone may be enough to convince a senior that now is the time to formally organize their wishes for the treatment of their medical care and property.

Getting started may feel overwhelming, but keeping it simple and enlisting professionals can help streamline the process and bring peace of mind for the whole family. The conversation about estate planning can be a tough one to start with a loved one, but one that is well worth it in the end because of the time and money it will save the estate and the family members who must sort out the details. suggests these initial considerations for anyone who is looking at his or her estate:

  • What are my assets and what is their approximate value?
  • Which people or organizations do I want to have these assets, and do I wish to give them up during my lifetime or after my death?
  • Who should manage these assets during my lifetime if I become unable to do so or after my death if management is needed?
  • Who should make decisions about my medical care and finances if I cannot make them?
  • After I die, do I want my remains to be donated, cremated, scattered, or buried?

These questions all guide an individual to begin to set up an estate plan. Estate planning is a process where an individual indicates in writing how his or her money and other property should be managed while he or she is alive and after death, and what should happen in the event that an individual becomes mentally incapable of making financial or health-related decisions.

The basic documents that experts recommend that an individual have in an estate plan are a will or a living trust, a durable power of attorney for finances and health care, and advanced medical directives. Depending on the complexity of the estate, other documents may be necessary. Ask professionals, such as an estate attorney, an elder law attorney, a financial planner, and a physician, for guidance with these documents if you are not sure.

A will and a living trust

A will is the most basic estate planning tool and may be all the planning that someone needs. It is a document that names one or more people to manage a person’s estate and declares specific transfer of property. It could be made public and go through probate. A living trust is a more common estate planning document these days. It allows people to control their own assets during their lifetimes and then change ownership of the property in the trust to a named trustee at the time of death. The property is not processed through probate or made public.

Family Education cites three basic reasons why people write wills or create trusts. They want to:

  • Pass their assets on to their family members rather than let the government take over their assets.
  • Keep peace in the family by identifying who gets what.
  • Plan ahead for the costs of incapacity, including the care of their spouse.

Each state has laws regarding setting up wills and living trusts. MetLife has a booklet that helps guide people in creating a will. Download a copy of MetLife’s free booklet on “Estate Planning: understanding distribution of assets and estate taxes.”

Starting a conversation with a parent:

      Opening up the conversation with parents about a will or a living trust can be difficult. Express appreciation for the lifetime of saving they have accomplished, and try these approaches: (sources: Family Education, MetLife):
      • “You have saved wisely over the years and have many beautiful possessions. I really want to carry out your wishes for the future of all that you have accomplished, but I need to better understand them. Do you want to pass down property to the family? Do you want to be able to draw down money from your assets to help care for you and Mom?”
      • Acknowledge that you fully understand that this is their money. Emphasize that advanced planning on their part means that they can keep control over what happens to the possessions they have spent a lifetime collecting. Your goal is to help them keep control – not relinquish it to the government or strangers in a courtroom.
      • Stay focused on your parents’ concerns. This is about them, not your needs and wants. They may be worried that they will outlive their resources or that the kids will fight over the estate. They may be struggling with finding a fair way of dividing up what they’ll leave behind without causing problems between family members. Listen to what they are really concerned about and help them find resolution.
      • If you feel they’re uncomfortable talking with you, ask them to see a financial planner who is an objective third party.

Power of attorney for finances
With power of attorney document, an individual names a trusted person to handle their financial matters if they become unable to handle them on their own. In the event that this document is not on file when a person becomes mentally incompetent, a judge will then appoint someone to manage the finances for them, even if the person appointed is unfamiliar with the individual or their money matters.

If your parent wants to appoint you as their power of attorney, they should inform you of their decision and share with you their financial situation and specific wishes.

Starting a conversation with a parent:

      Protecting assets is the main focus here. Given the gravity of the topic – money – emotions can run high. Encourage your parent that it is in his or her best interest to appoint a person whose actions have shown that he or she can be trusted to manage your parent’s finances should something happen. This is an opportunity to assure that the money your parent has spent a lifetime accruing is in the best possible hands.

Advance medical care directives and power of attorney for health care
These documents are crucial when the individual is no longer capable of making decisions about life-prolonging treatments and medical care in a hospital, whether because of a lengthy illness or a sudden unexpected accident.

Advance medical directives specify your treatment wishes, such as a “do not resuscitate order”, tests, surgery, medication, and organ donation. This document clearly indicates which course of action the doctor, hospital and your appointed power of attorney for health care should take with regards to your health if you are unable to communicate that yourself.

The power of attorney for health care, or health care proxy, is someone that is named by the individual who is trusted by the individual to carry out the advance medical directives and to make medical related decisions that would align with the individual’s wishes should the advance medical directives not specifically cover that issue.

The person who is appointed as the power of attorney for health care should be very familiar with the wishes, any religious and cultural beliefs of the individual that could affect health care decisions. It is best to talk at length about all aspects of a potential medical crisis and the types of decisions that the individual would favor.

Starting a conversation with a parent:

      Health care and medical conversations of this type are never easy because they focus on the realities of end-of-life. Assure your parent that you want them to be as comfortable as possible in the event of an illness or accident and that you have their best interest at heart. Communicate your willingness to abide by their wishes in the event that you are all faced with this situation.

General rules of thumb apply as an adult child approaches estate planning conversations with parents. Always include as many of your siblings or other appropriate family members as you can, so no one feels like they are being left out of the process. The family may appoint one person to discuss all these estate planning documents with the parents or decide that working as a group would be best.

Keep the discussion focused on how to protect the assets the parents have worked so hard to acquire and how to protect their wishes when their health and comfort is at risk. Ultimately, the goal of estate planning is to allow the individual to feel like they have more control over their assets and their health/medical planning than they did before the creation of documents. Legally that is true, so the approach taken with the senior parents should reflect just that. Once the documents are drawn up, they need to be reviewed and revisited periodically or when there has been a life-altering event, such as a death or divorce.

Make your parents and their goals and wishes the primary focus of every discussion and the estate planning will move forward and provide peace of mind for the whole family.

Submitted by Gabriela Brown, CSA
Constant Companions Home Care San Diego and SW Riverside