The Who, What and Where of Elder Care

Chapter one

Introduction: Before the Deluge — Be Prepared

It often begins with a phone call in the middle of the night. Dad — a widower for many years — has fallen, may have broken a hip and is in the hospital three time zones away. You're supposed to take the kids to school, get to work and attend a meeting that evening. Instead, you find yourself on the phone for hours, talking to strangers, trying to make arrangements for care you didn't think your father would ever need. You try to organize your own affairs until you can catch the first plane out. Once at the hospital, you hastily select a nursing home based primarily on location and availability, while trying to locate your father's insurance cards, Social Security number and other critical information you know little about, including what he actually will need on hand.

Another scenario begins with less drama but will become equally demanding. You notice that your favorite aunt — the one who always dressed impeccably and never forgot your birthday — has begun to act differently. She is increasingly disoriented and forgetful during your weekly check-in visits. She's begun calling you by someone else's name, has lost weight and neglects to pay her bills. You know you need to do something to help, but you're not sure what to do, or where to turn for help. Both situations are all-too-common reminders that elder care can take many forms and come in many incarnations, from direct intervention during a crisis to regular phone calls to an elder loved one who lives alone. Experts say that, if you have any suspicions or anxieties about an elder's wellbeing — mental or physical — you fall in the category of a caregiver.

Elder care need not always translate to "elder crisis." "Elder concern" can consist of virtually anything centering on someone's care, whether shopping for groceries, helping with bills or making daily visits to a nursing home. Often, elder care comes in stages. The elderly uncle you take to lunch once a week now may become someone for whom you provide fulltime care next year. If you're helping to care for an elder loved one in any way, you can consider yourself a caregiver.

As a caregiver to an elder loved one, you're far from alone. More than one-fourth of the adult U.S. population has provided care for chronically ill, disabled or elderly family members in the past year. Elder-care experts predict that, within the next 10 years, more than 60 percent of this country's adult population will be involved in some type of elder-care activity. As part of the estimated 50 million Americans who are caregivers, take heart: With proper planning and guidance, elder care can be a rewarding experience. To share in the experience of helping another, in whatever ways you can, is not only a way to care for an elder loved one, but gives you a chance to prepare for what may lie ahead in your own elder years.

When It's a Crisis

Not everyone involved in elder care has the luxury of time. Accidents happen, situations arise and, before you know where to turn, someone is asking you to make a decision about something you may never have thought about or wanted to consider. When "elder care" becomes "elder crisis," tough decisions have to be made quickly and confidently. Letting go of perfection, along with self-criticism or self-doubt, will help you make the best decisions possible, even under the most arduous circumstances.

Caregiving is an art, not a science. As difficult as it may seem, try not to let guilt influence your decisions. Trust your gut and proceed with courage.

Most elders who are admitted to the hospital will need further care once the immediate crisis has been resolved. If a loved one is hospitalized, don't wait until the day of discharge to begin planning for continued care. Hospitals employ social workers, case managers and other professionals who specialize in discharge planning. Start talking to them as soon as possible — even as soon as a loved one is admitted — about what type of care will be needed once the elder leaves the hospital.

Make sure you know your elder loved one's blood type, allergies, chronic conditions and medications being taken, and take all medications to the hospital at admission or as soon as possible after admission. This may be the only way to protect against negative drug interactions, especially if your loved one is not fully coherent at admission.

Talk to doctors (don't forget to write down their names and the date of every conversation) about what type of continuing care, if any, your elder loved one may need. Ask frank questions such as, "Is there a possibility my loved one may need to go into a nursing home?" Many nursing homes offer short-term or rehabilitation care. Ask doctors what situation would be best. Ask specific questions about elder care, especially about practical matters such as toilet use and bathing, medical equipment, insurance, and how to hire home-health-care workers.

During a crisis, take time out to organize your thoughts. Write down questions you don't understand and never be embarrassed to answer "I don't know" rather than being pressured into making uninformed decisions. "Don't be shy about asking for help from professionals involved in the care of your loved one," notes Ron Rothstein, president of Levindale Hebrew Geriatric Center and Hospital and Jewish Convalescent & Nursing Home in Baltimore, Maryland. Rothstein advises caregivers to prioritize their decision-making and then to tackle these tasks in a methodical manner. If several family members or individuals are involved, Rothstein says to delegate tasks to those with the best ability to get the task accomplished.

 "People need support during the transition to a nursing home or other facility," notes Doris Randall, LCSW-C, director of Social Work at Levindale and Jewish Convalescent. "Usually, older people have experienced trauma that has taken them from their homes, and they're not sure if they'll be able to go back to their independent living." That uncertainty can create fear and stubbornness or a reluctance to face reality.