It is a concern many caregivers have: "Should I encourage my parents to get more help? The last time I visited, my mom seemed very confused, like she just wasn't quite there. Dad didn't seem to notice and didn't want to talk about it when I asked him."
If you do not see your parent often, changes in his or her health may seem dramatic. In contrast, the primary caregiver might not notice such changes, or realize that more help, medical treatment, or supervision is needed. Sometimes a geriatric care manager (GCM) or other professional is the first to notice changes. For families dealing with Alzheimer's disease and other dementias, it can be easier to "cover" for the patient—doing things for him or her, filling in information in conversations, and so on—than to acknowledge what is happening.
A few good conversation starters are:
- If you thought there might be a change in Mom's condition, whose opinion would you seek?
- I didn't notice Dad repeating himself so much the last time I was here. Do you remember when it started?
Some changes may not be what you think. Occasional forgetfulness does not necessarily indicate Alzheimer's disease. Before you raise the issue of what needs to be done, talk to your parent and the primary caregiver about your concerns. Try not to sound critical when you raise the subject. Instead, mention your particular worry, for example, "Mom, it looks like you don't have much food in the house—are you having trouble getting to the store?" and explain why you are concerned. Listen to what the primary caregiver says about the situation, and whether he or she feels there are problems.
Discuss what you think needs to be done: "Do we need to get a second opinion about the diagnosis? Can you follow the medication schedule? Would you like some help with housework?" Try to follow up your suggestions with practical help, and give specific examples of what you can do. For example, you might arrange to have a home health aide come in weekly. You might schedule doctors' appointments or arrange for transportation.
In some cases you may have to be forceful, especially if you feel that the situation is unhealthy or unsafe. Do not leave a frail adult at risk. If you have to act against the wishes of your parent or the primary caregiver, be direct and explain what you are going to do. Discuss your plan and say why you are taking action.
Geriatric Care Managers
Here's an example of how a geriatric care manager can help:
Gina lived in Phoenix, and her father, Bill, lived alone in an LA apartment. She visited him several times each year. When she began to notice that Bill was starting to have problems managing some things on his own, Gina called the Area Agency on Aging. The Agency staff helped her to set up daily meal delivery and a home health aide for Bill. A few months later, Bill fainted in church and was taken to a local hospital. He was there for a day before someone was able to track Gina down. The hospital discharge planner wanted Gina to come in person to discuss what her father needed—but Gina couldn't get away immediately. Her husband suggested hiring a geriatric care manager, someone based in LA who could keep tabs on Bill more efficiently than Gina. Now a care manager visits Bill once a month and calls Gina with updates and recommendations.
Professional care managers are usually licensed nursing or social work professionals who specialize in geriatrics. Some families hire a geriatric care manager to evaluate and assess a parent's needs and to coordinate care through community resources. The cost of an initial evaluation varies and may be expensive, but geriatric care managers can offer a useful service. They are a sort of "professional relative" to help you and your family to identify needs and how to meet them. These professionals can also be helpful in leading family discussions about sensitive subjects.
When interviewing a geriatric care manager, you might want to ask:
- Are you a licensed geriatric care manager?
- Are you a member of the National Association of Professional Geriatric Care Managers?
- How long have you been providing care management services?
- Are you available for emergencies?
- Does your company also provide home care services?
- How will you communicate information to me?
- What are your fees? Will you provide them in writing prior to starting services?
- Can you provide references?
To find a geriatric care managaer near you, start your search with the AgingCare.com Geriatric Care Manager Directory »
The National Institute on Aging (NIA), one of the 27 Institutes and Centers of the National Institute of Health (NIH) leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. In 1974, Congress granted authority to form NIA to provide leadership in aging research, training, health information dissemination, and other programs relevant to aging and older people.