Different people have different views on when a person can live alone, depending on whether the person is your parent, your patient or your neighbor. I think you need to ask these questions. These are the questions a health facility look at on discharge. Are they physically safe? Can they get in and out of bed by themselves? In and out of the bathroom? Can they get themselves out of the house in case of a fire? Are they mentally safe? Can they call 911? Can they lock and unlock doors appropriately to let good people in and keep bad people out? That is really about it. Now the question becomes would their lives be better (safer, improved quality, etc) if they: went to assisted living, moved closer, took a smaller place, on and on. Those are questions only the elder can answer. I see parents in the same light as my semi adult children. I know what is a good decision and I can see the train coming sometimes, but I cannot force them. Sometimes I beg and plead. In the same mind, it is my choice whether or not I pick up the pieces when the train hits.Yes I feel morally and ethically responsible, but it is a decision. Most of us want the best for our parents and we also want decisions that will ease the burden of caregiver that we have assumed. Often our parents motives aren't the same, they want to continue to live at the very edge of their abilities and have the offspring help maintain that style. Caregiving would be much easier if those we cared for accepted the limitations that aging has presented. My mom is a perfect example. She has Parkinson's and had been living on the edge for months in spite of pleas to enter assisted living. She fell at home (thankfully had a cell phone), fractured her arm and has not been able to live alone since then. She is unable to get out of bed and into a wheelchair by herself. I hope these answers have helped.
Assisted living is usually considered an option if someone cannot perform basic ADLs (activities of daily living) independently, or if their behavior could jeopardize themselves or someone else.
Basic and Complex ADLs (Activities of Daily Living) are those activities that are essential to independent living. They consist of basic and complex activities.
Basic activities include: Feeding one’s self Using the bathroom appropriately Maintaining good personal hygiene Dressing appropriately for the season
Some select warning signs: Late bill payments Changes in mood or behavior Missed medications or medications taken incorrectly Repeated accidents in the kitchen or bathroom
We’ve all had these symptoms, And a time or two doesn’t usually indicate a problem caring for one’s self or staying safe. However, if they occur often, you may want to consider a geriatric screening. A geriatric screening is an exam usually conducted at a hospital where you can identify (or rule out) signs of aging that may impair your loved one’s ability to live independently.
Trust your instincts if you feel something’s wrong. If you start to see symptoms, be proactive and consult a doctor.
It is clean! The staff are passionate and full of energy. No one is taken out at sunrise as if they are in boot camp or worse. Those who want to get up and sit, sit. Those who want in their wheelchair, do. But if like my mother they do not want to, they don't.
I visit in a very unpredictable time, part of the day and which day every week. I might and do sometimes show up after the office staff has gone home. The social worker has commented on how observant I am which is true. Take any martial arts for about 10 years like I have and you will become incredibly observant and aware of your surroundings.
I'm complimentary of those I see work with the most compassion for the residents; passion for their work; helpful competency. I also point out areas where I think things really must be done better next time. I find these things are most easily dealt with directly and at the time instead of working through the director of nursing or other administrator type person. When I actually worked, this is how I interacted with people and I still do. Also, when I see an administrative person showing some really good leadership, I'll compliment that too. Mediocrity does not get complimented on purpose so maybe people will notice what kind of worker I do compliment which realistically speaking is not often the case, but one can try.
Let's hope that the place is clean, and that the CNA's are going out of their way to help on all levels. Let's hope also that they don't require the residents to rise at dawn and sit in wheelchairs all day long.
I'm glad that you were realistic enough to deal with it despite how hard it was to do.
My elderly step-dad whose 85 and in a wheel chair and his non CNA or from an agency helper thought they could care for my mother even though she had one seizure after another.
Instead of looking at this as being so bad and hard, try to see it as you did the responsible adult like thing in your role as now the parent type for the aging parent who needed for someone to make this decision for their benefit that they were not able to make for themselves and like a child for whom a parent has made some new rules it's going to be an adjustment. My biggest advice to not hold yourself responsible for her feelings. Let her deal with her feelings instead of absorbing her feelings into your emotions which will get things all chaotic and enmeshed which makes the transition more difficult.
Home health care tried to telling them she was not safe. PT as well as some rescue people who had taken her to the hospital told her that she was really taking a risk staying at home. Her neurologist who she loves so much and the only doctor she has never fired tried to tell her. During that very touch and go year, I was calling my mother twice a day to make sure she took her medicine which was becoming a problem due to her dementia.
I gave them a chance after she got out of rehab with a lot of success after 20 days which now I regret for every bit of progress the gained they allowed her to lose in 8 days at which point she was undernourished, dehydrated, etc.
When I came up to go with her for a doctor's appointment I was appalled at her condition. The doctor told me and the helper that anyone who loved my mother would have her in a nursing home. We got her to a hospital and to a rehab place where she was doing really well once again. That place also has assisted living. It looked like things were looking up until she fell and broke her hip or as I think happens more often broke her hip and fell.
The total impact of this drama led my mother away from fighting the idea of a nursing home to accepting it. Anyhow, that's what she'd been paying premiums for since buying a long term care health insurance plan the year her mother died in 1996. My step dad was afraid to put her in the nursing home and use the insurance because he was afraid the insurance would imprison her there. He is so out of touch with reality that he does not realize that with his limited income, he should thank God she got that policy or he would be homeless. No wonder they got behind on taxes since 2004 and poor things hid the truth from me and my step-siblings which now is almost completely resolved.
To this day, my step-dad thinks the nursing home caused my mother's decline when in fact he and his helper almost killed her trying to care for her at home for they were not qualified and still don't get it that they are not qualified.
It is also tragic that I was not able to get durable or medical POA any sooner than last February for some things would have changed.
For one thing, I would have found that insurance policy sooner and seen all the riders she paid for to cover home health care and home builder care for her.
Dumb step dad would rather not use that for her but instead got some non agency person off the street to help who forged checks for over $15,000, but did not want to believe it when it happened nor did my mother want to believe.
On top of that, my step dad gave the thief some money for his defense against them charging him forgery from three banking accounts. I'm thankful that he never got a hold of the big account which is my mother's private one.
Even more stupid is my step brother does not or refuses to see how incompetent his dad has become, but he's not whom I'm authorized to help. My step-brother has medical and durable POA over my step-dad, but refuses to use it.
And I feel stupid for not picking up on evidence of things not being right. It did not help any that I went on full disability in 2003 with their secret downfall starting in 2004 with my wife going on full disability in 2002.
All of the things posted previously are wonderful indicators and helpful links. Read them. Take them in. Think and ponder on each and every one of them. The answer will come. Keep in mind, it may not be the one you LIKE, but it will be the best one. Whatever the choice you make, you should make without guilt. It's the right choice. If the tables were turned, your parent(s) would do the same thing. It's whatever is best for them at this point. Good luck. Come back to this site. It's a great one.
We just put my mom in a residential/assisted living/nursing home yesterday. She no longer could stay home because of depression and self neglect. She lost her husband, my dad in October, I've been giving her time to grieve but she was going downhill, staying in bed all day and not bathing. She needed alot of help and I had to take her to the emergency room and they put her in a Senior Behavioral Center for a week while I looked for places for her to go into. With the help of A Place for Mom agency we found this small homelike facility for her to be transferred to. It only has 23 residents and 24 hr nursing.She was not happy about being there and had a little tantrum. The manager says it will take about 2months for her to adjust and she will have her good days and her bad. It's been the hardest thing in my life to do but we know it is for the best. I tried to keep her in her home with caregivers but it just wasn't working. We were not qualified to give her the type of care she required.
all situations different- my mom wanted to die in her home- my 44 year old brother has never moved out- they have not good relationship- she 79- always crying and said once that he ignores her- whenever i went over there i wuld have to go to the other living room to see him - never talks to her - she would not admit it - seemed scared- she said she wants to live with me so now she is- has dementia- he has refinanced 4 times and has used up most of equity - he called last week cuz he had someone come over to refi but was not comfortable doing it cuz said she doesnt seem to know whats going on- no one has power of attorney - he asked if i could bring mom to livermore cuz he found someone who would refy the home and give him $39,000- he wants to put siding , new lino, carpet and new cabinets in the kitchen- i said yes- called my other brother and he said no - so now i am calling probate to see what i need to do to get conservatorship- he also told me not to change the soc. sec. deposit into my account that he would write me a check for $600 each month- he kept feb. check - not surprised- so anyway thats where i am at- my mom was not willing to move from her home of 40yrs. and then 1 day she wanted to get the heck out- everyday she asks can i stay here? do you have a bed for me? i say of course you can- and she smiles=yahoo!!!
We have been struggling with the same question for 2 years. We went with my father in law to doctors visits over and over the dr. kept telling us that he should not be living alone but the dr. would not do anything positive to make that happen. Dad refused to move willingly. It was totally up to us. We knew he was declining, physically and mentally but we were stuck in knowing "how" to go about it. We recently met with a Geriatric Care Management Professional for a counseling session. It was so helpful! We had to put the emotions aside and know that if there was danger and health concerns with him living alone, we had to do something for his welfare. The transition just happened and so far we are shocked at how much easier it has been than we anticipated. He is actually seeming to be relieved. We are still praying this one through that the adjustment will take and he will be more and more accepting. Good Luck! Keep in mind safety and health come first.
Leda: we probably need a little more info. about your Dad's current state....
My philosophy is that parents are much healthier and more mentally stimulated if they can remain in their homes. I am a big fan of the "aging-in-place" movement and have been gathering as much info. for my Mom as I can. I was just speaking to a friend yesterday and we marveled at how all our grandparents lived in their homes/apts. until their deaths(they were all in their 70s to 90s and had various illnesses - it was unheard of not to stay in your home back then.)
So far, my Mom has been able to live in her apt. with lots of care from us and a little by a caregiver who comes in once a month or so. As time goes on she may need more in-home care. However, if it gets to the point where she needs more medical and physical supervision that we all can offer, it is in her best interests to be given a safer environment.
You have asked the 64 million dollar question. And there is no one-size-fits-all answer, other than "you will know it when you see it." In the meantime, you can be looking for both in-home alternatives and care facilities in your area.
As caregivers, many of us have taken an oath to do no harm. Sometimes we decide an individual can no longer live alone based on his/her ability to care for themselves. But there's a lot more to it than that.
There has to be an ethical component that includes the impact our decisions will have on the individual and ourselves. In a nutshell, we'll have to be able to live with the decisions we make on behalf of others under our care and supervision. Consulting others in the care team is the best way to know we're doing the right thing.
In the meantime, keep coming back to this site and surf the Net for information. If you go to ask.com and post a question such as the one you're asking here, it'll lead you to many useful articles. On http://www.alzheimer.ca/english/care/ethics-alone.htm, you'll find some tips that you can tailor to your Dad's needs.
That is really about it. Now the question becomes would their lives be better (safer, improved quality, etc) if they: went to assisted living, moved closer, took a smaller place, on and on. Those are questions only the elder can answer. I see parents in the same light as my semi adult children. I know what is a good decision and I can see the train coming sometimes, but I cannot force them. Sometimes I beg and plead. In the same mind, it is my choice whether or not I pick up the pieces when the train hits.Yes I feel morally and ethically responsible, but it is a decision. Most of us want the best for our parents and we also want decisions that will ease the burden of caregiver that we have assumed. Often our parents motives aren't the same, they want to continue to live at the very edge of their abilities and have the offspring help maintain that style. Caregiving would be much easier if those we cared for accepted the limitations that aging has presented. My mom is a perfect example. She has Parkinson's and had been living on the edge for months in spite of pleas to enter assisted living. She fell at home (thankfully had a cell phone), fractured her arm and has not been able to live alone since then. She is unable to get out of bed and into a wheelchair by herself. I hope these answers have helped.
Basic and Complex ADLs (Activities of Daily Living) are those activities that are essential to independent living. They consist of basic and complex activities.
Basic activities include:
Feeding one’s self
Using the bathroom appropriately
Maintaining good personal hygiene
Dressing appropriately for the season
Complex ADLs include:
Cooking
Shopping
Effective communications
Following directions
Taking medications appropriately
Money management
Some select warning signs:
Late bill payments
Changes in mood or behavior
Missed medications or medications taken incorrectly
Repeated accidents in the kitchen or bathroom
We’ve all had these symptoms, And a time or two doesn’t usually indicate a problem caring for one’s self or staying safe. However, if they occur often, you may want to consider a geriatric screening. A geriatric screening is an exam usually conducted at a hospital where you can identify (or rule out) signs of aging that may impair your loved one’s ability to live independently.
Trust your instincts if you feel something’s wrong. If you start to see symptoms, be proactive and consult a doctor.
I visit in a very unpredictable time, part of the day and which day every week. I might and do sometimes show up after the office staff has gone home. The social worker has commented on how observant I am which is true. Take any martial arts for about 10 years like I have and you will become incredibly observant and aware of your surroundings.
I'm complimentary of those I see work with the most compassion for the residents; passion for their work; helpful competency. I also point out areas where I think things really must be done better next time. I find these things are most easily dealt with directly and at the time instead of working through the director of nursing or other administrator type person. When I actually worked, this is how I interacted with people and I still do. Also, when I see an administrative person showing some really good leadership, I'll compliment that too. Mediocrity does not get complimented on purpose so maybe people will notice what kind of worker I do compliment which realistically speaking is not often the case, but one can try.
My elderly step-dad whose 85 and in a wheel chair and his non CNA or from an agency helper thought they could care for my mother even though she had one seizure after another.
Instead of looking at this as being so bad and hard, try to see it as you did the responsible adult like thing in your role as now the parent type for the aging parent who needed for someone to make this decision for their benefit that they were not able to make for themselves and like a child for whom a parent has made some new rules it's going to be an adjustment. My biggest advice to not hold yourself responsible for her feelings. Let her deal with her feelings instead of absorbing her feelings into your emotions which will get things all chaotic and enmeshed which makes the transition more difficult.
Home health care tried to telling them she was not safe. PT as well as some rescue people who had taken her to the hospital told her that she was really taking a risk staying at home.
Her neurologist who she loves so much and the only doctor she has never fired tried to tell her. During that very touch and go year, I was calling my mother twice a day to make sure she took her medicine which was becoming a problem due to her dementia.
I gave them a chance after she got out of rehab with a lot of success after 20 days which now I regret for every bit of progress the gained they allowed her to lose in 8 days at which point she was undernourished, dehydrated, etc.
When I came up to go with her for a doctor's appointment I was appalled at her condition. The doctor told me and the helper that anyone who loved my mother would have her in a nursing home. We got her to a hospital and to a rehab place where she was doing really well once again. That place also has assisted living. It looked like things were looking up until she fell and broke her hip or as I think happens more often broke her hip and fell.
The total impact of this drama led my mother away from fighting the idea of a nursing home to accepting it. Anyhow, that's what she'd been paying premiums for since buying a long term care health insurance plan the year her mother died in 1996. My step dad was afraid to put her in the nursing home and use the insurance because he was afraid the insurance would imprison her there. He is so out of touch with reality that he does not realize that with his limited income, he should thank God she got that policy or he would be homeless. No wonder they got behind on taxes since 2004 and poor things hid the truth from me and my step-siblings which now is almost completely resolved.
To this day, my step-dad thinks the nursing home caused my mother's decline when in fact he and his helper almost killed her trying to care for her at home for they were not qualified and still don't get it that they are not qualified.
It is also tragic that I was not able to get durable or medical POA any sooner than last February for some things would have changed.
For one thing, I would have found that insurance policy sooner and seen all the riders she paid for to cover home health care and home builder care for her.
Dumb step dad would rather not use that for her but instead got some non agency person off the street to help who forged checks for over $15,000, but did not want to believe it when it happened nor did my mother want to believe.
On top of that, my step dad gave the thief some money for his defense against them charging him forgery from three banking accounts. I'm thankful that he never got a hold of the big account which is my mother's private one.
Even more stupid is my step brother does not or refuses to see how incompetent his dad has become, but he's not whom I'm authorized to help. My step-brother has medical and durable POA over my step-dad, but refuses to use it.
And I feel stupid for not picking up on evidence of things not being right. It did not help any that I went on full disability in 2003 with their secret downfall starting in 2004 with my wife going on full disability in 2002.
I believe this books lists some concrete criteria that will help you answer this question. The same material can probably found elsewhere also.
My philosophy is that parents are much healthier and more mentally stimulated if they can remain in their homes. I am a big fan of the "aging-in-place" movement and have been gathering as much info. for my Mom as I can. I was just speaking to a friend yesterday and we marveled at how all our grandparents lived in their homes/apts. until their deaths(they were all in their 70s to 90s and had various illnesses - it was unheard of not to stay in your home back then.)
So far, my Mom has been able to live in her apt. with lots of care from us and a little by a caregiver who comes in once a month or so. As time goes on she may need more in-home care. However, if it gets to the point where she needs more medical and physical supervision that we all can offer, it is in her best interests to be given a safer environment.
You have asked the 64 million dollar question. And there is no one-size-fits-all answer, other than "you will know it when you see it." In the meantime, you can be looking for both in-home alternatives and care facilities in your area.
Good luck...
As caregivers, many of us have taken an oath to do no harm. Sometimes we decide an individual can no longer live alone based on his/her ability to care for themselves. But there's a lot more to it than that.
There has to be an ethical component that includes the impact our decisions will have on the individual and ourselves. In a nutshell, we'll have to be able to live with the decisions we make on behalf of others under our care and supervision. Consulting others in the care team is the best way to know we're doing the right thing.
In the meantime, keep coming back to this site and surf the Net for information. If you go to ask.com and post a question such as the one you're asking here, it'll lead you to many useful articles. On http://www.alzheimer.ca/english/care/ethics-alone.htm, you'll find some tips that you can tailor to your Dad's needs.
Stay sane, Leda. And let us know how it goes.
-- ED