Aging brings with it changes in our health and/or mental capabilities. If you have an aging loved one, you can save your senior person and yourself a lot of stress and time by preparing now. Locate and organize important documents or at least place them in one specific place, and tell someone where to find them.
Important documents include:
Wills: Names executor, guardian for minor children and distribution of property. Living will: A directive to physicians as to which medical procedures you want taken if you are too ill to state your wishes. Power of attorney: Written authorization for a designated person to act on your behalf for whatever purpose you designate. Durable power of attorney: Becomes effective if you become incapacitated and unable to manage your own personal and financial matters. Health care power of attorney: Names the agent you appoint to make health care decisions on your behalf if you become incapacitated.
Financial documents: Include records of checking account, certificates of deposit, savings, pensions, retirement, Social Security and investments, along with any debt, credit card and loan information.Insurance documents: Include health insurance (personal, Medicare, Medicare supplemental), life insurance, long-term-care policy, home insurance and auto insurance. Personal documents: Include Social Security and driver’s license numbers, military records, birth, marriage and divorce certificates, tax records, passport number, appraisals of valuables. You should also include security system codes, spare keys, codes to locks and firearm location and papers. And—pet records.
Medical records: Should contain physician’s names, prescription information and background on any health issues.
You can help a senior make the transition from being self-sufficient to being dependent while being sensitive to his or her preferences and feelings. Determine the situation as to physical and mental capabilities, ability to pay, attitude toward giving up driving a car, selling a home and moving.
Include in your assessment of the senior’s health: observation of balance, signs of fatigue or sleeplessness, vision or hearing difficulties, depression, dementia and ability to take medications correctly. Additionally, is he/she able to perform basic daily activities like dressing, bathing, using the telephone, using the toilet, rising from a chair or negotiating stairs, shopping, preparing meals, driving safely, doing housework? What about appearance and hygiene issues — personal cleanliness, oral care, combed hair, clean clothes, trimmed nails and appropriate clothing?
This evaluation will enable you to match the care to the need. Types of care include:
Telephone call assurance service: Contacts the senior at home on a regular, scheduled basis to assure he or she is OK and has taken medicines.
Companion/caretaker: Comes to the home to help with chores, driving, shopping and light housekeeping. Some caretakers live in and help prepare food, bathe, wash hair, ensure medicines are taken and generally help with daily living. No medical care is provided.
Visiting nurse: RNs who perform medical care, rehabilitation or hospice care in the patient’s home.
Continuing care retirement community: Offers housing options meeting needs as the needs change, from independent living to assisted living to nursing facilities.
Assisted living facility: Provides continued independence while also providing some care, social interaction and meals.
Nursing home: Provides full-time medical care, meals, housekeeping, laundry and organized activities.
Hospice care: Offers a specific type of care by specially trained nurses and caregivers to terminally ill patients, at home, in the hospital or at a hospice facility.
Some examples of caretaker experiences:
Example 1
Liz’s widowed mother, Sara, rocked along independently in her own residence until she reached her late 90s, when surgeries on her leg prevented her from walking or standing without the use of a cane or walker. Although she had a housekeeper, she now needed help with meal preparation and clean-up, bathing, hair washing and an occasional fall.
Sara lives in another Texas city, and one of her sons lives in the same town and can help with errands and hospital or doctor visits. When a caretaker was hired, Sara was not thrilled with the idea — she didn’t like the idea of a stranger living in her home, and she became demanding, suspicious and complaining. After a few months, the caretaker left because of her own medical problems. Luckily for all concerned, a replacement known to a friend became available at just that time.
Liz says that over the past year or so, Sara has become argumentative and repetitive from the loss of her short-term memory, causing frustration for her family. She is adamant about staying in her own home. She does have Medicare and a private insurance policy, and with these, along with retirement income, is able to pay her own way. Her important documents are organized, and her final wishes have been documented. At 100 years of age, she’s a bit lonely, a little depressed and extremely tired. Liz visits as often as possible and reports Sara “is still as bossy as ever.”
Example 2
Kate’s mother, Belle, lived out-of-state. Around age 72, concerned friends of hers reported to Kate that something just “wasn’t right.” Kate visited Belle and found that she was, in fact, making some very questionable decisions, such as throwing away her husband’s framed Ph.D. diploma while saving his certificate for lifetime membership in the PTA. Kate arranged for the sale of Belle’s house and brought her to San Antonio, setting her up in her own apartment. After a short while, Kate moved her mother into a duplex closer to her home because Belle began talking about things that weren’t actually happening. For a while, things seemed to be going well. That’s until one day when Kate went outside and saw a fire truck parked in front of the duplex! Smoke was billowing from Belle’s side, resulting from a pan of bacon grease left on an active burner on the stove. Belle knew enough to call the fire department, but not enough to open the door for them.
Kate used her two weeks of vacation to find an in-home caretaker for Belle during the daytime. They went through a succession of women — none of whom Belle liked. Finally, she realized she could no longer take care of herself and needed more care. Kate checked out some recommended nursing homes, and Belle chose the one she wanted to live in, paying from her proceeds from her house sale and her retirement income.
Kate regularly visited Belle and occasionally took her out to lunch until it was no longer possible because of her declining mental awareness and safety concerns. She would wander off alone. Kate described this time frame as “like dealing with a 2-year-old in an adult body.” As Belle’s health continued to decline, she “forgot” how to chew and swallow, eating only pureed foods, and spent her time curled up into the fetal position.
Important note: A physician at the nursing home had a feeding tube inserted WITHOUT consulting Kate. Belle lingered two more years in this condition. If there had been a medical power-of-attorney, it would have given Kate the option to speak for her mother.
Example 3
Rose’s widowed Aunt Betsy lived independently in her own home in another state. Over the years, Rose and her family visited their diabetic aunt often. Betsy remained active, driving herself and others to doctor visits and personal errands. Around age 84, her neighbor’s children, who carried out her trash each day and did other odd jobs, noticed one morning that her curtains were still closed and her car was parked in the driveway. This was very unusual, and they told their mother. When they went to check, they found Betsy on the floor. This was the beginning of her two-year ordeal of being in and out of the hospital, diagnosed with congestive heart failure.
When Rose tried to find out medical information long distance, her request was denied. Since they had almost lost her aunt before, Rose obtained the various powers-of-attorney — financial, health, medical — and her will. She was advised to fax the necessary documents to the hospital, and then she would be allowed to check on the status of her aunt’s health.
Finally, Betsy was healthy enough to leave the hospital, but she needed 24/7 health care, so she was now convinced to sell her home and move to a facility in San Antonio, as Rose had been urging her to do for several years. Rose researched several care facilities, and Betsy was settled in immediately upon arrival. She began to have panic attacks when she felt insecure. Not long after, she fell in and out of a coma, but she was awake when she heard the doctor order a feeding tube be inserted. She told Rose, and repeated in front of witnesses, she did not want a feeding tube. With the medical power-of-attorney in place, Rose could honor her wishes.
As Betsy’s health continued to decline, Rose contacted the hospice care of her choice to come to the hospital. The sale of Betsy’s home allowed her to pay for her care, and there was help from Medicare to pay for the hospice services because she had congestive heart failure.
Example 4
When Fran and Joe were a young couple with two small children, they were suddenly thrust into caregiving activities for not one, not two, but three grandparents. They were not the sole caretakers, but were very “hands on,” running errands, visiting, performing chores and dealing with nursing homes.
Only a few years later, they became involved in caregiving again, with their own parents. Fran’s parents, Mr. and Mrs. Jones, moved to San Antonio after her mother’s brain surgery for a benign tumor, her development of heart flutters and a near-death experience.
Although Mr. Jones was happy to care for his wife, they both realized it was time to move close to their daughter in San Antonio. Fran’s father, having held high-level executive positions, planned and built a home customized to meet possible future needs. Included are wheelchair-accessible halls and doorways, handicap-ready bathrooms and a special area for live-in help, all on one level. He also worked with Fran and an attorney for estate planning. This became a very important factor later, when her dad suffered a brain injury, which sometimes leaves him unable to recognize family members.
The Joneses insist on taking care of each other to the extent that they can. There is no live-in caretaker, but a visiting nurse comes by to check vital statistics. Driver/helpers take Mrs. Jones to church, the beauty shop and minor errands. In addition to family visits and holiday gatherings, Fran goes over at least two days per week, takes them to doctor or therapy appointments and does the major grocery shopping. Many times after work, she prepares dinner and dines with her parents as well. Fran, a paralegal, takes care of financial matters, including her father when possible. Mr. and Mrs. Jones can afford their health care, which is fortunate for their children.
Joe’s mother, JoAnn, also requires assisted living and was quite upset when she had to give up driving and move from her home. The move, however, has turned out very well. She has access to a cafe, bank, beauty shop, physical therapy and organized activities right where she lives. She sometimes makes confusing calls to Joe in the middle of the night, which, of course, he must check out. Joe and his family visit regularly, take her to appointments and other outings and have her over for holiday celebrations.
Joe and Fran have learned from their experiences: You need to have a crash course on Medicare. You need to maintain respect for each other. For them, it works best for Joe and Fran to discuss things involving the other one’s parent(s) because “emotional buttons aren’t being pushed.” And, yes, stress is increased on a couple’s marriage, but so is bonding.
Remember, if you are the caretaker in your own home, there are more challenges you may encounter. Caregiving takes time away from your family and from your job. You may have to leave work to take your loved one to doctor appointments, go into work late, leave work early, take days off. You may have out-of-pocket expenses for food, transportation, medical insurance co-payments and medications. You may suffer physical and mental stress, feelings of frustration, exhaustion, anger, sadness or resentment.
Keep in mind that if you and your parent(s) plan for the future, your job will be easier, and they will get their wishes.
