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Providing Home Care for an Older Adult: A Good Fit?

Daily home care
There's rarely one perfect solution for providing daily care. It boils down to weighing and balancing many factors to settle on the best option.

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November 9, 2010

What to consider when an older adult needs daily care at home

When someone you're caring for begins to need daily care, one option is to set up systems to provide care in her own home. Whether this will work depends on many factors, including her health and your ability to give or hire care. The first step is to realistically review what's involved.

Will it work on a practical level for her to live at home?

  • Start with a medical consultation. When an older adult needs daily assistance, start by consulting with her doctor about housing options. Be sure to ask how her needs could change over time, which may influence your decision.
  • Home safety and accessibility. Her house may need adaptations, such as grab bars in the bathroom, handrails, and wheelchair ramps. Are these changes doable? Will stairs, stoops, and narrow hallways make getting around difficult or impossible if she uses a wheelchair or walker?
  • Room for overnight caregivers. If she needs 24-hour in-home care, is there sleeping space for an overnight caregiver or room for another bed or large couch?
  • Space for equipment or supplies. Does she have enough room for a hospital bed (bulkier than a regular bed), commode, oxygen tank, or other portable medical equipment if needed?
  • Bathing. Because they're weak or have trouble balancing, some older adults can only bathe in a bathtub. Others need a freestanding shower stall with handholds. Can these adaptations be made?
  • Proximity to you. Does she live close enough so you can assist with her care without long commutes? If she lives far away, can you manage -- and afford -- the traveling back and forth, or can you afford to hire a caregiver and possibly even a care manager?

Can you or she afford it?

  • Will you need to cut back on your work hours? In some cases, managing home care in someone else's house is only possible if you, your spouse, or another caregiver leaves a job or works reduced hours. Can you afford this?
  • Paid caregivers. Providing daily care often requires the help of paid caregivers, including overnight coverage. Factor this into your budget.
  • Home upgrades or accommodations. Consider the costs of any needed remodels, safety-proofing, or accessibility accommodations such as wheelchair ramps.
  • Distance. If the older adult lives far from you, take into account the costs of commuting and long-distance calls -- it might be worth buying an unlimited calling plan.

Do you have enough caregiving and emotional support to provide daily care to an older adult?

There's rarely one perfect solution for providing daily care. It boils down to weighing and balancing many factors to settle on the best option. Home care is challenging, but it can also be deeply rewarding. Caring for an older adult in her home is a great choice for some and simply not workable for others. Other options to consider include moving her into your home or into an assisted-living community.

Support considerations

  • Caregiving support. Daily care requires hours of labor. Many people use a combination of family members, friends, and paid caregivers. Are you comfortable building and managing a network of caregivers? Do you have family members or friends who can pitch in and help on a regular or occasional basis, especially if you can't afford hired help?
  • Outside caregivers in her home. Is she comfortable having paid "stranger" caregivers in her home?
  • Overnight care. Will she need 24-hour care? If so, how do you feel about organizing this level of care? It can be especially tricky if you live far away, but possible if you have enough family friends or relatives and can hire some help.
  • Breaks. All caregivers need time off, and sick days are inevitable. Any care plan should include backup for caregivers, including you.
  • Emergencies or unexpected events. Obviously, an emergency is more challenging if you're not on the scene. If a caregiver suddenly quits or the person in your care has a medical emergency in the middle of the night, you'll need to have a plan in place. A personal emergency response system is also a good idea.
  • Your daily routine. Can you adjust your routines to make enough time for daily care management if you don't have hired help? Do you have scheduling wiggle room; or are you OK with cutting back on your activities if necessary, including what you do for fun?
  • Getting her out and about. Will she need to be driven everywhere, by you or someone else, or can she use public transportation or paratransit? Are there reliable senior transportation or paratransit services in her area?

Emotional considerations

  • Your feelings. Being responsible for a frail older adult can be draining, especially if she's very sick or experiencing dementia. Do you think you can handle all of this emotionally, and do you have the support you need?
  • The older adult's feelings. Most older adults prefer staying in their homes, or "aging in place," for as long as they're able, and it's beneficial for their health and well-being. But some are more relaxed in a situation where they feel more supported, like an assisted-living community or your home. Pay close attention to her opinions and ideas, and give her as much control as possible.
  • Family dynamics. Spouses, kids, and grandkids can all be affected by home care, even when it's done in the older adult's home rather than your own. What will change for your family? How do you think it will affect your marriage? Consider holding a family meeting or two to discuss changes, fears, and expectations. Remember that caring for someone usually has rewards, too.
  • The reality of intimate care. Daily care can include personal tasks such as bathing, dressing, toileting, and feeding. Some people are more comfortable with this than others. If you can't afford a paid caregiver, can you handle these tasks?
  • Your instincts. Does your gut tell you it's a workable situation?

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Thoughts and stories from others
  1. November 24, 2010 at 2:25 am | Posted by JaneeS

    I'm thankful to have family in the neighborhood to help take care of my dying mother-in-law. She has 2 adult children who were entrusted with financial aspects and legal status through powers of atty. My husband is very busy in the military and we live 2 hrs away. The daughter lives in San Francisco and has POA and primary financial info for her mother. She is 8 mo pregnant, just got married and is very self-centered naturally. Yet I am doing this mostly alone. I have found a live-in assistant that I think I need to demand more of. When my MIL returned from a Hospice hospital facility I ended up in the middle of a nasty situation about hiring full time care. Husband fully agrees with my decision but his sis is in a dreamworld that we should "just do what Mom wants". I have said to every one that I have to make thee decisions since no one else is but I strongly consider what Mom wants. So they say "no,no" one of them will always be there plus they are so paranoid that someone will steal all the nice stuff from the house. I can't believe their naivety, having seen my own family go thru this several times. Finally when hubby could come there, they believed what I was saying. AS if I were LYING that we needed extra help and I was just trying to push them around on my own. Neither hubby nor sis saw their father suffer and pass in about a week. I was there to help. Hubby saw him sleep at the very end, but sis couldn't come until 2 days later. She had NO idea of what her mom and I faced in the hospital before he passed just 3 months ago. I'm glad hubby is here to see and help Mom in some ways. SO I pull the night shift and it is totally throwing me off. Many days I am needed to coordinate with Hospice, insurance co, home healthcare agency, visiting nurse, creating computer forms to ensure who knows what to do and when, phone calls, bill paying and figuring out what food we should make for the family. Meanwhile working to buy a house 100 miles away with a bank that is giving us the hardest time.I have so many contractors to hire and be there to show the house, but WHEN? on weekends, the rest of the family disappears, as if, the "kids" are here to take care of things.So hubby and I both try to handle everything with a bit of respite health from the home aide.We have to arrange for med equip, supplies, copies, banking, proper meds.So where are the family members who"would always be there and Mom would never be alone." ? If this were a different forum, I'd be cursing my head off, so I just say &$^&^$!!!! I am a project engineer by profession, so I am used to handling many aspects at once, but I feel anger toward the other family members. Don't tell me something and change the rules half way thru. As usual I give people a chance and find that no one does what is agreed, so I have to treat them like a bunch of idiots. One of the family who helps is even an RN! When I'm not there, and can't make it back by a certain day since our new house buying is falling apart and I have several important health appointments, I just perceive they are "disappointed or taken aback that I can't make it back as planned". Yes, I am sensitive too, and I know I'm doing the best I possibly can. Our home aid spend lots of her time watching TV and cooking African food, plus bits of house work. She does jump up in a flash when I need her at night. I guess I need to create more of a job description for her. I feel like I'm the only non-idiot there. Even my hubby mostly sits with his mom, plays his iPod games, offers drinks. Meanwhile the bills come so I hand him a check and say "sign". Other wise he'd lose everything everywhere. He does handle a lot of the new house financial and legal aspects, but it's getting to the point that we need contractors that I have to choose before we can move and rent out our old house. The Hospice nurse estimated that Mom might be gone by New Year's. I'm not happy to hear of an end date, but I can't stand to see her shriveling away with no strength, saying "I wanna dye". Well, if we lived in a Dr. Assisted suicide state, maybe she would have more control. She ABHORS being in this condition Some days she looks like she'll pass in a couple days but then she again gathers some strength to wake up and have tiny bites of food. It's the painful waiting game and no one except my mother understands. Just had to get that off my chest. I'll probably find another place to post too.

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