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>> Is Staying At Home The Right Choice? <<

I call it "care creep." In the beginning it's almost unnoticeable
as we make a quick trip to the store or run by our elder's home
to drop something off. It expands to a regular weekend visit,
then mid-week trips to the doctor. Then you're making daily
calls to be sure medications are being taken and your elder is
able to answer the phone. You stop by every night on the way
home.

They say everyone wants to stay at home. If we discount the
woman who for twenty years has detested the retirement
location her husband insisted on, or the couple who are bone
tired of taking care of the empty four-bedroom house they
raised their children in, this is the way most people feel.

But for most of us, even "successful" aging eventually brings
with it some loss of flexibility, some aches and pains, perhaps
vision and hearing changes. It gets harder to do what needs to
be done to stay at home without help. If memory problems
surface it's eventually downright dangerous to live alone at
home. If one spouse needs a great deal of care, the other
spouse can become exhausted and depressed, and often dies
before the more "disabled" spouse.

So, staying at home requires a great deal of thought and
preparation if it is to go well.

Parent at home can be the most expensive choice of all the
residential alternatives available. In a group living situation
(assisted living, personal care home, or nursing home) an
aide will take care of several people. His or her salary is
spread across all of them. At home, an aide or companion is
giving undivided attention to just one or two people and
there is no one with whom to share the cost. This can get
expensive fairly quickly.

I have found that, once the amount of care needed at home
grows to more than 5 or 6 hours a day, it begins to be less
expensive financially to look for alternate living arrangements.
Of course, this is "only money." There are a lot of other benefits
to staying at home that have nothing to do with money. But if
money is tight, it can make staying at home difficult if not
impossible as time goes by.

The decision to stay at home should be a joint decision. Ideally
both the caregivers and the care recipient will talk about what is
and what isn't possible to do at home before urgent needs arise.
Unfortunately, we don't always have the opportunity before
an emergency crops up and decisions have to be made in a
hurry. Whether you have the chance to talk it over ahead of
time, or you're working against the clock, the "thinking &
talking" points below should help to clarify whether staying
at home is the best decision.

Many families say they are willing to do "whatever it takes"
to keep an elder at home. Most often they make this decision
while caregiving is not overwhelmingly difficult. But as time
goes by and demands on their strength and time increase,
they find themselves stretched to the breaking point - often
before they see it coming. This is care creep, and it's almost
universal for those who are trying to take care of aging loved
ones at home.

Few of us are in a position to leave our jobs and families to
take on complete responsibility for an elder's at-home care.
Eventually almost everyone has to turn to some kind of
outside help. If your elder is capable of understanding this,
and is willing to accept that staying at home will eventually
involve financial costs, then staying at home may be an
excellent choice.

If your elder isn't willing to consider at some point having help
from someone other than family, then remaining at home will
probably be immensely difficult for the long term.

The following checklist gives you some important things to
consider and talk over. Note that most of the items on this list
suggest that the older person must not only have the funds,
but must be willing to use them. He or she must also be
willing to accept the help. This is often the big barrier that
many older folks aren't willing to cross.

__I understand that if my needs increase I will probably have
to pay for additional help to stay at home. I understand the
approximate cost of this kind of help, I have the funds to pay
for it, and I am willing to use my money for the help I will
need to stay in my own home.

__I have a close neighborhood support system (other than a
family member) who I can call on in an emergency. These
people are at home during the day and are willing to help.

__ My home is in good repair, and I have working smoke
detectors. If not, I'm willing and able to get started on making
it so, or I'll hire someone who can do the work.

__I am not confused. I would know what to do in an emergency.
I would be physically able to do it. If not, I would be willing and
able to pay the costs of having someone stay with me, and I
would be willing to accept someone other than a family member.

__I have not fallen more than once in the past 3 months, or
I was able to get up by myself if it happened. If I have fallen
more frequently I understand that I probably need someone
with me when I walk. This may not always be a family member,
and I am willing to accept help from others.

__I can remember necessary daily activities such as taking my
medications and bathing, or I am willing to accept assistance
from someone who comes in regularly to help me if I
cannot do these things.

__My bedroom and bathroom are on the ground floor.

__I would be able to get around indoors using a walker or a
wheelchair, or I can afford the necessary renovations. There
are no sunken rooms. Thresholds are not raised. Doors are
wide enough to pass through.

__Indoor clutter is minimal, or I am willing to clear out/
rearrange my rooms.

__I have an alternate source for transportation if I should be
unable to drive, and I am willing to use it.

__I can prepare nourishing meals and clean up afterward, or
I am willing to accept (and pay for if necessary) help with
my meals.

__I can do light housework and laundry, or I am willing to
accept and pay for help if necessary.

__I have an extra bedroom where a companion or aide
could spend the night.

If you and your elder have not been able to honestly say "Yes"
to most of these items, then staying at home for the duration will
be extremely difficult, especially for the elected caregiver. An
elder who is too "independent" to acknowledge that he or she
may one day need help will probably refuse the help when it is
really needed. This can put your care "creep" into caregiver
overload and burnout, as well as create an unsafe living
situation.

If your elder does not have the funds to pay for necessary
renovations to his home or extended care through the day,
this checklist will give you a better idea of when it will be a
good idea to start seriously considering your alternatives.

Of course, if you're properly covering all your bases, you'll
be looking seriusly at all your alternatives before you make
any decisions.

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Why is it that holidays intended to bring people together are
so stressful and often unhealthy? Make a pact with yourself to
enjoy what's coming, tolerate the inevitable comments that
rub you the wrong way, and assume that every mode of
transportation currently in use will be running late.

--Alan Weiss

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If you know anyone with kidney disease, especially anyone
who is on dialysis, you should know that their medical
regimen is nothing to mess around with. Getting those
medications may be more complicated now that Part D is
here. But there's help especially for renal patients. First, the
social workers in dialysis facilities have had special training
to help their patients find the right plan to cover their
particular medications. Make it a point to get together with
that social worker as soon as possible, because the line of
people waiting to see them is only going to get longer.

Second, there is a website especially for those with kidney
disease who are faced with Part D. You'll find current
information about how to choose a kidney-friendly plan
and get the most help paying for your prescription drugs:
http://www.kidneydrugcoverage.org

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Going home for the holidays? If your elders live "away," while
you're there get a copy of their Yellow Pages. Bring it home
and keep it handy. The next time you need a resource for them,
if you don't have an advisor to call, you'll be able to "let your
fingers do the walking."

* * *

If you've got a Reader Tip you'd like to share, please send it
to molly@eldercareteam.com with the subject line "Care Tip."

Let me know if I can use your name. Or if you'd rather have me
leave your name off, that's OK, too.

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Middle age is when you've met so many people that every
new person you meet reminds you of someone else.

--Ogden Nash

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I am collecting testimonials about this e-zine from those of
you who have been subscribers for a while. If you'd like to
provide a testimonial, send it by e-mail and include a link to
your website so I can link back to you:
molly@eldercareteam.com

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I hope everyone had a peaceful Thanksgiving holiday. Those
of you who are caregivers may not have had the most
relaxing of times - the holidays can be stressful for our
elders and sometimes caregivers bear the brunt. If that was
so for you, can you take some time for yourself now that
the big dinner is done? There's another one around the
corner, and we need to store up some quiet and a little
relaxation when we can get it this time of year.

It actually makes the idea of being snowed-in sound kind
of nice. For about 20 minutes.

Molly

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© 2005 Molly Shomer, All rights reserved. You are free to
use material from Elder CareTips: Mastering The Eldercare
MazeT as long as you include complete attribution, including
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Dallas, TX 75370