What A Holiday Visit Can Reveal About Your Aging Parents

If you're a long distance caregiver, you may be planning a visit to check in on your aging loved ones. This visit is, perhaps, the first opportunity in several months that you'll have to personally observe them.

If you've relied on regular telephone conversations and assessments by other closer-living relatives to gauge their well being, the upcoming holiday visit may be revealing. Absence - even for a short period - often allows us to observe a situation through new eyes. I know, I've been there myself.
I lived 200 miles from my mother who lived alone after my father passed away. Shortly thereafter, mom started showing signs of a decline. To honor her wishes by staying in her own home, I needed to know when it was time to bring in outside help.

I kept a close eye on the following areas during each visit:
Physical Changes
Was she losing or gaining weight? Was she sleeping too much? Was she sleeping too little? How was her balance? Was she walking with any discomfort, or was she unsteady on her feet? (Note: certain medications can cause joint or muscle issues.) When there were concerns, I made sure they were addressed with her primary care doctor. If I noticed any sudden odd behavior, I quickly checked with her doctor to see if it was a urinary tract infection (UTI); very prevalent in elders and easily resolved with antibiotics. (Discover how a urinary tract infection can cause dementia in aging adults)

Emotional Well-Being
I took notice of whether she was still engaged in her normal routines, such as grocery shopping, preparing meals, basic housekeeping, reading the newspaper and personal hygiene. Was she still socially engaged with friends and family? Still going to church on Saturday? Still seeing the hairdresser on Friday? Once there were obvious signs of decline in these daily activities, I knew it was time to seek outside help with a home health aide. Luckily, I was able to get an excellent referral from a relative. (In case you don't know someone who can give you a referral, here are a few tips for how to find the right home health care agency)

Medications
Like many elders, my mother did not like medications. This was very obvious as she had expired and unused prescription bottles strewn throughout the house. This was one of the first areas that I got help with. I started by asking a neighbor to keep an eye on things, then, later I hired a caregiver. On each doctor's visit I obtained an updated medications list and posted a copy on her fridge and in her wallet -- very handy in case of an emergency. (Learn why you should always add identification to an elder's emergency plan)

Home Environment
I took a look to see if and when the bills were getting paid.Once I started finding bills unopened, or tucked between sofa cushions, I knew it was time to step in and help.Since I was already on my mother's checking account and also had Power of Attorney (POA), I had the bills mailed directly to me, ensuring they were all in one place and paid on time.I also paid close attention to the stove being shut off. When mom kept leaving it on, it was time to disconnect it and let the caregiver take over the meal preparation.

Steps to take:
If you see a pattern of decline in your loved one, but you're not sure where to start, I suggest beginning the initial conversation by mentioning what concerns you have, as well as the measures you can take to make things better.

1. Discuss the idea of a having a health assessment done by your loved one's primary care physician.
2. Your loved one may need help with housecleaning or bill paying. Ask them how they would feel about having a home health aide visit a couple times a week? I was able to convince my mother of this by reminding her that keeping her healthy and safe would allow her to stay living in her own home.
3. Maybe you loved one has some legal questions, and would benefit from making an appointment with an attorney – preferably one who specializes in elder law.My mother's attorney was very helpful in so many areas.
4. Identify resources that can be your eyes and ears when you go back home. This list may include neighbors, family and friends.Make sure everyone on the list has your contact information, in case of an emergency.
5. Pay a visit to the local Council on Aging or Town Hall to learn more about resources and services available in your loved one's community.

The more systems you have in place, the more your loved one will be kept independent and safe in their own home. This will give you peace of mind as you return home from your holiday.

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Caring at a Distance

If your mother has Alzheimer's disease and lives in Phoenix and you're in New York, how do you help take care of her? Angela Heath, director of the Eldercare Locator Hotline of the National Association of Area Agencies on Aging, has compiled 10 strategies to help you cope. This article is adapted from Heath's book, Long-Distance Caregiving: A Survival Guide for Far Away Caregivers.

Tip No. 1: Get organizedKeep track of important information in a care log.

I didn't know anything about Alzheimer's before my mother and my stepfather developed it at roughly the same time in the spring of 2005. I was living outside of Portland, Oregon; they were living in Mission, Texas. They were 86 and 84, respectively. I had tried to talk them into moving to an assisted-living community in Portland previously, but they always said they were doing fine. So I was surprised when my mother called one morning out of the blue and said, "We need help." My husband and...

Tip No. 2: Identify your informal networkAsk for help from people in your loved one's community, such as relatives, neighbors, longtime family friends, and members of religious, civic, and social organizations. Ask them to call you collect if they spot a problem with your loved one.

Also, consider installing a webcam in your loved one's home as a way to check up on them and see how they are doing. Also equip your loved one with an emergency necklace or bracelet that allows them to alert the police or paramedics with the push of a button should they need help.

Tip No. 3: Investigate travel alternativesBe prepared to "care commute." Investigate travel options in advance. Keep your car in good repair, and check on the route and weather before traveling.

If you rent a car, look for the best rates. Don't pay for insurance if you already carry full coverage or your credit card company offers coverage. You may get a discount when buying bus or train tickets if you disclose that it's an emergency. Learn how to buy airline tickets in a way that ensures you get the best deal.

Tip No. 4: Discuss legal and financial issues
These topics may be difficult to talk about, but they help ensure that your loved one maintains decision-making authority even when incapacitated. Preplanning will also lessen family disagreements and protect family resources.

• Will: Your loved one decides how to dispose of assets after death.
• Power of attorney: Gives a caregiver the authority to act on behalf of your loved one.
• Trust: Estate-planning document allows your loved one to transfer assets and avoid probate and other legal problems.
• Joint ownership: Makes it easier to gain access to your loved one's finances.
• Representative payee: A caregiver receives government checks for the loved one unable to manage money.
• Medigap insurance: Pays portion of medical bills not covered by Medicare.

Tip No. 5: Take care of necessary paperworkFind all legal, financial, and insurance documents, including birth certificates, social security cards, marriage or divorce decrees, wills, and power of attorney documents. Identify bank accounts, titles, sources of income and obligations, and auto, life, homeowner's, and medical insurance papers. Review these documents for accuracy and update them if necessary. Store documents in a secure place such as a safe-deposit box or a fireproof box. Be cautious -- make duplicate copies.

Tip No. 6: Tap into the aging networkContact the local department on aging in your relative's community. This agency can help you identify helpful services. Use the National Eldercare Locator Service at (800) 677-1116 to find local aging agencies.

Tip No. 7: Develop a plan of careIf possible, bring the family together for a meeting. Decide with your loved one what his or her primary needs are, who can provide assistance, and what community resources would help. Summarize your agreement in writing. Keep in mind that family difficulties are typical. You may need to bring in a family therapist or social worker to help.

Tip No. 8: Adjust your plan of care when necessaryBe aware that your care plan may need to be altered. Your loved one's needs may change, and helpers will come and go. Use your care log to deal with changes.

Tip No. 9: Explore relocation issuesPrimary questions are when, who, and where.

• When: Relocation is appropriate when a health professional recommends a change, your loved one needs 24-hour care, his or her safety is at risk, or the home does not meet fire or safety standards. Other reasons may be less obvious. Remember, your loved one may be willing to bear a little inconvenience to remain in his or her home.
• Who: Should you or your loved one relocate? Examine the financial and emotional costs.
• Where: There are many options for senior housing. Contact your local department of aging for assistance.

Tip No. 10: Take care of yourselfCare giving can be taxing. Maintain good health, make time for yourself, set limits, and allow others to help.

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Is It Right to Convince Mom and Dad to Move Close to the Kids?

I often have readers write me that they are begging their parents to "come back home." Many people, after retirement, like to leave our cold winters behind, so they summer up north (often in the Minnesota lake country) and then go to the southwest for the winter months. We even have a name for them – snowbirds.

Not all of these people even come back for the summer. Many make a permanent home in a warmer climate that is easier on aging bodies. There are communities in Arizona that have more people from North Dakota than many towns out on the prairie have in total population. So, what happens when Mom and Dad have lived like this for two decades, and then one of them gets ill or one dies and the other is left alone?

The adult children are in a quandary. They know that their parents have formed a close relationship with the people down south. Most have joined a church. Many have joined community clubs and enjoy community events. This is their home and these are their "people." Yes, they visit the kids and grandkids, wherever they live, but then they are anxious to get back to their adopted home.

However, health issues become a problem as parents age. I advise the adult children on ways to find long distance help through the eldercare locator (www.eldercare.gov) and other avenues. I advise them on how to check references and make sure the folks get much help as possible. But let's face it – long-distance caregiving is hard, especially when not even one family member lives nearby.

Often the adult children need to travel south to handle sudden hospitalizations or other emergencies. This causes problems with jobs and kids at home. So they beg their parents to come "back home." Parents balk. "This is my home, now. I don't want to leave my friends. I don't want to leave my church. I don't want to live in the cold and risk a fall on the ice."

Then there's the reverse.

I saw this with my friend Grace. Grace lived in the same apartment building as my parents, before my parents one-by-one entered Rosewood On Broadway, a nearby nursing home. Grace's husband also lived at Rosewood, as he'd had a stroke several years before. Grace didn't drive and had been totally dependent on her husband. It was one of those relationships where she hadn't even been writing checks, until he became ill.

I took Grace under my wing as much as I could, considering I was at the time, primary caregiver to five elders and two sons, one of whom has chronic health problems. When Mom was still living in the apartment building, I'd pick up Grace at the same time I picked up Mom and I'd take them both to visit the men in the nursing home. It grew more complicated after Mom went into Rosewood. How much could I help Grace?

Fortunately, Grace had many friends and she also qualified for senior rides so she did get a lot of assistance. Eventually, Grace's husband died. She was, of course, devastated. Her health deteriorated and I found myself on call for her many emergencies. This was extremely difficult for me to handle with all of my other obligations, but I couldn't ignore Grace either.

Grace's kids were caring and did their best, but they each lived hundreds of miles away from Grace, in different directions. It slowly became evident to them when they visited that Grace couldn't continue to live on her own. What to do?

Grace didn't want to move from Fargo. She'd live here nearly 50 years. This is where her friends were. This was home. But her kids couldn't move back here, either. They had jobs elsewhere and their kids were settled in schools. Yet, they didn't feel they could give Grace the care she needed, from such a distance. So, unwillingly, Grace moved to be close to one of her sons.

The family did everything possible to make it a good experience. They found her a beautiful apartment close to their home. She spent much time with them. They arranged for time with women friends she'd met when she'd visited through the years. They did everything possible. Still, when Grace contacted me she cried. She missed Fargo. She missed me. She missed her friends. She missed her church. She was depressed.

What was the right decision for Grace? I think her kids did the only thing they could do. But, obviously, it wasn't a perfect scenario. I'm not sure Grace ever totally adjusted.

So, do we move the folks so we can keep a closer eye on them or do we stumble along with visits and long-distance caregiving? I wish I could say which is best. I tell my readers that both options are imperfect and will present difficulties.

But is that any different than deciding if elders should stay in their home when their home is lonely because the neighborhood has changed, and it's impractical and dangerous as the only bathroom is on another floor as opposed to moving to an assisted living center – even a highly rated, wonderful center – with lots of socialization and good food and available help, but which means leaving many beloved belongings and a familiar way of life? Which is right?

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