Often the need to help your aging mom or dad develops slowly over time. You notice signs that they are slipping in their ability to perform daily activities. At first these are occasional and mostly benign, but eventually become more acute and demand attention.
However, sometimes these needs appear quickly. A medical emergency, an accident or a rapid decline in function necessitates urgent action. How do you know if this is the case? And what should you do if it is?
[See: 9 Rewards of Caregiving.]
If this scenario scares you, then good. Elder care experts all recommend strongly that families put plans in place well before such a need arises. Do your research to find options in your community that you and your loved one will be happy with, if and when the times comes. Waiting until a health crisis occurs "can be dangerous," says Anthony Cirillo, a health, aging and caregiving expert and president of The Aging Experience. If you haven't done your homework and now have to act immediately, you might be limited in your choices. "That is why preparing for these situations sooner is important," he says.
If that ship has already sailed, you need first to evaluate just how much help your loved one needs. Will at-home care be enough? Will they require the support of an assisted living facility? Are their medical needs so great that they require a skilled nursing facility -- otherwise known as a nursing home?
Don't expect your mom or dad to make it easy on you. According to AgingCare.com, older people often find it hard to accept the fact that they need any type of assistance. Giving up independence is difficult, and it usually takes a traumatic event to force them to realize they need assistance. "The added emotional stress of a sudden hospitalization or fall further complicates this process," it says.
Talk to an Expert
If an older loved one is being released from a hospital or rehab center and you don't know where he or she should go next, talk to an appropriate person at the facility they are leaving. "If you are their caregiver, meet with a case manager or discharge planner and talk about transitional care planning, including where your loved one will go when discharged," says John Mastronardi, executive director at The Nathaniel Witherell, a short-term rehab and skilled nursing facility in Greenwich, Connecticut. Do this well before discharge to learn what date they will be released, what level of care they will need moving forward and what the staff recommends for next steps.
Those recommendations will depend most on the care needed. Care after hospitalization "is not always cut and dried, not black and white," Mastronardi says. Will the elder require wound management, medication management, special medical equipment or skilled nursing care? Or are their needs less serious, such that they could be provided at an assisted living facility or at home through a certified home health care agency that provides part-time services? Depending on the answer, you will know if your loved one would be better served by assisted living or a skilled nursing facility. "You shouldn't be shy about (asking)," Mastronardi says. "Ask if the loved one needs more than going back home, and where should they go. There are many options."
You can also solicit the help of your loved one's doctors or a hospital counselor or social worker. "They can help and give decision support to wade through the myriad choices that can be confusing, overwhelming and tough to figure out," he says.
Finally, contact the facilities you are considering and speak with their advisors. "Don't be afraid to call for advice," says Maria Hood, director of admissions for United Hebrew, a campus of elder-care facilities in New Rochelle, New York. "When a family member calls me and says, 'I don't know anything,' I say, 'Of course you don't. It's OK. That's what I'm here for.' Even if it's early in the game, and maybe they just need help at home for now, we can talk about that."
Signs of Need
Urgent need isn't only caused by an illness or accident. Sometimes, those small signs of trouble suddenly become much bigger. But it's not always obvious. "Families sense that things are wrong, but can't put finger on it," Hood says. "At the end of the day you have to go with your gut. You know your loved one better than anybody."
Hood offers her own father as a perfect example: A man who always took pride in his appearance would stop shaving and go out in rumpled clothing. Gentle probing revealed he wasn't showering for fear of falling. One day, he drove her to the airport, and she noticed he would not drive faster than 45 mph on the highway. "He had white knuckles around the wheel," she says. These and other signs alerted Hood's family to the need for action.
Even so, you need to move delicately. "They are embarrassed. They don't want to be a burden," Hood says. "You have to say, 'We are a family, we are in this together, we are here to help each other.'"