Making choices for elder care
Regardless of what option turns out to best fit your family’s needs, there are some very important points to remember as you’re making choices
By Missy Morris
I am currently at that awkward age. No, not the one with bad acne and braces, where my face is too long for my unfulfilled jawline and I haven’t mastered my clumsy feet that grew two sizes over the summer. I am talking about that age when my children are mostly self-sufficient and the idea of settling into a retirement fantasy is forever tickling my thoughts. After a long and satisfying career in law enforcement, my days should be filled with contemplation of forever homes, leisure, hobbies, travel, and the next generation of grandchildren.
Instead, I have no time or resources for such nonsense. And I don’t mind telling you, I used to be angry about it.
I have entered the age when my aging parents are needier than my children were as teenagers. As their mental acuity continues to wane, they struggle to remember anything I tell them. They make reckless choices with trust. Grieving the loss of friends and relationships is traumatic for them. And they seem to consider the privilege of driving a right, even as they become more and more worrisome behind the wheel.
I am overwhelmed with the choices for elder care. Home health aides, retirement graduated living, respite care, and the worst-case scenario, hospice – these are terms I have heard but never took the time to fully investigate. Well, the time is here. I cannot put off my homework any longer. Decisions and tough talks are looming, and they won’t get easier with procrastination. Neither will my preferred choices for options. But just how do I delicately bring up these topics to a father who repeatedly told me, “I brought you into this world, and I can take you out!” each time I made him angry?
The game plan
Everyone says they want to live out their golden years in their own home, their place of security and familiar comfort. Not so fast. What are the limitations of the current living situation? Here are some factors to consider.
The geography of the location. Is adequate medical and emergency care available within a reasonable distance? Carting mom or dad twice a week to oncology appointments and time-consuming chemotherapy treatment can take its own toll on the health of everyone involved. How much care is needed now, or in the near future, based on the current prognosis?
The layout of the house is also a factor. Does the home have multiple levels? How easy is it for someone on unsteady feet to get through the front door or come in through the garage? Can the bathrooms be easily converted for someone using a walker or wheelchair? Will remodeling/retrofitting expenses put a strain on already limited funds needed for actual professional care?
Money is almost always an obstacle. It can be expensive to age in place. Part-time, in-home healthcare workers generally cost around $4,000 to $5,000 per month. The cost can skyrocket from there based on time and hourly needs. On the West Coast, full-time home aides run around $15,000 to $20,000 a month. For those prices, it is easy to see why the practical choice may be moving the loved one into a smaller residential group home, an assisted-living facility, or the home of a family member.
It takes time and commitment. Even if you share some of the responsibility with other family members, close friends, or neighbors, the time needed to care for a loved one with diminishing abilities can be exhausting. Make sure everyone involved is fully committed to working together for the long haul.
This begs the question, how easily does your loved one handle change? If my own mother-in-law is any barometer, the idea of coffee at 0700 hours instead of 0645 hours is likely to ruin the rest of the day. Taking steps to help aging family members retain as much normalcy as possible can help smooth over their response to other disruptions in their lives. Efforts need to be made to help them maintain strong ties with friends, church congregations and other community groups. Maintaining a consistent home environment can be comforting to those losing their connection to the outside world.
Ask yourself which hobbies or interests the elderly person has maintained. Woodworking, cooking, fishing, quilting, card games and gardening are less rewarding when done alone. Having a group of like-minded souls nearby to share interests with can be very stimulating and help maintain quality of life.
My parents’ friends all live in a 55-and-older development accommodating several thousand seniors. The good news is the planned community has graduated living options. Those who are still independent live in small ranch-style homes that are both senior-friendly and ADA-compliant. Others have moved on to assisted dormitory living, with meals and regular nursing care around the clock. For those requiring an even higher level of care, the development has on-site convalescent and hospice facilities within visiting distance of community friends.
Finally, let’s talk about the disruption of death itself. In addition to local hospitals and clinics, the development also contains funeral homes to handle arrangements when one of the residents passes away. As a police officer, I dealt with death on a fairly regular basis. Still, it’s rather macabre to watch the residents make their way to their front porches to find out where the Grim Reaper has paid a visit. This is particularly upsetting to my mother. For this reason, I am not sure the benefits of this lifestyle outweigh the downside.
Regardless of what option turns out to best fit your family’s needs, there are some very important points to remember as you’re making choices for elder care.
Financial considerations. Even with Medicare and the supplementary options, government health care for the elderly is woefully underfunded. We all know Social Security and related regional health benefits are severely lacking across the country. Don’t forget to check with your own health insurance. Since I started my career in law enforcement, additional optional benefits such as child care, elder care and even pet insurance have been gradually added. You may have resources out there you never knew were available.
Reverse mortgages are touted by some and demonized by others. The fact is, there are circumstances where they just make sense for a senior who maintains equity in their home but needs funding for current and future care. Talking to a respected expert can give you the facts to decide if this is a viable option.
Respite care. If you’re the sole caregiver for an elderly person, you’ll need a break from time to time. Look into respite care to allow you to maintain your own life as you help your parent or other relative do the same.
Everyone needs a break – even the elderly. While you toil to care for Mom or even a grandparent near the end of life, the person with failing health never gets a break from the sadness and stress of aging. Just like you need a vacation, to have a moment of peace and to regroup from your responsibilities of care, remember the elderly person you care for may need a respite from you just as desperately. The strain on even the closest of familial bonds is real. Ask a trusted person to provide regular breaks in caregiving. Respite groups, nursing services, and even some community groups will provide someone to sit with your loved one and provide everyone with a much-needed break.
Advocating for dignity. I’d heard the term ombudsman in the past, but never really paid much attention to what it meant. That changed as I began taking more responsibility for my aging parents. For a senior without the money or stamina to fight unfair treatment, an ombudsman can literally be a lifesaver.
An ombudsman is someone who investigates complaints against maladministration and elder abuse. In the world of long-term care, this can range from issues in day-to-day care, to problems with health and safety, and compliance with personal requests. For example, every person has a right to dignity. If your parent is left partially clothed in a bed within view of other residents, who will advocate for them? When a caregiver is suspected of being verbally abusive, who can investigate and find out what really happened?
And ombudsmen aren’t just there to help the patient. They can also assist you in finding possible facilities or other caregivers in your area. They are well educated, with plenty of resources and skills to help solve problems. They are not, however, a substitute for a criminal complaint. They cannot press charges on someone else’s behalf. They cannot act as legal counsel, nor do they have the ability to influence policies, procedures, or laws. Instead, they work with legal authorities to assist in protecting the rights of the elderly. If you are researching a skilled nursing facility for someone, ask if the residents have access to an ombudsman. Seek that person out and get to know this resource well.
Considering choices for elder care
As a former cop with a Type-A, overachieving personality, I really like to win. But aging is not a game you can win. When I finally had to face the reality of my parent’s waning health, I became angry that my “good” years were being sacrificed for theirs. Arming yourself ahead of time with answers to these questions about elder care should help steer you in a direction that will work for you. It can help narrow your options to choices everyone can live with.
Having a good fit for parental care, making sure financial stress is accounted for, getting regular relief from caregiver responsibilities and knowing someone else is also watching out for my loved ones’ best interests – these are the best comforts I can expect during this season of my life. The anger I felt as I first faced these challenges won’t be there when my parents have departed this world. The emotion will not be everlasting, but the result will be.
NEXT: Basic estate planning for first responders
About the author
Missy Morris started in public safety as a juvenile probation worker after graduating from University of California Santa Barbara in 1991 with a degree in behavioral psychology. She moved to the San Francisco Bay Area to work in probation before quickly transitioning to police work. After serving three years with the Palo Alto and Mountain View police departments as a patrol officer, she spent the following 22 years of her 28-year career at the City of Roseville. Missy worked in critical incident negotiations, eventually becoming the multi-city team leader and serving seven years on the state board of hostage negotiators. Missy feels her greatest assignment was a five-year stint as a traffic motor officer riding a BMW and working fatal accidents. She held several special assignments before retiring in 2020 as a lieutenant. Missy now works with the Lexipol Professional Services Team, working closely with Cordico wellness solution.