How do I know when it is time to get "In-Home" care for my parents?
What signs should I look for?
The factor that most usually dictates the need for supplemental in home care is support structure. There are many scenarios in which older adults live and function. Certainly the scenario of an adult child whose family structure allows for one or more members of the family to be home continually is the most effective and one that mostly negates the need for hired caregivers. However, even in this situation, in-home caregivers are a great option for vacation and respite care needs.
Another scenario is when there is a family member that lives in the home, but may not be at home all of the time. For example, an adult child who works and is out of the home for 8 to 10 hours a day can be effective in some situations. They can monitor the medication count, even if they are not at home during all of the dose times. They can prepare and encourage regular healthy meals, while monitoring the intake of at least 1 most likely 2 of these meals. They can assist with the shopping, cleaning and laundry, plus bathing assistance if that is a comfortable arrangement for both the parent and the adult child. As the elder's care needs increase this arrangement may not provide adequate assistance and supervision. In this situation, in-home care is often the missing piece.
If the elder seems to be more forgetful: i.e leaving the house and becoming disoriented, leaving the stove on or water running, forgetting to take medications and missing meals when not directly supervised. If the elder is unable to discuss what they did during the day while the adult child was at work. If conversation becomes limited and the answer frequently becomes "no". If hygiene lapses (i.e. wearing dirty clothes or inability to remember their last bath or shower) become apparent or there is evidence of incontinence. If the adult child notices an increase in difficulty ambulating and/or a decrease in the elder's confidence in their ability to ambulate. In situations like this an in-home caregiver may be best utilized beginning in small increments of time and increasing as the need increases or as the elder's comfort level with the service increases. Very often, in-home caregivers not only assist with everyday tasks and functioning, but also fulfill a social role
Although we would all like to be in one of the two situations described above, these are more the exception than the rule. In many cases, the elderly parent has lived alone and independently for many years. In this case, it is often more difficult to judge their need for in home care and a more sensitive topic to discuss.
Many adult children live in different homes, towns or even states than their aging parent. Visits may be routine or sporadic depending on distance. The elder's support structure in these situations may also include close neighbors and relatives. In a scenario such as this there is often another factor to consider, is the elder driving? Many families in this situation feel that they have so many people willing to help, they will never need to hire in-home care givers. It is however often more difficult to manage with many caregivers who are randomly volunteering.
As an elder's level of independence changes, one of the most important aspects to consider is a routine that can be easily followed and allows for a sense of security and continuity. Changes in the elder's level of independence may be more difficult to recognize during visits that are not long enough to establish patterns and see where new needs might exist. Feedback from neighbors, relatives and acquaintances is important. Is your parent going out less frequently? Are they getting their hair cut? Are their clothes clean? Do they know when the last time they got groceries was. Is there food in the cabinets and refrigerator? Do you notice any weight loss (i.e ill fitting clothes). Is the house at it's usual standard of clean, is the lawn tended? Check the medication bottle dates and prescribed dosages - do the math, are the pills being used as prescribed? Are their conversational skills the same, are they less talkative and more inclined to answer "no"? Certainly there are more obvious signs that are directly related to the elder's safety, such as leaving the stove on, falling or having difficulty getting up. The list of observations you can make goes on and on.
The fact of the matter is that change happens subtly and the idea of an in home caregiver is one that should be considered as early as possible. The best idea is to put on paper what you think is a good estimation of the elder's "schedule", decide where you think a care giver might be able to assist and talk to them about it. It may be difficult to ask them if they want help, but start with areas like housekeeping and lawn care. Broach the subject of their independence gently and always remember that in home care givers are not "nurses". In-home care givers are helpers and very often become companions who meet very important social needs. Stress the idea that they can be depended on for scheduled visits. Emphasize that these care givers will not simply "drop in". Give examples of tasks they might help with. In-home caregivers that are introduced into the day-to-day dynamic in small increments early on can often extend independence. Caregivers who become a recognizable part of the day-to-day routine can increase their time as the elder's needs increase with out adding confusion. It is often very difficult to face the idea that our parents are not as independent as they have always been. It is however important to recognize and respond to our elderly parents changing needs in order to keep them safe and nurtured.
