By Lisa Esposito
U.S. News & World Report/New America Media
“I’m doing fine.”
That’s reassuring to hear when when you call a parent who lives far away.
But the fact is, seniors living alone in their 70s and beyond may keep serious problems to themselves because they don’t want to worry you or feel like a burden.
Sometimes it takes a crisis – like a call from the hospital – to realize how far from fine a family member really is. Visiting in person is the best way to see what’s what, experts agree. And witnessing the gaps in a parent’s well-being is the first step to getting the right help.
Your parent prizes his or her independence and insists on living at home, alone. However, you see signs of vulnerability and a precarious situation with the potential for falls and injury, poor nutrition and your parent becoming neglected or housebound. You want to help, but you live at a distance and don’t know where to start.
Concerned adult children can build a network of services to keep aging parents safe and restore their quality of life. Read on to discover your many options and how to set them in motion.
First, Meet Basic Needs
Some of the basics that people need to live are healthy meals, taking the right medicine, being safe, talking to other people and getting out of the house for fresh air. When you realize parents are missing out on these things it’s time to tap into local resources.
At Meals and Wheels of Takoma Park, Md., a hot meal of macaroni and cheese, baked beans and spinach is on the current menu. “Comfort food,” says cook Cathryn Pethick, on a recent rainy February morning, as she and the kitchen crew filled trays.
Many clients are the “old old” of their 80s and 90s, says Jill Feasley, director of the Takoma Park program. The low-fat, low-salt meals contain two-thirds of needed daily nutrients, she says. While there’s no minimum-income requirement, those who can afford it are asked to contribute $7 a day or $140 a month toward costs. You can find a local provider at the Meals on Wheels America website.
Driver Kay Behall covers a regular Wednesday route of suburban Maryland houses with wheelchair ramps leading to the front porch or “No Smoking: Oxygen in Use” signs on the door. Her clients include Kathy Yowell, 83, who has lived in her bungalow more than 50 years. She loves to chat and Behall is happy to listen. “I thrive on service organizations,” Yowell says, explaining how she manages day to day.
At another stop, Moses and Virginia Rich both receive meals: He has Alzheimer’s disease, and she’s the caregiver. The service is “lifesaving,” Virginia says, since she wouldn’t otherwise be able to provide balanced meals.
To find a host of area services, the nearest Agency on Aging is a good place to start, says Sandy Markwood, CEO of the National Association of Area Agencies on Aging. You can use the Eldercare Locator to sort out aging programs, services and resources.
If at all possible, start the caregiving ball rolling with an in-person visit to your parent’s hometown. That gives you a chance to accompany your parent to see his or her primary care provider. You can learn about your parent’s health status, ask questions and streamline and update medications. If your parent has been on the same prescription drugs for years, or can’t say why he or she is taking a medication, ask whether the drug is still needed. Your parent’s pharmacist also can evaluate his or her current medications.
Also, you should meet and talk to your parent’s neighbors. They represent valuable eyes and ears looking out for your parent’s well-being. Make sure you have their phone numbers and they have yours. To find help with strenuous chores like mowing the lawn or shoveling a snowy sidewalk, Markwood suggests joining a neighborhood listserv.
Consider Home Care
Companionship services, light housekeeping, meal preparation and help with transfers, hygiene, bathing, dressing and medication-adherence are some of the home care services available to seniors, says Phil Bongiorno, executive director of Home Care Association of America.
When hiring home health care, especially from a distance, Bongiomo suggests family members consider the following: Are they going through a referral agency that just places members or a company that has dedicated employees? Will there be a care plan? Is backup care available? Is the company available 24/7 if you need to contact them? Are caregivers licensed and certified according to state requirements? Do they undergo background checks? The issue, Bongiorno says, is accountability.
You’ll probably have to pay for services out of pocket. Medicare provides limited coverage of home health care that’s necessary for the treatment of illness or injury, such as skilled nursing services by a registered nurse. However, services such as 24-hour-a-day home care, meals delivered to the home, shopping, cleaning and laundry or personal care like bathing or dressing are generally not covered.
According to an April 2015 study on regional private duty billing rates from a survey done by Home Care Pulse, hourly rates ranged from $21 to $28 for one-to-two hour visits in 2013, the latest year for which data are available. With longer visits, hourly rates drop incrementally. For instance, with care episodes lasting 12 to 24 hours, hourly rates ranged from $17.25 to $21. For live-in care, daily rates ranged from $240 to $315.
If you want to keep your older mother or father in their own home, and their situation is complex, for instance involving dementia, it’s “critical” to arrange care in person, says Stephen Golant, author of Aging in the Right Place (Health Professions Press, 2015) and a University of Florida gerontologist.
“You have to make that one-week trip to interview, very carefully, that caregiver,” Golant says. “You can’t rely, in my opinion, on the home-care agency approach, where you’re getting someone three or four hours a day. Someone who has early-stage Alzheimer’s more likely needs somebody for 24/7 care.”
Coordinate the Network
Putting together a network of home and health care providers and other local services – all while keeping lines of communication open – can be complicated, especially from a distance. Care management is one solution, says Jennifer Leeflang, senior vice president for Partners in Care, a subsidiary of the Visiting Nurse Service of New York.
“We send out a registered nurse who completes a comprehensive assessment,” Leeflang says, including evaluating a patient’s medical, psychosocial and environmental status. The provider completes a report and makes recommendations based on individual needs – anything from adding grab bars in the bathroom to having a certified home health aide accompany seniors to adult day care, so they can socialize more.
Services most people might not be aware of include assistance writing checks and paying bills, walking and navigating the city together or even accompanying people to theaters and restaurants. “When the nurse and the aide goes to visit, we explain, ‘This is not about you losing your independence,’” Leeflang says. “’It’s about you helping you maintain your independence and keeping you safe at home.’”
Online care coordination sites like Lotsa Helping Hands help families track how someone is doing and improve how members communicate. “Basically, you build a community,” says Jody Gastfriend, a licensed clinical social worker and vice president of senior care at Care.com.
Lisa Esposito, a health reporter at U.S. News & World Report, wrote this story with support from the Journalists in Aging Fellowships, a program of New America Media and the Gerontological Society of America, sponsored by the Silver Century Foundation.