Saturday, August 17, 2013

The Stress of Caring for Elderly Parents

"The strain you feel may not be your own"

Ask any Baby Boomer who is caring for, or has cared for an elderly parent and they probably will all agree that it's a stressful time. Stress by one definition is change. When we care for our elderly parents there are countless changes and decisions that are experienced almost daily. These stressors can fracture some relationships among siblings and even between parent and child.


I am a retired physical therapist with some forty years experience. I have worked with the elderly in nursing homes, hospitals, home health and in out-patient centers. We are currently going through this very situation in our family - and that's why I decided to write about it. Today's Blog is a combination of my family and my years as a therapist treating the elderly.


When the dust settles after an incident with the parent - say a fall at home, then the conversations begin about what to do next. The average family doesn't have a clue where to turn for answers. Always look to your social service departments at facilities for community resources and guidance. Most physicians are too busy. In our family I am used a resource. I can't imagine what would happen otherwise.

There are  many concerns and decisions that have to be made almost daily, in what seems like a rush. These include: staying at home or going to a nursing home or assisted living facility; Receiving home health or out-patient services; How will the well-parent cope with new responsibilities is high on the list of stress; Will one single child be responsible for decision making, or will it be a group of children.


Other concerns are for the "well parent" and his or her health having to care for the injured /sick spouse. Concerns here are a severe loss of sleep by the spouse worrying if the other may fall again in the night, will there be enough money for the financial drain that is about to occur, will they need to sell their house / downsize / move to an apartment in a large facility, will they lose their friends and will there be a loss of independence by having to stay in the home 24/7 attending to the needs of their spouse. Then what happens if the well-parent becomes ill?

Let's use the model of a patient being able to stay at home. Someone needs to decide if there are funds for a move to an apartment at a large facility that might have assisted living or nursing home connected to it. So the parents make the move. They now live in a space half the size of their previous home. 


Identity items that belonged to the injured or sick person are sold. The thought being, he or she will never use them again. Their vehicle is sold because he/she will never drive again. How would you feel to watch all your hobby tools and your vehicle sold while you sit in a chair? Now imagine you are 85 years old. Selling items tied to a person's identity should be one of the last acts that is done and should occur out of sight of the sick parent. This affects their mental and physical health. I've seen situations where the patient felt, "Well, I guess it's time to die."


Deciding who to hire for in-home care is a huge stress. If you are fortunate to have insurance, the company may have a list of certified agencies they use. Someone then has to interview the companies and decide who will be hired. I've seen families look for a shortcut in home sitters or caregivers that can be financially destructive on the estate of the parents. They hire a nice person from church, a cousin of a neighbor, a real nice lady at the gas station. They do this to save money. In healthcare we have a saying, "Pay me now or pay me later". YOU are responsible for any medical costs from an injury that occur to the person you hired off the street! I have heard it so many times, "Oh, they're so nice. They won't sue." Guess again. Your family will pay all medical bills related to the incident for as long as the person lives. Lawyers love this deal.

Always hire a licensed agency. One of the reasons it's expensive is the workers compensation they carry on their employees. When going into a nursing home or assisted living facility ask to see the latest Federal Inspection Report. The summary is required by law to be visible and posted. Research at the courthouse what pending law suits there might be against the company or ones they had in the past. This is all public record and the county staff has to assist you.

If staying at home ask for an Occupation Therapy Home Assessment. Occupational Therapists are trained in teaching and helping patients with activities of daily living. They can assist with teaching showers, shaving, dressing, bed mobility and the list goes on and on. They are also trained to evaluate your home to see if there are any hidden hazards that might lead to another fall.

Ask for home physical therapy. You will receive only a few visits for about thirty minutes each, but the therapist can train any family members who ask. DO NOT be passive. All care in the home requires the help of all children and grandchildren. 


Schedules should be set so that one child is NOT responsible for the entire care process. He / she will burnout. Even teenage grandchildren can help. Go to grandma's and sit with grandpa while she gets out of the house and gets a break from all the stress. If there's any dementia, even little kids can help. have the sick / injured parent color, do crosswords or play board games like checkers. Stimulate the environment.


Other children can help with the dementia issue by taking the sick parent out for a ride. Go sit by a river, buy an ice cream cone, go to a park - do things the person no longer is capable of doing. Separate the parents. Give the well parent a break.

Having worked in many nursing homes I would NOT recommend that avenue unless it's a last resort. The places are typically understaffed and cursory care is the rule for the day. There have been reported abuse situations in some of these places - both physical and sexual. That's why I mentioned to check your local courthouse. 


I know of one assisted living facility where the patient was a deaf 96 year old with macular degeneration and was nearly blind. Her daughter placed a fifty-dollar bill folded over several times and hidden inside a secret pocket in her mother's mink coat. Her mother just wanted to know she had some money for an emergency. The coat was inside a carrier bag in the closet. Someone on the staff stole that and a few pieces of jewelry. It was blatant pilfering.

One of my friends had a home health company coming to the home to help his mother. There were little things that disappeared over time. The family began to take note. Someone even stole his high school graduation picture off the dresser. I guess they liked the frame.


I recommend that if you have strangers in your home, Remove Valuables and Don't leave money out in the open. Thievery is health care is more common than we would like to think.

We all will die. We may all be where our parents are now - elderly. Give them support, give them respect, give them dignity and give them love.

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