Dorothy expressed it best in The Wizard of Oz when she said, “There’s no place like home.” And that’s exactly how most people feel. But staying at home when a person is aging or has special needs takes planning and creativity. If you or a loved one prefer living in your own home rather than moving to a care facility, here are tips from experts about how to make it work.
Bonnie Lazor, M.D., a geriatrician who owns Vintage Care Inc., Louisville, visits homebound Medicare patients. Lazor says one the best ways to make a home safe is to go through the house and eliminate fall risks.
“Get rid of throw rugs,” she says. “Maybe put a full rug on a slippery floor. Make plenty of open space for people to maneuver, and be sure that your loved one is wearing the correct footwear. Tennis shoes may cause a person to fall” as they can have too much traction for a person who is walking with a shuffling gait.
Regardless of age, everyone needs a purpose in life. Home-bound seniors can make phone calls to check on each other.
Lazor says, “It is especially important for anyone who wants to remain home to keep their range of motion.
When people become sedentary, they have less physical reserve and their muscles atrophy. So if you want to stay home, you must exercise. You can march in place while sitting in a chair, do a butt squeeze, and do sit-ups in a chair or in a bed. Doing these exercises helps to strengthen the muscles that are used to get out of a chair. There are inexpensive elastic bands that can be used to improve strength and range of motion, such as Thera-Bands, that can be put on a door and help to build resistance.”
Her other suggestions include the following:
- Use aids, such as canes and walkers, to maneuver safely.
- Maintain a support system, whether it is family, church, or community resources.
- Eat in a healthy manner.
- Use hearing aids and eyeglasses when needed. Seniors become reclusive if they cannot hear or see well.
- Stay active.
“The three most important diseases that you should allow doctors to treat that have been proven to influence quality of life and longevity are high blood pressure, high cholesterol, and diabetes,” says Lazor.
There are 15 area agencies on aging that serve every Kentucky county. (See the sidebar below for how to contact your area agency on aging.) Check with these agencies for adult day-care centers, free legal assistance, family caregiver support groups, home-delivered meals, health promotion programs, senior center activities, benefits counseling, home care services, and transportation for seniors. If you have a need, call for help.
Ralph “Punch” Mitcham, 83, Brandenburg, has dementia, but was doing well at home until he had gall bladder surgery in March. Then he became combative with his wife, Eleanor, 80, so his family placed him in a nursing facility. When Mitcham became aggressive, he had to leave that facility and was sent to another. The same thing happened at two more facilities, leaving his family confused and uncertain about what to do.
Mitcham’s daughter, Becky Richardson of Louisville, says, “We realized that we couldn’t handle this situation, so I called Linda Kempf to help us find a solution.”
Kempf, an RN and geriatric care consultant who owns All About Care…Care Check, has extensive experience as a former director of nursing in nursing homes, is a national speaker about aging and senior care options, and is a private consultant to clients throughout the state wanting to make the best choices for their loved ones. She immediately went to assess the situation with Mitcham.
“Mr. Mitcham had behavioral problems, a severe urinary tract infection, and needed to have his medications adjusted,” Kempf says. “He was admitted to the psychiatric unit of a hospital and his medicine was regulated so that he was much less aggressive.”
Now with several aids––deadbolts on doors, locks on windows, and other items—Mitcham is at home and thriving in his environment. At first, he had a caregiver at night to help Mrs. Mitcham if the need arose, but that turned out to be unnecessary. A caregiver comes in during the day and helps with many tasks. Mr. and Mrs. Mitcham are both glad for the things that have made it possible for them to continuing living in their own home.
“At first, I was surprised to hear Linda say that my dad should come home. But it is important to have a person like Linda who knows your loved one’s needs, how the system works, and what is available,” says Richardson. “Otherwise, the whole process can be emotionally and financially expensive.”
Sometimes staying in your own home is as simple as finding the right tool or aid. When one of her clients had back problems that prevented her from reaching far enough for proper hygiene, Kempf went onto the Internet and found a site that had just what the woman needed, a self-wipe toiletry aid. This item, which costs between $40–$50, was one aid that made it possible for the woman to care for herself in her own surroundings.
“Simple things can drastically change an outcome. If I think someone is able to return home, I will do whatever it takes to coordinate services to make that happen,” Kempf says. “Sometimes returning home is not an option and in those cases, placement in a quality facility is vital, regardless of their financial abilities.”
Susan Ganote, Ph.D., R.N., program director at Our Lady of Peace Center, a psychiatric hospital in Louisville, states that a common theme of aging is loss. There’s a loss when a person’s vision deteriorates and he cannot drive or when a recent fall or accident sends him to a rehab facility. Having friends, a spouse, or a child die is a loss. Losses can cause depression. Older Americans, especially white, elderly men, have the highest suicide rate of any age group.
“Older adults still learn and that’s why they need to know about depression and anxiety,” says Ganote. “They need a support system, such as a neighbor, a sibling, or someone from church. People who have dementia need to have the opportunity to learn to say goodbye.”
Ganote suggests creating a “memory center” in the kitchen with a calendar that has the previous days marked through, keys always placed in one spot, and medications always in the same place. Use reminders as cues, help the loved one with grocery shopping, and when baking a cake, for instance, have the person check off the ingredients as they are added. Take advantage of what services your community offers.
“Older adult and family members need not be afraid to go for help. If you are a caregiver, you need to take good care of yourself,” Ganote advises.
When is it time to move a loved one from home? Ganote says, “It is the hardest thing for family members to admit they cannot continue caregiving. But assess the person’s physical functioning. Can he feed and bathe himself? Can he walk unattended and take care of his bathroom needs? When a person wanders or hurts himself or others, he may need to move to a more protected environment.”
OTHER AIDS FOR AGING ADULTS
Other ideas that Kempf has used and suggests to keep clients in their own homes include:
- Use a surveillance camera on a computer to monitor an older adult home alone, with their permission.
- Have home health care.
- Have the senior put a sign in a window that faces a neighbor’s house and turn it each morning and evening. Ask the neighbor to be sure that the sign has been turned, which will indicate that the older adult is okay.
- All seniors should carry a cell phone when driving or outdoors and know how to use it.
- Indoors, clip a phone with speed dial to the person or get a medical alert service such as Lifeline ($35–$40/month) for emergencies.
- Use deadbolt locks, which must be opened with keys, to prevent wandering, and window alarms. Bed alarm pads and chair alarm pads can alert a caregiver when a person is getting up and may fall.
- Use a roll-in shower chair or a resin lawn chair in the shower.
- Use a handheld showerhead with a long hose ($15– $20) and shower slippers.
- Have an adult walker with a seat or sling, but be sure it is the correct height for the person so that it will not tip easily.
- Some scooters have hydraulic lifts to help adults reach into tall cabinets.
- Get rid of the stove and get a microwave. Dangling sleeves of robes touch the stove burners and may catch fire. Stock frozen dinners or have the family prepare meals in advance and freeze them.
- Buy a silicone glove to handle hot foods.
- For medications, there is a Medi-Planner II pill storage unit that organizes medication for a week and organizes dosage schedules up to four times a day.
- Make sure the person has working hearing aids and current prescription eyeglasses.
If a homebound senior is threatened by violence and in need of an Emergency Protective Order but is unable to make the trip to court to obtain one, Kentucky is now the only state that will send someone to the person’s home for that purpose. Call Elder Serve at (502) 587-8673.
10 TIPS FOR HELPING YOUR AGING PARENTS
Source: National Rural Electric Cooperative Association
According to the National Council on Aging, persons age 65 and older are the fastest growing segment of the U.S. population. Did you know that almost 40 percent of all U.S. workers are now as involved with caring for an aging parent as they are with a child? It’s called the “sandwich generation,” a metaphor used to describe the circumstances of today’s middle-aged adults who are increasingly finding themselves “sandwiched” between the care and demands of their children and their aging parents.
An estimated 45 million Americans now care for an aging parent or relative, according to the latest research (Kaiser Family Foundation, 2002). Are you prepared to handle the difficult issues that can arise when faced with caring for an aging parent? The following guidelines can help ensure that you make the best choices possible, for your parent, your family, and yourself:
1. Find out your parent’s wishes. How great is your parent’s need for independence? What goals or dreams remain to be accomplished? What are your parent’s needs and concerns about the future? What aspects of your parent’s life are most important to him/her at this stage of life? Being near family? Seeing certain friends? Practicing his/her religion?
2. Be sure your parent’s legal documents are in order. Has your parent executed all of the important legal documents and are they up to date? These would include an up-to-date will, living will, durable power of attorney for health care, and durable power of attorney.
3. Learn your parent’s desires regarding healthcare. Does your parent have a doctor who he/she trusts? If your parent is sick presently, what is his/her prognosis and how will it affect his/her personal care, housing, medical needs, or finances? If you had to make medical decisions for your parent, what would he/she want you to know? How would your parent weigh the benefits or burdens of various medical treatments? Is there a certain point after which your parent would no longer want aggressive medical care? Are advanced healthcare directives in place (living will, durable power of attorney for health care)?
4. Find out your parent’s wishes regarding housing. How important is it to your parent to remain in his or her own home? Where would your parent want to live if he/she could no longer manage at home? Is your parent familiar with other housing options available? What if it isn’t possible for your parent to live with another family member?
5. Learn about your parent’s financial resources. What are your parent’s present financial needs and potential future needs? Is he/she in a financial position to meet these needs? Is your parent’s insurance—including life, health, home, and auto—adequate and current?
6. Be sure that your parent has all relevant documents, records, and information in order and be sure that you or another family member knows where they are. As your parent becomes increasingly frail, your family will need certain financial records, insurance information, advance health care directives, names of doctors, etc. Talk and plan together now about how your parent’s affairs should be handled in the event he/she becomes incapacitated.
7. Learn about sources of help for seniors and housing options available. Chore services, housekeeping, home-delivered meals, senior recreation, day care, respite care, and transportation assistance are some of the services available in many communities. Housing options include living with family, foster care, home sharing, board and care homes, senior apartments, continuing care communities, or nursing homes.
8. Meet with family members to discuss various responsibilities should your parent become incapacitated. Who will be the designated agent on the durable power of attorney for health care or durable power of attorney? Is in-home care a possibility? Under what circumstances?
9. Don’t offer personal home care unless you thoroughly understand and can meet the responsibilities and costs involved. Closely examine your family’s ability to provide long-term in-home care for a frail and increasingly dependent parent. Consider the family’s physical limits. Plan how your own needs will be met when your responsibility for the dependent parent increases.
10. Gather information now on how to care for an aging parent. There are numerous resources available that discuss: housing options, preparing wills and advance health care directives, long-distance care giving, protecting and maximizing financial resources, health care, community and home-care services, dealing with Alzheimer’s disease or other disorders, etc. An excellent book to use as an ongoing reference is: How to Care for Aging Parents, by Virginia Morris, Workman Publishing, New York.
RESOURCES FOR AGING ADULTS
A Dignified Life: The Best Friends Approach to Alzheimer’s Care, A Guide for Family Caregivers
by Virginia Bell and David
How to Care for Aging Parents
by Virginia Morris
The 36-Hour Day: A Family Guide to Caring for Persons With Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life
by Nancy L. Mace
and Peter V. Rabins
ACCESS TO JUSTICE FOUNDATION
209 E. High Street
Lexington, KY 40508
Phone (606) 255-9913
ADULT PROTECTIVE SERVICES
Available in each county in case of elder abuse
Outside Louisville (812) 475-1012
24-hour helpline (800) 272-3900
Division of the Kentucky Attorney General’s Office
A free national service from the Administration on Aging that helps you locate a wide variety of resources and services available in your local community for older adults and family care-givers, including how to contact your local area agency on aging. Call Monday–Friday, 9 a.m.-8 p.m., Eastern Time.
LINDA HITT KEMPF, RN, LNHA
All About Care…Care Check
1114 Flat Rock Road
Louisville, KY 40245
KEYWORD EXCLUSIVE: MORE RESOURCES FOR AGING ADULTS
For additional resources and services available to aging adults, click here: aging.