Caring for the Aging
Providing for the elderly can present problems and rewards
When I was a child, my Aunt Louise taught me how to roll a meatball and make a bed. She told me stories, gave me the wings when she fried chicken and preached her own philosophy of optimism, faith and kindness.
As the years went on, she was my personal Ann Landers, helping me navigate the joys and sorrows of adult life.
She lived on her own well into her 90s, and retained the cheerful demeanor that made her so beloved by all her nieces and nephews. In the last few years of her life, which ended just short of her 97th birthday, she taught me one final lesson: how to accept the changes old age brings with grace and dignity.
Today, many in the so-called “sandwich generation” are caring for their children and also responsible for aging parents, siblings and spouses. The burden can be heavy, but the reward is sweet; I relish the memories of the days when at last I was able to help the aunt who had lavished so much time and attention on me.
To be a successful caregiver to an aging relative, you need a network of allies. A good place to start is with your family’s physician. If the doctor has treated your parent for years, he or she will be familiar with your mom or dad’s medical condition and can make the segue into evaluating other situations, such as whether they are capable of driving, preparing nutritious meals or navigating stairs. It can be easier for the physician to bring these issues up, says Dr. Pedro Cazabon, section head of general internal medicine at Ochsner Medical Center.
Cazabon says he tries to steer the conversation toward concrete choices, such as whether a cleaning lady would be helpful, rather than let the discussion deteriorate into an argument during which the care-giving son or daughter makes general statements like “Mother isn’t capable of doing things by herself anymore.”
Adult children should remember that in their parents’ eyes, they are still the givers of care, not the receivers. It is psychologically difficult for many elderly people to drop the role of parent and accept help from their children, Cazabon says. “An astute physician can broker deals,” he says, convincing the aging patient that he or she deserves to take it easy after so many years of hard work. Remember, too, that many elderly adults came of age during The Great Depression and have held on to the thrifty habits that served them well in the past, Cazabon says. Younger people who are used to a disposable lifestyle can find themselves aggravated with older parents who reuse plastic bags or insist on hoarding rubber bands and string.
Medical advancements have taken some of the sting out of aging, Cazabon points out. Cataract surgery has become routine, and hip and knee replacements spare many elderly confinement in a wheelchair. Those with a positive attitude and a willingness to make adjustments can remain active well into their 80s, he says.
Deciding where to spend those later years is another hurdle. Independent living? Assisted living? Nursing home?
Mother-in-law suite? It can be difficult to figure out what’s best. One source for advice is the geriatric case manager, a nurse or social worker who undertakes the task of helping caregivers come up with a plan that meets their loved one’s medical and emotional needs.
Nurse practitioner Scharmaine Baker set up Advanced Clinical Consultants in New Orleans six years ago, drawing on her experience of helping an elderly grandmother. “It can be a little scary,” she says. Problems can be as small as how to line up care for Grandma’s dog or as major as arranging for house calls by doctors and dentists.
Baker says she can give caregivers the benefit of her knowledge of the availability and skill of area home health agencies and assisted/independent living facilities. Geriatric caseworkers are familiar with safety devices, such as fall-alert bracelets, that can help seniors live independently. At present such services are paid out-of-pocket, but Baker says she foresees a time when insurance companies will cover some of the cost, perhaps as part of long-term care policies. (Learn more about the National Association of Professional Geriatric Managers at www.caremanager.org.)
For those seniors who need some care, assisted living can fill the bill. Louisiana has about 140 licensed assisted living facilities, says Lisa Comeaux, executive director of the Louisiana Assisted Living Association. A good number are available in the New Orleans area, she says. Pluses include lots of activities that encourage socialization, nutritious meals and a secure environment.
Remember that moving into assisted living is an emotional, as well as physical, transition, says Regan Forrester, director of social services at Lambeth House in New Orleans. Those who decide to move on their own usually make the change more smoothly than those whose relatives force the move, she says. Moving is also more difficult for those who are dealing with confusion and dementia. A professional, welcoming staff can make the difference between a rocky adjustment and an easy transition, and a stable population is another plus.
The major problem with assisted living is paying for it, Comeaux says. Neither Medicare nor Medicaid pay for assisted living and because house prices have fallen, lots of elderly people can’t count on selling their homes for a profit and using that money to pay the cost. Grown children who’ve seen their portfolios tank are less able to kick in, too.
Those who need more care may need to move into nursing homes. Although several nursing homes closed in the New Orleans area right after Hurricane Katrina, the population shrunk as well, so the market still has sufficient capacity, says Joe Donchess, executive director of the Louisiana Nursing Home Association.
The staff-to-resident ratio in nursing homes exceeds that of assisted living homes, Donchess points out, which means hands-on care for frailer individuals. He outlines a simple way to measure whether a person can live alone, even within an assisted living facility: If the fire alarm went off, could your elderly parent evacuate independently?
Would he or she become disoriented?
Donchess says some seniors perk up in a nursing home after living alone because they are brought to the dining room to eat and visit with others. Independent living can bring feelings of isolation and depression, he says.
If you’re shopping for a nursing home, Donchess recommends visiting with the administrators and the director of nursing, and asking to spend some time alone with a staff member and maybe a resident. Cost comes in to the picture as well; Medicare does not pay for nursing home care, and Medicaid only kicks in when an elder has “spent down” his or her assets. Most nursing homes in Louisiana are Medicaid facilities, Donchess says, and as federal and state dollars shrink, he foresees a shrinkage in the services offered as well. He recommends buying long-term care insurance policies that will pay for nursing home care.
Almost two years have passed since our aunt died, and my cousins and I still enjoy reminiscing about our experiences with her. The famous “tincture of time” has softened our grief, and we can laugh now about how she fought to remain independent even as we tried to make things easier for her. We cherish the way she cared for us when we were kids, but we cherish equally the fact that we could return the favor.