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Managing Care for a Parent Who Lives Alone

Managing Care for a Parent Who Lives Alone

Journalist Lisa Esposito, a health reporter at U.S. News & World Report, suggests ways to help parents who live alone, even though you’re not near at hand. She wrote this article with support from a Journalists in Aging Fellowship, sponsored by the Silver Century Foundation, as part of a fellowship program created by New America Media and the Gerontological Society of America. The article—the second of two parts—first appeared in U.S. News & World Report. On April 1, 2016, it was re-posted at the New America Media website. It’s reprinted here with permission. Part 1 explains how to tell when your parents need 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. 

Eating 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 basics, it's time to tap into local resources. 

At Meals on 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" in 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 doors. 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. 

Accessing Tech for Care  

Personal emergency response systems—which can detect falls, connect to emergency call centers and allow communication with family members—are geared toward people living at home who want to age in place, says Jody Gastfriend, a licensed clinical social worker and vice president of senior care at Care.com.

The simple cellphone is the best, most-used technology for connecting families, says Andy Cohen, CEO of Caring.com, a resource for family caregivers. From what his group hears from family members, most seniors don't like to Skype that much. "They think it's because it's not intuitive and it's difficult," he says. He believes seniors will be more comfortable with newer-model TVs that offer Skype interface. 

Gerontologist Amoke Alakoye, herself a family caregiver, describes how going online helped her aunt. "She fell in love with the laptop about six years ago," Alakoye says, "because her world had closed so much socially without her being able to get around without her wheelchair. Now she's on the Internet and she emails us all kinds of things and she's talking to so many of her friends." You can find computer and technology classes for seniors through the AARP website. 

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 [also] 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

Meet and talk to 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, he 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 is 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 (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 [with] 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 [go] to visit, we explain, 'This is not about you losing your independence,'" Leeflang says. "'It's about 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. "The community can be family; it can be friends; it can be professional paid caregivers." It's a way of being more organized and not duplicating tasks or stepping on one another's toes.

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Lisa Esposito trained originally as a nurse but has since earned a master’s in journalism from Georgetown University. She has worked as a reporter and editor, specializing in health news, for a number of publications and now reports on health and medical issues for U.S. News & World Report. She lives in the Washington, DC, area.

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