On Meeting Up with Elders: The Early Bird Special

On Meeting up with Elders: The Early Bird Special

BLOGGERS: Mary A. Languirand, PhD & Robert F. Bornstein, PhD

A friend told us the story of her mother’s most recent visit. Her mom didn’t drive, and planned to come by train. While not thrilled by this plan, there were few realistic alternatives, so our friend agreed—reluctantly, to be sure—and promised to be waiting at the station to pick her up. She arrived 10 minutes before the train was due, only to find her mother shivering on the wind-swept platform, clutching her suitcase: She’d taken an earlier train, having arrived at her departure station well ahead of schedule. The inevitable “why didn’t you call?” was met with protests that she was perfectly fine, didn’t want to disturb her, and so on. Our friend’s initial response was guilt, quickly followed by irritation, generating more guilt.

As we age, our capacity to judge time accurately diminishes: Most people begin to perceive time as passing more swiftly. This tendency is magnified significantly in the early phases of certain forms of dementia, when minutes start to feel like hours. However, the behavior isn’t limited to people with dementia—many older folks become hyper-aware of how time is precious and fleeting, and not wanting to miss out on anything, even the most laid-back elders evolve into “early birds”.

Other age-related factors also contribute to this shift. Deteriorating night vision can lead to avoidance of rush hour traffic and crowds, while the need for frequent bathroom breaks may make your loved one insist on multiple pit stops everywhere you go. For some family members and friends these behaviors are seen as harmless quirks, good for the occasional joke about having dinner mid-afternoon. However, these quirks can actually lead to some significant stress, particularly when you’re their primary source of transportation and support. When your own schedule is already overbooked, Dad’s insistence on arriving for his doctor appointments half an hour early may grate on your nerves (especially if his doctor is notorious for running late….and whose isn’t). A dozen phone calls to remind you of the appointment beforehand along with requests that you “hurry up” while en route may generate tension. So do frequent “what time is it getting to be?” queries while you sit in the waiting room, powerless to move things along.

It’s hard not to resent Dad for getting you into this mess in the first place, and hard not to deliberately start running late on pickup days to regain control of the situation. So what can you do? Three things.

First, try to determine whether your loved one’s “need for speed” is motivated by underlying worries about issues other than concern with timeliness. You may discover that Mom’s fear of getting home late is actually due to concern about her dog, or that Dad’s insistence on dining early is based on his need to save a few dollars. Addressing those issues may lead to much relief all around.

Next, set a realistic time schedule, review it as needed, and stick to it. If you know from experience that it takes Mom at least 10 minutes to put on her coat, lock the door, and put her keys in her purse, factor that into the schedule. Explain what you’re doing: “Your appointment is at 10:00am. It takes 10 minutes to get out of the house, and 15 minutes to get there, so I’ll be at your place at 9:20. We’ll have plenty of time to get a parking space and hit the bathroom.” While unforeseen circumstances may arise, stick with the plan; with sufficient repetition, your loved one will realize that you’ll get where you need to be when you need to be there. (And if she wants to stand on the porch for a half hour before you arrive, that’s her decision.)

Finally, review your own attitudes toward time. “Wasted” waiting room time can be a valuable opportunity for a one-on-one chat with your loved one. It can also be an opportunity to catch up on your reading, draft this year’s holiday message, plan next week’s menus, or text that friend with whom you’ve been meaning to re-connect. It can also be a brief interlude of relaxation for you to enjoy. A bit of reframing on your part can go a long way toward making a frustrating situation much more tolerable….for both of you.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press. The second edition, revised and updated, was recently released. Here’s the link: http://www.newmarketpress.com/title.asp?id=901

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FINDING HOME CARE FOR ILL OR AGING PARENTS

Finding Home Care for Ill or Aging Parents

BLOGGERS: ROBERT F. BORNSTEIN, PHD

MARY A. LANGUIRAND, PHD

In an earlier blog we talked about strategies for coping with caregiver stress–finding ways to manage the upset that follows those inevitable glitches and setbacks that occur when caring for an ill or aging parent.  In this blog we explore one way of preventing caregiver stress before it occurs: a professional caregiver.

There are many different types of home care services, and they vary according to the care-receiver=s needs.  The more complex the problem, the more highly trained the caregiver must be, and the higher the cost.  The average cost per visit for a home care nurse today is more than $120; the average cost per visit for a home health aide is more than $60.

To be covered by Medicare, a service must be ordered by the patient’s physician, who declares the service medically necessary.  A wide range of in-home services can fall into this category, including:

·      Skilled nursing care

·      Speech, physical, and occupational therapy

·      Dietary and nutritional consultations

·      Some educational services (for example, diabetes self-care)

·    Rental or purchase of medical equipment (such as a wheelchair or blood-glucose monitor)

How can you fund services not covered by Medicare?  For many people the best option may be a long-term care insurance policy.  Unlike Medicare, most long-term care policies cover some custodial or non-skilled services (such as light housekeeping and transportation).  Eligibility criteria differ from policy to policy, and you should check with your insurer for details before you contract for services.

Who May Provide In-Home Care?

In-home care is typically provided by certified home health care agencies, and certified independent in-home caregivers (also known as independent providers).  A certified home health care agency is a corporation that provides a range of in-home services.  To become certified, the agency must meet stringent federal and state standards in a variety of areas.  Certified agencies must make their customer satisfaction data available to anyone who requests it, so don’t be shy about asking for this information: Reputable agencies are usually happy to share it with you (it’s a big red flag if they hesitate).

Not all good caregivers choose to work for agencies; many prefer to offer their services privately.  Independent providers can usually be located through Medicare, from insurance companies, via the web, or in the Yellow Pages (look under AHome Health Services@ and ANurses@).  Like home health care agencies, independent providers are required to meet certain criteria in order to be licensed.  They must have adequate training, and appropriate experience.  They must also have malpractice insurance, adhere to the ethical standards of their profession, and fulfill continuing education requirements to stay up to date on the latest findings and treatments.

How to Evaluate an Agency or Provider

Once you find an agency, or independent provider, how do you assess the quality of their services?  First, meet with them personally.  There=s nothing like a face-to-face interaction to help you judge a potential caregiver.  Second, review their credentials.  Everything should be in order here–no exceptions, no excuses.  Third, ask others about the provider=s performance.  Past clients are a great source of input.  Finally, trust your instincts.  If something feels wrong, it probably is.

Questions are important, but not all information can be obtained just by asking.  To evaluate a potential caregiver, you’ll need to judge a few things for yourself.  Any good caregiver–whether they’re an independent provider or employed by an agency–should have six qualities:

·      A professional appearance Although most caregivers don=t look like television nurses, a sloppy or unkempt appearance simply isn’t acceptable.  A professional caregiver should be clean and well-groomed, and dressed appropriately for the job.

·      Good observational skills A caregiver must be sensitive to changes in the patient’s condition–especially those the patient can=t describe directly.  Having the caregiver interact with the care receiver can be helpful in this regard.

·      Good communication skills A caregiver must be able to communicate clearly with folks who have perceptual problems (so don’t be surprised if they speak slowly, loudly, and very directly).

·      Quiet self-confidence Self-confidence is essential in a caregiver.  After all, part of the caregiver=s job is to provide reassurance to you and your loved one.  A good caregiver helps both patient and family member feel that everything is in good hands.

·      An open mind Caregivers and care receivers are often quite different–in age, gender, and perhaps religious or ethnic background.  Care receivers often vent their frustration on those around them, blurting out insults when depressed or upset.  An experienced caregiver expects this, and won’t take it personally.

·      A sense of humor Professional caregivers know to expect the unexpected.  Food gets spilled.  Bedclothes get soiled.  An even temperament and a dose of good humor are essential in a caregiver whose work is sometimes unpleasant.

Robert Bornstein and Mary Languirand are the authors of When Someone You Love Needs Nursing Home, Assisted Living, or In Home Care, published by Newmarket Press.  The second edition, revised and updated, was just released.  Here’s the link: http://www.newmarketpress.com/title.asp?id=901

To find out more about Robert Bornstein, click here to read his bio.

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