Staying at Home for People with Alzheimer's

Q.

Dear Adia,

My mother was recently diagnosed with Alzheimer's. She is 81 years old and lives alone in Palos Verdes Estates. When I learned of the diagnosis, I immediately went into "research mode." I found a great book entitled The 36-Hour Day and watched a few highly recommended films: Savages and Away From Her. Both films were a huge eye-opener into the reality of living at an Alzheimer's facility - quite troubling to watch. In the end, the films convinced me to do everything in my power to keep my mom at home. The thought of her living like a "room mate" with strangers and ultimately, being moved to the "progressive unit" for those with advanced Alzheimer's is more worrisome to me. It's like you're on another planet! I hugely respect all the good efforts to make the person feel comfortable and safe at Alzheimer facilities, but home is always the best place. After watching these movies, I feel "no one" or "no place" can carbon copy the home environment in which my mom cooked, laughed, decorated and raised her kids. Home is home. For this reason, I am determined to modify my mom's home to be "Alzheimer's friendly." I need help to understand how to modify her home ensuring she is safe, comfortable and.happy as best as possible.

Thanks,
Mr. Extreme MakeOver Home Edition

 

A.

Dear Mr. Extreme MakeOver Home Edition,

There are stages of changing or adjusting the home environment of a person with Alzheimer's. Factors in the physical environment, such as lighting, color or noise, can significantly impact the behavior of a person with Alzheimer's. Making changes and adjustments to the home environment can help make activities of daily living easier, more enjoyable and safer for the person with Alzheimer's. Equally important, changes to the home environment can reduce specific high-risk symptoms, such as wandering and getting lost. Research demonstrates that when the physical environment of people with Alzheimer's are specially designed to support their abilities, they are able to remain more independently and socially engaged, have fewer delusions, combative outbreaks as well as experience less anxiety. 

There are many home modifications which have shown to be beneficial in reducing certain problematic behaviors in people with Alzheimer's:

• Buy a phone with large numbers and speed-dial with pictures of family / friends
• Adjust the lights to have low levels of light during meals
• Minimize clutter throughout the home
• Use sturdy furniture that does not tip and remove furniture with corners
• Remove fake fruit and other "look-a-like" decorations like magnets
• Play consistent background noise like the person's favorite music or sounds
• Place objects such as photographs, mementoes and familiar furniture in clear view
• Use appliances that shut off automatically, setting timers or alarms to remind one that something is cooking or that it's time to take medicine
• Post notes and lists to organize activities every day of the week
• Post emergency phone numbers next to the phone
• Hide extra set of car keys
• Place decals on glass from preventing the person from walking into the glass
• Check gas appliances ensuring the pilot lights are working properly
• Mark smoke detectors and fire extinguishers with clear instructions
• Remove toxic or poisonous items, such as cleaning solutions, bleach, drain opener and prescription medicines, should be kept in a safe place to prevent accidental ingestion.
• Install handrails throughout the home, grab bars, non-skid mats and shower chair in the shower in the bathroom
• If wandering is a problem, install alarms or locks on doors. There are various programs available that provide identity bracelets for people with Alzheimer's, so that if they do wander from home or work, they may be returned safely.
• Hire a professional caregiver to stay with the person 24 hours a day to prevent wandering and becoming endangered. Additionally, the professional caregiver can facilitate consistent plans and schedules for exercise and social activities, both of which are key in still sustaining a safe and comfortable life at .home.

Each person with Alzheimer's is different. Researching ALL housing options is important, including the option of staying at home. Make the best decision based on a wide range of options and factors such as costs, stage of the disease, management, home care services, support system, home modification options and family circumstances.

Yours Truly,
Adia LLC
www.adiacares.com

How Will I Get Where I Need to Go?

Dear Adia,

My husband and I have lived in Manhattan Beach for over 50 years in the original house we purchased when my husband started working at Northrop Grumman.  We have enjoyed an active and fun lifestyle living in the beach cities. We often brag to our friends about the success our two children have had since moving out of state.  Recently, we had a major set back that has changed our lives drastically; we lost our privilege to drive.  Due to the inefficient transportation system in the Beach Cities as well as not having family in town, we have been less and less active. It's beginning to feel like our world is closing-in on us! Even the most basic joys of my week like getting my hair and nails done have been a struggle in trying to keep appointments. The last straw came a week ago when my husband missed an important appointment with his cardiologist because my housekeeper quit - unexpectedly. We depended on her for the occasional ride. She promised to be there to help and take my husband to his appointment. Later, we learned that she accepted an offer to work elsewhere for more hours than we needed. Oh boy, were we surprised!!  What options do I have in the South Bay for transportation and occasional help around the house without having to  promise full time work and not be left in a lurch?  

Our Best,
Mr. and Mrs. Car-less

 

Dear Mr. and Mrs. Car-Less,

Aging affects the reaction time, sight and hearing. Your reasons for not driving anymore can be due to accidents or near misses, difficultly seeing pedestrians, or adverse reaction to medication preventing you from driving safely. Despite this, your ability to live independently should not be based on whether you can drive or not. Living without a car should not make you homebound - it's simply a lifestyle change! Today, there are many options enabling older adults to continue their favorite activities and remain mobile. Below you will find a list of options allowing you to move freely around the community. Keep in mind there are pros and cons for each option:

1. Taxi Service
2. Hire a Private Driver
3. Paratransit Service
4. Senior Transportation Services / Senior Shuttle
5. Local Senior Car-Pool Program
6. Call a friend, neighbor or volunteer
7. Hire a Caregiver / Home Care Company

Options 1-6 are restricted to transportation only and may have possible schedule conflicts. Hiring a Home Care / Caregiver Company (option 7) like Adia provides a wider range of services including transportation. In this case, you receive more value since the person is able to provide more than just transportation, such as light housekeeping, meal preparation, medication reminder, and joyful companionship, if and when needed. Thus, hiring a homecare company can provide greater access to a full range of activities that contribute to quality of life.

Before making a decision, create a list of your needs and activities throughout the week. Second, create a schedule and timeline of destinations. Third, research the options in your community and compare each option based on affordability, accessibility, safety / auto insurance, driving history, reliability, payment terms, minimum hours of service and geographic service areas. Also, consider whether you need the transportation provider to be wheelchair or walker-friendly.

People often look to family and friends for transportation assistance. This may be a good temporary option, but it may not always be the most convenient for you or them - every time. There are many options that enable you to remain mobile and "go out and about, safely" on your terms.

Yours truly,
Adia LLC

My Mom Wants to Stay Home! Long Distance Caregiving

Q.

Dear Adia,

I was a long time resident of the South Bay until 2006 when I moved my family from Manhattan Beach to Bend, Oregon for an amazing job opportunity.  My only regret was leaving my 91 year old mother who lives alone in Torrance at the home my parents bought when i was a young boy.  "This is my home.it's the only place I know" says my mom every time I call and visit.  I feel there was nothing I could do to convince her to move north.  Over the past few years, I try to visit often.  My daughter lives in Redondo Beach and checks-in on her at least once a week.  In addition to the changes in my mom's body due to advanced age, her muscular dystrophy (MS) has not completely confined her to a motorized wheelchair.  I am concerned about the revolving door of independent caregivers and their random schedule.  I discovered in my last visit that often times they leave my mom home alone for several hours.  The most recent incident was learning that my mom would be home along on Thanksgiving Day and weekend.  OOhhh NOOOO!!!  I quickly flew back to Los Angeles with little more than a day's notice.  This was the last straw!  I was livid and very, VERY concerned to face what was going on at my mom's home.  Our family feels frustrated, worried and vulnerable but need to respect my mom's desire to stay home.  What reliable and safe options do I have for Mom?

Sleepless in Oregon

A.

Dear Sleepless in Oregon,

The task of caregiving by long distance can be difficult, stressful, and time consuming.  The natural questions that creep into the mind are, "Can I deal with the problem over the phone or do I need to be there in person?"  Answering these questions without being physically presents are often one of the most difficult aspects of long-distance caregiving.  Emergencies obviously require a trip.  However, other situations can be too difficult to judge over the phone through mom or even, a friend.  Being miles away from your mom also means being miles away from local phone books, hospitals and caregiving companies whose purpose is to help older adults.  There is no magic formula, but there are a number of steps you can take to make the task more manageable.

1. Understand Geriatric Managed Care: Geriatric Managed Care involves a manager, whose primary job is to prepare, plan, coordinate, manage, report and oversee all aspects of care for an older adult, including schedule and back-up management, employee management as well as care plan management.  When screening prospective caregivers or caregiver companies, ask about their systems, structures, protocol and procedure of managing care and employees.  This is important because it will affect the quality, continuity and reliability or care which is most valuable for sons and daughters trying to care by long distance.  A "revolving door" of unmanaged, unsupervised caregivers is dangerous and puts the health and safety of older adults at tremendous risk.

2. Know the Caregiving Vocabulary: Live-In or Live-Out are widely used terms in caregiving.  "Live-In Care" is provided by a caregiver who lives at home of the care recipient and earns a wage for the "day."  Typically, the live-in caregiver provides assistance with the activities of daily living (ADL) and/or instrumental activities of daily living (IACL) during the day and sleeps at night.  The ideal situation for a live-in caregiver is when the older adult sleeps through the night without the need for assistance.  "Live-Out Care" also includes ADL's and/or IADL's but it's broken down by hours and shifts.  A team of caregivers work 1 - 12 hours per day.  When older adults require 24 hour care, the shifts are split (day shift & night shift) into three-8 hour shifts or two - 12 hour shifts.  Often times, the two terms are mistakenly used interchangeably; however, ensure you understand the difference.  If mom is incontinent and needs assistance to the bathroom many times during the night, the caregiver should be awake, alert, able and willing to assist mom when she needs it, not expect mom to wait until the caregiver wakes up in the morning to help her.  You need a caregiver prepared to work through the night to prevent the risk of falls by the older adult.  Know the needs and behavior in the night hours before making a decision between "live-in" versus "live-out" care.

The adult children of aging parents may feel they've entered into the Atlantic Ocean on a small raft when caregiving by long distance!  Make the best decision by working with a team of professionals focused on geriatric care management and wellness services.  You will experience peace of mind and the assurance that mom can stay at home! ..safe and comfortable.

Yours Truly,
Adia LLC

Hip, Hip, Hooray

Dear Adia,

I am a strong, active older adult who enjoys traveling with my husband since we both retired 10 years ago.  We spend out summers visiting friends and family throughout the United States.  When we’re not on the go, we have a very active lifestyle with our church and charities in the South Bay.  Last week, I began preparing for a necessary surgery on my hip that I have been putting off for months.  I can no longer ignore the serious repercussions of my declining health and fear of surgery.  I am in pain often and don’t feel as physically capable to perform my normal daily activities.  What can I do to plan ahead for my needs after surgery?  My husband and I have been told we will nee to make arrangements for help in the home.  What does this look like?  I am too young to have a “caregiver” but I know recovery will take time.  How can I get back on my feet after my surgery?  I have always taken care of everyone else.

Many Thanks,
Travel Bug

Dear Travel Bug,

Glad to hear that you will not let your pain stop you from LIVING!  Given the stress of the surgery, sounds like you have postponed it until now.  There is a lot you can do to make sure your surgery and recovery go as smoothly as possible.

1. Know as much as possible about the surgery, benefits and risks.  If your doctor and the attending nurse are not  willing to take the time to discuss the procedure with you, find other professionals.
2. Bring someone with you to the pre-surgical appointments to take notes.  If this is not possible, bring a tape recorder.  You will hear a lot of information in a very short period of time, and it can be hard to digest and remember all the medical terms.
3. Ask for a post-operative checklist.  For each item, write (1) if you can do it alone, (2) can complete the task with some assistance or (3) cannot complete the task on your own.  Use the 1-2-3 rubric.
4. Pick up post-operative prescriptions filled and other medical supplies before the surgery so that you do not have to wait in line at the pharmacy.
5. Visualize your recuperation.  Will you be able to move around your house by yourself or will you need to hire help?  Will you be able to drive?  Ensure you factor in the side effects of the medications that may make driving unsafe, and possibly illegal.
6. Hire Professional Post-Operative Caregivers– In an effort to not impose on your friends, neighbors or spouse during a tough, but temporary time, hire professional caregiver whose job duty is to make your life (as well as your family) easier.  A professional caregiver will drive you to appointments, prepare your meals, clean your house, communicate with the doctor or nurse for follow-up care procedures, remind you to take your medications and keep track of your meds, assist with bathing or dressing, run errands for you, as well as ensure your recovery home environment is clean from any cross-infection risks commonly found at the hospital.
7. Do not let the hospital send you home if you don’t feel ready.  As for help from the Patient Advocate if you feel pressured. 

Lastly, know your rehabilitation and physical therapy plan ahead of time.  Commit to following it.  Slacking off on your rehabilitation plan is a sure way of having a botched recovery!  Therefore, having a professional post-operative caregiver during this time can ensure your recovery does not fail and ensures you are back on your fee, traveling with your spouse, happily every after…Hip, Hip, HOORAY! 

Yours Truly,
Adia LLC

Home is Where the Heart Is

Q

Dear Adia,

My grandmother is 91 years old and lives alone in her house in Manhattan Beach. Although the house is small in size and manageable, sometimes I worry if I don't make time to stop by 2-3 days a week things may fall apart. Grandma is sharp as a tack and very independent but she just can't do a lot alone anymore. When is the right time to put her in a convalescent home or assisted living facility?

Best regards, 
Guilty Granddaughter

 

A

Dear Guilty Granddaughter,

“Home is Where the Heart is” is something that you say which means your true home is with the person or place you love the most.  Before you decide when it’s the right time to move your grandmother into a nursing home or assisted living facility, you should first asses her physical, social and emotional needs. The needs will provide clarity on whether she really needs to move to another location or not. Moving is a big deal for people of all ages, especially older adults. It’s no fun! It’s a big deal because you’re leaving a familiar and comfortable environment to an unfamiliar, unknown new environment despite all the “hotel” perks, it’s still not “home.” That said, consider her own home as the first option before assuming she needs to relocate. Before deciding when is the right time to move her out, answer the following exploratory questions. These questions will help break down the process of determining what is in best interest of your grandmother, now and in the future:

1. What are her needs? Create a 3-column list and assess the tasks she can:
   1. Do Alone
   2. Do with Assistance
   3. Needs Full Assistance
2. Do the basic survival tasks like eating, bathing, dressing, toileting require stand-by assistance or full assistance?
3. How much time is needed to meet the needs? Few hours? Daily? Weekly? How do you help your grandmother during your visits?
4. What worries you the most about her needs?
5. What does the “Assisted Living Facility/Home” offer that you like?
6. Can you offer the exact same services in her own home?  Who can provide such services? Part-time or full-time caregiver? Live-In caregiver?
7. What are the costs for staying at home versus moving her into an assisted living home? Short-term and Long-Term costs.
8. What do you love most about the time you spend with her? What would it take to continue enjoying your time with her at home as a granddaughter, not a caregiver?

Make the best decision based on a wide range of options and factors such as needs, costs, care management, social aspects, home care services, support system, home modification options and family circumstances.

Yours Truly,
Adia LLC
www.adiacares.com

Oh Sweet Silver Bells

A Holiday Season Shines through the Clouds of Alzheimer’s 

Q

Dear Adia,

I am 83 years young living comfortably in the South Bay. My bride and I became empty nester’s almost 29 years ago and since then, our lives (and hearts) have taken us down many paths, with lots of twists and turns. The most memorable path is when my wife decided it was Christmas Day – everyday. This happened approximately 11 months after she was diagnosed with Alzheimer’s. It seems that her memory is fixed on the Christmases of the past. As a result, we have a permanent and beautifully decorated Christmas tree, gifts, snow flakes and lights throughout our home. From time to time, I’ll change the lights when the bulbs burn out. Because of Alzheimer’s, my wife does not have any context about the meaning of the holiday season. She enjoys seeing the lights and tree everyday but she can’t share why the holiday season is important.  What can I do to make this holiday season feel special for her…and different from our everyday?

 

A

Alzheimer’s can be an especially sad disease during the holidays. The clouds that surround a loved ones memory prevent them from making connections with people, places, things and feelings from the past. The key is taking advantage of a possible opening in the fog. Those in the family that do not have the disease should take this possible opening as an opportunity to be there and ready when the clouds part. In your case, this is important because your wife will be looking for you to be there as if nothing has changed in any way.

The flurry of the holiday season may not always fill people with holiday cheer and thus, your own memories of this time can be a mixed blessing. The central issue that concerns family members of loved ones with Alzheimer’s during the holidays is the inevitable emotional  disconnect and sometimes, physical separation. The inability for our loved one with Alzheimer’s to be “mindfully present” at the moment of thanksgiving prayer or not cooking the old family recipe anymore may trigger or enhance feelings of isolation, depression and separation for family members. A sense of loss and powerlessness sets in and changes the holiday experience. It’s hard to accept that the typical “emotional response or behavior” that the loved one with Alzheimer’s used to exhibit during the holidays will not happen anymore. Such behavior may no longer exist when clouds fog their memory. Examples are “My mom used to always fold and save the used the wrapping paper for next year ” or “my mom made funny faces when she opened gifts…” or “dad insisted to cut the turkey with his vintage set of knives from WW II…and always made a fuss about not finding the same quality of knives at Sears anymore…”

The memories of the holidays often change when caring for a loved one with Alzheimer’s. Celebrating the holiday season takes on new meaning for people with Alzheimer’s and their family members. Sometimes the best decision is to change some of the family traditions, but it’s still possible to find new innovative ways to keep the holiday spirit cheerful for you as well as the rest of the family.

Here are good tips for you and your wife during the holiday season:

1. Clothing

• Pull out her favorite “special” dresses or knit sweaters as well as the pearls that matched perfectly. ALL women have at least one favorite dress and an all-time-favorite piece of jewelry.

2. Pictures and Story-Telling

• Display old pictures around the house. Have scrapbooks and pictures books of family reunions and events near the tree or decorations throughout the house. On the days when the clouds are too dark and she can’t remember the moments in the pictures, take heart, because the clouds come and go.
• Share stories without the expectation that your wife will remember. Just talk to her about her favorite and finest moments in life. She may, just maybe…trigger a memory. Hold her hand while you share the sweet stories. Holding hands doesn’t require much but a warm heart.
• Take a moment to sit and admire the lights on your tree together in her “favorite spot.” Perhaps buy a new set of lights and decorate together!

3. Outdoor Decorations

• Drive to a local neighborhood with lots of holiday decorations and lights on trees, front yards and homes.  There are many homes professionally decorated throughout the Los Angeles County which are fun, safe and entertaining activities.

4. Holiday Carols

• Call a local nursing home or senior center for a Holiday Caroling schedule. Often times groups of volunteers carol for the residents of nursing homes. The familiar songs may momentarily trigger a parting of the clouds.

5. Watch the movie entitled “The Notebook.” You and your family will learn how to keep loving and living with a loved with Alzheimer’s disease. It’s a great movie!

6. Take time for yourself

• Remember that consistent exercise, joyful companionship and a good diet are key factors to preventing and/or slowing the progression of Alzheimer’s according to many national studies. Don’t lose sight of your own health!

 Welcome helping hands to assist you in caring for your wife. Many of the physical needs associated with Alzheimer’s can be met by hiring a professional caregiver to assist with basic activities of daily living such as meal preparation, medication reminder, assistance with dressing, bathing or toileting, exercise plans and joyful companionship! These types of services must be customized for people with Alzheimer’s. Seek out quality caregivers or friends that truly understand how to care for someone with Alzheimer’s because there is a difference in care!

Lastly, join the journey when the mind of a loved one with Alzheimer’s strays. Please remember it’s not the person (your “beautiful bride”) refusing to recall holiday family traditions, it’s the disease.

In the moments when the clouds part, remember to appreciate every single story told by your loved one. Often times our loved ones tell the story not to amuse (or bore) the listener, but to test if they can still tell the story…over and over again.

Yours truly,
Adia LLC
www.adiacares.com

Making a Difficult Choice Easier

Where do I begin?

Q

Dear Adia,

I am a mother of 3 kids, all under the age of 12, needles to say our lives are busy and hectic.  Recently, my husband and I have found ourselves making 2 to 3 times more visits per week helping my 81 year old mother-in-law who lives at home alone in Rancho Palos Verdes.  Our dearest Nana is active with church, friends and fiercely independent but, over the past few months, we’ve recognized that she isn’t able to manage her day to day activities as well as she used to, not to mention she was unable to renew her drivers license which was a real set back for her.  Our family has never been in a position of looking for part time/full time help for a loved one in the home.  We received a long list from the hospital of various companies that provide nurses and caregivers. We also have lots of suggestions from friends and neighbors who have hired independent people that help. We really aren’t sure of what to look for and what we need to do to protect our beloved Nana.  We are very concerned that she also will resist a professional caregiver.  We need HELP! We’re feeling overwhelmed and I am not sure how long we can manage this schedule. Where do we begin?

Best regards,
Concerned Daughter-In-Law

A

 Dear Concerned Daughter-in-Law,

Caring for an older adult changes everything. Your experience and concerns are real and much the same of many sons and daughters of the baby-boom generation. It’s a struggle to balance and juggle all the forces competing for your time and attention. Your concern of letting one ball fall and as a result, put your family and/or mom-in-law at risk is worrisome for many families working double or triple duty. The natural behavior is to automatically become the point person / caregiver yourself. However, do you have the skills needed to care for an older adult at home; do you have to quit your job to do so? Can you afford to quit your job? Who is taking care of your own family? These are natural questions that must be fully assessed. Below are key questions to ask yourself and prospective caregivers (or caregiver companies) before making any permanent decisions.

Preliminary ElderCare Preparation and Planning:

1. What are the needs? Daily Chores or Critical Care (bathing, dressing, eating, or incontinence care)? Both? Transportation and Companionship only?
2. What does my loved one “perceive” she/he needs? 
3. Does my loved one need a nurse, a caregiver or a care companion / friend?
4. What services does a nurse provide versus a caregiver? Medical Needs?
5. What are the costs? Per hour or per day?
6. What are the housing options? Stay at home or Senior Facility?
7. Do I call a professional caregiver company or an independent caregiver?
8. Do I have to become an “employer” if I hire someone independently?
9. Is the list from the hospital reliable? Pre-screened companies?
10. What are the risks and costs of not hiring a person or company that is insured, bonded and licensed?   

Questions to Ask when Interviewing a Prospective Caregiver or Caregiver Company:

1. Type of services? Are the services managed? What is a “Care Plan”?
2. Is the caregiver trained to work with older adults?
3. Does the caregiver have a criminal record? Safe driving record?
4. What if the caregiver doesn’t show up to work? What is the back up plan?
5. Who will supervise caregiver?
6. What happens when the needs of my loved one changes?
7. Does the caregiver speak English and have a safe / reliable car?
8. What is the right personality type for my loved one? “Chatty Suzy”, “Mrs. Doubtfire” or “Quiet Betty”
9.  What if the caregiver falls and suffers an injury in the home? Who pays for the medical expenses?
10. Is the caregiver or caregiver company insured, bonded and licensed?
11. Can you meet the caregiver before he/she meets your loved one?

Choose potential caregivers very carefully, even if the person is a family member. Every prospective person should go through a rigorous screening process with the intent of evaluating “fit & compatibility” on many levels – needs, skills / competency, accessibility, geographic location, cultural orientation, personality type, coordination management and costs on a short and long-term basis.  

Make the best decision given a wide range of options. Your goal is to create a positive, long term experience and friendship for both your loved one and yourself.

Most Sincerely,
Adia LLC
www.adiacares.com

Dear Adia, I'm a Mama's Boy...

Oh Momma Mia, Oh Momma Mia!

Q

Dear Adia,

I am a 46 year old self described “momma’s boy” living in Manhattan Beach.  I have a wife and three beautiful daughters ages 7, 9, and 14.  Life is good and a bit crazy!  Recently the pressure has multiplied with the failing health of my mother Margie who lives alone in my boyhood home located in Rancho Palos Verdes.  She used to be independent, active, and even helped us with the kids weekly.  Recently we have seen a change in her moods and energy.  My dad died 4 years ago and my mom broke her hip last year (falling in home), and as a result, she no longer wants to drive.  We try to visit frequently but my wife and I know it’s not enough.  I love my mom but I feel helpless.  What can we do to reverse this downward spiral?

Warmest Regards,

Momma’s Boy

A

Dear Momma’s Boy,

Aging is inevitable, but getting older doesn’t mean getting sick.  The body naturally declines with the lack of physical activity, increased refinement of processed foods and as a result, worsening of our diet.  Just because an older adult has retired at the age of 65 doesn’t mean they “retired from living.”  Aging simply means that they have to work harder at maintaining an optimal level of functioning – a “new” level than when he or she was 20, 30, 40 or 50 years of age.  That said, there is a lot you can do to ensure the aging process of your mother goes as smoothly as possible and help identify her “new” optimal level of functioning.  By doing so, you can reduce the risk of injury, neglect, accidents and equally important, give you a peace-of-mind knowing mom is safe and not home alone.

1. Know as much as possible about the things she can do alone versus the things she needs assistance or can no longer do alone.  Start with a list of her daily chores (AKA “activities of daily living”) such as meal preparation, medication reminder, housekeeping, bathing / incontinence, dressing and transportation.  From this list, determine the degree of assistance she needs to do each task.  If she needs help for more than two lifeline tasks, you must strongly consider hiring a caregiver or care companion.  If not, you run the risk of her leaving the burner on if she tries to cook for herself, forgetting to take her life-sustaining medication, or falling while bathing.  Who will help her in these situations?

2. Where there is smoke, there’s fire means that if something looks or sounds bad, something is wrong – don’t ignore it and pretend it will go away.  Accepting the fact that mom needs support to keep her safe is the first step towards ensuring she lives an easier and more enjoyable life at home.  The second step is to find the right caregiver or care companion for her.

3. Hire a professional caregiver – Don’t impose on your friends, neighbors or spouse to care for your mom, the best and most reliable solution is to hire professional caregiver(s) whose job duty is to make your mom’s life easier.  A professional caregiver will drive your mom to appointments, prepare her meals, clean her house, remind her to take her medications, assist her with a sponge bath or full bath and/or dressing, run errands, as well as ensure her daily experience at home is safe, happy and comfortable.  Consider whether mom needs a live-in caregiver or a live-out caregiver.

Don’t make this decision in the midst of a crisis – it’s hard to think straight while seeing red!  Prepare now by creating a short term and long term care-plan of action.  Empower your mom by including her in the decision making process of accepting help (when, where, how and why).  It will make a significant difference!

Yours Truly,

Adia LLC

www.adiacares.com

Dear Adia, Where Should Grandpa Go?

Home Is Where the Heart Is

Q

Dear Adia,

My grandfather is 91 years old and lives alone in her house in Manhattan Beach.  Although the house is small in size and manageable, sometimes I worry if I don’t make time to stop by 2-3 days a week things may fall apart.  Grandma is sharp as a tack and very independent but she just can’t do a lot alone anymore.  When is the right time to put her in a convalescent home or assisted living facility?

Best Regards,
Gulity Granddaughter

 

A

Dear Guilty Granddaughter,

“Home is Where the Heart is” is something that you say which means your true home is with the person or place you love the most.  Before you decide when it’s the right time to move your grandmother into a nursing home or assisted living facility, you should first asses her physical, social and emotional needs.  The needs will provide clarity on whether she really needs to move to another location or not.  Moving is a big deal for people of all ages, especially older adults, it’s no fun!  It’s a big deal because you’re leaving a familiar and comfortable environment to an unfamiliar, unknown new environment despite all the “hotel” perks, it’s still not “home.”  That said, consider her own home as the first option before assuming she needs to relocate.  Before deciding when is the right time to mover her out, answer the following exploratory questions.  These questions will help break down the process of determining what is in the best interest of your grandmother, now and in the future:

1. What are her needs?  Create a 3-column list and assess the tasks she can:

a. Do Alone

b. Do with Assistance

c. Needs Full Assistance

2. Do the basic survival tasks like eating, bathing, dressing, toileting require stand-by assistance or full assistance?

3. How much time is needed to meet the needs?  A few hours?  Daily?  Weekly?  How do you help your grandmother during your visits?

4.  What worries you the most about her needs?

5. What does the “Assisted Living Facility/Home” offer that you like?

6. Can you offer the exact same services in her own home?  Who can provide such services?  Part-time or full-time caregiver?  Live-In caregiver?

7. What are the costs for staying at home versus moving her into an assisted living home?  Short-term and Long-term costs.

8. What do you love most about the time you spend with her?  What would it take to continue enjoying your time with her at home as a granddaughter, not a caregiver

Make the best decision based on a wide range of options and factors such as needs, costs, care management, social aspects, home care services, support system, home modification options and family circumstances.

Yours Truly,
Adia LLC
www.adiacares.com

Dear Adia, My Mom Wants to Stay at Home

My Mom Wants to Stay Home!  Long Distance Caregiving

Q

Dear Adia,

I was a long time resident of the South Bay until 2006 when I moved my family from Manhattan Beach to Bend, Oregon for an amazing job opportunity.  My only regret was leaving my 91 year old mother who lives alone in Torrance at the home my parents bought when i was a young boy.  “This is my home…it’s the only place I know” says my mom every time I call and visit.  I feel there was nothing I could do to convince her to move north.  Over the past few years, I try to visit often.  My daughter lives in Redondo Beach and checks-in on her at least once a week.  In addition to the changes in my mom’s body due to advanced age, her muscular dystrophy (MS) has not completely confined her to a motorized wheelchair.  I am concerned about the revolving door of independent caregivers and their random schedule.  I discovered in my last visit that often times they leave my mom home alone for several hours.  The most recent incident was learning that my mom would be home along on Thanksgiving Day and weekend.  OOhhh NOOOO!!!  I quickly flew back to Los Angeles with little more than a day’s notice.  This was the last straw!  I was livid and very, VERY concerned to face what was going on at my mom’s home.  Our family feels frustrated, worried and vulnerable but need to respect my mom’s desire to stay home.  What reliable and safe options do I have for Mom?

Sleepless in Oregon

 

A

Dear Sleepless in Oregon,

The task of caregiving by long distance can be difficult, stressful, and time consuming.  The natural questions that creep into the mind are, “Can I deal with the problem over the phone or do I need to be there in person?”  Answering these questions without being physically presents are often one of the most difficult aspects of long-distance caregiving.  Emergencies obviously require a trip.  However, other situations can be too difficult to judge over the phone through mom or even, a friend.  Being miles away from your mom also means being miles away from local phone books, hospitals and caregiving companies whose purpose is to help older adults.  There is no magic formula, but there are a number of steps you can take to make the task more manageable.

1. Understand Geriatric Managed Care: Geriatric Managed Care involves a manager, whose primary job is to prepare, plan, coordinate, manage, report and oversee all aspects of care for an older adult, including schedule and back-up management, employee management as well as care plan management.  When screening prospective caregivers or caregiver companies, ask about their systems, structures, protocol and procedure of managing care and employees.  This is important because it will affect the quality, continuity and reliability or care which is most valuable for sons and daughters trying to care by long distance.  A “revolving door” of unmanaged, unsupervised caregivers is dangerous and puts the health and safety of older adults at tremendous risk.

2. Know the Caregiving Vocabulary: Live-In or Live-Out are widely used terms in caregiving.  “Live-In Care” is provided by a caregiver who lives at home of the care recipient and earns a wage for the “day.”  Typically, the live-in caregiver provides assistance with the activities of daily living (ADL) and/or instrumental activities of daily living (IACL) during the day and sleeps at night.  The ideal situation for a live-in caregiver is when the older adult sleeps through the night without the need for assistance.  “Live-Out Care” also includes ADL’s and/or IADL’s but it’s broken down by hours and shifts.  A team of caregivers work 1 – 12 hours per day.  When older adults require 24 hour care, the shifts are split (day shift & night shift) into three-8 hour shifts or two – 12 hour shifts.  Often times, the two terms are mistakenly used interchangeably; however, ensure you understand the difference.  If mom is incontinent and needs assistance to the bathroom many times during the night, the caregiver should be awake, alert, able and willing to assist mom when she needs it, not expect mom to wait until the caregiver wakes up in the morning to help her.  You need a caregiver prepared to work through the night to prevent the risk of falls by the older adult.  Know the needs and behavior in the night hours before making a decision between “live-in” versus “live-out” care.

The adult children of aging parents may feel they’ve entered into the Atlantic Ocean on a small raft when caregiving by long distance!  Make the best decision by working with a team of professionals focused on geriatric care management and wellness services.  You will experience peace of mind and the assurance that mom can stay at home! ….safe and comfortable.

 

Yours Truly,
Adia LLC
www.adiacares.com