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When mom and dad can't care for themselves |
'Today' contributor Alan Kopit has advice for children
faced with placing their elderly mother or father in a nursing
home
By Alan Kopit
Contributor
Today show
Deciding the kind of care needed for an aging parent can be an
emotional and financial burden for adult children with families
of their own. But when that time comes and for whatever reason
your loved one can no longer live independently, are nursing homes
the best answer or are there other alternatives? “Today” contributor
and consumer lawyer Alan Kopit has some advice
So many of us today find ourselves caring for our children and
our parents at the same time. You may find yourself “in
the middle” simply because your parents are aging and can
no longer do all that they did before or you might be thrust “in
the middle” because of a medical emergency. But whether
you can consider the care your parents need without undue pressure,
or whether a medical condition requires immediate action, you may
need a roadmap to assess alternatives for your parents if living
independently is no longer an option.
Do your parents need help?
Obviously with age, the ability of someone to care for
themselves changes. You may see changes in driving habits,
in your parents’ ability to conduct activities of daily living,
or in simply getting around the house. You may also notice changes
in personal hygiene, speech, their ability to handle their finances,
or to think clearly or remember basic things. We all want
to support our parents’ desire to live independently, even
when we have concerns about their safety and well-being. But
there may come a time when you need to step in because their safety
and the safety of others are at stake.
Stepping in starts with an assessment, which is simply a full
review of a person’s overall condition to determine his or
her ability to remain safely independent. There are tools
available on line, through social service organizations, or with
healthcare professionals that can assist with the personal assessment
of your parents.
Assessing a parent’s need
An assessment is a comprehensive review of a person’s
legal, physical, mental, environmental, social and financial condition,
which helps to establish his or her ability to remain safely independent. It
identifies risks, and offers options for reducing them. A
successful assessment will result in a comprehensive plan for meeting
needs and addressing problems, whether those needs are met at home,
in an assisted living facility, or nursing home. It is essential
that your parents participate fully, if they are able to do so,
in the discussion of options.
It is important to discuss:
- What your parents need to feel secure
- Whether your parents are self-sufficient
- If it becomes dangerous for them to live alone, where they
would like to live.
- You must also learn about their financial condition as this
may dictate the type of care they can afford and that can be
provided.
Listing these issues is easy, but actually discussing them with
a parent can be very difficult because of your parents’ fears
about losing independence and facing a future with unknown consequences. While
it is possible for families to complete assessments on their own
using standard checklists, there are also experienced professionals
who can help. Professionals will often be able to assist
with communication issues as well, which in many ways can be the
most difficult hurdles to overcome.
Alternatives if a parent cannot live safely alone
If an assessment shows that a parent cannot live alone,
there are several alternatives:
Home Car
Most people want to stay in their homes or apartments as they
always have. While this is not always possible, there are
services and support systems that may make this possible for the
short or long-term. Services include personal care attendants
who can help with daily needs, and even a trained person who may
come to your home to help with a special health problem. In
addition, there may be services outside the home that permit someone
to still live at home but spend the day in an adult day care center,
for example, where meals and activities are provided.
Assisted Living Facilities
Assisted living facilities are for people who need some help
with daily living, but who want to live on their own as much as
possible. Assisted living is a step between living completely
on your own and living in a nursing home. These types of
facilities may offer help with medication, may offer daily visits
from trained personnel, may offer activities, may serve all of
the meals, and help in an emergency with a trained staff on duty
24 hours a day.
Nursing Homes
Nursing homes are for people who need more nursing care than
you would usually get at home (skilled nursing care). A nursing
home may be needed right after you leave a hospital following an
illness or injury, or may be the best place for you to live as
you age and cannot do much on your own. In a nursing home
there is nursing care 24 hours a day, and all meals and other needs
are also provided. The cost of these facilities can be quite
expensive and that may dictate where and what type of nursing home
you attend. Consider the following issues when evaluating
nursing homes:
Bed availability (is there a waiting list to be admitted or can
one be admitted immediately?)Provision of services that the resident
will need (are there special needs of concern
to this resident?)Affordability (can one meet the monthly rent
and for how long?)Quality of the facility (what do you know about
the living conditions at the nursing home?)Location (is the home
located somewhere that is convenient for you or a loved one to
visit often?)Continuing Care Communities. In a continuing
care community, you can move in while you are still healthy and
active, and stay in the community for the rest of your life. You
will get the kind of care that you need as you age and your health
changes. Continuing care communities are like little towns
with different kinds of housing. There are apartments, small
houses, assisted living homes, and nursing homes. You live
in the place that provides the care you need and move when necessary
(and space is available).
Selecting the appropriate facility
Whether someone is using home care, going to an assisted
living facility, considering a nursing home, or going to a continuing
care community, consider the following before making any of those
decisions:
Use your senses
When you visit the facility, does it seem like a cheerful
and pleasant place? Do the residents appear happy and alert? Are
the rooms, hallways and meal tables clean? Is the facility
free from unpleasant smells? Do the meals look appetizing?
Observe the staff
Does each shift have enough help to be able to care for the
residents? Does the staff appear to be enjoying their work? How
much training is given to the staff? How does the staff assure
family and resident participation in care planning meetings?
Learn from other residents and their families
Does the facility respect the resident’s wishes about
their schedule (for example, activities, bedtime, baths, meals)? Is
attention given to residents at night if they are awake and need
help? Do residents participate in care planning conferences? Does
the resident get outside for fresh air as much as he or she wants? Who
handles resident or family member concerns?
Family involvement
Is the family able to participate, speak up and raise concerns? Does
the family have an opportunity to attend care planning conferences
on a regular basis? Has the family been given an opportunity
to get to know the staff and to help them understand the needs
of the resident?
Document your evaluation
Be sure to document your reaction to various facilities so
that you can “compare notes” after you have done an
evaluation. It may be difficult to remember all of the details
if you haven’t taken good notes during the process as a great
deal of information will be provided. Go back for more information
if you still have unanswered questions.
Help is available from professionals and other groupsGeriatric
assessment centers exist in every community, and are comprised
of healthcare professionals such as physicians, nurses, social
workers, dieticians, physical and occupational therapists and others
who can help to conduct comprehensive assessments if you have any
questions. They can also help you make decisions on what
kind of facility is best for your parent. There are also
geriatric care managers who are healthcare professionals with aging-related
expertise and a familiarity with services available. They
are especially useful for families who are assisting with care
from a long distance. Also, consider these groups for more help:
National Association of Professional Geriatric Care Managers
Website: www.caremanager.org
Phone: 520-881-8008
AARP
Website: www.aarp.org
Phone: 800-424-3410
Family Caregiver Alliance
Website: www.caregiver.org
Phone: 415-434-3388
Eldercare Locator
Website: www.eldercare.gov
Phone: 800-677-1116
National Council on Aging
Website: www.ncoa.org
Phone: 202-479-1200
ALAN S. KOPIT
3300 BP Tower
200 Public Square
Cleveland , Ohio 44114-2301
(216) 274-2278 . FAX (216) 274-2478
e-mail: askopit@hahnlaw.com
Professional Experience
Alan is Partner in Charge of the Firm's Cleveland Office. He continues to focus
his practice in the areas of Commercial Litigation, Creditors' Rights, Reorganization
and Bankruptcy (a practice he Co-Chairs), and Government Relations (another
practice he Co-Chairs). Alan is a member of the Firm's Board of Directors
and Chairs the Information Management Committee. Among his accomplishments,
Alan served as President of the Cleveland Bar Association for the 1996-97
term. In 1987, he was appointed by President Ronald Reagan to serve as a
White House Fellow, assigned as the Special Assistant to Secretaries of Defense
Caspar Weinberger and Frank Carlucci. Alan also was appointed by Cleveland
Mayor Michael White to serve as Co-Vice Chair of the Cleveland Bicentennial
Commission. Currently, Alan provides regular "on-air" commentary
on legal issues on The Today Show (NBC).
© 2004 MSNBC Interactive
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