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Caring From A Distance – When is Home Not Enough?

John was the oldest son in a family of four siblings with aging parents who had retired some years ago in Florida. As he and his siblings lived in various other states, and John lived the closest to his parents, it was decided he would be the one to take on the role of “remote caregiver” for his parents when their health began to fail. He used the services of a local care management company to help arrange providers to come into the home of his parents and perform the services needed. These duties included such things as help with housekeeping, assistance with transportation to doctor’s appointments and occasional meal preparation.

Whenever John called to talk with his parents, they sounded happy and well cared for. Both his mother and father denied having any unmet needs. Still, John worried if his parents were truly thriving. Most recently, his father had begun to fall and was even hospitalized with a broken hip from his last fall. John had read about the effects of social isolation on seniors, and he knew that his parents were no longer visiting with their friends and rarely left home for anything other than medical reasons.

John was right to be concerned. Too often, our aging loved ones hold back when it comes to questions regarding their needs and overall well-being. As we age, we tend to equate admissions of “need” as letting go of our independence. Another reason older adults may hold back when asked about care their care is the fear of increasing financial burdens on others.

In the case of John’s parents, John decided to make a visit to observe first-hand how well his parents were doing. While visiting, he had opportunity to speak with a neighbor in the apartment across the hall. Much to his surprise, John learned his father had experienced numerous falls over the past several months. He was only aware of three. The neighbor shared that he personally had helped John’s mother to assist John’s father off the floor after falling at least seven times that he could recall. It was the neighbor who had called for the ambulance when his father fell and broke his hip due to the fact that, “he wanted to get up and go back to bed, but I didn’t think his leg looked right the way it was turned out.”

John had researched the pros and cons of home care and community care, and he knew what signs to look for while visiting. He soon realized all was not so well. His father, though alert during the day, had developed a confused state of mind at night. He would get up and down after going to bed as his mother tried to sleep, looking for people and places that no longer existed. As morning came, both his parents were tired and weary from the night’s activities. Neither had the energy they needed to do the things they needed to do for themselves. Instead, they slept in late, failed to comply with their medication schedules, and often skipped meals.

After visiting his parents, John shared his findings with his siblings. Soon, they were all in agreement that the time had come for mom and dad to make a change in their living arrangements. While the decision wasn’t easy, and John’s parents were resistant at first, his mother now says her only regret is that they did not make the decision to move sooner. They now live in an assisted living community near their daughter in Georgia. They are visited regularly by family, have made new friends, and according to John, look happier and healthier than they have in years.

When the remote caregiver visits their loved one, they may only have a few days to ascertain how well the person being cared for is doing. Are there needs being met? Are the services they are receiving really enough? It can be a difficult process to know what to look for, especially if the person being cared for is less than forthright in answering questions or is incapable of sharing details. The following list is helpful for remote caregivers when looking for clues regarding overall care needs:

1. Evaluate prescription medications: Look at the date the pills were last dispensed and the number of pills dispensed. Based on how the pills were ordered, does the amount of pills left in the bottle(s) add up to what the amount should be? Is the amount over or under in quantity if the daily dose(s) was taken correctly?

2. Evaluate eating habits and food supply: How old is the food in the refrigerator? How is the food stored? Is there a healthy variety of food in the home? What types of containers do you see in the garbage? Are clothes fitting appropriately, or does it appear they have lost weight?

3. Evaluate management of finances: If your loved one is still managing a bank account, ask to see the bank statement. Are the transactions appropriate? Are funds being paid out that are questionable? Are bills being paid on time?

4. Evaluate personal hygiene: Are there any odors in the home? Are they well groomed? Any sores or open areas on their skin? Is the laundry kept up? Bed sheets clean?

5. Evaluate environment for safety: Are the walkways free of clutter and fall hazards? Are they able to get in and out of the shower safely? Walk safely in all areas of the home without tripping and/or falling? Are they able to get in and out of the bathroom without difficulty?

When deficits are found in these areas, it is time to reconsider the current plan of care. While a loved one may tell you “all is well,” it certainly will not be well for long if overall needs are going unmet.

Posted in Alzheimer's and Dementia Care, Perspectives on Alzheimer's, Resources on January 23, 2019

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