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Caring for an Aging Loved One
Introduction
Calculate the Future
Living Arrangements and Care Options
Is Home Care the Answer?
Making the Transition
Preparing Your Home
Adjustment Strategies
Maintaining Dignity
References & Special Offers
This Life Advice® Program guide about Caring for an Aging Loved One* was produced by the MetLife Consumer Education Center and reviewed by the National Council on Aging.
*"Loved one" can describe many specific individuals in your life. For simplistic reasons, this guide uses the term broadly, and also uses forms of the pronoun "he."
When you think of family, your loved ones come to mind — a spouse, children, parents, grandparents, perhaps an aunt or uncle, or even someone special whom you consider "family." And, if you're lucky, these people are with you today, sharing in and contributing to fulfilling family life.
According to statistics, there's a good chance you will be enjoying their company for many years to come. Thanks to healthier lifestyles, advances in medicine and improved living conditions, the average life expectancy of a man today is 72, and it's 79 for a woman.
But with individuals living longer, the role of many adults has changed. Even if your loved ones are self-sufficient today, there is no guarantee their independent lifestyle and good physical health will continue. Eventually you may have the responsibility of arranging for their care. No one likes to think about the consequences of growing old, so this isn't an easy subject to bring up. But if you prepare and make plans now, you can lessen the stress and guilt during a crisis situation.
For starters, take a good look at your loved one's financial picture. Explain that, not only do you want him to be comfortable in his retirement years, but you also want to arrange for his assets to be transferred according to his wishes upon his death. Talk with your loved one about his intentions, and include other family members in these discussions. Be direct and honest. Tell him your concerns, listen to his. That way if the time ever comes when your loved one cannot participate in the decision making, you'll know you are not acting alone, but carrying out his wishes.
The following steps are intended to help you in this process:
Does your loved one have a will that has been reviewed within the past three years? Do you know where to find all your loved one's financial and legal papers and advisors? Do you know the approximate annual cost of maintaining your loved one's current lifestyle in retirement, and do you know if he has sufficient financial resources to do so? Have you reviewed your loved one's assets to ensure there will be enough cash readily available to pay the estate taxes due within nine months of the date of death? Does the trustee of your loved one's estate have the health, financial insight and willingness to perform the required duties? If you are concerned about the mental or physical health of your loved one, have you considered the use of a durable power of attorney? Have you or your loved one considered the use of trusts as a way to manage and transfer assets to avoid either estate taxation of life insurance proceeds or the hassle of the probate administration process? Depending on the value of your loved one's estate, he has made provisions to fully use the "unified credit" available to shelter his assets from gift and estate taxes? To reduce estate taxes, have you or your loved one considered a formal program to make annual gifts to children and grandchildren? Have you reviewed your loved one's retirement plans, including the plan balances, beneficiary designations and tax consequences? SCORE Give yourself two points for every YES answer. Total _____ 16-20. 10-14. 0-8. |
Living Arrangements and Care Options
When discussing who will provide continuous daily care for your loved one, you can choose from these general categories:
Independent living. Your loved one stays in his own home or rents an apartment and provides for himself. You oversee the situation and offer assistance and guidance when necessary.
Assisted-living community.
Your loved one lives independently in a facility that provides some additional support, such as light housekeeping or daily meals. The facility may or may not have a nursing care option available for residents who become ill.
Adult day services.
A community-based group program helps meet the needs of your loved one through an individualized plan of care. Such programs provide a structured comprehensive program in a protective setting for a part of each day, for example, while you're at work.
Home care.
You become responsible for seeing that a loved one's needs are met around the clock. You can move in with your loved one, move your loved one into your home, and, if necessary, either hire home health care professionals or become the sole caregiver yourself.
An intermediate care or skilled care facility, such as a nursing home.
These facilities are designed for people who need continuous, professional care at some level. Ask doctors, hospital discharge planners, social workers and friends for suggestions. You can also obtain a catalog of nursing homes from your state department of health or state agency on aging.
Discuss with your loved one what might happen if you can't maintain the level of care needed for him at home. Often people dread the idea of nursing homes and hospitals, but they may become necessary. On the other hand, these options may be out of financial reach so all other options must be exhausted first. Remind your loved one that the final decisions will depend largely on his health and finances at the time. Explain that you will try to carry out his preferences, but don't make promises you may not be able to keep.
If you think that home care may be the best alternative for your loved one, consider the following factors:
Physical and mental health.
Even if your loved one is in good health now, chronic and accelerating illnesses often accompany advancing age, and his state of health may change quickly. Such changes may dictate the type and level of care needed. Can your loved one manage routine chores and necessary tasks such as personal grooming, cooking, shopping, house and yard work and managing his finances? The more he can do for himself, the greater his choices will be.
Financial Resources.
How much care will your loved one be able to pay for? How complex will that care be? Will he need custodial or skilled care? Are you prepared to subsidize his expenses? You may think your loved one has adequate financial reserves now, but those funds could be depleted if he lives another 15 years or more or comes down with a serious illness. Long-term care is expensive, whether you deliver the care or place your loved one in a nursing home. Depending on where you live, home care can cost up to $35,000 a year and nursing home care can cost more than $55,000 a year.
Your own family arrangement.
If you are married, your partner's feelings about the possibility of your becoming the care provider should be considered. And don't forget your children, especially if they still live at home. If there are disagreements, counseling might be a nonthreatening way to let all family members speak their minds.
Family support.
The family unit is a major support system. Do you have family — or close friends — willing to share in the caregiving or to lend financial or moral support? If so, accept help if they offer — and don't be afraid to ask for assistance.
Community services.
If you plan to assume complete responsibility for your loved one, be sure to check out community support services. Caretaker burnout can be avoided if you make good use of services from the beginning. To find out what's available, start with your local Area Agency on Aging or call the social services office at a local hospital. Some possibilities:
Change is difficult for everyone, especially for the elderly, who may feel they already have lost control over much of their lives. If a new living arrangement involves uprooting a loved one to another city or town, he will need a considerate and caring transition. It helps to include him in the decision. If you are caring for your loved one long-distance, you may want to use the services of a geriatric care manager. For a fee, trained professionals provide a variety of services, such as helping to choose a health care facility, evaluating and monitoring care, and helping with activities of daily living.
If you've decided care in your home is appropriate, you'll probably need to make some changes around the house. Changes can be as complex as adding another bathroom or converting a first-floor den into a bedroom or as simple as attaching a safety rail to the shower stall or having an amplified receiver installed on the telephone. Here are a few examples to get you started thinking:
Most people picture a loved one, particularly a spouse or parent, as eternally strong and capable. It's as hard for you to adjust to a loved one's physical decline as it is for him. Here are some ways to help both of you:
Examples of One Serving 1 slice of bread |
It's important that your loved one maintain a sense of personal dignity. Try to demonstrate respect with the following suggestions:
Be patient and calm.
If a loved one has difficulty hearing, speak slightly slower and use a lower pitch. Use simple, short sentences, and let your loved one see your face and expressions when speaking. Repeat and clarify when necessary-without being patronizing.
Make short, simple lists of daily activities and encourage your loved one to contribute.
Check off completed items each day.
No matter how helpless a loved one appears, don't reverse roles.
Treating a loved one like a child can crush any remaining feelings of dignity and independence.
Calmly discuss all plans and decisions.
Be positive and firm, and avoid emotional outbursts that only upset both of you. Explain that you need your loved one's understanding and cooperation. If you reach an impasse, consult with a third party such as a care manager, doctor or member of the clergy.
Respect your loved one's religious or spiritual beliefs.
Help your loved one remain active and alert.
Encourage reading, hobbies and helping out around the house, if physically able.
Welcome visitors and encourage your loved one to continue to participate in groups, clubs and organizations, if possible.
Caring for an aging loved one may be not only the most practical choice in your situation, but also the most rewarding. Home care offers an opportunity to demonstrate your love and commitment. Sometimes unresolved issues in your relationship may come to the surface. It may be helpful to have a professional (a case manager, social worker, counselor or support group) assist you in working through these difficult times. Home care may not always be the easiest arrangement. But for those who approach it with a realistic attitude, caring for a loved one in a time of need can be a gratifying experience.
BOOKS
Taking Care of Aging Family Members: A Practical Guide
Wendy Lustbader and Nancy R. Hooyman
The Free Press, A Division of MacMillan, Inc $24.95
How To Care for Aging Parents
Virginia Morris
Workman Publishing $15.95
The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing Illnesses, and Memory Loss in Later Life
Nancy L. Mace, M.A. and Peter V. Rabins, M.D., M.P.H.
The Johns Hopkins University Press $13.95
PAMPHLETS FROM THE FEDERAL GOVERNMENT
The quarterly Consumer Information Center Catalog lists more than 200 helpful federal publications. For your free copy write Consumer Information Catalog, Pueblo, CO 81009, call 1-888-8-PUEBLO or find the catalog on the Net www.pueblo.gsa.gov.
For guidelines on selecting services, contact the following:
National Adult Day Services Association: 202-479-6682 or on the Web at www.nadsa.org
American Association of Homes & Services for the Aging: 202-783-2242 or on the Web at www.aahsa.org
Assisted Living Facilities Association of America: 703-691-8100 or on the Web at www.alfa.org
For additional assistance, on primary research, contact the following:
Elder Care Locator: 800-677-1116. Service that links to local agencies.
Children of Aging Parents: 800-227-7294 or on the Web at www.caps4caregivers.org.
For additional assistance on legal and financial issues, contact the following:
National Association of Elder Law Attorneys: 520-881-4005 or on the Web at www.naela.org
National Association of Professional Geriatric Care Managers: 520-881-8808 or on the web at www.caremanager.org
For additional assistance on Medicare, contact the following:
Centers for Medicare & Medicaid Services (CMS) : cms.hhs.gov for Medicare and Medicaid insurance and www.medicare.gov for nursing-home search tool and comparison guide.
ADDITIONAL RESOURCES
If you're currently caring for an aging loved one or will be, check these sites out.
* Because the content of websites changes constantly, it is impossible for us to review it all. We are not responsible for the content of any of the above links.
June 2002
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