All throughout July I hear fireworks, see red, white and blue and hear advertisements that feature ‘Independence’ as a theme. For many in the aging life community – practitioner, protector, senior adult and concerned child – ‘independence’ is a challenging concept. Diminishing skills tend to take seniors’ independence while the senior adult fights against its loss.
Perhaps no sign of a change in a senior’s independence causes more upset than moving – or actually, being moved – from one’s home to a care facility, a combination room or apartment with a professional care staff that takes over responsibility for a senior’s life. According to AARP research, nearly 90% of seniors want to stay in their home. Often referred to as “aging in place,” this option can be possible depending on the senior’s need for care and their financial resources.
If aging in place is a real option, a strong financial plan is necessary. For example, it’s important to explore all benefits that might be available, both at the state and federal level. Veteran’s Administration aid is often overlooked yet typically provides benefits for both veterans and their surviving spouses. National programs like PACE (Program for All-inclusive Care for the Elderly) help people stay out of nursing home care and, if the senior can’t age in place, they can help find a Medicaid-covered group home with several other seniors living in a familiar, home-like setting.
Another option is to investigate any existing long-term care insurance policies. While older policies may imply they cover nursing homes only, it is worth having someone contact the insurer and advocate for home health care, a much less expensive option unless the senior needs round-the-clock care. Insurance often include an opportunity to approve payment for several hours of in-home care per day vs. the expense of a nursing home facility.
There are also life insurance companies that will help cash out the face value of a life insurance policy to pay for care. Reverse mortgages can also be helpful if your loved senior is committed to staying at home.
As far as the safety of aging in place, technical advances in equipment help people keep their independence. For example, you’ve most likely seen TV advertisements for Life Alert; it is motion-sensitive and automatically sends its alert if there is a fall. And, a bath tub can become a low-entry shower to make bathing safer. Bed alarms and mats are available to place next to the bed, sending an alert if there is the appearance of wandering. And there are devices at this link which you can install on the stove burners to ensure they shut-off automatically, preventing fires if your mother forgets to turn them off.
You can install safety features like grab bars and non-slip mats in the bathroom and sturdier handrails on the stairs. You and your parent may feel more comfortable with her/him at home alone for a longer period of time with safety gadgets like these.
Through Medicare, an Occupational Therapist or Care Manager can come to the home and review all safety hazards. This way you can know exactly what changes are necessary to create a safer environment.
From the standpoint of maintaining personal pride for the senior who’s capable of staying home with some supportive family or the occasional visiting professional, let mom be part of scheduling or writing her checks, going over the mail, or creating shopping lists. The person who often takes the lead on these tasks is the Power Of Attorney. Perhaps there other people – a neighbor, frequently seen handy man, friend – who can influence mom’s behaviors, keeping her on track to maintain healthy habits?
Engaged family can take advantage of gerontologists, social workers, and the previously mentioned Care Manager to facilitate needs and perhaps divide up roles among those in the senior’s life who are able (or paid) to step up. For example, use others to maintain your senior’s health: keep her/him off ladders, let someone take garbage to the curb, walk the dog, move oft-used items from high shelves; the goal here is to prevent falls and accidents.
If you can afford to have someone come in to help your mother once a week then do it! Their help can go a long way to keeping your senior independent and in her own home. For example, a weekly housekeeping visit can do the tasks your mother may find exhausting or forget to do, which will keep her from overexerting or hurting herself. Weekly visits from a physiotherapist may help keep your mother physically capable.
Often the first step to keep your independent senior at home is to help mom/dad age well with a plan. Part of this is simply talking about the process of aging, something we don’t typically do before the parent loses her authority role and child becomes care giver. Have the conversation with your parent – what do you want to happen and when? Home care? Assisted living?
Another form of protection to hold onto independence is to put mom’s money in a trust, preventing the tragedy of sophisticated scammers who find so many ways to prey on someone’s fears or sympathies.
Use this link on our sister site, Aging Life Network, to find a tremendous range of resources to assist, using the values that are critical to your aging parent and family. The sooner these conversations happen, the easier the shift and ongoing care will be.
While the solutions above will lessen the sting, or even the need, for drastic changes in the life of your beloved senior, the time may come when more serious changes are needed. Yet, more than the loss of independence, much more is at play in their mind, preventing easy acquiescence with your best intentions: pride, role reversal, depression, guilt over the memory of how they were forced to care for their parents are all swirling around their brain, along with the loss of authority, credibility and autonomy I mentioned initially.
The role of guardian ad litem may represent the best interest of the senior who fears all of the above. How to determine if the time has come? Medical records, doctor’s notes, the potential risks to the senior if no intervention is taken must all be considered. Too often, by the time the guardian is called in, a desperate situation exists: rotting food, empty pill boxes, dishes piled high, no clean laundry are all signs of a need for immediate intervention.
And, when likely resistance shows up, it’s important to distinguish: is the senior simply stubborn, cognitively impaired, or under undue influence by an acquaintance?
In some cases, engagement with former hobbies or life enrichment programs can help. A strong tool is art therapy. Shown to be a powerful tool, art therapy can help your aging parent reconnect with the world. Painting, drawing, sculpting, paper crafts, writing, poetry, music, and even dance can all be part of an art therapy program. There are many reasons to design some art therapy for your parent, or to encourage them to participate in art therapy offered by their retirement community, if, in fact, that’s where they land.
Art therapy has a variety of cognitive and emotional benefits including slowing of memory loss, combating boredom, loneliness and depression, increasing self-esteem and even having physical benefits. Art forges new neural pathways in the brain and strengthens existing connections. Calling on past events to create art improves memory. Using a variety of colors, materials and textures increases sensory stimulation and using art to convey religious beliefs can reduce depression and anxiety. And, of course, when creativity is shared with others it increases social interaction, personal expression and relaxation.
Overall, art therapy is a powerful tool to keep your parent engaged with those around them and with their own story and experiences. There are art therapists who can help you develop a program suited to your parent. Alternatively, you can find many ideas online about art therapy.
What happens if your parent has been diagnosed with mild dementia? Is it safe to leave her/him at home? People with mild dementia usually do well if they are in a stable environment they’ve lived in for a long time, especially when they maintain their established routine. When they forget things, a system of reminders can help them stay on track. For example, if you’re worried because your mother is struggling to recall your number when she wants to call you, writing it out on a sticky note and leaving it next to her telephone can solve the issue.
However, if dad can’t recall emergency numbers when he needs to, that’s more serious. The emergency number in his area has likely been the same his whole life, so forgetting it is also a sign of growing memory issues. Leaving the number on a note pad on the fridge can be helpful, but it is still a sign dad shouldn’t be living alone.
Other ways to extend senior independence? Reminders can be set-up to help navigate day-to-day tasks. You can set up reminders to pay bills with her bank, or add them to her monthly calendar. If your mother can use a cellphone you can program reminders for anything she needs, including reminders to eat dinner or to take her medication.
It’s a must to check-in on your dad regularly, as you never know when dementia may become too serious for him to be alone. It can also help your dad maintain his routine if you or another family member call on a set schedule. For example, if you find your dad is forgetting to lock doors at night you can call every evening at around the same time to prompt him to do so.
Eventually, some incidents will remind you it’s time to re-evaluate your parent’s situation. Falling, getting lost, leaving the house at night, and giving money away are all serious indications that your senior may not be safe to remain at home alone.
If you feel that despite all these support tools your senior would be best served with a guardian, please reach out to me directly for the best and healthiest way to proceed.
Celebrating Decades: the 20 teens
In October of 2017, bipartisan legislation was passed by Congress and signed by President Trump to protect seniors from financial exploitation.
The Court-Appointed Guardian Accountability and Senior Protection Act passed Congress as part of the Elder Abuse Prevention and Prosecution Act. The legislation, authored by U.S. Senators John Cornyn, R-Texas and Amy Klobuchar, D-Minnesota, strengthens accountability and oversight for guardians and conservators.
Under the new law, state courts may apply for funding from an existing program created to protect older individuals, and use the funding to assess the way the courts handle proceedings related to guardians and conservators, so that improvements can be made. Examples of potential improvements include electronic filing systems to keep tabs on guardianships and conservatorships, and the institution of background checks for guardians and conservators.
National Council on Disability
Aging Life Network
American Association for Retired Professionals
attorney Cristy Carbon-Gaul