Geriatric Care Managers

When discussing who will provide continuous daily care for your aging parents, you can choose from these general categories:

Discuss with your parents what might happen if you can't maintain the level of care needed for them 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 parents that the final decisions will depend largely on their health and finances at the time. Explain that you will try to carry out their preferences, but don't make promises you may not be able to keep.

Is Home Care the Answer?
If you think that home care may be the best alternative for your aging parents, consider the following factors:

Physical and Mental Health.
Even if your parents are in good health now, chronic and accelerating illnesses often accompany advancing age, and their state of health may change quickly. Such changes may dictate the type and level of care needed. Can your parents manage routine chores and necessary tasks such as personal grooming, cooking, shopping, house and yard work and managing their finances? The more they can do for themselves, the greater their choices will be.

Financial Resources.
How much care will your parents be able to pay for? How complex will that care be? Will they need custodial or skilled care? Are you prepared to subsidize the expenses? You may think your aging parents have adequate financial reserves now, but those funds could be depleted if they live another 15 years or more or if they come down with a serious illness. Long-term care is expensive, whether you deliver the care or place your parents 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 aging parents, 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:

	Contact a local geriatric care manager with proper credentials.
	Hire a housecleaning or yard service.
	Find a transportation volunteer through your church or local senior service organizations to drive your parents to medical appointments or deliver groceries and prescriptions.
	Use a meal service such as Meals on Wheels.
	Enlist the services of a visiting nurse or a home health aide.
	Inquire about senior center information and referral resources and adult day service facilities.
	Contact the local chapters of associations, such as the Arthritis Foundation, the Alzheimer's Association, YMCA, American Red Cross and Veteran's Administration. They're often pipelines to the services available in your community.
	Be good to yourself. Don't be a martyr — ask family and friends to help out. Consider joining a support group

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, they will need a considerate and caring transition. It helps to include him in the decision. If you are caring for your parents 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:

	Install a help alert system.
	Remove clutter, sharp objects and throw rugs.
	Install nonskid strips in showers and bathtubs.
	Place a flashlight by the bed.
	Install night-lights in halls and bathrooms.
	Install railings next to all stairways and steps.
	Set the hot water heater to a lower temperature.
	Take a certified CPR course. In addition, you'll want to make your loved one feel welcome in your home by displaying his favorite possessions — particularly mementos and photographs — in plain sight

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:

	Make routines easy-to-follow, and try to stick to a schedule.
	Good grooming is essential to your loved one's physical and emotional well-being. Include hair, nail, skin and dental care in your daily routine.
	Make sure eyewear prescriptions are up-to-date. If your loved one's sight is failing, provide good lighting; a magnifying glass; large-print editions of books, newspapers and magazines; and other low-vision aids.
	Ask how your loved one feels on a daily basis, and keep notes for the doctor.
	Arrange regular dental checkups.
	Consult your loved one's physician about dietary needs. Disease and medication can affect dietary requirements as much as age. If allowed, try to provide a variety of foods, using the food pyramid as a resource (see chart below). But don't forget to include your loved one's favorites. Also, make sure you serve food that can easily be chewed, cut up in manageable pieces or pureed, if necessary.

It's important that your loved one maintain a sense of personal dignity. Try to demonstrate respect with the following suggestions: