Is In Home Care The Answer?

In my last post Will An “Elder Monitor” Keep Mom At Home Longer?, I mentioned that my Dad chose to move to senior independent living rather than stay in the home he owned. Still mentally alert and generally capable of taking care of himself, he was having difficulty climbing the stairs to the second floor of the house.

But that was only part of the reason to move. It was the ongoing maintenance of a modest three bedroom Cape Cod that he wanted to eliminate. He had never been a supervisor in his career. Managing the gardener was not something he liked doing.

Those traits that made Dad outstanding as an aircraft quality control representative, paying attention to tiny details and holding fast to specific procedures to complete a job, made for immense frustration with a “mow and blow” gardener.  The gardener was trying to accomodate this 82 year old man while juggling the demands of other customers. There was only so much time allocated to each house.

The gardener understood very well that “Time is Money.” If my father didn’t get to the door rapidly (which was hard for him)  when the gardener ran the bell, the gardener would take off for the next house.

Dad and I discussed getting more help in the home for him. He just didn’t want to manage more people. ”They all try to cut corners,” he emphatically told me.

As a long distance caregiver, I was at a serious disadvantage.  Some people management issues can be resolved by phone, but most of the time, face to face talks are the best way to get things done. “Let me show you exactly which weeds didn’t get pulled.”

Dad was clear that he didn’t want to manage workers. I was too far away. We didn’t have a local family member who could act as “manager” of the service providers.  More service providers, like house cleaners and in home care providers, would make his life more complicated rather than easier. So, moving to retirement community where all of the maintenance was handled seemed like the perfect solution.

The concept of living in a secure, resort-like community with meals, house cleaning, and laundry services like a four star hotel had captured Dad’s imagination. Free local transportation, regular pinochle games, planned activities (Miko the Magician!) and weekly excursions added to the allure.

His cute little house, which had no sentimental value, was in a nice middle class suburban community where the overwhelming majority of residents worked during the day. His grey striped tabby and the newscasters on CNN  were his only companions.

Shops and senior services (lunch at the community center was just $1.25!) were only short drives from the house, but I could already see that his driving days were numbered. Diabetes had taken its toll on the circulation in his legs. He tried to compensate for his slower reaction time when he drove which was becoming less and less frequently. So when a a vacancy came up (after 3 months on the waiting list) in the lowest cost retirement community in the area, he made the move.

Other family members have made different choices. I have two aunts who chose to stay in the homes they have each lived in for half a century. In each case, one of their children moved in to manage care for the parent. One has daily in home care so that her son can work during the day.

My cousin tells me that he has fired more in home providers than anyone else he knows. He shrugs , “I’m tough to work for. She’s my mom and I want her treated right.” He has tried agencies; he has hired directly. One woman has cared for my aunt for seven years. Other have lasted just weeks or months. Because she need around the clock care, several providers are needed.

Still, in home care has been the right choice for my aunt. She had gotten very personalized care in familiar, comfortable surroundings. Nursing homes just can’t provide that. But in home care hasn’t been inexpensive. The largest cost has been my cousin’s time to hire and manage the care providers and take care of my aunt in the evenings.  He has put his own life on temporary hold.

For those families who can’t provide this type of caregiving, there are geriatric care managers who help elders and their families find the right solution and even manage providers. A geriatric care manager typically has a nursing or social work background and is very familiar with all of the services available in a local area. Some companies are even offering these services as part of employee benefits.

When I first became a long distance caregiver, I had the help of a free service provided by a local hospital where I lived. The care manager was a tremendous help in finding information I needed.

Unfortunately, the assistance the care manager could provide was limited by distance. She lived in California. My father lived in New Jersey. I tried to discuss the idea of hiring a local care manager to help him when I couldn’t be there. Dad rejected the idea of hiring anyone. Loudly!

Much later, I would discover the hidden reason why. (to be continued in next post)