Most families assume there are only two outcomes possible when an older parent starts having difficulties; they can live entirely on their own at home or they must enter a nursing home. This either/or proposition causes families unnecessary stress and guilt. In reality, there’s a whole spectrum of support that exists between these two extremes and that can make a huge difference — but it’s hardly ever mentioned in your doctor’s office, and it’s not the topic of conversations in those panic-filled family meetings that often occur after an accident.
What Partial Support May Look Like
The middle ground doesn’t represent one level of support; it represents many. It may be the case that your mother is no longer able to safely manage stairs, but she is still able to cook breakfast and put on her clothes; she needs help, but she doesn’t need someone watching her full-time.
Partial support can look like professional help. This can include part-time paid help. Someone may need only a few hours of support each day to be able to stay safely in their own house. There are many services that can offer this kind of flexible framework for support; Elderly Care Philadelphia, for example, offers caregivers who come for specific tasks. Someone might need reminders to take their medication, help to bathe, someone to prepare their meals and clean them up, or simply someone to converse with or observe them during those hours of the day that are most dangerous for them.
This is also scalable. It can be as simple as starting with someone coming in three mornings a week and then increasing or decreasing as needed. Unlike entering a nursing home, it’s not an all or nothing scenario.
Why Families Don’t Think About This
The problem is that families often only begin to consider care in the midst of a crisis. Your father takes a tumble; he breaks his hip. Your mother has some sort of episode. Suddenly, the discharge planner at the hospital has questions about where your parents will go when they leave the hospital.
Older adults often slide into needing extra support. They may do so at a rate that no one in their family is actually noticing. But when there is a crisis, hospital staff do not have time to help you appreciate all of the options available to you and your parents. They may talk about rehabilitation facilities and nursing care but they don’t always tell you about the many different ways help could be provided at home.
What happens next is often a flurry of phone calls and meetings between various family members trying to make what feels like an impossible decision regarding placement. Conversations with insurance companies can be equally unhelpful. Medicare only covers some things, and very specific events, often limited in time. It may be used after a hospital stay for physical therapy but it does not apply to daily support that keeps someone functioning as an independent person. When families hear “not covered by insurance,” they often assume it’s impossible.
Another problem is that there is an expectation within families of older adults that someone living on their own who needs help needs “real” help from medical professionals to provide hands-on support. The idea that someone might benefit from professional help with non-medical activities of daily living seems absurd (and an admission of incapacity) to many families, but it shouldn’t be.
Actual Cost Comparisons
Let’s talk about money, since the costs of care are often what helps people make a decision about care arrangements. A nursing home will usually cost between $7,000 and $10,000 per month; sometimes quite a bit more and that’s for shared quarters.
Professional support at home varies depending on how many hours someone needs each day, and where they live, but if someone needs support 4 hours a day 5 days a week, for instance, that may cost between $2,500 to $4,000 a month in many areas. That’s still thousands of dollars less than care in a facility.
And here’s the kicker: professional support also allows your parent to be in their own home surrounded by what they know and love.
The math becomes a little more complicated if family members are already doing a lot of the care (for free). If you are driving 40 minutes across town each day to help your mom take a shower, make sure she eats something, and sit with her for 10 minutes, you are spending several hours of your week in addition to gas and wear and tear on your car. You are also potentially spending money you could be earning if you’re still working and need to take time off.
Here’s when partial support works best:
The partial support system works best for older adults who are cognitively intact but physically challenged. They can still make decisions, balance their check books and know what they need; they just physically can’t do it anymore.
It also works for early stage dementia if the affected person is still primarily functional, but needs someone there for supervision and safety. They can still do a lot on their own, but they may forget to turn off the stove or lock the door. They may wander out of the house at unusual hours. Having someone come to check on them regularly or stay during those times that are considered the riskiest alleviates catastrophe without robbing someone of their independence.
This system also applies to people who are transitioning into needing more structure and support cognitively and physically. Aging is not an overnight process, nor is the decline after which someone genuinely needs support 24/7.
It’s not developmentally appropriate to just throw people into a nursing home. Starting with a few hours of help per week that can be adjusted as needed is easier.
What happens if you wait too long?
One potential downside of there being so many options is that families wait so long to address the issue that they never act upon any of them; the older adult has now passed the point at which partial support would have met their needs.
In the meantime, everyone has burned out trying to do everything on their own while also working, raising kids, and trying to have lives of their own.
If your parent is continuing down a path of denial of what they can no longer do on their own — not because they want to, but because they feel embarrassed about needing help — they will also continue to miss out on activities and events that might otherwise have enhanced their quality of life.
They can also continue to slide down into a place where they cannot function at all without support. Relatively easy to solve issues with older adults such as forgetting pills or monitoring when they come and go can lead to serious accidents if they are left unattended.
How to Approach It
Bringing up the idea of gaining outside help can feel uncomfortable; introducing the idea that a parent who has dedicated his or her life to living independently is no longer able to function without help may be challenging. Start small; it may be easier to point out specific issues rather than make sweeping generalizations about how you feel it’s time for them to gain outside help.
Instead of saying “I’m worried about you living alone,” you might preface it with something specific you’ve noticed — “I’m worried about you living alone and I’ve noticed you’ve been having trouble with the stairs.” Consider preemptively tackling 1 or 2 situations where you feel outside help could ease the difficulty before tackling the full day-to-day experience.
Many parents in this situation will probably be relieved when help is offered; they’ve been struggling but didn’t want to make it public by admitting it to anyone. Others may push back hard; this is where you may have to be significantly more insistent about what you’re observing and why you’re concerned.
Overall:
There’s no right answer for every family; some families have the resources (and time) necessary to provide much help on their own; others do not.
Some older parents have plenty of finances while others struggle from check to check.
The middle ground between living independently without care versus needing absolute care exists for a reason; not everyone needs the same kind or amount of support.
