Situation Rescue -
Typical Caregiver Situations & Possible Solutions

 

Caregiver Specialists List Most Common Questions

 

Mother and Daughter
The family caregiver experience is unique for each family, but overall issues tend to be similar. Our caregiver specialists have compiled a list of fifteen of the most common issues that arise during the caregiving experience. We have offered a brief indication of where to start to find answers and we direct you to locations within the site where more in-depth information may be found.

 

1. How do I choose a nursing home?

First, decide what level of care is needed. Then, it is appropriate to begin your search. Many Area Agencies on Aging maintain lists of facilities along with contact information. Use a checklist to help you compare facilities.

 

 

2. What are the differences between assisted living, nursing homes, and continuing care facilities?

Assisted Living facilities are a type of residential housing that provides a limited about of assistance, if needed. Within this broad category, there are sub-categories of housing. Each requires a basic level of independent functioning for entry.

Nursing homes are designed to meet the needs of persons convalescing from illness or to provide long-term nursing supervision for persons with chronic medical problems. Nursing homes are not hospitals and do not provide acute care. Residents are admitted by a physician’s order. There are several levels of care available.

Continuing Care Retirement Communities, better known as CCRCs, offer housing and health-related services either for life or for a period in excess of one year. Usually, potential residents must be capable of independent living when they enter the community. Most do provide Adult Care Home and/or Nursing Home levels of care so that as a resident's health declines, they are able to continue to live within the community.

To find out more about each of these options and how to find and choose one, use the links below.

 

 

3. How do I know which of the above my loved one can afford? How can I compare them?

Easy to use checklists are the best way to start your evaluation of facilities. Visit at different times. Talk to residents and staff. Consult with your local Ombudsman to find out how to access survey or state evaluation reports. These reports will show you how well the facility follows the state rules and regulations. Your state may have other reports available. Your Ombudsman will be able to guide you.

 

Paying for care is always a big concern. And, there are many many ways to pay for care. We have put together information on each of them. Your personal situation will determine which is most appropriate or if a combination will work best. Caregiver Specialists are available to help you as you navigate the many avenues of payment types.

 

 

4. How do I know if my parent can no longer live alone?

As a family member ages, we often don't notice the subtle changes in functioning. For a caregiver, checklists can help you to think about your family member in a practical and functional way. If you decide to work with an Information and Referral Specialist or Caregiver Specialist, having completed the checklists beforehand will help you to help the professional. If you decide to access services yourself, completing checklists can help you to determine what services may be needed and the level of care that will best suit the needs of your family.

 

 

5. How do I start a conversation about my parents’ future (or current) care needs?

Conversations of this type are frequently very awkward and difficult for families. Start by becoming educated on likely topic areas such as driving, retirement planning, housing, safety, long-term care, organ donation, funeral plans, etc. By knowing about the topic, you will be better equipped to handle these sometimes difficult discussions. Then, learn about techniques to help you bring up these subjects and divert resistance to the discussion.

With conversation techniques and knowledge of the issues and local services and resources, discussion of these topics with your aging relative may be much easier and less stressful.

 

 

6. Is live-in help a practical option for my parents?  They would like a student. Where do I start?

Every situation is different. There are many things to consider. This becomes particularly important if your family member is frail and/or if his or her decision making skills are impaired (through the beginnings of dementia, medications, or other factors). Long-distance caregivers often face a more difficult burden because they are often forced to rely on others - individuals they may never have met in person.

Caregiver Specialists can be a great help in this situation. They can help evaluate the overall situation and point areas in which you need to be particularly aware.

 

 

7. I have hired an aide and ordered home delivered meals. My mother has fired them all. What should I do?

For starters, find yourself a support group where you can exchange ideas with other family caregivers.  Your Family Caregiver Support Specialist can assist you with locating support groups in your area that are attended by individuals who are encountering similar challenges. 

Male Caregiver
You could also consider some follow up conversations with the aide(s) and home delivered meal provider.  You will get some valuable insights into whether it was simply not a good match or whether your mother is consciously rejecting their assistance.  It is not uncommon for an elder who is in early stages of memory illness to be very suspicious of helpers.  By the same token, many elders do not believe they are in need of assistance and reject any and all help. 

 

You might consider introducing the aide to your mother as a friend.  Expose the new friend to your mother several times before your friend actually starts to work.  Talk with your mother several times about the friend’s desire to help her around the house – before the friend actually reports for duty.

Perhaps an approach you could take with your mother is to convince her that by allowing you to arrange this help, it’s actually you that’s being helped.  If you’re balancing several responsibilities of your own (family, job, etc.), you may discover that your mother would be more open to receiving this assistance if you convinced her that it was actually lightening your own load. 

 

 

8. My mother has stopped all her favorite activities and complains about low energy. The doctor can’t find anything wrong. What should I do?

The answer to question #10 below fits this question as well. Low energy could be a symptom of a variety of different things from boredom to depression to inappropriate medications (dosage, type, interaction with foods or vitamins) to stress. Talk to your mom to see if you can find out if she might be bored or depressed or stressed. Is she worried about paying her bills? Does she visit with friends? Does she have a spiritual family? A Caregiver Specialist can help walk you through these discussions. They can then help you decide the next step.

 

 

9. My parents live far from a memory disorders clinic, but I am really concerned that my mother may have some dementia. What can I do if the family doctor minimizes her symptoms and ignores my concerns?

Elder patients often minimize what’s going on, assuring their doctors that all is well.  To compound that, HIPPA (patient privacy) rules have curtailed much of the conversations physicians used to feel comfortable having with family members of their patients. 

It’s important to note that there are several factors, such as urinary tract infections, drug interactions, and/or depression, which could manifest confusion and symptoms that resemble dementia.  Since addressing those issues can often alleviate the symptoms, it might be wise to ask your mother’s doctor to evaluate those areas.

If possible, go to the doctor with your mother.  If it’s not possible, you might consider writing a letter to your mother’s physician, in which you describe the behaviors you are seeing that are causing you to suspect some type of dementia.  It’s very important that you provide factual information (i.e., mother has left the oven on three times in the past week; mother doesn't know what day of the week it is when I call; mother can’t seem to remember that I spoke with her just yesterday, etc.) as opposed to emotion (mother hurt my feelings when she forgot my birthday).  The more concrete information you can provide the doctor, the greater the chances that he/she will take your concerns (and your mother’s wellbeing) seriously.
Female Caregiver

 

If you are not satisfied with the results you get, then don’t be afraid to change doctors.  Ask for a second opinion; ask for a referral to a specialist.  At least one dementia medication works best in the early stages of memory illness, and the sooner the medication can be administered, the greater the chances are that it will be beneficial. Call the memory disorders clinic and discuss the situation with them.

 

Find yourself a support group where you can exchange ideas with other family caregivers.  Since “Necessity is the Mother of Invention”, you might be surprised by the innovative strategies that other family caregivers have discovered. 

 

Finally, a call to your local Alzheimer’s Association chapter can also provide you with additional insights to help you work with your mother’s physician.   And don’t forget, your local Family Caregiver Support Specialist has a wealth of information that is yours for the asking.

 

 

10. My parents are slipping into a downward cycle of inactivity—almost inertia. What is available to help?

There are a variety of issues that could be at play in this situation. They could be bored or depressed. Medications might be slowing them down. Vision difficulties might be keeping them from being as mobile as they used to be. Hearing may be keeping one or both of them from being able to communicate successfully. An underlying medical condition might be slowing one or both of them down.

Female Caregiver
So, the first thing to do would be to try to identify what the problem(s) is and whether both of them are inactive for the same reason. For example, your Mom might be inactive because she doesn't want to go do things herself and your Dad doesn't feel physically able. A Caregiver Specialist can help you ask the right questions and help you be able to successfully talk to them about this issue.

 

Depending on the cause of the inactivity, there are many possible avenues of assistance. Some are identified below. Also consider having each parent's doctor or pharmacist evaluate all medications for adverse interactions or side effects.

 

If you find that none of the above seems to fit, it might be worthwhile to get them each to schedule a complete physical with a doctor and/or consider getting both of them evaluated at a Geriatric Evaluation and Treatment Center. You can also use our checklist to help you evaluate their functional status. This will help any doctor who would see them and will help you as you try to help them.

 

 

11. My parents no longer have any friends in their home state. Their health is failing. Should I consider encouraging them to move to be near me? What help will be available for me and for them?

This is a difficult situation that many families face. A lot depends on your family situation. First, investigate living arrangement options and costs where you live. If you have siblings who live out of state, have them do the same. Call a family meeting, including your parents, to discuss all the options.

It is important to be honest about the amount and type of help you will be able to provide. A candid look at your daily schedule, as it is now, is probably a good indicator of how much time you will be able to devote to your parents. When considering a move, parents deserve this kind of candor from their adult children. Too often parents move long distances after a good “sales pitch” by their children, and they are disappointed by the subsequent reality.

A caregiver specialist can help you understand what resources are available locally and can help you determine the best type of living arrangement for your parents based on their healthcare needs.

 

12. Food preparation seems to be a big problem. My parents canceled Meals on Wheels, and they do not like the food that the aide prepares. What other options exist for them?  Food is one of their only enjoyments…..

Have your parents prepare a list of foods they enjoy and pull recipes they are used to and like. In-home aides can be taught to prepare the food the way your parents like and they can portion them in individual meal sizes and freeze them. Or, find a catering company that will make and package meals per your parent's specifications. Many cities now have that service. If not that particular service, check for the service where you go in to the agency and prepare a week's worth of food for freezing. Perhaps you or another relative would be willing to do that for your parents.

 

13. My mother was always a “pack-rat”, but now the situation is out of control. She won’t let me throw anything out, and I am afraid she will fall over the piles on the floor. Is there any help for this?

Attempting to persuade your mother that she has too many things and that the piles on the floor are a safety risk is apt to cause her to argue for the opposite position, namely that there is no problem and that she is quite comfortable and safe in the home. It may be necessary to seek outside help. Professional organizers, home health aides, visiting nurses and geriatric care managers can provide help with de-cluttering and organizing.

If you are convinced that there is imminent danger and she is not willing or able to acknowledge this difficulty you  may need to contact your local department of social services or your local department of public health.

Before doing that you should try to get your mother to cooperate.

These approaches can be helpful:

  1. Decide together to start by clearing one area of the home.
  2. Provide emotional support. This is hard work and your mother probably feels misunderstood. Use statements like, “I can see how hard this is for you,” or “I understand that you have mixed feelings about this.”
  3. Whenever possible help your mother make decisions but do not make decisions for her. It is helpful to develop rules for discarding. Good questions to ask are: “Is it useful?” “Do you need it?” “Can you do without it?” “In the long run, are you better off keeping it or letting it go?”

In addition to the above recommendations, the following “don’ts” are suggested:

  1. Don’t argue with your mother about this. It will only cause negative feelings and slow progress. When conflict arises, take a break.
  2. Don’t tell your mother how she should feel. While it can be hard to understand why she is keeping particular things that seem to be useless, the thoughts and feelings about these things developed for a reason. Items that appear useless may in fact have great value to your mother.

There is helpful information about dealing with hoarding  on this website:

 

 

14. My father has just been discharged from the hospital. What resources are available?

Male Caregiver
Your Area Agency on Aging and local Caregiver Specialist can connect you with a variety of local resources and services. They, in conjunction with the hospital discharge planner/social worker, can also help you figure out what services he may need. Since services may vary from county to county and may change at any time, contact either of the above to find out what is available and contact information for your local aging agency.

 

 

 

15. Is there any financial support available to help me as I try to arrange for services?

Paying for care is one of the areas of most concern, as you might imagine. We have devoted an entire section of the website to the topic.

 

 

Puzzle With Piece Missing

 

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