Aging Parents: Far-Away-Living Children (or Not)–Thoughts About Home Health Care (or Not) w/ 2014 update


Thoughts about home health care and related options for helping parents age well were triggered when I read The Huffington Post, Huff Post 50 (online) 8/8/13 post, “Home Health Care: Peace of Mind for Long-Distance Caregivers.” The writer heads Partners in Care, an affiliate of Visiting Nurse Service NY. Most caring children, living far away or not, think about the time when parents’ health issues increase, making living alone problematical. Is home health care the answer for our peace of mind and our parents’ enjoyment of life?. 

 “Is it better for my parents, or better for me?” is one of this blog’s key thoughts

There are helpful ideas in the post.  Yet, having spent my adult life with elderly parents living on the West coast and now an almost 100-year-old m-i-l in the Southwest, the post “gives me pause.” First, Why the pause? Second, What should we keep in mind?

1. Why? Expense and Intrusiveness. Home Health Care can be expensive and possibly intrusive. It would be the latter for Sr. Advisor, R,  (my m-i-l). But then, she has caring neighbors, decent mobility, and a good mind.

Sr. Advisor, R has repeatedly and adamantly said “NO” to any suggestion of help in her home–beyond the 4-hour day, once-a-week cleaning woman. Many of R’s contemporaries  with a “companion” (including one with major vision loss) complained throughout the years that it was intrusive: the companions liked to have conversations in the “down time” and these elders didn’t feel they wanted to “entertain” someone who was supposed to make their life easier. R has mentioned assisted living as an option, if necessary.

At Home in Assisted Living

Of course assisted living charges for every “extra,” making it more expensive as people’s health issues increase. For example, my cousin, about whom I’ve previously written, has a big bed covered with large pillows and a beautiful, heavy-looking spread. Commenting that it looks lovely, then asking if it took her 45 minutes to get the bed made up. Her reply, “I pay someone to do it each day.” Yep! Assisted Living extras…and we haven’t discussed charges for dispensing medications, bathing……. and, oh yes, we must very carefully select the assisted living facility as we learned from the PBS documentary: Life and Death in Assisted Living.

At Home With Health Care

I phone Partners in Care in NY. I’m told it’s “private pay–no Medicare or HMO insurance accepted, but some long-term care insurance qualifies.” I ask about fees for home healthcare in New York City (thinking it would be more expensive than anywhere else in this country), so we have a comparison. This is my understanding from an impressive, extraordinarily helpful person who took my call:

1. When a family needs “a lot more help than family members can provide” and staying at home is the goal, home health care becomes an option.
2. An assessment–usually by a geriatric nurse and/or social worker–is $200. After the assessment care recommendations are made.
3. Care management (as opposed to in-home-care) is $175 for 15 minute increments if booked through PIC. Parents remain in their home and licensed care managers–usually former nurses or social workers–do well whatever you ask them to do. (Care management is especially helpful to busy people or far-away-living children.)
4. Fees for a home health aide: minimum 4-hour day: $86 They do light housework, help people bathe, prepare light meal, take grocery shopping etc. (Check for specific “duties.”)
5. Bath service only (2 hours) $44 (bathing,  grooming, dressing, perhaps prepare light meal).
6. Home health aides can’t perform nursing duties, can’t give medications, can’t lift.

Using New York’s Visiting Nurse Service is less expensive . It’s not “private pay.” A physician must request the individual assessment and supply many particulars about the older person on a special form. Medicare and insurance coverage is accepted (Check type of insurance accepted.) Assessment cost: $95 for, I believe, people who recently came out of the hospital (within 30-90 days). Check for other specifics including whether Medicaid is accepted and definitely ask: “Is there anything else I should know about cost coverage?”

If you missed this excellent Mayo Clinic item in Newsworthy (right sidebar) re: questions to ask when considering home care services, check it out now. This was post was written before Newsworthy was a feature of this blog.

Always check Newsworthy (right sidebar) for the latest research and information from highly respected institutions–to help parents age well.

Seniors’ Insecurities–What We Should Know to Help Parents Age Well–continued

Are we aware of our parents’ insecurities or do they cleverly hide them? Why do they do this?
Because of: pride, our youth-oriented culture, denial, valuing independence
What are the insecurities?
Concern about meeting responsibilities, looking old,
acting old, forgetting, having an accident, losing mobility, losing sight, losing control and probably most of all, fear that their children will make them move.
Our psychiatrist-senior advisor, Dr. Bud, explains: With aging comes loss.  When normal aging changes impact what we’ve taken for granted throughout our life, (eg. vision, hearing, strength, ability to heal rapidly, move quickly, enjoy mobility, count on our memory)–a sense of loss occurs–sometimes a profound sense of loss can occur. Loss can undermine confidence and create insecurities. There’s a new reality. “We can’t do what we used to do.”
To begin, there can be problems with Acceptance: Julia (who won’t tell her age until she’s 100–OK that’s pride)–is a real, very wise person in my unpublished book. Involved in a discussion with other octogenarians about when older people should stop driving, she says pointedly: “A lot of people can’t be honest with themselves and try to be something they can’t be. It’s acceptance,” she continues, “an accepting of a lessening of yourself and it’s not pleasant. But you have to settle for some of this.”
And there’s Denial: We’ve all seen people who deny aging by their actions and their affect (the way they look). The cliche is the old man flirting with the young women– and the young “trophy wife.” R once told us that one of her trying-to-act-young contemporaries  (both in their 90’s at the time) was still “teetering around” on high heels. We knew this woman’s son and when we asked how his mother was, he responded that she was still wearing those high heels and he feared she would fall one day. (She never did.)
3.  Pride is a motivator that keeps older people looking good and meeting responsibilities.  In our youth-oriented society, it’s not cool to be seen as old. Independent elders, like Sr. Advisor R, take care to maintain their image. They make the effort and take all the time necessary to look as good as possible. They’ve learned to compensate for vision loss, hearing loss, hair loss, energy loss, etc. and many do physical and mental exercises. While they are more cautious, especially when vision impairs seeing well at night, they are more graceful about it. R will now ask for your arm when stepping of the curb to cross a street–a direct, dignified request.
R isn’t driven by our youth-oriented culture. Perhaps it’s because she learned grown up responsibilities when very young. She says her father taught her to be responsible very early on due to family illness. That included learning to take a streetcar by herself to get places. And R has accepted “the lessening,” figuring out how to compensate so she can do most of the things she has done since she was widowed in her early 50’s.
She still lives alone and independently, knows what’s going on, helps friends, supports her favorite charities, and has love and admiration from–I don’t think it’s exaggerating to say–every young person (boomer and younger) who spends 5 minutes with her.
I’ve quoted R many times, saying (once she entered her 90’s) that “things get more difficult each day.” We believe her, but don’t see the evidence except where energy is concerned. So what do we, adult children, do? We try to empower. We respect her wishes. We give legitimate compliments and praise when appropriate. If she doesn’t ask, we keep most suggestions to ourselves. We try to supplement groceries or make things easier in any way we can during the months we’re with her.
A geriatric social worker said once “It takes a village to keep the grandparent in the village.” To that end, R’s neighbors wheel her garbage and recyclables to the street and back each week, bring the daily newspaper and mail to her back door, leave flowers, baked goods, little notes by her back door, and two women (one 51, the other a boomer) phone each week when they go grocery shopping–inviting her to go with them or asking what they can get for her.
How fortunate older people are when they have thoughtful, caring neighbors who value older people and help make aging in place possible; and how grateful far-away-living children are for these wonderful neighbors who fill in the gaps (thus unseen insecurities don’t overwhelm), and–in general–help parents age well.

What Pope Benedict XVI (85) and Sr. Advisor R (99) Have in Common

“I want to quit, ” Sr. Advisor R’s voice came clearly through the phone early Monday morning around 9:30 am. It was the day before yesterday…a cloudy, gray day with periodic rain falling. I phoned her –basically to double-check that there were no new developments in R’s life that I should be aware of before coming to pick her up for her wound care center appointment at 1:45.“The Pope is quitting. I want to quit,” she continued. (Obviously she had already read the paper.) She went on saying something like “I understand his not having the energy for all the responsibilities.

“You know I’ve been feeling this way for some time now. I’m tired. I’ve done everything. Helped everyone I can help; given all I can give–financially not that much, but every bit counts– to help people and the charities I know do good right here in town; and I just don’t have the energy for the responsibilities any  more.”

Of course the Pope can quit and basically remain in the environment he knows with people to take care of his needs. R, on the other hand, would need to give up her home and go to a new environment–a senior retirement place, she decided. Why? Because the responsibilities associated with taking care of her home are feeling overwhelming. That said, she wants to research before making any decisions.

At 99 years of age, she’s dependent on certain people, but… The gardener no longer comes when he should, “the grass looks awful.” She’s alway taken pride in her home. Her cleaning lady (R cleaned until 5-6 years ago) leaves dirt in the corners, always wants to talk, no longer does the heavy cleaning; and the man who comes once a week to take care of the shrubs and citrus trees and do small errands has a bad back. R doesn’t know how long he can continue. Plus the weather–it’s supposed to be warm here but this has been a cold winter. Her bones hurt. R tells me I’ll understand about cold weather and bones when I get older.

My thoughts go back to Dad. He died at 94 1/2 (as he liked to tell everyone). Being a far-away-living daughter it was easy to notice that the last year and a half he began to “pull in,” often preferring to sit in his recliner chair alone in the den, reading his favorite (“because they have happy endings”) Louis L’Amour Westerns with the stock market channel on TV as background noise. Having some of my childhood friends (who he’d known almost all my life) visit, was an added stress, added commotion–even though he liked them. And even his granddaughter (age 2) often generated too much energy and noise for him and he turned down offers to have her come and visit.

So what are we saying? People who have aged well can legitimately feel “old.” At different chronological ages (perhaps 65, perhaps 99) they share commonalities. Their energy wanes, former challenges and responsibilities that they handled impressively before, begin to weigh more and more heavily. They have pride. They want to do. Their mind is still good. They may even feel young inside. But they–if they know themselves–realize the need to relinquish certain responsibilities and simplify and/or de-stress  their lives.

We try hard to help parents age well. If we’re lucky, they do and they live well longer. But there can come a time when they feel it’s time to “quit.” For me, who’s a cheerleader at heart, and my dad it was clear (knowing he had no clinical depression) that I needed to stand back–and basically be a loving daughter.

Help Aging Parents: When Life (and Death) Get in the Way

When parents need us, we are there–if we can possibly manage it and are committed to helping them age well.  And so it is today, that a dear friend, Edie, was laid to rest in NY.  She was almost 101 years old and she did age well with help from her two daughters and as much love and caring as was possible from grandchildren who adored her.

Using Edie’s example, I want to write a bit about how family contributions help old/older people age well.

You may have met Edie in previous posts: quoted for her wisdom about old peoples’ driving and cited for her always-in-order, stylish appearance among other things.  She was intelligent and well read, and her good eyesight enabled her to read, as well as write a note on a January letter to me (dictated to her Tenessee-living daughter, who then printed it out so Edie could add the note) in her very legible, somewhat shaky, handwriting.

Edie lived in NY (with a daughter who has health issues and her daughter’s husband), but kept close ties to both daughters.  A year ago around Mother’s Day, Edie’s Tennessee-living daughter came to NY to take Edie to live the rest of her life in Tennessee–a mutually-agreed-upon move.

The Tennessee-living daughter is Edie’s youngest and she visited NY periodically.  On those trips she and Edie shopped for clothes at Talbots–one of Edie’s favorite stores (obviously another option for clothes suitable for old women). She also went to Edie’s hairdresser’s and opened an account to ensure Edie’s weekly hair appointments.

We know how important hair is in looking “put together.” While clearly looks aren’t everything, they make a first impression.  And Edie’s first impression was yes old, but well-groomed, nicely dressed…with-it.  Additionally, weekly hair appointments got Edie out of the house and into real life at the hair salon with all the gossip and friendly chatter that involves.

When Edie stopped driving at 90 something, another family member or friend drove her to the beauty salon each week. More contact with others, more socialization, more stimulation–all of which as we know helps people age well.

Once in Tennessee, Edie’s younger daughter, a teacher, became caregiver during her nonscheduled working hours. She arranged for someone to be at home with Edie during the day while at school.

Many of us are familiar with the routine–put our life on hold until the end of a long day then take care of our own responsibilities. Papers needing to be graded awaited Edie’s daughter at night.  So once the night was hers, she began another kind of work. But she wouldn’t have changed that for anything, she says.

I began writing about old people and change in the last post. While change is difficult for most old people, Edie seems to be an exception.  The fact that moving was a mutually-agreed-upon change, was no doubt a big factor. Edie also liked the gentler pace of Tennessee.

While Edie lived with her NY daughter and husband for many years, we all knew about her yearly trips (in her 90’s) to Tennessee as well as to Texas and California to see her grown grandchildren. Shortly after arriving in Tennessee last summer, Edie’s daughter and husband drove her to Texas to visit one granddaughter and her family. More stimulation, more social contact. “Can you imagine we’re driving all the way to Texas?” she wrote me.

Edie’s was a life well lived. She was a member of that remarkable generation–widowed relatively young with two daughters, always upholding her end while moving everyone forward in the most graceful, positive way. When she neared 100 she needed help and her family was there for her. What goes around, comes around.