Planning Care
So you’ve reviewed the finer points of Aging Well and Getting Organized and you’re ready to begin Planning Care. Okay then! Let’s get to it.
Fig. 1: The five steps to planning care for your aging parent according to Maria
There are five steps to planning care for your aging parent. I strongly suggest that you take them in order.
Why? I’m glad you asked!
Each of the steps I’ve laid out builds upon the last. In other words, there’s a method to planning care. If you just jump in anywhere you run the risk of getting nowhere. The five steps are:
- Step 1: Know Your Limits
- Step 2: Determine What Help Your Aging Parent Needs
- Step 3: Determine What Help Mom/Dad Will Accept
- Step 4: Find Resources
- Step 5: Rally Support
Step 1: Know Your Limits
Make no mistake about it – you as the family caregiver are the base of this care planning operation. As the adult son or daughter, chances are extremely high that you already are, or will be, the first “go-to” person when your aging parent needs assistance. Planning care must begin with an acknowledgment of your time and energy limits.
Don’t forget your day job(s)!
Did you know that the vast majority of family caregivers work full-time outside the home and that a full quarter are also raising children under the age of 18? If you’re one of these busy people then I am talking to you! And if you hear nothing else on this page I want you to hear this:
You Matter.
You are one person with one gas tank and when it’s empty, you must refuel or risk causing yourself harm. What this means is that you can’t do everything despite how much you may want to or others might want you to.
So if you’re just beginning your caregiving journey (and even if you’re further on down the road), I’m urging you to take a step back and ask yourself what’s really feasible now and in the long run. Doing so will enable you to effectively take the next step…
Step 2: Determine What Help Your Aging Parent Needs
To figure out what kind of help your parent would benefit from, an assessment is needed. If you want to do this yourself, the first step is to familiarize yourself with the warning flags to look for on your next visit.
So what if you don’t see any of the warning flags, but you’re still concerned about your parents? Maybe you just want the reassurance that you’re doing the best you can for them? There are a lot of people with you in this boat! For one thing, keep in mind that a geriatric assessment is a skill; what your aging parent needs may be less obvious to you if you don’t have training in geriatrics. Also, your parent may be doing just fine! We often forget that “no problems” are a possibility!
If you want to be sure that you’re not missing anything and/or you’re note sure how to proceed with the warning signs you’ve identified, it may make sense to hire the assistance of a Geriatric Care Manager. But don’t be misled by the title – you don’t need to hire the Geriatric Care Manager to manage your parents’ care if you don’t want to. You can hire him/her to complete the assessment only. As part of the assessment, most Geriatric Care Managers will also create a Care Plan for you and assist you in establishing buy-in with your parent. This is the core task in Step #3.
Step 3: Determine What Help Mom/Dad Is Willing to Accept
This is the most critical step in planning care for your aging parent because you cannot force him or her to accept assistance. Let me say that again. You cannot force your aging parents to let a home attendant, cleaning lady or live-in aide assist them. This means no day programs, Meals on Wheels, friendly visitors – not even a medication reminder service unless mom and dad agree. Did you know this? Well now that you do you can see why this particular step is so pivotal.
When aging parents refuse to have assistance in the home, many adult daughters and sons turn to fancy home monitoring equipment or at the very least, try to convince their aging parent to wear a medical alert pendant in case they require help and can’t get to a phone. However, my best advice is to tread lightly here. These interventions can feel very invasive. If you’ve hired a Geriatric Care Manager it’s a good idea to seek advice on how to broach the topic with your aging parent.
Can my parent refuse services if he/she is cognitively impaired?
Alright, you got me. This is the one exception to the rule. If your parent is cognitively impaired (i.e. he or she has Alzheimer’s or another form of dementia) and is not competent to make decisions, then in most cases the family can override his or her choices and put care in place. However – and this is key – it isn’t enough for you to think that your parent is cognitively impaired; a physician (and in some cases, more than one) need to concur before decision making power is legally passed on.
What if your parent is STUBBORN, but not cognitively impaired?
I know, I know – there are a lot of you in this boat. And before you become angry with your aging parent for not agreeing with what you think he or she needs, think for a minute about how welcoming you’ll be when your son or daughter comes to tell you that you need help. It’s really not easy. Think about how you’d want to be talked to and proceed accordingly.
Engage your parent in a talk about what they’d like most
And I would urge you to start the ball rolling just like that! “Is there anything that would make you feel better, Dad?” Familiarize yourself with the keys to aging well and use them as a guide to your conversation. They’ll help you ensure that you’re covering all the bases.
Also, don’t forget that any kind of change is an adjustment and should be treated as such. Your parent who has always done his or her own laundry may not want to fully give up that responsibility just because you think it’s a good idea. He or she may derive pride and enjoyment here that you’re unable to see. That said, try to stay with them and respect the transition they’re experiencing as much as possible. If they’ll agree to let someone else do the laundry every other week, that’s progress! Rome wasn’t built in a day.
Step 4: Find Resources
Armed with the knowledge of what your own limits are, you’re now ready to go in search of the services that your parent will accept. First you’ll want to find out what’s available in their community. Call the local senior center and/or speak to your parents’ neighbors as a quick and dirty way to get started.
Step 5: Rally Support
Step 5 brings together all the prior steps you’ve taken. By now you should have a clear understanding of the holes in your parents’ care and which they are willing to have filled. Having begun this process by being honest about what you can and can’t manage, you should also have a good sense of the kind of support you need.
Congratulations! You are well-able now to bring the help of others to bear on your aging parents’ situation.
The people you should turn to first to help you care for your aging parent
The first people that should leap to mind when it comes to enlisting help to care for your aging parents are your siblings. Although the reasons should be obvious, what’s not always clear is how to convince your brothers and sisters to pitch in.
Why is this? Well, much has been written about sibling rivalry that rears its head around the care of mom or dad, but I think it boils down to this: the roles that were established when you were kids are pretty hard wired – if your sister was self-centered then, she may still be. Getting her to acknowledge what mom and dad need (much less what you need!) won’t be easy. BUT, it is possible. Here’s how:
Ask for something specific
Maybe you’ve tried to engage your brothers or sisters, by letting them know that “mom (or dad) needs help!” I wish you luck with that approach because quite honestly, I don’t often see it work. And I’ve talked to enough of the less involved siblings to tell you that a request for “help” can leave a person wondering – what “help” means.
Instead, refer to the what you’ve already identified as help your parent will accept and ask for something specific (or a number of things). This enables your sibling to think about what his/her limits are and get back to you. So that this request doesn’t come out of nowhere, it might be best to…
Fire a warning shot
The purpose here is to give your brothers and sisters a heads up that you are in the planning care phase and that action steps will soon be needed. I think e-mail works best here, provided your siblings all use e-mail. Your note can (and should) be short and sweet:
(Example: “Hey Guys, Just letting you know that I talked to/saw ____ the other day and _____ about that interaction was concerning to me. I’m going to visit on _______ to see what more I can find out. I’ll keep you posted as to what I find. Hope all is well on your ends.”)
(Please note: If you go this route, my best advice is to do it between Steps 1 & 2 above.)
Think Locally
When it comes to creating a plan of care for your aging parent, don’t overlook the informal supports that are at work and already in place. Many of these can be enhanced to create a more comprehensive plan of care for your mother or father.
Does your mom socialize with a woman or group of women there that are able to walk or drive better than your mom? If so, perhaps they’d be willing to swing by and pick up your mom on their way to the grocery store or pharmacy.
What about the woman with the teenage kids in your father’s building? Perhaps she (or even her teens) could be enlisted to check in on your dad on a regular basis. Now is the time to explore the willingness of these individuals to lend a hand as part of the care plan.
Don’t forget about you!
Planning care isn’t easy! That means that part of rallying support is identifying who you can turn to for support if (when) you need it. Do you have good sources of emotional support in your life? For many people emotional support is derived from a spouse or group of friends or colleagues. But what about finding support among other caregivers? These are folks who know exactly where you’ve been and in some cases, where you’re headed.
Do you feel that you have enough support for you?
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