“Better barley soup at home than a roast at someone else’s home.” That age-old Yiddish expression still has resonance for many of us (I’m a vegetarian, but I still like the sentiment). We feel most comfortable in our own home. This is reflected in many of the calls we receive on JFCS of the East Bay’s Senior Informa-tion Line — often from adult children who want to help their parents stay in their own home, but have concerns about their safety living alone.
Unfortunately, the calls often come in reaction to a crisis — an older adult has fallen or is hospitalized, and an immediate intervention is needed. This usually necessitates moving a parent closer to the adult child, finding assisted living or a nursing home, or hiring an aide to help out in the home.
Adult children take note: If you have concerns about your parent living alone, get a home assessment now to reduce the risk of a crisis later on. You can hire a care manager, contact your county’s senior injury prevention program, or do the assessment yourself. For information, a good place to start is the Centers for Disease Control and Prevention’s “Check for Safety: A Home Fall Prevention Checklist for Older Adults” (www.cdc.gov/homeandrecreationalsafety/falls).
But whether propelled by a crisis or ongoing concerns, keep in mind that the goal for you and your parents is to find a way for them to “age in place.” More often than not, the preferred solution is home care — which can range from help with shopping or cooking a few times a week, to having an aide live in the home.
First, a brief introduction to home care. There are two types: non-medical (also called custodial, personal care or simply home care) and medical (also called skilled or home-health care). Non-medical care refers to help with activities of daily living such as shopping, bathing and cooking, while medical home care includes things that can only be done by a skilled nurse or health professional, such as medication set-up and wound care. This distinction is important because Medicare only covers medical home health care.
Once you’ve identified which kind of help you think your parents need, it’s time to have a conversation with them about your concerns and settle on a plan. One of the big issues we hear about at JFCS is that even when adult children feel like their parents need assistance, there is a natural resistance to seeking that kind of professional support. Many older adults understandably see this as a loss of independence.
While there are no magical solutions for dealing with a parent who doesn’t want home care, here are a few tips that might make the conversation easier:
• Pick the right person to talk. You have a long history with your parents. Sometimes a care manager, physician, lawyer, or friend can better initiate the conversation about home care.
• Put yourself in your parents’ place. One caller told us she was having trouble convincing her mother to get a home care aide. But after her mother said, “You are making me feel like an invalid” — which clearly was not the daughter’s intent — the whole tenor of the conversation changed.
• Involve your parents in the process. Make sure you know what they want.
• Shift the focus. Let your parents know that having a caregiver will help you not worry.
• Know when to back off. Have patience and don’t force the conversation.
• Start small. Initially, hire a caregiver for very practical, short-term tasks and limit the number of hours.
Once you and your parents decide home care is in order, how do you find the right person for the job? There are basically two ways you can go: hire someone independently or go through an agency.
Because cost can be a concern, some people choose a private caregiver by asking friends or looking online. While this can be more economical than using an agency, it comes with risks. Besides the lack of ongoing supervision, the caregiver may not be properly screened and trained. Another caveat: When you hire someone independently, you are the employer and must comply with all the tax and legal requirements.
JFCS recommends using an agency to ensure that the caregiver has been screened, bonded and insured, and has received some training (although the extent of training varies from agency to agency). Agencies also provide a higher level of supervision, in case there are issues with the caregiver. JFCS/East Bay’s Brief Guide to Hiring a Home Care Aide (go to www.jfcs-eastbay.org) offers information.
Once you’ve chosen a home care agency, the next step is pairing your parents with a caregiver who will meet their needs and be a good match for their personalities. Because it is vital to ensure that the caregiver and your parents work well together, you want to think specifically about what issues are most important to you and your parents. Family Caregiver Alliance (www.caregiver.org) has an excellent fact sheet with detailed questions that can help you think this through.
Having an aide in the home can be an adjustment for parents and adult children — but it is often the key element that allows an older adult to continue living at home while aging, and many people find that the right caregiver and older adult can develop a strong and meaningful relationship.
Rob Tufel, MSW, MPH, is director of adult services at Jewish Family & Children’s Services of the East Bay. His columns appear regularly in j’s seniors supplements. Have questions about your aging parents? Email firstname.lastname@example.org or call (510) 558-7800, ext. 352.