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THE FIRST PHONE CALL

Written by Susan Lewin, LICSW,CMC,FCM, Principal, Generations, All About Elders, Brookline MA

February 2, 2014

My office phone rings,  and the conversation starts off like this:  “I’m worried that something’s wrong with my mother.   She’s seems to be having trouble being alone in the house.  Every time I visit,   she’s wearing the same clothes; the kitchen table is piling up with unopened mail; she looks like she hasn’t bathed in weeks; she repeats herself over and over; and there’s no food in the refrigerator.  And on top of it all, she’s already told us children whenever we bring up our concerns that she doesn’t want any help from anyone.”  Then the panic in her voice continues and the questions start:  “What should I be doing?   Where do I begin?  Who and what’s out there to help me and my family?

This is an all too familiar situation for an adult child who is aware that their parent(s) is in need of help but doesn’t know where to begin.  There are no simple answers, but there are steps a family can take to address this situation.  It takes time, but when the steps are properly done, much unnecessary stress and feelings of helplessness can be avoided.  And whenever possible,  these steps should be taken before a major crisis develops.   Poor decisions can easily be made when the pressure is greatest.

START WITH A FAMILY MEETING: (not including the elder)

First, have a family meeting, whenever possible.  Regardless of the relationships,  siblings should do their best to get together (teleconference calls work, too)  to discuss each person’s concerns/observations about the older person.   You may want to include other family members, such as the elder’s sibling(s) or trusted friend.  The more input, the better.  Pick a spokesperson or moderator, someone to keep everyone on the topic,  and to frame the issues and move the meeting along.    

Finish the meeting with a “to-do” list and divide it among those present.  If there’s a family member on a speaker phone, see that they also get an assignment.  Be realistic; don’t give a member something that you all know will not get done in a timely fashion. 

Next, plan your meeting with the elder to review concerns and schedule the next follow up meeting with the family.  

BE INFORMED/GATHER INFORMATION:

Keep a notebook or binder to record your family member’s important information.  This would include, but not limited to,  the following:  their full name, address, social security number, telephone, date of birth, Medicare/Medicaid numbers, medigap (secondary insurance) number, other insurance policies that produce income/dividends, list of family members with their addresses and phone numbers, physicians (include specialist/psychiatrists, etc) and their phone numbers, neighbors/other caregivers or agencies involved on a regular basis, list of medications taken, medical history/surgeries, allergies, pharmacy number, any special needs (hearing loss,  poor vision or use of a walker/cane),  as well as their preferred hospital.  All this will be handy if you need to make calls for your parent for most anything that may come up. 

Obtain copies of documents such as Power of Attorney and Health Care Proxies, Living Wills/Advanced Directives and Last Will & Testament.   In addition, make note of names and phone numbers of your parent’s attorney, personal financial advisor,  and accountant, including a copy of the most recent income tax statements.   Include getting information on their monthly income, assets,  pensions and the amount of social security payment.  If possible, calculate their annual income to help plan for short or long term care needs.  Learn which banks their accounts are in and the account numbers,  and the location of the bank vault key. 

This all sounds very intrusive and complicated, but if and when you need to involve outsiders either for in-home care or placement in a facility, you will need to know all these things and more.

Keep track of out-of-pocket expenses you may incur as a result of caring for an elder.  At some point, you may be able to get reimbursed, or at the least, ask siblings to share the expenses fairly.

EDUCATE YOURSELF

Investigate and educate yourself on the following issues that may be relevant to your situation: 

Legal planning…

Learn how to protect the family home, parent’s assets or those of the spouse remaining at home, Medicaid rules/regulations/application process, special needs of a disabled child, estate planning, guardianships, conservatorships, health care proxies/living wills, Durable Powers of Attorney

financial planning…

Know the difference between various trusts,   Medicaid rules allow you to anticipate future expenses and learn how to manage your assets.   It’s never too early to educate yourself.   An elder law attorney is a specialist who handles legal and sometimes financial matters for older adults.  You can find one at “www.naela.org” for the National Academy of Elder Law Attorneys. 

in-home care

Investigate what local agencies provide for short term or part time help to your elder.  For example, a homemaker can come one time or more a week to not only clean but do laundry, run errands, cook a meal, shop; this option can turn into 24/7 care if it is financially feasible and your elder’s needs can be met at home.  Learn the different types of home care companies available, such as employees vs. independent contractor.

Comparing costs is one way to investigate,   but it’s a very competitive market and getting references from current clients is your best bet. 

If your elder has long term care insurance, take out the policy and understand the details.  Call the carrier to explain,  if necessary.  Each policy is unique and you need to know how your loved one will be covered as soon as possible.

alternatives to remaining at home

If or when remaining at home isn’t an option, understand the different housing options available suited ,to your elder’s level of care needs and affordability.   For example, can they manage at an Assisted Living facility or is a nursing home needed for medical management?  Do you know the many options for Assisted Living, such as buy-in vs. rental, subsidized opportunities vs. market-rate?  Which facility offers which?  Today, there are also a number of free-standing memory and dementia facilities available today, if that’s what your elder needs. 

KNOW YOUR LOCAL resources:

Most every town/city has a Council on Aging and a Senior Center.  Familiarize yourself with its location, what services it provides, and use it as a resource.  Call, or better yet, visit it.  Introduce yourself and meet the Social Worker.  Get a list of the months/weeks activities.  Many times you can discover homemakers, meals delivered to the door, activities/programs to attend during the week, transportation to and from appointments, free legal advice, help with insurance questions at these centers.  Understand the difference between an Adult Day Health Center and a Senior Day Program.  Massachusetts have 27 ASAP’s or Aging Service Access Points, covering just about every town in the state.  Often this is your best resource for community services.   Find theirs under mass.gov and familiarize yourself with what they have to offer.

THE CHALLENGE OF CAREGIVING:

There are 25M caregivers in the US; 60% caring for someone for more than 5 years; 80% of care giving is done at home and 47% of caregivers are in the work force.  Care giving is a huge challenge in many ways; because of the stress, caregivers are at higher risk than average for illness and injury, depression, physical strain, anxiety, substance abuse, weight changes.  They have feelings of neglecting their own families, themselves, their work.  Their sleep suffers and they don’t have time for friends.  Caregivers often suffer from financial stress, whether out of pocket expenses or lost wages and promotions, decreased productivity and even replacement at work. 

HIRING A GERIATRIC CARE MANAGER

When you think you don’t know where to start or who to turn to, or you feel overwhelmed by the amount of information available and need to narrow down your options or maintain your focus, a geriatric care manager can assist you by prioritizing your needs and narrowing down your options.  With their vast knowledge of your local community as well as information on your resources, they can be your one-stop shopping for what you need to keep you or your loved one safe and healthy.   You can find an ALCA at “www.caremanager.org”