Notice These Signs? You May Need to Seek Long-Term Care for Your Aging Parent
While the vast majority of long-term care moves are made from hospital stays, ideally families talk about these types of decisions before something serious necessitates it, says Dr. David Gifford, a geriatrician and senior vice president of quality and regulatory affairs at the American Health Care Association.
"If you see Mom or Dad starting to decline, you have to have the conversation," he says. "Don't kick the can down the road." Instead, pull over and take action if you see any of these "stop signs" along the way:
1. They can't get organized.
For instance, if you notice your parent start forgetting to pay their bills on time, it could be a sign of their declining cognition. Such changes are important to note, says Beth Sipple, a social worker and director of clinical services for Benjamin Rose Institute on Aging in Cleveland. "Are they going to the store and they forget their way back home? Are they losing keys? Are they forgetting to plan and go to appointments or social events?" she asks.
If the answer is yes, voice your concerns while your loved ones are still able to talk practically about the pros and cons of various options. "Somebody who has mild cognitive impairment is still able to tell you their preferences and articulate that," Sipple says. Better yet, bring up your own wishes while your mind is still sharp, Smith suggests. "No 'kid' in their 50s or 60s wants to have these difficult talks with parents," she says. "That's why I have reached out preemptively with my own kids and started the conversations."
2. They're letting hygiene slip.
Accumulating some extra hair grease or accidentally skipping deodorant one day isn't a huge deal on its own; we've all been there. But taken together with other functional declines – say, trouble bathing and cooking and driving – it's worth addressing, found Deborah Lynch, a 64-year-old retired nurse in Minneapolis.
"Following my father's death, we realized the great decline in my mother's socializing, cooking for herself, along with declining hygiene and apartment care," she says. After filling many of the gaps herself, Lynch and her family eventually decided on a "step down" program that provided their mom minimal care until she needed more attention. "We did it early enough for my mom to learn new faces, new routines and the staff to know and care about her," she says. "We have no regrets and urge people to consider early rather than later for the sake of the parent."
Indeed, experts say starting a discussion doesn't mean driving your parent to a nursing home the next day. In fact, many emerging services and technologies like GPS and webcams make it easier for older adults to stay in their homes longer, or to transition to more intense care gradually. "That kind of technology is helpful and sometimes preserves independence," says Dr. Patrick Coll, medical director for senior health at the University of Connecticut Health Center and a member of the American Geriatrics Society's board of directors.
3. They're declining physically.
A stroke, fall or a complication from surgery often sets off a chain of medical events that lead to long-term care. While such acute medical problems aren't always preventable, they are more predictable if your loved one has been seeing a health care professional regularly or gets a geriatric assessment at early signs of decline. Your loved one's physician, local aging agencies and local Alzheimer's association can all be good resources. "You want to make sure you've lined up and visited places so that when the event occurs, you're not just finding the best available bed," Gifford says.
Ideally, regular medical appointments and self-care begin far earlier in life. Coll's research, for instance, is looking into how taking care of yourself in your 30s, 40s and 50s affects not only how long you live, but how long you can live healthfully and independently. "People are living longer, which is a good thing, but living with prolonged periods of disability and chronic illness," he says. "That leads to a lot of dependency, which is not something that people want, and it's not something we want as a country."
4. You don't have the bandwidth.
Some of the signs that you need to consider long-term care for your parent don't have anything to do with the parent – they have to do with you. "What are your strengths? Are you able to provide this help if you're out of state? Can you mobilize resources that will help you get the tasks done? Are you able to take time off work?" Sipple asks.
Adds Coll: "There's a lot of responsibility that comes with being a primary caregiver for someone who has a particular disability or illness," he says. "That can have an impact on the caregiver's own health; their finances; the relationship they have with others in their family."
And while financing long-term care "may be the single biggest challenge" of these decisions, Coll says, delaying conversations about it won't help. Smith agrees. In her case, while discussions with her parents were successful, asking more questions of insurance providers early on may have saved a lot of money and frustration. "Circumstances change, and perhaps you pay for years on a policy that says you can die with dignity at home, but you end up in hospice so nothing is covered," she says. "Adult kids need to ask about this if nothing else."
Be honest with yourself and your family members about what you can and cannot offer your parents before looking into services that can help fill the gaps – keeping in mind that you may want more gaps filled in than your parent does at this point.