[ photo by Andrea Piacquadio ]

Taking care of elderly parent, Greg’s story.

Not long ago I had a discussion with a gentleman that I will call Greg. His mother-in-law (MIL) was recently diagnosed with Alzheimer's dementia. Shortly after her diagnosis, he and his wife and their young family moved her into the townhome that was adjacent to their own. They all believed it would be the safest solution for her and allow her to stay out of a memory care facility.

Unfortunately, she was quite demanding of her adult childrens’ time, often getting very angry if they didn’t drop everything to help her right away, even with the most trivial tasks. She would frequently show up to their home unannounced, insisting they help her right away. Greg was at his wits’ end and did not know how to proceed. 

I am sure that Greg is not the first person to go through a situation like this. Because of that, I thought it would be good to share how we worked through some possible solutions to these problems. To start, I commended Greg and his wife for the steps they had taken so far. They had taken the important step of setting her up with a neuropsychologist for evaluation to determine what specific areas his MIL would need additional assistance and attention.

I advised him to work with a geriatric social worker. A geriatric social worker can often be found through an online search. Many hospitals have these specialized social workers. They are advocates for their clients, securing the mental, emotional, social and familial support they need.

Options for elderly parent care in or near home.

From those initial steps, we went through a few different potential options. The first option was to have his MIL move in with him. That wasn’t necessarily a great option because she was already having trouble respecting boundaries. Moving her into their home would undoubtedly make that even worse. In addition, they had already taken a big step by moving her next door. That kept her close while still giving Greg and everyone in the family their own space. 

The next option was keeping her in her own home but hiring a caregiver to be with her. There is a high likelihood that her frequent invasions into their privacy was related simply to the fact that she was alone and maybe even bored. She was still early in her diagnosis, so it did not seem that she needed 24/7 care. Because of that, we discussed having a caregiver to be with her for certain periods of the day. In deciding when and how long the caregiver should come initially, we spoke about trying to determine if there was a pattern as to when his MIL came over with her demands of their time and help. If a pattern could be established then those would be the times Greg and his wife would have the caregiver be with their mom. If a pattern could not be determined, then I recommended the caregiver come during the times of day that he and his wife just simply couldn’t assist her, i.e. during dinner and the usual bedtime routine of the young children.

I think it is important to note that hired caregivers can be quite costly. Medicare benefits don't generally pay for this type of care, so it is usually paid for out of pocket. A social worker can help to determine if she might qualify for some weekly hours paid for by Medicare, however. Having someone come for set periods of time each day can be helpful in offloading the burden, so sometimes the cost of the caregiver is worth it to the family members. 

Greg and I also talked about the likelihood of her transitioning to needing someone with her around the clock. Greg and his wife took a big step in moving her next door, so they would be able to go right to her if she needed help quickly. One way to monitor her would be to use a baby or other type of video monitor to be able to quickly check in on her when someone could not be there with her. I have had family members do this before. Though not always the best option, it was often the option that worked best for those families that were determined to keep their loved one home for as long as possible. I also suggested that Greg and his wife look into local adult daycare facilities. This would cover some hours of the day in which his MIL would have supervision and would allow her to socially engage with other people in a structured environment.

Care for elderly parent at a specialized facility.

I also talked with Greg about the additional options for caring for his MIL as her disease progressed and she was requiring more help than he or his wife could provide. This included moving her to assisted living. As long as she could perform most of her own basic ADLs, needing only occasional help and oversight. This would be a safe option that would also provide social interaction and regularly scheduled activities.

The next option was a memory care unit. Oftentimes these are within a nursing home, but there are some facilities that house these units separately. Many assisted living facilities have memory care units on site, which can often mean a smoother transition for your loved one. Greg’s MIL was not yet to the point of needing this option, but I wanted to make sure he was aware of this in the spectrum of care. His MIL would need this down the road, in all likelihood.  

Important to include elderly parent in care decision.

I emphasized to Greg the importance of including his MIL in some of these steps of the decision making process. The decision to move someone can be a tough conversation to have with the family member that needs to be moved. If the conversation is had at the start of the process and the loved one is able to be a part of the decision making of where she lives, there is often more buy-in from the person.

In Greg and his wife’s situation, it was obvious they both cared greatly about their mother and wanted what was best for her. If you are going through a similar situation and taking the time to read this, I am sure you also want what is best for your loved one. It can be a hard path to get to that final decision, but hopefully with an open line of communication, you and your loved one can come to the conclusion together.

Are you taking care of elderly parents at home? What arrangement has worked for your situation? Please share in the Comment section.

© 2021 Jessica Kluetz, DO