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Elder Care 101

A Survival Guide for the Sandwich Generation (Or Everything You Need to Know to Care for Your Aging Loved One)

Craig Merrill

    My mother was in perfect health until shortly after her 75th birthday when my husband and I first noticed the trembling in her hands. Not long after that, she began experiencing falls. Doctors diagnosed her with Progressive Supranuclear Palsy, or PSP, a neurological condition similar to Parkinson’s.
    Nothing prepared me, an only child, or my husband for the enormity of issues we confronted as we navigated our way through the murky worlds of medicine, assisted living and skilled-nursing facilities, as well as guilt and fear, in an attempt to ensure that my mom received the best possible care.
    Navigating the healthcare system for an elderly relative can be one of life’s greatest challenges. It can be particularly difficult for members of “the sandwich generation”—sandwiched, so to speak, between the dual responsibilities of caring for children and an aging parent. When my mom first became ill, my son was 3 years old, and I found myself simultaneously serving as caregiver to two generations of family members.
    It’s a role that can seem overwhelming as caregivers attempt to manage their loved one’s finances and healthcare issues while also balancing their own careers and families. It can also take a physical toll on the caregiver. The San Francisco-based Family Caregiver Alliance says many caregivers report having one or more chronic conditions, such as high blood pressure.
    The good news is you don’t have to blunder through the maze of hospitals and other geriatric care services that comprise the elder-care system on your own. There are many local resources and experts available to help families ensure their loved ones receive the best possible care, and there is a solid sampling of such resources included here. With some forethought and planning, your experience can be as successful as the two East Bay families whose caregiving stories are recounted.
    But it’s not easy, by any stretch of the imagination. For some caregivers, the task of providing care to an elderly loved one is compounded by living in another state or trying to balance caregiving with the demands of working full time and raising a family. The end result, especially in the current economy, is a caregiver who feels stressed and overwhelmed, which complicates the task.
    “So many people take on the role of caregiver to their loved ones when they wouldn’t dream of doing any other job they weren’t trained to do,” says Roger Cormier, co-founder of Cohen and Cormier Home Care and Care Management in Oakland, an agency that helps families with geriatric care decisions. “Other people aren’t aware that there are agencies such as ours that can help to ease the stress of caregiving,” he says.
    Elder care or geriatric care agencies such as Cohen and Cormier can help families with both the practical and emotional demands of caregiving by providing them with geriatric care managers who have experience in aging and elder care issues. These managers typically are nurses or licensed social workers who can assess patients and consult with their families, develop a care plan, monitor and reassess a patient’s health. They can also assist families with long- and short-term care arrangements by providing hourly or live-in professional caregivers and ongoing care management such as monitoring a patient’s health and advocating on their behalf with doctors, staff at senior residential communities and other healthcare professionals. Most important, they can provide families with moral support and help in making tough decisions such as locating senior housing and helping a loved one transition from his current housing to a new residence that offers more assistance.
    Linda Fodrini-Johnson, a geriatric care manager and owner of Eldercare Services in Walnut Creek, provides similar care-management services to residents throughout Alameda and Contra Costa counties. Her agency also provides free support groups to family members who are caring for an aging loved one.
    “I tell families it’s never too early to begin talking to your loved one about their healthcare wishes, finances and living arrangements,” she says. “If you feel uncomfortable broaching the subject, try using the ‘I’ approach by saying something like, ‘Mom, you’ve always taken such good care of me. Someday I might need to take care of you, and I want to learn what’s important to you.’ ”
    Perhaps one of the biggest challenges facing caregivers is determining when a loved one needs assistance and what level of care is appropriate.
    “Almost 100 percent of our calls are initiated by an adult child who is concerned about his or her parent’s health,” says Cormier. “They witness changes in their parent’s health or home, yet their parent insists that everything is fine, and their children aren’t sure how to proceed.”
    For families who are concerned about the health of an aging loved one, the first step is often obtaining a medical consultation for their family member.
    “Sometimes the signs of a loved one’s declining health aren’t always that clear,” Cormier says. “We get so many calls from adult children who are worried about their parents’ health but who go on to say their parents are fiercely independent and may be resistant to admitting they need help.”
    When they need intervention is debatable, but Cormier says to watch for indicators such as changes in weight, appearance or personality­—poor hygiene; forgetting medications; depression; and symptoms of confusion or paranoia.
    Poor money management, as signaled by stacks of unpaid bills for instance, can also be a sign that an aging loved one may need assistance. If that’s the case, it may be time to call a professional fiduciary such as Scott Phipps of Phisco Senior Services in Oakland.
    “I work as a bill-paying service and help seniors to get organized,” Phipps says. “Someone in the beginning stages of dementia may need a little extra help managing their finances in order to remain independent for as long as possible. I can also help seniors to avoid a lot of financial scams.”
    Some seniors may just need a helping hand with grocery shopping, errands, housekeeping or meal preparation. Companies such as Comfort Keepers in Oakland can help with both short and long-term non-medical tasks.
    “Many of our clients are recovering from surgery and need help for several weeks while others are hired by their adult children who live in another area and are worried about their parents,” says Shelley Cooper, owner of Comfort Keepers. “We can also help seniors who may be isolated by providing them with companionship and engaging them in activities such as arts and crafts.”
    Studies show that most seniors want to remain living independently in their own homes as long as possible, but as they age and their health declines, these aging elders may need a little help.
    “Our services take some of the burden off the caregiver and also offer them a respite from the daily stresses of caregiving,” Cooper says. “Many of our clients tell us that our staff become a part of their extended family.”
    The reality is that caregiving is hard work, and there may be times along the way when you need information or encouragement for—or even a literal break from—your loved one.
    “The biggest mistake many families make is not realizing there are experts who can save them time and resources,” Cormier says. “All too often we get calls from families who wish they had known about our services years ago.”
 

What Families Encounter

A Daughter’s Story
    Pam Utter of Santa Clara was given a crash course in caregiving two years ago when her elderly aunt, Mildred Goebel, 88, was diagnosed with dementia and told she could no longer live on her own. Suddenly, Utter who is in her mid-50s, was faced with tough decisions: Should she move her aunt to an assisted-living community or a skilled-nursing facility and how could she ensure her aunt would receive good care?
    “The whole idea of senior housing was so foreign to me,” Utter says. “My aunt had no other family, and I felt as if I needed someone familiar with the elder-care system to serve as another pair of eyes and a sounding board.”
    Utter contacted a geriatric care manager and soon discovered she wasn’t alone in her plight. The experience of caring for her elderly aunt, who died in 2008, and working with a geriatric care manager also helped prepare Utter for the phone call she received several months ago. Her 90-year-old father, Harry, called to say he had fallen at his Alameda home and fractured his knee.
    “When I came to visit my dad, I also noticed that he wasn’t eating well and was losing weight,” says Utter, who left her husband and daughter temporarily to move into her father’s home and help nurse him back to health. She hired a part-time caregiver through Cohen and Cormier Home Care and Care Management in Oakland to stay with her father while she ran errands and did laundry.
    Like many older adults, Utter saw how her father valued his independence, and she found herself walking a thin line between making sure her dad was well cared for and allowing him the freedom to live his life.
    “At first I was treating my dad as an invalid, but he’s been eating better and as he gets his strength back he’s able to do more,” Utter says. “He can’t do everything he used to do, but he can probably do more than I think he’s capable of doing.”
    For now, Utter’s goal is to have her dad continue to live in his own home for as long as possible with the help of a part-time caregiver. Yet she admits that she also has an eye on the future and has started looking at assisted-living facilities near her home.
    “I want to prepare for the next step now rather than wait for an emergency,” Utter says. “If my dad ultimately needs a higher level of care, I’d like to move him closer to my family home so that I can be in a position to help him out more.”
    Utter says she and her father had a heart-to-heart talk in 2007, which led to her father giving her durable power of attorney for both his healthcare decisions and finances. The step gives a family member the right to act on his loved one’s behalf in the event that he becomes incapacitated. The person holding power of attorney can pay the family member’s bills and has the authority to make medical decisions in the event the loved one is unable to make them on his or her own. (Download free copies of power of attorney documents related through the California Coalition for Compassionate Care Web site, www.finalchoices.calhealth.org.)

A Son’s Story
    When Dennis Eagan’s 94-year-old mother, Beatrice Eagan, was hospitalized several times last year, he finally convinced her that it was time to move closer to her extended family in Oakland.
    “We had broached the subject of moving to Oakland before, but my mom valued her independence and enjoyed living in Rossmoor,” says Eagan, who lives with his family in Montclair. “After being hospitalized last year for cardiac problems, she agreed to move to a place where she could be closer to her family and receive some assistance.”
    Eagan and his wife, Joanne, started researching senior residential communities two years ago knowing the time would eventually come when Beatrice Eagan would require a higher level of care.
    “In retrospect, I’m glad we started looking at places long before Beatrice needed to move,” says Joanne Eagan. “It gave us a good idea of what was out there. We visited both assisted-living communities and residential care homes.”
    Many of the places the Eagans visited catered to residents with cognitive impairment. Since Beatrice Eagan is still mentally sharp, the Eagans hoped to find a residence where she could socialize with other seniors of similar cognitive ability and enjoy activities.
    After visiting several residential communities for seniors, Eagan, 67, and his wife discovered Oakland’s Mercy Retirement and Care Center, a nonprofit, faith-centered senior community off Foothill Boulevard. By offering everything from independent apartments to skilled-nursing care, residents can age in place, having their continuing healthcare needs met without moving to another location.
    “Some of the places we visited before Mercy were pretty grim,” says Joanne Eagan. “It seemed as if they existed just to warehouse seniors. “
    At Mercy, the Eagans were impressed by the spacious dining room, the views of the Oakland Hills, the estuary and the facility’s gardens.
    “The staff was very warm and friendly, and my mother-in-law immediately felt comfortable there,” Eagan says. “Since she’s closer now to her children and grandchildren. We can visit more often, having dinner with her or taking her on an outing.”
    The Eagans say their best piece of advice for families is to begin looking at senior housing alternatives before your loved one actually needs to move. Often, a loved one is hospitalized and the family is told their loved one can no longer return to living on their own, putting the pressure on families to find suitable housing quickly.
    Ombudsman Inc., a county senior advocacy organization, provides information and ratings on local long-term care facilities and indicates whether a facility has any citations. The organization also provides a list of questions to ask when visiting senior communities. Visit the Web site at www.oldwebsite.acombuds.org.

 

RESOURCES

Coping with dementia can take its toll on the entire family. Here are some ideas about where to turn for help:

    If a loved one has cognitive impairment, contact Alzheimer’s Services of the East Bay in Berkeley for local resources, adult day health programs and support groups in Alameda and Oakland. www.aseb.org, (510) 268-1410.

    The North County Senior Program offers an adult day care with activities including memory exercises, gentle movement, games and more as well as a caregiver support group in Oakland. Visit , (510) 601-1074.

    Giving up a driver’s license means giving up independence for many seniors. Here are some resources for seniors who need help getting around:

    Alameda’s Premium Taxi Service provides a 50 percent discount for taxi rides to medical trips, errands, etc. Eligible riders, who must be Alamedans, must purchase the required discount coupons in advance and be certified to use East Bay paratransit services, 75 years or older or 70 or older without a driver’s license. www.alamedaparatransit.com, Mastick Senior Center, (510) 747-7506.

    For Oakland seniors too frail to drive who need transportation to stores and medical appointments, the free senior shuttle operates weekdays from 10:30 a.m.–2:30 p.m. (510) 272-4796.

    Oakland’s Department of Human Services also offers a paratransit program for the elderly and disabled. This service provides door-to-door public transportation for people who cannot access public transportation and drives them to doctor’s appointments, grocery shopping and daily excursions. (510) 238-3036.

Depression, dementia and mobility are three of the biggest issues facing seniors.

These local programs keep seniors involved and active:

    Alameda County Adult Day Services Network offers a free personalized referral service to determine an appropriate adult day program.
The network has 15 adult day programs with a wide variety of activities to give caregivers a break. www.adsnac.org, (510) 577-3543.

    The Alameda Friendly Visitors program offers one- to two-hour weekly visits to the homebound, pairing volunters with seniors who share their interests. www.alamedamealsonwheels.org, (510) 748-0342.

    The Senior Center Without Walls program at St. Paul’s Episcopal Church in Oakland allows homebound seniors to participate in a variety of activities—book discussion group, bingo, brain aerobics—over the telephone. www.seniorcenterwithoutwalls.org, (877) 797-7299.

    The Alta Bates Summit Medical Center Tele-Care program provides a free, daily phone call check-in service to Alameda County seniors who are isolated, widowed, live alone or are homebound. (510) 204-4487.