Frequently Asked Questions On Elder Care Management

When I last visited my mother, I noticed some changes in her memory and ability to do tasks that were once easy for her. How do I begin to understand what that means and what options are available?

Observing a parent having difficulty completing tasks and traditions that previously seemed effortless, is often the beginning of a journey you may not have thought you would travel. Sometimes the changes can be subtle and present slowly over time. Other times, there can be an abrupt onset with drastic changes. It is best to start with a thorough evaluation with the primary care doctor to rule out reversible conditions such as an infection. Depending on the symptoms, other diagnostic tests such as blood work or imaging may be needed. If a diagnosis of Dementia is suspected, a recommendation might be made for an evaluation by a Neurologist for more formal cognitive testing.

An Aging Life Care Manager can provide guidance and advocacy during these steps, while putting a home care plan into place to provide support for activities of daily living, explore options for day programs, transportation needs etc. while monitoring the client’s symptoms for any changes. Another important recommendation at this time is to consult with an elder law attorney to review or implement key legal documents such as a Durable Power of Attorney, a Health Care Proxy, a MOLST form or other document, which expresses wishes for life sustaining treatments, and a Will. These documents must be completed before dementia advances beyond the early stage.

My father is becoming more dependent on me. He calls us frequently during the day and night. He will not agree to accept any outside help. What can I do?

This is a common frustration among adult children of aging parents. The underlying issue is often related to the fear of losing control, so it is crucial to emphasize understanding and show support for that need. Try to avoid confrontation when feeling frustrated. I’ve observed that families who move through this stage successfully are ones who do the following things:

Use “I” messages such as “I worry about you when…” or “I am afraid you might get hurt when…” rather than pointing out the elders deficits

Stay calm and focused during difficult discussions

Accept that elders have a right to make bad decisions and sometimes we have to wait for the crisis to implement a plan.

This can be very difficult to do. Even if your loved one is not ready to accept help, it may be helpful for you to consult with an Aging Life Care Manager to learn new strategies and build a safety net.

My father has been hospitalized 3 times in the past 6 months. He is discharged home only to end up back in the emergency room within a few short weeks. The visiting nurses see him when he returns home, but not as frequently as he needs. How can I get more help for him?

Recurrent hospitalizations are a strong indicator that your loved one is not able to manage his needs independently. Our current healthcare system discharges patients very quickly from hospitals and rehab centers, often without the ongoing support that is needed at home. A visiting nurse or physical therapist might visit for a couple weeks but they too, discharge once they feel the immediate needs are met. Elders often live alone, with family at a distance, leaving them vulnerable to a relapse in their medical condition.

An Aging Life Care Manager is different from the Case Managers you encounter in the hospital, rehab and Visiting Nurse Agencies. We do not have the constraints of healthcare systems, insurance companies or a large caseload. Since we are hired by the elder or their family, we work directly for the elder, as an advocate and supportive member of the team of providers, to ensure all needs are met for the long term.

I noticed a couple of small dents on my mother’s car. I am worried about my mother’s driving ability but don’t want her to become isolated if she is not able to be independent. What can I do?

Starting the conversation about driving ability can be very difficult and something that may need to be done in small steps. But once you determine that driving is no longer safe, you must be persistent in following through with other options.

You can start by asking how they are feeling about driving at night, or in the rain to see if you can gauge their level of comfort as well as how willing they are to have the conversation.

It’s important to avoid confrontation, again using “I” messages rather than focusing on their deficits.

Talk about the importance of their ability to drive defensively, with many distracted drivers on the road these days, can be a way to take the blame away from them.

Learn more about the alternative transportation options in their area as these can very greatly depending on where they live.

There are also driving assessment programs, often done by Occupational Therapists in a simulated driving environment which tests vision, spatial awareness, ability to shift attention, reaction time as well as physical and cognitive abilities. They may make recommendations for adaptive equipment, driving retraining or other therapy. They can also discuss alternative options if cessation of driving is recommended.

My mother lives alone and has some good neighbors who check in on her. I am worried this is placing a burden on them, or that they may one day not be available. How can I put a more reliable plan into place if I do not live nearby?

Friends and neighbors, who are checking in with increasing frequency, bringing meals and offering rides, can be a sign that more help is needed. Friends and neighbors will eventually get tired and often have a difficult time telling the family that they are worried or that they cannot continue to be the sole support of their friend. In my experience, they are always relieved when more help arrives on the scene and they can resume to visit on a social schedule.

Part of our comprehensive assessment covers identifying these issues and our plan includes keeping these supportive connections but without it being a burden on anyone.

In situations where the elder has family who live at a distance, we serve as a liaison, or a “surrogate” family member. Your eyes and ears, caring for your loved one as our own, connecting you with a reputable home care agency while monitoring the care and modifying the plan as needed. We can accompany elders to medical appointments, and communicate updates back to you. We can monitor medication adherence, prefilling a weekly planner and making changes when needed. We can visit on a regular schedule, each visit providing an assessment of their condition, monitoring medical issues, skin integrity, pain issues, etc. and maintaining communication with you and their physician.