Aging Parents And Long-Term Care
Karl Steinberg (Associate Medical Director, Sharp Mission Park Medical Group) gives expert video advice on: What are the signs my parent is ready for long-term care?; What is the first thing I should do if I believe my parent needs long-term care?; Who can help me implement a long-term care plan for my parent? and more...
What are the signs my parent is ready for long-term care?
As far as trying to decide when a loved one is ready for transition to a long-term care setting, I guess there are a variety of indicators. I think its just one of those things, its kind of like pornography, you know what it is, you don't have a specific definition of it, but you know what it is when you see it. And when your parents are, lets say, I bet a big one would be leaving the stove on, right? That's when you know there is maybe a little bit of a danger. When they're having falls, I mean, they're only going to fall a certain number of times before they wind up fracturing a hip. That may be a pre-terminal event. When they are having trouble with forgetfulness and the forgetfulness is more than just, "oh, I can't remember where I laid my glasses," but its things that you can see might cause a problems. Driving is another big issue and I'd say the things that most frequently land people in long-term care settings are incontinence and wandering or the risk of somebody getting lost. Those are probably the two biggest things that might be a signal to you. Now if you don't mind taking care of your parent's incontinence, that's not necessarily a sign, but a lot of people sort of draw the line there.
What is the first thing I should do if I believe my parent needs long-term care?
The first thing to do if you're starting to get a feeling that your parent or parents might need to move to a place where they're going to have some assistance is talk to them about it. Just talk to them directly and probably, 95% of the time, you're going to meet a lot of resistance, but you need to have an open and frank conversation about your concerns and the kinds of things that you don't want to see happen. Then you go from there, and if necessary you will bring in other people who are experts and just stick to your guns. Sometimes it can take a while to convince your parents that they really don't belong in a home setting. And at times you can get them to hire somebody to come in part-time, or you can hire somebody to come in part-time and help them, and a lot of times that's a great temporizing measure and some people never wind up having to go to long-term institutional care if they can just get some small amount of help in the home.
Who can help me implement a long-term care plan for my parent?
In terms of implementing a plan for long-term care for your parents or other loved ones, I'd say you should talk to health care professionals including geriatricians, long-term care nurses, social service agencies including the area agency on aging, and there are also geriatric care managers. Some of the larger assisted living facilities have people that will do geriatric assessments and try to assist in that. There are also agencies and private individuals in the community who can assist with placement as far as trying to tailor a care setting to your parents needs. I would encourage you to talk to as many people as you can who work in the industry to try to find the best place and the best plan.
What should I consider before taking on the role of long-term caregiver for my parent?
I think before you consider stepping in as a caregiver for your parent in a home setting or community setting, you have to consider your own life goals. And it's really hard to predict how long it's going to be, and with most circumstances, obviously if it's a hospice situation, if somebody's got a very bad prognosis, then it's time limited. Sometimes you're looking at a many, many year commitment where as you start off the needs may be relatively small, but they're going to get bigger and bigger as times goes by because the natural progression, the natural aging process is that people get weaker, have more medical problems and require more care and needs. So, that's one thing to consider. The other is your own emotional well-being. For example, in people who are caregivers for dementia patients, with family members with dementia, the rate of depression is just astonishingly high. It's not a 100%, but it's mighty close to it. It's probably at least 80% suffer significant clinical depression. So you need to make sure that you'll be able to take care of yourself too. If you can't take of yourself, you won't be of any use to your loved ones.
What is an independent living residence?
An independent living residence is a place where essentially people are able to come and go as they please. In a lot of these places, people may even have a kitchen to make their own meals, but most independent living settings also have a common dining area. They may have some rudimentary, minor amounts of other assistance that is available, for example, like a fluff and fold or dry cleaning service so that the people don't have to do their own laundry. For the most part, it is independent. A lot of the time, people will still have their own car, and they can go do whatever they want and so on. But again a lot of these places will also have transportation services like a van that will take a group out to the mall, or they can take you to your doctor's appointment. Its a pretty low amount of actual care, mostly just an apartment where you've got some additional assistance available to you.
What is an assisted living facility?
Assisted living facilities are called different things in different places, but for example, in California, it's considered a residential care facility for the elderly, but this is beyond independent living. These are definitely people who need some degree of assistance with activities of daily living, or the instrumental activities of daily living that would be like meal preparation and things of that nature. These are a variety of places. Some of them may be small, some may be big institutional type settings. They may share a room with somebody or they may have a room or an apartment of their own, but essentially all assisted living facilities have hands-on assistance for people who require it.
What are board and care homes?
A board and care home is a type of assisted living, I guess, or a type of residential care facility. Typically a small place, it might be any where from four to twelve beds. Usually it would be in a regular single family home, or a residential home. Typically in a neighborhood with other single family homes. There typically licensed by the state. I'd say they're good for people who like living in a house and who don't like living in an apartment. Who don't mind usually, you share a room with somebody. They can be relatively inexpensive and in my experience you get quite a bit of one-on-one care. You get home cooked food and they're pretty nice little places for the most part.
What is a nursing home?
A nursing home or nursing facility, I guess the generic term, nursing home would apply to both nursing facilities and skilled nursing facilities. And essentially it's a place where there are nurses, usually 24/7. Although some facilities may not have registered nurses 24/7. And a nursing facility that is not skilled doesn't have high-level types of nursing interventions but they do have the ability to take care of incontinence care and some degree of wound care, things of that nature. Whereas a skilled nursing facility pretty much has the full range of nursing services including taking care of lines or tubes. In fact some of them even may be able to take care of ventilator patients and things like that.
Is a nursing home and skilled nursing facility the same thing?
A nursing home is again just a generic term that you would apply to basically all nursing homes, all nursing facilities, both skilled and non skilled. So they're not exactly the same thing. A skilled nursing facility will have a higher level of nursing care and the ability to care for more complex medical conditions, whereas a nursing facility generally does custodial care and low level nursing interventions. They may be able to take care of a feeding tube or certain kinds of bed sores, but they aren't going to be doing IV antibiotics or taking care of trach patients or ventilator patients, things like that.
What is a continuing care retirement community CCRC?
A continuing care retirement community, or CCRC as they've been called lately - and the names change periodically, but this is one of the so-called aging in place concept type institutions where usually you have to buy into the place. They may be fairly expensive, maybe a half a million dollars or something like that, and when you first go in there you are pretty close to independent. You are going to live out your days there so they have the ability to care for you at different levels of care depending on exactly what kind of condition you are in. But the beauty of it is that you get to stay in the same community until the day you die hopefully, and if you need to go to assisted, if you need to go to an actual nursing facility, they have all of those things on campus.