Elder Care at Home

You’re not alone in feeling stressed caring for your mom. Many adult children these days are struggling to make sure their parents are safe at home. There are supports out there. Please try the following:

1. Contact the Texas Health and Services Commission at http://www.hhsc.state.tx.us/Help/HealthCare/seniors.shtml Depending on your mom’s financial situation she may be eligible for Medicaid, which would provide some help in the home.
2. Contact the Texas Department of Aging and Disability Services at http://www.dads.state.tx.us/services/index.cfm Ask them to direct you to services and supports in your town or city. There may be social work services in the area that can help with planning. Please ask about their adult day care programs
3. If your mom is having difficulties walking, then try to have her assessed by a physical therapist. The physical therapist can recommend the proper grab bars, shower chairs, raised toilet seats and other assistive devices that will make your mom safer in the home. A hospital bed may be appropriate and in some cases they are covered under Medicare.
4. When you contact the Texas Department of Aging and Disability please ask about support groups for caregivers as this may be helpful to you in managing your mom’s care.
    

A back-up plan is very helpful so you are not stressed when you are ill and can go on vacation knowing everything is in place. Here are some things I would recommend:

1. If you are not the Power of Attorney for your mom, please make sure that you and your husband are named. An attorney in your area can help you with that. You may want to consider adding one of your cousins as a backup.
2. There are many grocery stores that have online ordering and delivery. Please check in your area.
3. If your mom will allow all of her bills to go to you directly, that may make it easier. You can still review with her in person what has been paid. Paying bills directly online also makes things easier if you are comfortable with online banking.
4. If you would like to know that you have a professional on call when you go away I would suggest contacting the National Association of Professional Geriatric Care Managers. You can call 520-881-8008 or go to the website http://www.caremanager.org/contact/ to find a professional in your area. A Geriatric Care Manager can act on your behalf if your mom has an emergency while you are away.
5. Please look at your state’s office on aging: http://www.michigan.gov/miseniors/0,4635,7-234-43295_43600-165937--,00.html. There may be additional support services.
    

First, you should ask: Is this new behavior or a longterm pattern? It would be important to have a medical or psychological cognitive evaluation to better understand what may be contributing to this behavior.

Regarding the various options you are facing:

If you opt to have your mother-in-law continue living with you, it would be best to engage a professional from your community who has experience with hoarding behaviors: geriatric care managers (which you can find by conducting a search using the national website: http://www.caremanager.org) psychologists, or psychiatrists. They will help you find a way to communicate with your mother-in-law, and determine how to best intervene, how to create a safer living environment using a risk reduction model, etc.

It doesn’t seem viable to have your mother-in-law move back home with her husband due to his care needs, unless she could manage in her home with an outside caregiver providing care to the husband, and keeping an eye on her hoarding behavior. Additionally engaging a geriatric care manager to oversee the care and work with professionals to try to keep a handle on the hoarding behavior would also be advisable.

Although moving to a facility doesn’t seem possible for financial reasons, if needed, you can research public benefits your mother-in-law might be eligible for. For example, VA benefits if her husband was in the military. These could help cover the cost of an alternative living arrangements.

There are also some “Do’s and Don’ts” to bear in mind as general guidelines:

Do’s:
• Be aware that there is no quick fix
• Establish a positive relationship
• Gain your mother-in-law’s trust
• Empathize – see her point of view
• Give her choices, thus helping her maintain a sense of control
• Help set goals and time frames for getting things done
• Respect her meaning and attachment to possessions

Don’ts:
• Don’t work with hoarders if you feel negatively about this behavior
• Don’t expect miracles overnight
• Don’t overwhelm or threaten
• Never remove belongings without person being present
• Don’t do a surprise or forced clean-up if at all possible


Below is some general information about hoarding behavior that you might find useful:

First from Randy Frost’s book, A Cognitive-Behavioral Model of Compulsive Hoarding

Definition/presentation:
1) The acquisition of, and failure to discard a large number of possessions that appear to be useless or of limited value.
2) The living spaces in the home are sufficiently cluttered so as to preclude activities for which those spaces were designed.
3) There is generally significant distress or impairment in functioning caused by hoarding.

Second, the diagnostic criteria of hoarding as a subset of Obsessive Compulsive Personality Disorder from Diagnostic and Statistic Manual of Mental Disorders IV:
• Accumulation of clutter
• Difficulty discarding/parting with objects
• Compulsive acquiring of free or purchased items
• Distress or interference
• Duration at least 6 months
• Not better accounted for by other conditions (OCD, major depression, dementia, psychosis, bipolar disorder)

Prevalence and Demographics:
• Prevalence in general population – 3-5%
• Underreported problem –only five percent of cases come to attention of authorities.
• Prevalence among patients with obsessive compulsive disorder is approximately 20-30 percent.
• Prevalence among patients with dementia is approximately 20 percent.
• Education – ranged widely
• Typical age of onset was during childhood or adolescence.
• Strong familial link – 80 percent of hoarders grew up in house with someone who had hoarded.

Co-Morbid Problems Associated With Hoarding
Hoarding is associated with several disorders including:
• Dementia
• OCD
• ADHD
• Depression
• Anxiety (PTSD, general)
• Schizophrenia /psychotic disorders
• Substance abuse
• Personality Disorders

Hoarding Stems From Four Types of Deficits
• Information-processing – decision making; categorization/organization; memory.
• Problems with emotional attachments to possessions – objects as extensions of oneself.
• Behavioral avoidance – excessive concern over mistakes.
• Erroneous or distorted beliefs about nature and importance of possessions.
• Perfectionism
• Need for control
• Responsibility
• Emotional comfort

Treatment Interventions
• Medications
• Psychotherapy
• Cognitive Behavioral Therapy
• Harm Reduction Model

Challenges To Treatment
• Very little data available regarding treatment outcomes with hoarders.
• Little evidence that antidepressants or other meds used to treat OCD are effective in treatment of hoarding.
• Hoarders have poor insight into nature of problem (denial).
• Motivation to change is limited and resistance to treatment is high.
• Treatment is frequently lengthy (one to two years)
• Limitations of Cognitive Behavioral Treatment Model

Hoarding In The Elderly Population
• Age-related illnesses are not primary cause of hoarding.
• Hoarding is a common symptom in dementia patients.
• Memory loss: inability to discriminate between relative importance of articles in home.
• Forty percent (40%) of hoarding complaints to local health departments involved elder service agencies.
• Self-neglect associated with hoarding.

Causes For Hoarding In The Elderly
• Compensation for loss
• Grief reaction – death or divorce
• Avoiding waste – Depression era
• Traumatic event – Holocaust
• Social isolation
• Finding security

Interventions With Hoarding In The Elderly
• Hoarding is a mental health and a public health issue
• Treatment involves:
· Mental and physical health assessment
· Risk reduction
· Treatment for identified symptoms
 

You are not alone! Often times when a senior is confronted with the need to accept help, this is an unwelcomed acknowledgment that he or she is compromised or not able to manage. The initial response most commonly is denial or flat refusal of the care. If the focus can be taken off of the senior and redirected onto the adult child, often success can be achieved. Such as: "Dad, while I know you are confident that you are managing fine, I am losing some sleep at night worrying about you. I wish you would consider accepting just a little extra help, which will make me feel better and less worried."

Respite is key...you need to take care of yourself to insure your well being physically, emotionally and socially. If something happens to you, you will be of little good to your mom! Consider arranging for a respite caregiver. This can be another family member, a friend, a neighbor or a trained professional. Think about setting up a regular schedule, during which time you can take a break without having to worry about your mother. Lastly you may want to speak with a local expert in eldercare in your community who can help you to arrange for, screen and select the right caregiver. One such resource is a certified Geriatric Care Manager (www.caremanger.org).