Evaluating the Living Situation: Is it Time for Help?

After Carol M.'s mom broke her hip in a car accident, Carol tried setting up live-in home care, only to find it costly and isolating for Mom and burdensome for Carol, who still found herself stopping in every day to do tasks the home health aide could not do. With Mom's consent, Carol located an assisted living facility that would provide meals, help with medications and allow Mom to be among friends and socialize.

"I definitely feel less stress now, and I feel good about it because Mom likes it there," Carol says.

The need for extra care for Mom or Dad can sneak up on the children, who may notice — or choose not to see — signs that their parents are no longer able to manage. Often, a crisis such as Carol's mom's broken hip forces the issue.

_{Signs that say it's time for a change}
As a family caregiver, when you are under stress it is much more difficult to make good decisions. To preempt a crisis situation, Aileen Morales-Rabizadeh, eldercare liaison for Dignity in the Golden Years in Rockaway, New Jersey, advises children of older parents to check in often and look for these signs:

1. Periods of confusion or forgetfulness
2. Hoarding or changes in housekeeping habits
3. Financial troubles — past due notices, bills in the trash, etc.
4. Lack of awareness of time
5. Hygiene issues

_{When daily living goes wrong}
The issues described above relate directly to what are referred to as activities of daily living (ADL), a set of activities that determine whether or not an elder is able to remain at home living alone. "What determines the level of care a person needs is the number of and type of activities of daily living they can no longer carry out," says Robert F. Bornstein, Ph.D., co-author of "When Someone You Love Needs Nursing Home, Assisted Living, or In-Home Care: The Complete Guide," and a psychology professor at New York's Adelphi University.

Difficulty with basic needs is usually a signal that assisted living or nursing care is required. Dr. Bornstein divides activities of daily living into two types: complex tasks, such as shopping, cooking and managing money, and basic needs, such as bathing, using the bathroom and dressing appropriately for the weather.

_{Types of care}
Because most people want to remain independent and live in their own home, as a caregiver you may want to walk the road of care from the most independent to the least. Take note of the following: 

1. Home Care: Staying at home appeals to most people and it is often the least costly option. Approximately 37 million Americans care for a parent or in-law, and 80% of long-term care is provided by families, according to the Family Caregiver Alliance. Family care can be supplemented by a range of third parties, from companions to home health aides to nurses, with cost commensurate. When cost or burgeoning needs make home care no longer workable, it's time to consider a facility. "Seek outside placement with the idea that the loved one is going to get worse," cautions Morales-Rabizadeh. "This is not a retirement home."
2. Assisted Living: Assisted living can mean care in the home or at a designated facility. Assisted living facilities often provide individual apartments and daily meals, with other services available a la carte. Continuing care facilities enable easier transition from one step to the next.
3. Nursing Home: Also called a long-term care facility, these are for people who need around-the-clock help. "They've lost the ability to carry out activities of daily living and have been deemed by a physician to be unlikely to recover that ability," says Dr. Bornstein.

_{Important documents to have on hand}
Choosing care isn't just a matter of assessing needs and touring facilities. Finances and legal documents often dictate the options. These steps will help ensure a smoother transition when the need arises:

1. Durable Power of Attorney: This document grants the power to make health care decisions should a person become incapacitated. "It's very unwise not to have this in place," Dr. Bornstein cautions, because an incapacitated person can't grant such power. Lack of such a document can hold up important transactions, such as a need to sell the house. It's best to assign durable power of attorney to one person.
2. Living Will: Also called an "Advance Health Care Directive," this contains instructions specifying what should be done for an individual's health if that person is no longer able to make decisions.
3. Finances and Insurance: This topic can be uncomfortable, but insights into parents' cash flow, savings and the particulars of a long-term care insurance policy, if there is one, are key in securing appropriate care.

Setting up care for aging parents is a learning experience. One of the most important lessons, says Dr. Bornstein: Start early. "As you help your parents prepare for their later years, use that information to make preparations for yourself," he advises. "Everything you're doing for them, you should be doing for you."