According to Wikipedia,

We all have the ability to empathize; however, when it comes to our aging parents, it becomes difficult because our lives tend to be polar opposites.  We work; they are retired.  We have children at home; they are empty nesters.  We drive; they need to rely on others for transportation.  The list is endless.  Despite these opposites, it’s important to remember they once had our same position in life.

If you are giving care for older people and find them to be quiet, withdrawn, less positive, or even cantankerous, try to empathize and realize they have experienced many losses.  If you are struggling to identify with their losses, here is a simple exercise that may help:

List 10 things that define you (i.e. mother, wife, volunteer, businesswoman, tennis player, etc.).  Look over the list, and then take two of them away . . .  then take two more away . . . two more . . . two more . . . What are you left with?  Those are the losses your elderly parents are experiencing.

My father was a vibrant businessman who played golf once a week, was president of the Chamber and Rotary Club, was on the church and school boards, and was involved in all of his kids’ activities.  After a lifetime of that involvement, he now has a very limited social and active life.  In aging, losses come slowly, quietly, and usually with a tremendous loss of purpose.

To help build a bridge for you and a purpose for your elderly parents, here are a few suggestions:

• Focus on listening to their stories and history
• Help them identify their talents and abilities
• Address and acknowledge positive emotions
• Acknowledge stressors, losses, and fears about the future
• Believe in them!

Carol Hauser, M.A.

February 1, 2013

“Bill Wallace” has been a client of our agency for about six years.  He was referred to us for non-medical senior care so that caregivers can prepare a hot breakfast for him, clean up his apartment, and do his laundry.  They also take him out for shopping, errands, and sometimes for medical appointments.

About two years ago, Bill was diagnosed with inoperable cancer.  Physically, his body is wearing down, but Bill’s attitude has always remained positive.  He is funny, engaging, and grateful for everything his caregivers do for him.  His caregivers find him a joy to be around.

Bill’s caregiver “Nancy” happens to be a nun.  She recently took him to a clinic appointment.  Unknowingly, Sister Nancy was leaning on a buzzer at the reception desk, and it was ringing in the back of the clinic where the nurses are stationed.  One of the nurses came running to the front reception desk, calling out, “Mrs. Wallace!  Mrs. Wallace!  You are leaning on the buzzer!”

Shocked, Nancy looked around.  She felt very odd being called “Mrs.” for the first time in her life, but she and Bill got a good laugh out of it.

They spent the entire morning at the clinic because Bill needed a variety of tests.  By the time they left to go back to Bill’s apartment, he was starving.  Bill asked Nancy if she would take him to a McDonald’s drive-through before dropping him off at his home.  He wanted a double cheeseburger and fries, and he told Nancy she could order whatever she wanted.

After they placed their orders, Bill turned to Nancy and said, “Okay, now what should we get for the kids?”

Bill and Nancy had another good belly laugh.  And we all know laughter is the BEST medicine!

Julie Ellingson, LSW

January 28, 2013

It’s not an uncommon occurrence.  It’s your sister’s birthday, and although it’s been just a month since you last saw Dad, you notice the changes.  His breathing is more labored.  He looks thinner, and he’s tiring out more than you remember.  When Dad leaves the room, everyone brings up the inevitable.  Dad is aging faster than you expected.

Summer celebrations and family reunions are a natural time to catch up face to face and take a few minutes to talk about future care for elderly parents or other aging relatives.  As you initiate an open dialogue about health, financial and legal issues, it’s important to keep the conversation relaxed and show respect, love, and sensitivity toward each other.

The following is a list of possible elder care topics and questions to address with siblings and other family members:

Financial

• How will family members help with any current and future financial needs of your loved one?
• Is it time to consult with a financial advisor?
• Compile a list of financial institutions, assets, debts, and payments.
• Keep all financial, insurance, and legal documents within easy access.

Legal

• Make sure your loved one has an up-to-date will, living will, and other advance health directives.
• Discuss the benefits of consulting with an elder care attorney or family attorney skilled in estate planning, healthcare planning, etc.

Medical

• Assess the loved one’s current health and discuss any necessary doctor visits.
• Compile a list of medical providers, current prescriptions, and over-the-counter medications.
• Document details of prescription plans, long-term care insurance, Medicare, Medicaid, etc.

Living Arrangements

• Discuss options for when your loved one needs in-home care or cannot live alone.

Caregiving Roles

• Who will be the principal caregiver and who will share responsibilities (doctor visits, medication supervision, etc.)?
• Develop a plan for involving timely caregiving help.

What concerns do you have with talking through care plans for your senior loved ones?

Paul Blom, CEO

August 6, 2012

During the initial home meeting prior to the start of home care services for seniors, many elderly folks have trouble thinking of things with which they may need assistance.  And if they are lonely, they would never admit to anyone that just having someone with whom to talk or do things would be a good idea.  However, once services have begun and the initial adjustment period is over, almost every one of our senior care clients wonder why he or she didn’t start assisted home care services much earlier.

Most elderly clients need help with homemaking tasks, which include things like vacuuming, dusting, mopping floors, changing bed linens, wiping down appliances and countertops, and doing laundry.  Since many of our clients live in small apartments, these tasks can be easily completed within a 3-hour visit or less.  So many clients ask, “How will I fill up the time?  I don’t have that many things that need to be done.”

There are many little everyday tasks that need to be done, or that people prefer to have done, in the process of maintaining a home.  Sometimes, I’ll give a client a list of potential tasks to get them thinking about what kinds of things, besides the obvious, with which an at-home caregiver could assist them.  Have you thought of these?

• How about organizing the junk drawer or filling your humidifier?
• Opening jars or peeling potatoes?
• Sorting mail or watering plants?
• Assisting with setting up appointments or writing letters?
• Hanging pictures or recycling newspapers?
• Prepping salad fixings or wrapping gifts?
• Thinning out your closet or cooking you some oatmeal?
• Taking you for a walk or baking you a cake?

If you are willing to pay for mileage or if you have a care plan that will authorize transportation, homemakers or companions may also do things like the following:

• Take you out for coffee or run you to the grocery store
• Help you shop for gifts or take you for a drive
• Take you to the bank or to the post office
• Attend church with you or pick up your prescriptions
• Take to you to visit a friend or to visit the cemetery
• Go with you to the movies or out for an ice cream treat

The ways that we can help are many and varied depending upon the needs and desires of the people we serve.  We will develop an individualized home care plan just for you.  We can also talk with you to assist you in determining the ways in which we can be helpful to you as well as meet our goal of improving your quality of life.

Julie Ellingson, LSW

July 31, 2012

When family members call our office wanting information about our home care services for seniors to help them in taking care of elderly parents and relatives, they usually call with a list of important questions—costs, cancelation policies, the list of services we provide.  When all is said and done, we often hear, “I guess that’s it.  I don’t know what else to ask.”

We often answer, “Ask us about our caregivers.”

In elder care, caregivers are everything.  If your elderly parent has a quality caregiver, your elderly parent is receiving quality care.  For our Right at Home, great care starts with finding great caregivers to hire and then keeping them.

Think about it.  A senior home assistance company can have a gifted marketing person to spread the word, intelligent social workers or nurses to oversee client care, and the kindest person answering the phones.  However, when Aunt Esther is having a bad day with her dementia and is refusing to eat, it’s the caregiver who will be the one to help her.  It’s important that caregivers know how valued they are and feel welcome to reach out for support.  It’s important that they feel connected to office staff and other caregivers, most of whom they will not see on a regular basis.  It’s also important that they feel satisfied and want to remain with the company for a long time.

We are very proud to have been awarded the 2012 Star Tribune Top Workplaces Award as the #1 mid-sized business in Minnesota.  In the first Top Workplaces ranking in 2010, we started as the #3 business, and in 2011, we moved up to become the #2 business.  In addition to this honor, our owners, Paul Blom and Bob White, have been awarded the Leadership Confidence Award for three consecutive years.

The process of being selected as a Top Workplace in the Star Tribune started as an initial nomination by a caregiver in 2010.  For each year, all Right at Home employees are asked to complete an online survey pertaining to a variety of topics related to the workplace.  In addition to objective questions ranking the workplace in a variety of categories, the survey also involves short answer questions.  These responses are then analyzed by WorkplaceDynamics, a company with which the Star Tribune partners to create their Top Workplaces rankings.  From there, the rankings are calculated and the individual awards are determined.

So, how important is caregiver satisfaction in providing quality care?

Extremely.

After all, if your elderly parent has a quality caregiver, your elderly parent is receiving quality care.

Carol Hauser, M.A.

June 22, 2012

The unfortunate part was that Roger lived four hours from his nearest family.  Roger and Mary never had any children, and although they were in regular communication with their nieces, the distance was a real problem.  Nobody in the family could really tell how Roger was getting along.

This dilemma is not unfamiliar to many who are taking care of elderly parents and relatives from a distance.  You aren’t sure if Mom or Dad is being honest about what’s going on.  You can’t physically see their space to look for telltale clues that there are problems.  As a result, the family becomes entirely reliant upon the senior’s perception of their situation, which may or may not be distorted.

For many seniors, the greatest fear is no longer being able to live at home.  Because Roger watched as his brother’s family forced his brother into a nursing home, it tainted his relationship with his nieces.  Although his family came to visit and do homemaking tasks while Mary was alive, Roger wasn’t so open to it after she was gone.  When his family came to town, Roger often met them at a restaurant rather than inviting them to his home.

When Roger died at age 92, it was apparent to his nieces that, although he was safe to live at home, he could have used some homemaking help and a second set of eyes to check in.  There were piles of dirty dishes, stacks of unopened mail, and dust and dog hair covering everything.  In the few years since Mary’s passing, many of his belongings—furniture, decorative items—were in such bad shape, they needed to be thrown out.

So how do you manage a long-distance caregiving relationship?

1.  Be Aware that Most Seniors Want to Stay at Home

Their motivation to stay home may affect how elderly family members communicate to you about what is happening in their home.  If you are entirely reliant on what they tell you over the phone or via email, you may not be getting the whole picture.  Instead of admitting that they’ve been falling, for example, they may say that their refrigerator handle just happened to fall off.  They may not divulge that they got lost on their way to the veterinarian.

2.  Have a Heart-to-Heart Discussion

Share your concerns in a non-threatening manner.  Assure them that you want to help them remain at home by being involved.  Talk about your concerns, and make a plan on how to minimize risks in the home.  For more information on this, read our blog “I Get By (Better) with a Little Help from My Friends.”

3.  Visit Periodically

If you can, make a point of visiting, and be deliberate in offering assistance around the home.  Read our blog “Home for the Holidays Part 1: 6 Signs Grandma Needs Help” for ideas of what to watch for when visiting.

With Roger’s family, the key would have been to make a point of going to the house and inviting themselves in.  Although it may have appeared rude, dropping in would have given a clearer picture of what was going on and how the family or others could have helped.

4.  Enlist the Assistance of an Elderly Home Care Service

For Roger, a regular visit from an at-home caregiver would have been enough to enrich the last few years of his life and improve the quality of his life, not to mention keeping his house clean and protecting the value of his belongings.  If needed, he also could have had access to a PCA or a Home Health Aide to assist with personal cares. In-home senior care providers become the eyes and ears for family members who cannot be regularly present.  They can share with families the concerns they see, such as fall hazards or changes in health, cognition, and diet.

5.  Keep in Contact with Neighbors

It’s not uncommon for seniors to have a network of neighbors checking in on them.  These neighbors’ eyes won’t be the same as your eyes, but get their phone numbers and don’t hesitate to check with them periodically.  They may have noticed that Grandma isn’t getting out like she used to or that Grandpa seems a little confused recently.  These details could prove to be helpful as you try to gauge what is happening in the home.

Julie Ellingson, LSW

June 18, 2012

Much confusion exists about the kinds of in-home help available for seniors.  It is not uncommon for me to take an inquiry call, and the person on the other end of the phone will say, “I need a PCA.”

I’ll ask, “What do you need the PCA to do?”

“Oh, maybe change my bedding and do my laundry, help me keep up my house—you know, that kind of stuff is just too difficult for me to do any longer. I can take my own shower and stuff.”

“Oh, I think you mean you need a homemaker,” I reply.  Then begins the process of explaining the difference between the various levels of homecare licensure, what the workers are called, and the kinds of tasks they are able to do.

There are three main levels of home care services for seniors.  I will try to explain each level in a basic way.

The highest level of care is called a Class A license.  This level of care is overseen by a registered nurse who may delegate medical or nursing services or tasks.  Home Health Aides (HHA’s) fall under this category.  The tasks they perform are of a medical nature.  For example, they do administration or set-up of medications, body positioning or transfers, feeding clients, bowel and bladder assistance, and skin care, to name a few of their tasks.  This care can sometimes be covered by Medicare or insurance, depending upon the situation.

Class B Licensure, the next level of care, employs workers who are called Personal Care Assistants (PCA’s) or Home Care Aides.  At this level of care, the in-home workers assist with dressing, grooming, bathing or showering, and oral hygiene, if the client is ambulatory and has no serious acute illnesses or infectious diseases.  Under certain circumstances, these workers may also perform household chores in the presence of technically sophisticated medical equipment or episodes of acute illness or infections. They are also able to prepare modified diets, such as diabetic or low sodium diets, provide medication reminders, and help with performing exercises.

Home Management Registration includes services that are not listed in Class A or Class B.  Workers at this level are often called homemakers, companions, or caregivers.  These workers assist with non-medical senior care tasks in the home, such as general weekly housekeeping, meal preparation, shopping and errands, respite, and companionship.  They can also assist with safety supervision, medication reminders, and standby assistance in the bathroom.  Many clients can stay in their own homes and apartments indefinitely with this kind of help, provided they are safe and that is where they want to be.  Homemakers and companions are not covered by Medicare or other medical insurance because they are not medical services.  Some long-term care policies will cover this type of care, depending upon the policy and the client’s diagnosis.  Other entities, such as the Veterans Administration, the MS Society, or the Parkinson’s Foundation, may have financial resources for this type of care in certain situations.  If a person is low income and eligible for county waivered services (Alternative Care or Elderly Waiver), these programs also provide some resources for home management services.

It is not uncommon for our clients to start out needing service just a couple of hours a week, or even every other week, for routine housekeeping assistance.  The things that most elderly people are physically unable to do include vacuuming, changing bed linens, mopping floors, and cleaning out the bottom shelf of the refrigerator.

As needs change over time, other elderly home care services can be added.  For example, if a person’s condition changes so that he can no longer bathe or shower himself, services for that can be added to the homemaking services already in place.

If you are unsure of what type of services your elderly parents are in need of, don’t hesitate to call our office at 952-854-6122. We can help you sort through your options for home care in Minnesota!

Julie Ellingson, LSW

June 8, 2012

When seniors have the in-home help of a caregiver on a regular basis, they actually have a person who is fulfilling many different roles.  Some of these roles include:  friend, advocate, chauffeur, problem-solver, “chief cook and bottle washer,” secretary, and “go-fer,” just to name a few.

It is also true that anyone working with an elderly person should expect change.  Over time, as people age, their needs and situations often shift.  Appetites abate.  Physical conditions deteriorate.  Medical issues recur or flare up.  It’s common that a senior’s sense of smell isn’t as acute, her eyesight can diminish from glaucoma or macular degeneration, and her hearing also decreases . . . especially if she won’t wear hearing aids!

Caregivers are the eyes that see and the ears that hear when changes are happening in the home. And although it’s not the most pleasant part of their job, they are also the noses that smell when garbage piles up, refrigerated food gets old, or the Depends aren’t taken out regularly!  Caregivers are observant and know to call the client’s social worker, case manager, or family members when they see changes or have concerns about their clients.

Many times good observation makes it possible for seniors to avoid a crisis situation.  The following, adapted from Navigating the Maze of Senior Care by Fairview Care Management and Coordination, are some indicators that can help you to gauge your aging parent’s ability to remain independent and will call attention to the areas that may need some attention or an intervention:

1.  Unopened mail or missed payments indicating a need for assistance with financial management

2.  Medications that have not been taken according to doctor’s orders or missed altogether

3.  Safety concerns in the home involving the stove, other appliances, candles, stairs, rugs, or the inability to contact 911 or family in the event of an emergency

4.  Social isolation and inability to access groceries, food, or meals, as well as community resources or medical care

5.  Changes in behaviors including lethargy, aggression, or depression

6.  Poor hygiene from inability or lack of interest in bathing, dressing or grooming

7.  Cognitive changes such as confusion, inability to find words, forgetfulness or trouble with abstract thinking

Your parents may have all or some of the above conditions, any of which is a good reason for you to consider implementing elderly home care service on a regular basis.  As mentioned above, caregivers can be your “eyes and ears” if you are unable to make frequent visits because of your own personal, family, and job responsibilities.  When caregivers work with the same client week after week, they get to know their client and what is “normal” for that person.  Paying attention to changes—things that are happening or have happened—is how caregivers may help families who are taking care of elderly parents to prevent a crisis.

Those of us who work in the senior companion care industry know that a crisis can change everything!  A crisis may be the difference between a person being able to stay in the comfort and privacy of home and a person who has to move to an assisted living or nursing home setting.

Julie Ellingson, LSW

May 25, 2012

The National Association for Continence estimated in 2004 that urinary incontinence affects 25 million people, including 65% of those folks living in nursing homes.  The elderly are prone to urinary incontinence for many reasons, including that, as people age, their ureters (the tubes that carry urine from the bladder to the urethra) shrink to about half size.  This makes elderly people more prone to bladder infections, which can cause incontinence.  Bladder capacity also shrinks from one-half to one-third of its original size.  This means that older people have to void (or empty their bladders) more often.  As we age, muscles often relax, making it more difficult for the bladder to hold urine.  Some medications, such as diuretics or muscle relaxers, can also cause urinary incontinence.

Types of Urinary Incontinence

There are three primary types of urinary incontinence.  The first is urgency.  This simply means that you feel a significant need (urge) to go to the bathroom and urine loss occurs very shortly after you feel the need to void.  Urgency usually starts when the bladder is approximately half full.

Stress incontinence is when a person loses urine as the bladder or the muscles controlling the bladder are under stress, usually caused by coughing, laughing, jumping, walking, etc.

Mixed incontinence is a combination of the urgency and stress incontinence and is the most common type of incontinence.

Physical and Social Repercussions

It is no secret that as people age, urinary incontinence becomes more of an issue, equally for men and women over the age of 65, and can significantly lower quality of life.  If you are prone to urinary incontinence, there are many consequences if it is not well controlled.

Some significant physical consequences of urinary incontinence include skin breakdown from failing to keep clean or from the skin being constantly moist from the urine loss; increased urinary tract infections; and falls or injuries from rushing to the bathroom and from needing to make frequent trips to the bathroom.

Because seniors have a less acute sense of smell, they many times have an odor that they don’t notice.  If it was apparent to them at one point, they may have gotten accustomed to the urine smell and may no longer be aware of it.  The urine odor gets to be a nuisance to those around them, and it can be embarrassing.  Urine odor can be both in their homes and on their person.  It may be on their body from not bathing often enough, or it may permeate their clothing.  As a result, some people with urinary incontinence isolate themselves and eventually altogether withdraw from social activities.

Treatment

Since urinary incontinence is embarrassing to discuss, many people go untreated, when, in fact, there are several treatment approaches that can be quite successful.  These techniques include scheduling voiding at regular intervals, bladder re-training, prompted voiding, special exercises to strengthen the pelvic floor, and electrical stimulation.  Sometimes medications are helpful.  A good team of physical and occupational therapists and nurses together can help a person to manage incontinence issues. This will help to make people with these problems feel more confident and comfortable participating in activities and in leaving their own homes or apartments.

On the practical side, it would also help to have an in-home senior care provider scheduled to help keep the home free of urine odor, if the senior is not able to perform needed homemaking tasks herself.  Tasks that a non-medical senior care agency could assist in performing would include prompt and regular garbage removal, regular bed linen changes, prompt laundering of soiled clothing and bedding, and cleaning the bathroom regularly.  By removing urine-soaked Depends and other items, it will be less likely for the odor to linger or permeate the home.

Other practical suggestions to manage this health condition would be to wear clothing than can be pulled up instead of clothing with buttons, having grab bars in place in the bathroom, and making sure that there is a clear pathway to the bathroom from wherever the person spends most of his or her time.  (Sometimes physical limitations, rather than underlying incontinence issues, can cause urinary accidents simply because of difficulty in getting to the bathroom in a timely manner).  Limiting water intake is not a good solution since you don’t want your elderly parent to become dehydrated, but limiting fluids after 6:00-7:00 p.m. at night may help.  It should also be noted that alcohol, artificial sweeteners, and caffeine can increase the incidence of urinary incontinence.

If you are taking care of elderly parents with urinary incontinence issues, don’t be afraid to address it with them.  Even though it may not be possible for them to be totally continent, it is possible to figure out ways for them to be dry and for their homes and apartments to be clean and free of odor.

Julie Ellingson, LSW

May 17, 2012

As adult children taking care of elderly parents, we often consume most of our caregiving time addressing the medical problems and physical limitations of our elderly parents who need help with bathing, medication management, housekeeping, or errand-running.  Stopping in after work or going over on the weekend to help out is about all the time we can muster, and by the time those tasks are addressed, we are too pooped out to sit and visit, have a leisurely meal together, or play cards with them.  Besides, our kids needs us to chauffeur them to their soccer/basketball/hockey/dance events, and we need to run!  We try to be everything to everyone, but instead, we end up feeling exhausted and sometimes even resentful.

A client’s daughter recently asked, “You mean I can pay someone to play cards with my dad?”

I responded, “Absolutely!”

“But I feel guilty about that,” she said.  She was already doing so much for her father and realistically could not find any more time to be with him than she was already spending.  Fortunately, there is help for senior caregivers.

There are two solutions to her problem.  The first is to hire a senior companion care company to provide a caregiver to help with the household chores so that the daughter, when she does have time to spend with her dad, can spend it visiting with him or playing games instead of being the housekeeper.  Most of our parents would give the world if their busy children could just sit with them awhile without jumping up to do this task or that!

The other solution is to continue doing what needs to be done around the home, if she’d rather, and then hire a caregiver to spend quality time with her dad doing the things that he enjoys doing, whether it be playing cards, looking at old photographs, or discussing the current news.

Quality of life for elderly people is more than just physical health.  Social, psychological, and spiritual needs should also be addressed, although they are sometimes overlooked.  Many times older folks won’t admit to their families that they are lonesome or wish they had someone with whom to talk or play games.

Even when our caregivers are hired to do the “cleaning” and other senior home assistance tasks, the more important role becomes befriending the elderly person.  Caregivers have stories to share, and most importantly, they haven’t heard the stories adult children have heard from their parents over and over again.  Sometimes just having a fresh face from the outside world makes a huge difference in the mood of an elderly person who doesn’t get out much.

Julie Ellingson, LSW

May 1, 2012