Each unique elder care journey is a personal experience. However, it can be a relief to know that guidelines do exist to help you make informed decisions. Many other Bay Area individuals and families have successfully walked this same path with the support and assistance of qualified and experienced advisors. The very first step on your journey is, of course, to assess your concerns so that you can educate yourself, develop a plan, and begin to take action. This page is a good place to start.
Changes in Physical and Cognitive Abilities
If you are starting to notice subtle or not-so-subtle changes in an older family member, you are their best advocate when it comes to assessing risk and seeking help. Some things to look out for are:
- Disinterest in activities they normally enjoy
- Increased clutter in their living space
- Lack of attention to personal hygiene
- Piles of unread mail
- Signs of accidents—either something physical, like bruising, or damage to their vehicle
- Difficulty performing tasks such as cooking or paying bills
It’s ideal if you can start a conversation with your loved one and talk to them about what you are noticing and how they are feeling. Often, they are aware of the changes but scared and unsure what to do. Let them know that they are supported. You can support them with little things, like getting someone to come manage their garden, help them with bill paying, or drive them to doctor’s appointments.
If these little sorts of fixes won’t solve the problem, it’s time to consider other options. We can help you assess your choices.
Unmet Medical Needs
An unmet medical need is when a person has medical issues that are not being monitored or addressed by a healthcare professional. This can occur for several different reasons.
- Financial — Lack of insurance coverage is often cited as a reason why people will not seek out medical care. Think Medicare Part D and the doughnut hole. Many people will stop taking medications when they hit their coverage limit for the year.
- Lack of Services — Another reason for unmet medical needs is a lack of services available. Fewer doctors accept Medicare insurance and it is more difficult to jump through the hoops for additional service benefits such as military benefits or employer benefits.
- Inertia — The more common situation is subtle, and it stems from the person’s unwillingness to address healthcare concerns, either from fear, lack of understanding, or even some initial memory loss.
Over time, unmet medical needs build up, compound and become larger issues. The decision to get involved in your family member’s health care is not an easy one. It is best to start the dialog early and to have a plan in place. Be aware of subtle changes and find a way to talk about what you see. If that is uncomfortable and the concern is serious, consider talking to the family member’s doctor. The doctor will not be able to disclose any information but, if you share your observations, it may help him/her to develop a better understanding of the situation so that they can alter their treatment plan accordingly. We are not always the best historians of our own health.
Safety at Home
Home accidents among the elderly are a major source of injuries. A simple fall that results in a broken bone can become a serious disabling injury. As we age, our senses of sight, touch, hearing and smell tend to decline. Simple precautions and adjustments can help ensure a safe, accident-free home.
- Self Evaluation Tools — The Center for Disease Control and Prevention has a very simple checklist to assess your home safety. You may evaluate the layout of your home and undertake modifications to ensure mobility, access and security or install available technology to monitor personal safety. http://www.cdc.gov/HomeandRecreationalSafety/Falls/CheckListForSafety.html
- Health Care Professional Assessments — Your doctor can determine eligibility, but in some cases a PT or OT (physical therapist or occupational therapist) can come out to your home to make sure it is safe, particularly in the case of a recent fall or post surgery. You may be eligible for adaptive equipment to improve home safety (like grab bars, toilet seat risers, etc).
Loneliness & Isolation
Studies show that loneliness and isolation in the elderly can raise potential health risks including depression, heart disease and high blood pressure. Increasing physical and social activities is a great way to reduce or even prevent both. Things to consider:
- Active Social Circle — Make a lunch date or a standing walk in the park date with a friend.
- Friendly Visitors — Local communities and religious organizations often have an outreach program.
- Pet “Therapy” — Cats and small dogs make great companions. If owning a pet is daunting, try LITA — Love is the Answer. They match pet & pet owners to an older adult to match home visits.
- Find a Sense of Purpose — volunteer programs like senior corps, RSVP — Retired and Senior Volunteer Program
- Learn a New Skill — look at the lifelong learning programs such as UC Berkeley’s OLLIE and USF’s Osher. They offer great classes at affordable rates throughout the Bay Area.
Transportation issues affect social isolation and the basic logistics of getting to appointments. It is often difficult or impossible to take time off work to get your family member to appointments, let alone set up a calendar for activities and events. There are several transportation options to consider:
- Paratransit — Many people will resist this option and say: “But I am not handicapped.” The truth is, you don’t have to be handicapped in the strict sense of the word to use Paratransit. To be eligible, you simply must be unable to use public transportation without the aid of someone else. Many people fit this criteria. If your house is in an area that requires a good deal of walking to get to public transportation, or if once on public transportation you have concerns about getting on and off, or if you have mild cognitive impairment, this might be the best solution.
- Taxi Scrips — Another low-cost solution is to apply for Taxi Scrips in your area. Taxi Scrips provides a limited amount of “paper money” that certain taxi companies in your area will accept as payment for rides.
- In-Home Caregiving Agencies — Most of the caregiver agencies will provide a companion that can drive you to and from appointments as well as help you during that time. Some agencies will book appointments for as little as two hours, some require a four-hour minimum.
- Private Transportation Services — More and more small business owners are starting transportation services to assist their customers.
Housing and Long-Term Care Needs
Do you know the difference between an assisted living community and a continuing care retirement community? Not sure what home health agencies really do? There are various housing options available to you as you age, but understanding the different options can be overwhelming. The right choice for you depends on the care that you need and how far in advance you wish to plan. While you plan for the future, you may also want to consider looking at your financial portfolio and insurance options, and make sure that you have all of your medical paperwork completed. You may want to get the support from a geriatric care manager to see if assisted living, a board and care home, skilled nursing, CCRC or home care is the best option for you. From planning your retirement to end-of-life care, we have the information you need to make informed decisions.
Long-term planning is a broad category and can refer to anything from long-term care insurance and advance health directives to estate planning, trusts and benefits. We recommend that you leave this to an expert! Here are some important things to keep in mind when you are evaluating your planner:
- “Financial Planner” is not a legal definition. Look for someone who has a legal fiduciary responsibility to look out for your best interests. It is best to ask: “Are you a fiduciary?”
- Ask how they make their money. Be wary of the commission-based advisors because they make their money on the highest commission trades. Although it is an extra cost, you are better to use a fee-for-service advisor so that you know exactly how they make their money.
- Check qualifications. Are they a member in good standing of PFAC (Professional Fiduciary Association of California)?