ORIGINALLY WRITTEN DON RATZLAFF
For many adult children, deciding whether an elderly parent needs nursing-home care is one of most difficult decisions they must make.
Fortunately, they have professionals in the field who can help them assess their unique situation and help them find the most appropriate solution.
Noreen Weems, who directs the Marion County Department for the Elderly, said the goal of her office is to help an elderly person retain his or her independence for as long possible.
“What we try to do, for children who ask, is to show them options as to what kind of in-home services their parents or loved one can receive,” she said. “Then we have a case manager for our county who can also go out and do assessments.
“A lot of times from that assessment we can learn a lot about the individuals, to see whether they are at high risk staying in their own home, or whether they need to seek other types of housing.”
Connie Suderman is the case manager in Marion County for the Northcentral Flinthills Area Agency on Aging.
“We try as hard as we can to keep people at home,” Suderman said. “That’s our first agenda. We do what we can to build in the support to keep them there. It’s cheaper for everybody and it’s more desirable for the folks who are living in their home-but it doesn’t always work.”
Suderman said by the time she receives a call, a family usually has basic information about their options. After she completes some preliminary paperwork, she will contact the elderly person to arrange a formal assessment within a few days, if possible.
The assessment, which takes a couple of hours, includes a visual assessment of a given living environment, plus a series of questions that indicate the person’s cognitive and physical abilities.
The assessment can be done with family members present or privately with the individual.
“Depending on what we determine the needs are, I or the family will coordinate the services, or at least point them in the direction they should go,” Suderman said.
If nursing-home care is indicated, the speed with which a placement can be made depends on the institution involved.
“If the family can see the social worker quickly and there’s an opening, it doesn’t take very long,” she said. “But if they are on a waiting list and they are doing intermittent services, it could take a while longer.”
If the situation doesn’t warrant 24-hour care, Weems and Suderman said they can help families find the services that can keep an elderly person in the home-such as housekeeping help, delivered meals, medication checks, and even bathing and personal hygiene.
Suderman said the ongoing involvement of family members is helpful.
“Things move more quickly if family members help with contacts and keep involved,” she said. “A lot of times, these people have to fill in the gaps until the appropriate services are in place.”
Intermittent services aren’t always an option, though.
“If it comes to the point where I determine through the assessment process that the loved one is is in some sort of physical harm, then I don’t offer in-home services,” Suderman said. “I would have that family contact Social and Rehabilitative Services and have someone come in and assess them for safety. That happens very rarely, though.”
Suderman said most families are good about asking for help in a timely manner. If the family is hesitant to explore nursing-home care, it is usually because they aren’t sure it is affordable in their situation or, even more likely, the loved one doesn’t see a need for assistance and wants to remain on his or her own.
In such cases, the family needs to consider some mediating strategies.
“One of the things I recommend is that they involve their doctor and tell him or her what their concerns are, what they see in the home, so the doctor can use assessments and judgment to encourage the older person in the direction they need to go,” Suderman said. “I really encourage people to bring their doctors in and have them be part of the team.”
She also suggests that families visit several nursing homes and explore the available options.
Sometimes, as a professional in the field, she can be of help, too.
“Sometimes a person with a name tag who is from an aging agency can have some influence,” she said.
Another idea to make a transition more palpable is to make decisions in incremental steps.
“You can build in some supports, and maybe they’ll accept one thing,” Suderman said. “And then, one or two months down the road, I might be able to increase the services because they decided having an aide or a nurse visit isn’t as bad as they thought it might be.
“We try to work with (the elderly person) as much as we can and not try to force the issue.”
Added Weems: “We try to provide as many in-home services as we can, so going into a nursing home would be one of the last resorts. Let’s look at if the parent would be safer, better fed, better nourished, or remember their medications better if they were in an institutional setting.”
Weems said that sometimes what an elderly individual or couple need is simply smaller living space that they can still manage on their own.
“Apartment living is really neat when you’re at the stage where you you don’t want to worry about yard work, or gathering firewood, or maintaining a home and yard, but you can still take care of most of your personal needs,” Weems said.
Even when offered kindly and with patience, the persuasive efforts of family members and health professionals aren’t always effective, Weems admitted.
“I know we have people out there who are living at home, alone, and probably should be in a nursing home,” she said. “And there’s no way you’re going to get them to budge.”