When the author’s mother, Sarah, could no longer take care of herself, he hired a home healthcare aide.
What to Do When the Call Comes
By Gary M. Stern
If you’re a baby boomer, and even if you’re not, the call will eventually come. Your elderly mom or dad fell and has been taken to the hospital. Perhaps it’s time for a homecare aide, a nursing home, or an assisted-living center. But if you’re like me and you don’t have a master’s degree in social work, or really any knowledge about eldercare in general, you’re going to need help.
Luckily for me I’m a reporter, so all I had to do when my call came was click into professional-action mode. This meant tracking down experts just as I would if I’d been assigned a feature on eldercare, and had to deliver my copy on a very tight deadline. I rolled up my sleeves and got to work; Within 24 hours I had spoken with a social worker who specialized in eldercare, an attorney who specialized in eldercare, and a homecare service. I used Google to lead me to professionals whose training and experience could and did help me guide my mother toward the best possible decisions given the particulars of her circumstances.
It was my mother’s friend who delivered the wake-up call that jolted me out of my comfortable but busy workday routine. She told me that my 85-year-old mother had fallen down. I rushed to Queens and took my mother to the doctor. He was attentive, but couldn’t figure out what had triggered the purple welts under my mother’s eyes. Because of her dementia, he was also puzzled about where and how she had fallen. Based on the location and severity of her bruises, he suspected the accident had occurred while she was getting out of bed. But because of her compromised mental capacity, neither he nor anybody would ever know for sure.
The doctor recommended that I admit her to a nursing home because she could endanger her own life by forgetting something simple like the fact she had food cooking on the stove. “She needs to be in a nursing home,” he said with impact. Then he turned to my mother. “Mrs. Stern, don’t you want to be in a nursing home where they can make all your meals?”
My mother is forgetful and absent-minded, but that didn’t stop her from replying flatly: “I want to stay in my house with my cat.”
Thinking to myself that this guy was an internist, not a specialist in eldercare, I mustered the resolution I needed to counter his authoritative tone. “One fall doesn’t mean she’s incapable,” I said. “I’ve fallen several times and I’m quite capable.”
Identify resources
After our visit to the doctor, I compiled a list of referral services from the National Association of Social Workers (www.socialworkers.org. Click to find a social worker, choose geriatrics as a specialty, add your zip code) and New York State Bar Association (www.nysba.org; 518-463-3200), which offers half-hour legal consultations for $35.
I might not have realized the importance of consulting an attorney had it not been for my wife, who had already helped her parents move into an assisted-living center. There she had been advised to hire a lawyer who could help her obtain power of attorney and health-care proxy. I was eager to learn from her experience. The social worker and the lawyer combined cost only $235 for initial referrals that armed me with sufficient knowledge to keep my mother comfortable in her own home, at least for a while. Claire Berman’s book Caring for Yourself While Caring for Your Aging Parents (Holt, 1996) also offered helpful background and tips, on which my wife relied heavily while helping her parents through their difficult transition.
Use a social worker as a consultant
Social workers may not get as much press as Paris Hilton, but they are an invaluable resource when it comes to evaluating the status of an elderly parent, and choosing from an array of options. Furthermore, social workers consider the emotional well-being of an older person while many physicians focus solely on the nuts and bolts of physical condition.
I arranged an appointment with social worker Joyce Stratton. Ms. Stratton, who worked for the New York City Department of Aging (visit its special caregivers Website at www.nyccargiver.org) for more than 20 years, is now a consultant. When I described my mother’s fall and the doctor’s suggestion that she immediately be placed in a nursing home, Ms. Stratton was outraged. She suspected the doctor of overreacting and being insensitive to my mother’s wishes and needs. Instead of a nursing home, Ms. Stratton recommended hiring a part-time homecare aide so my mother could go on living with her beloved cat. This wouldn’t solve the long-term problem of fading memory, but it could keep my mother happy and at home for a couple more years.
Before proceeding, I made a second appointment with the doctor. “I respect your judgment and your knowledge,” I told him. “But I got a second opinion and think that, with a homecare aide, I can keep my mother at home and monitor the situation.” Indignant and defensive, he rebuked me for disagreeing with him and told me I was misguided. He did grant, however, that in the end it was our decision.
Hiring a homecare aide
In my own opinion, if your parents have any savings or financial resources, paying for a homecare aide is money well spent. And the fees are less than one might expect. For a four-hour shift we pay $44 a day, or $220 for a five-day, 20-hour week. To me, this seems like a modest fee for a trained professional.
Most homecare aides are immigrants from Asia or the Caribbean, and have the equivalent of a high-school diploma. But don’t let their unpretentious credentials mislead you. Homecare aides from reputable agencies are trained to deal with difficult people of advanced age. Moreover they clean, cook, and can shop if the supermarket is close by (many don’t own cars).
If neither you nor your parent has sufficient financial resources to cover the expense of a homecare aide, and no long-term-care insurance has been purchased in advance, your parent may be eligible for Medicaid. Unlike Medicare (government-funded health insurance for senior citizens), Medicaid (government-funded health coverage for the poor and disabled) does cover homecare on a limited basis for people who are partially disabled but do not required 24-hour-a-day skilled nursing care. Because Medicaid eligibility and benefits differ from state to state, it’s best to go directly to www.cms.hhs.gov while also consulting with an elder-law attorney if at all possible.
Aware that personal and professional networking almost always yields helpful results, I called a friend who had been through a similar situation with his elderly parent. Through his recommendation, I reached a homecare service and arranged to interview three aides with the head of the agency sitting in. I brought a spoon from home as a prop for a role-play to test the prospective aides in action. During each interview, I said we were going to act out a scene that might happen with my mother. I threw the spoon down on the floor and said to the aide: “How could you be so clumsy! Why did you make me drop that?”
All three handled the role-play with assurance. “Let me pick up the spoon. It was my fault,” said one woman. “Why don’t we watch television?” said another, nimbly changing the subject. “Forget the spoon. Let’s have lunch,” suggested the third. All three were clearly skilled and experienced. I informed them that my mother’s house was a mess (she had stopped cleaning), would take weeks to tidy up, that she had a cat, which was special to her, and she could be resentful or even nasty at times. I hired the aide named Marie and spent her first day on the job with her at my mother’s house. No conflicts arose, but at 5 p.m. the owner of the homecare agency called to tell me that Marie had resigned.
I was flabbergasted. Everything had gone so smoothly, and my mother was appreciative of the help, not nasty or troublesome. The owner of the agency told me: “Marie felt that the house was too messy, and she’s not fond of cats.” Hadn’t I forewarned her about both these factors? “Yes,” came the reply, but it hadn’t sunk in.
After one day of believing I had the problem solved, I was back at square one. I called Joyce Stratton, who explained that homecare aides – most of whom are paid hardly more than the minimum wage – often quit for little apparent reason. She advised me to restart my search. “You may have to go through three before you find one that stays,” she said prophetically.
Find a reputable homecare service
I finally got in touch with the Jewish Association for Services to the Aged, which handles people of all religions (www.jasa.org, 212-273-5272 for the Manhattan service center but check the Website for other locations) though it no longer provides homecare services. But it did send me a list of reputable agencies within proximity of my mother’s house. I called X-Treme Care (718-461-9602), a Flushing service that in short order sent an aide named Veda, along with a nurse who performed a diagnostic on my mother. I hired Veda, who lasted two weeks. After a check-up with her own doctor, Veda informed me that she was allergic to cats. “If your mother gives up the cat, I’d love to stay,” she said. Veda was dismissed. X-Treme Care then provided Marcia, a lovely, caring woman who has now been looking after my mother for four months. She’s my “eyes and ears,” and I speak with her every day.
Obtain health-care proxy and power of attorney
Joyce Stratton also suggested obtaining a health-care proxy and power of attorney before my mother’s mental condition deteriorated to where she could no longer make informed decisions. So I hired eldercare lawyer Daniel Fish for a $600 consultation. An associate from Fish’s office accompanied me to Queens and painstakingly explained to my mother what health-care proxy and power of attorney meant. He eventually got both papers signed.
So thanks to a little investigative research, I managed to hire a social worker, a lawyer, a homecare aide, and a nurse to perform a diagnostic – all without emptying my mother’s bank account of mid-five-figure savings.
My mother still has dementia, still has bad days as well as good. But she lives at home with her beloved cat, and she calls Marcia – her homecare aide – a friend.
