THE MINDFUL CAREGIVER

PLANNING AHEAD PREVENTS RASH, COSTLY DECISION-MAKING ERRORS

By Nancy Kriseman
AJT CONTRIBUTOR

Welcome to the first Mindful Caregiver column. If you are reading this, you may be taking care of an elder family member or assume this role in the not too distant future. As a geriatric social worker, I like to tell my clients that “Aging is a family affair.” What do I mean by that? When elders become frail, many may not be able to care for themselves. At some point, family members may need to create a support network and perhaps become actively involved in the elder’s day to day care. Here are some statistics that support the notion that aging is truly a family affair:
• People who live to be 65 tend to live another 20 years
• The fastest growing population in our country is the 85 plus group
• 80% of elders are cared for at home
• The majority of caregivers are women
• Caring for a frail elder averages between 6 to 10 years

Hopefully these statistics will encourage you to become proactive in care planning for your elder loved one. So when an elder becomes disabled or needs care, you will have done your homework on elder care options ahead of time. Planning ahead prevents you from having to make decisions in a crisis. Quick decisions can be costly — from a financial and personal care perspective. Making the best choice about where an elder should reside takes time and requires careful research. For example, many highly regarded assisted living and nursing homes have waiting lists.
Likewise, bringing in a home-care agency involves researching the various agencies, assessing the services provided, and asking key questions about how they train and supervise their professionals. In addition, it can take some time to interview and match the best caregiver to your loved one. By planning ahead, you can determine the costs, learn what’s involved in the process of securing care, and maximize your choices and options. And a by-product of this is that your stress can be reduced if you encounter a crisis.
Knowing your options ahead of time can also help you have a more productive care conversation with your elder family member. A care conversation encompasses talking with your elder family member about the things that will need to be in place if and when the elder becomes frail and can’t make care decisions for him/herself.
Here are some tips on how to begin this difficult conversation. First, make sure you choose the ‘best person’ to begin these care conversations. It might not be you but instead, a grandchild, good friend or Rabbi. Next, validate how well the elder has managed his affairs. Let him know you respect his independence. Reinforce that you want him to make his own decisions, which is why you are having this conversation. Start with the least threatening issue. For example, that might be asking him to provide a list of his financial accounts, his financial and tax advisors, or checking to see he has an up-to-date will. Then later you can begin to tackle the more sensitive issues around care. Realize that these care conversations may need to occur in small chunks and not all at once, so as to not overwhelm the elder.
There are three critical topics that need to be part of the care conversations. First is money, and how will she pay for her care. Be aware that Medicare does not pay for home care or assisted living care. Medicare will pay for short-term skilled care in the nursing home, but not long-term care. The second is location, or where care will be provided. Does your elder want to stay at home or would she be comfortable in an assisted living community. Third, are the appropriate legal provisions in place. This includes Powers of Attorney for Health Care and Finances, Wills and Trusts.

I hope after reading this article you are more aware of how planning ahead of time and having these care conversations can bring forth more positive options.

Nancy Kriseman is an author and licensed clinical social worker who specializes in working with older people and their families. This column is about helping families make the best decisions possible and be pro-active when supporting and caring for elder family members.