WHEN IS IT TIME TO INTERVENE?

BY NANCY KRISEMAN
AJT CONTRIBUTOR

I am sure that many caregivers have heard, “I would rather be dead than move out of my home.” So how do you determine whether your love d one can remain at home? Be mindful of the following issues:

How old is your loved one?
Most geriatric professionals advise caregivers to consider age when weighing the pros and cons of keeping your elder loved one at home. Generally speaking, when elders pass the age of 75, their health can change on a dime. They are more likely to be diagnosed with a major illness, have a serious fall, experience complications from surgery, develop memory issues, or be challenged by hearing and sight. I can’t tell you how many times I have had clients experience a rapid change. Their elder family member, who was managing well at home and active in her community, had a fall, which triggered hospitalization, followed by rehab care. This then led to the serious exploration of whether or not the elder could move safely back home.

Can Your Loved One Care for Himself?
It is important to assess a person’s ability to take care of oneself, or what professionals call “activities of daily living” or ADLs. ADL’s are the day to day personal tasks, such as bathing, dressing, grooming, cooking, eating and toileting. For elders to remain in their homes, ask the following.
• Is your elder effectively managing his health on his own? Can he properly take care of his ADL’s, such as bathing, dressing, grooming, toileting and eating? Poor hygiene can lead to urinary tract infections, skin breakdown and pressure sores. Inadequate nutrition and hydration can cause a host of medical problems, including kidney infections, confusion, depression, The Mindful Caregiver fainting and falling.
• Is your loved one going to doctors as needed? Is she going more frequently because she is experiencing problems from not taking proper medical care of herself? Or, do you have the opposite situation, in which he refuses to go to the doctor? Both of these scenarios may indicate that additional help is needed.
• Is your loved one frequently frequently ending up in the ER? More often than not, an elder who is not properly following medical directions will end up in the ER time and time again. If you are seeing this pattern, it is time to intervene and make sure your loved one has the medical and social support he needs.
• Does your loved one still have good cognitive functioning? Even intermittent memory issues can impact the safety and health of your elder loved one. This can include forgetting to take medications, leaving the stove burner on, or innocently letting a stranger into the home.
• Can your loved one take care of his home? Consider the consequences if the house is maintained. I’ve seen elders who have haven’t repaired their air conditioning and aren’t sure how to go about getting it done. If you are going to keep your elder at home, is there someone to monitor the situation? And are there resources to pay for help? And if so, will he even allow someone else to help? If not, how will this affect his health and living situation? If you answered no to any of these questions, a red flag should pop up. You need to be thinking about home care, other services, or alternative living options.

Is the Home Safe?
Safety is paramount when considering how long your loved one can remain at home. First you must evaluate whether the home is elderly- friendly. Are there safety hazards inside the home that could present danger? This includes throw rugs or clutter that could pose a trip hazard, a bedroom that requires too many steps to access, or a bathroom that doesn’t have a walk-in shower. Don’t forget to access the outside of the house. This can include the steps that lead into the house or uneven pavement leading to the mailbox. Fixing these common situations can be costly in time and money.

Will Your Loved One be Home Alone?
It’s been my experience that caregivers tend to underestimate the importance of activities and social engagement when keeping their loved one at home. If your loved one is going to remain at home, ask yourself how much interaction she will have with others? Are you or others able to visit regularly? If not, it can be easy for an elder to become isolated. This can lead to poor nutrition, decreased mobility and depression. And elders have a tendency to not admit that they are lonely or bored.

Caregiver Needs
Last, but not least, have you factored in your own health and well-being? Too often caregivers take on the responsibility of keeping their loved one at home and do so at their own expense. Mindful caregivers have to carefully review all the pros and cons and realistically look at the whole picture.

Please send your questions, ideas and topics of concern to this paper. I will do my best to respond to the most common questions and issues posed. You can also visit my Geriatric Consulting Services website at www.nancykriseman. com, my Facebook page, or follow me on twitter @Geriatric- MSW