The Life Transition Blog

If you are the adult child of an aging parent, you have probably asked yourself, "How do I know what type of help my aging parent needs?" Unless you are a senior resource professional, sorting this out can often seem overwhelming. So, here are six questions to ask to help sort it all out.

What is my parent's physical condition?

What is my parent's emotional condition?

What is my parent's cognitive level?

What financial resources are available to pay for help?

What human resources are available to provide help?

What input has my parent given on the entire topic?

Your parent's physical condition will help you determine such things as whether your parent needs help with activities of daily living (e.g., toileting, dressing, feeding, mobility), with medication management, or with managing medical conditions such as diabetes or using supplemental oxygen. Your answers will help you decide whether your parent's physical condition allows them to be safe in their current living environment without extra help, or whether you need to arrange for in-home help or possible transfer to an independent or assisted living setting. If your parent's physical condition is likely to be short-term, as when she is recovering from surgery, you have other options to consider, such as having physical or occupational therapists come to the home, or perhaps a short stay in a rehab setting.

Sometimes, your parent is physically capable of taking care of himself, but he has become isolated and is not engaging in social interaction with others. This might be simply because he can no longer see well enough to drive or because many of his friends have passed away and he lacks someone to "hang out" with. Whatever the reason, social isolation can often lead to depression or other emotional difficulties. If this is your situation, you might decide to look into available senior centers, adult day care, or companion services for your Dad. Depending upon your answers to the other questions, you might also consider an independent or assisted living arrangement since these environments generally offer a great deal of social interaction and stimulating activities.

Some of the toughest decisions come when your parent is memory impaired. If your parent wanders outside of the house and gets lost, or leaves the stove on overnight, she needs closer supervision. If she becomes agitated due to the cognitive impairment, she may require someone around all of the time to keep her calm. If your parent suffers from Alzheimer's disease, there are often physical considerations as well, especially in the later stages of the disease. As is always the case, safety should be your first concern.

When it's time to figure out what help to put in place, there is no way to escape thinking about the financial side of the decision. While some home care is covered by health insurance such as Medicare, most care related to activities of daily living is not. If your parent has long term care insurance, it will generally begin paying for services once your parent meets the policy guidelines, which typically state that a physician must certify that they have difficulty with two or more ADLs and that this state will continue for at least three months. Some long term care policies provide for "first day" coverage for in-home assistance or services within an assisted living facility. You need to know whether the care you seek will be covered by Medicare, and if so, you must use a Medicare certified home health agency. If you are paying privately, then you have the flexibility to use any agency or to use a private caregiver who is not associated with an agency. Be sure to take the time to decipher your parent's insurance policies in advance so that you have some idea about what will be covered.

Many families are able to take care of their aging parents themselves. This is especially true when there are many adult children who live nearby and who can take turns or divide up the duties. If this is the case with your family, it is helpful to sit down before a crisis strikes to figure out who has the capabilities and the time to do what. In that way, the entire family will function as a team, and if supplemental resources need to be hired, everyone on that team will understand why that needs to happen. Some families set up care contracts so that the family caregiver is paid by the parent for whom they are providing the care.

Last but not least, if your parent is able to provide input to this discussion, it is a good idea for them to do so. It is helpful to understand what your parent's desires are, and if practical, to honor at least some of them. This is not always possible, but when it is, it is an important step in the process of a smooth transition.