Aging in Place and Social Distancing

I am thankful that right now I don’t have to balance my children’s needs, my client’s needs, and my aging parents. My parents have both taken a celestial departure from this earth, but in just imaging them being around now … I feel my chest tighten.

I am working with several families who have a loved one that someone from my company works with in the metro-DC area. Our goal is to support our clients by assisting, managing in tandem, or by just handling the day-to-day financial matters (bills, home maintenance, long term care and insurance claims). After caring for two parents who had different types of dementia, I am very attuned to how much it means for them to live their life and manage their affairs.

So here we sit with several clients who still live alone in their homes. Some have stopped all external visits from health care managers, cleaning services, and personal care assistants while others doubled down and now have 24/7 help and care in their home.

There is no right or wrong. There is just right for each individual.

The initial two week social distancing came and went. Now we are looking at near isolation for some or escalating care expenses for possibly three months. I am curious to see how we all emerge and adapt after this experience.

What I have noticed in working with adults with cognitive disabilities is that the more they interact with others, the higher they function when we sit with them to do basic bill pay tasks. However, most of those isolated at home are now getting regular calls from the family, and are having to manage in their home all on their own. In calling many of them regularly, they are doing fine and have managed to adapt to our virtual support.

Will any of us win this experiment? Will those on their own emerge stronger after showing us all how they can manage? For those that could not manage on their own, will they do better than those in communities when it comes to exposure to Covid-19?

All I know is that we are all doing the best we can with the information we have at this time, and within the resources we have at our disposal. We may just see how well our American ingenuity shines at a time when modern medicine can’t protect us.

I’m looking forward to being able to see this one in my rear-view mirror. Wondered.

Moving Choices: Aging in Place – Part 2 of 3

The first in the series The Angsty Discussion About Moving: Life Care Communities is a general overview of of how they are structured, the reality of the choice, and some things to know and consider if you are looking into this option.

I’m not gonna nove and you can’t make me.”

Now it is time to share some of the common issues and themes I see when a spouse is working to stay in the home with their loved one who needs more care as well as when adult children are helping a parent live at home alone.

In the beginning, it can be less expensive to layer in the care to support staying in their home. However, especially for a spousal caregiver, the care needs and isolation can become overwhelming in addition to the drain it takes on the health of the caregiver. According to the Family Caregiving Alliance, spousal caregivers ages 69 to 96 have a 63 percent higher mortality rate than noncaregivers in the same age group.

Often, the individual living with dementia doesn’t understand why their spouse is hiring outside help. Many living with dementia cannot recognize the necessity that someone help them through their day or the need for their spouse to be off the clock. The caregiving spouse starts to lose their outside connections and support in addition to skipping their own medical appointments and care needs.

Even though the couple is together, I am seeing that they both begin to feel isolated. The loss of a partner can also be more devestating since their partner might be their only engaging social connection. I saw this with my parents.

For those that choose to stay in their homes either with or without a spouse, there are engaging adult day programs for the individual with dementia. Isolation can actually lead to a faster cognitive decline and studies have likened the health risk to smoking a pack of cigarettes a day.

Generally, I see many couples and individuals supported by an adult child living at home alone resist outside support. Unfortunately, about half the time a critical incident occurs and blows up this option and a scramble to employ support occurs. If no prior plans are made, the available options are usually not the best fit. A little support layered in early can be an ounce of prevention and provide more options should care suddenly be needed after an event.

Living at home can also end if an individual living with dementia starts to wander or becomes combative.

The successful couples and families managing a loved one living at home have been able to integrate supports for daily engagement through personal care assistants or the use of an adult day program for the individual with dementia. I know how challenging it can be to start so just ask them to try it out for a few hours and days. Forced changes usually are met with solid resistance.

As a security measure, individuals and families that plan ahead have also selected at least one community that might be a fit if they need to make a change and gotten on the wait list. You can always decline the space when it becomes available but remain in the queue.

PROS:
– Familiarity in the home environment can help someone living with dementia stay independent longer since they have long-term patterns established.
– Expense. If you only need some part-time support or help, or even sign up for an adult day program, the total cost of living is less expensive.
– The individual with dementia wants to stay in their home.

CONS:
– Isolation impacts health and cognitive function in negatives ways. Even introverts (like me) will benefit from social engagement.
– Spousal caregivers have an increased risk of death.
– When something happens, there is no quick solution to provide support (unless you have already planned ahead or gotten on a wait list at a local community).
– Moving after dementia has been diagnosed usually means that learning new things will be more difficult. It can be tougher to make friends and engage within a new community.
– Expense. There is a tipping point when bringing all the services to you can be more expensive.

RECOMMENDATION:
– Make a plan for social engagement and find ways to make it happen. Call your county Area Agency on Aging to find out what resources in your community are availble to help.

There is no right or wrong choice when it comes to choosing the best option for your loved one and their primary caregiver — Just the best option for them and the caregivers when you need to make a choice. Advised.

Up Next, Moving As Needed