This article is based on episode #10 of A Bridge To Wholeness podcast. You can listen to the episode on iTunes, Stitcher, and on our website.
We are here today to talk about a subject that can be very challenging for many of us. The podcast today is going to deal with when we become parents for our own parents, and I think this subject is so vitally important for many of us, because as we age, our parents are aging as well, and there’s so many decisions that need to be made. Oftentimes, we really are caught unawares of what is going on with our parents until something happens. Maybe that might be medically, maybe it could be emotionally or spiritually, something in their environment, something changes and we start to think to ourselves, “Oh my gosh, are my parents needing more help? Do I need to step in now and do more work for them?” Or you find yourself actually doing more and more for your parents, and before you know it, you have actually given several hours of week of your own time to your parents, and you start to think, “This is really getting to be too much for me. What do I do? How do I get them the help that they need? Do they even need help? What’s going on here?”
This happens quite a bit, and all the sudden you find yourself in a position where your whole life has also shifted and changed. I’m here to tell you that there are many things you can put in place for your parents or maybe a loved one, maybe a spouse that’s going through a difficult time. Maybe you are facing end of life decisions for your loved one. Maybe you are facing having to move your loved one into some type of a facility because you really can no longer care for them. There’s a couple things that I want to talk about today. First of all, let’s just set up the situation and we’ll go from there. If this relates to you, fine. If it doesn’t, you can probably still use a lot of the information.
Okay, let’s say mom or dad or spouse has a medical issue, and you have been following them for six months to a year, and they’ve had a degradation in their health and wellness. They’re actually not getting better. They’ve plateaued. They haven’t gone back to their baseline, so we say. They’re just not able to do as much as they were previously. You’re now considering whether to get them some type of helper to come into the house, if that’s some type of an aide or maybe another family member, a friend, whatever that might be. Or maybe you’re at the point where they can’t stay in the home anymore. What do you do? Where do you even begin?
What I’m going to suggest is if you have family members who are willing to have a discussion about your loved one, gather them together. Set an actual meeting time. Now, this can be in person. Maybe you can use the computer, maybe you could use a Zoom platform like I do, or you could use a Skype, you can have a conference call, whatever it is, but set up an actual physical time for you to have the meeting. Don’t just do it as part of a discussion, and then people start talking. Set it up. Establish ground rules. The reason I tell you this is because this is what we did in our family, and it really, really helped quite a bit. I am one of six children. I have five siblings, and all of us are very busy, and we found this was so helpful.
Once you set your time up, set ground rules. They could be something as simple as every person has an opportunity to speak and express their opinion about mom or dad or the spouse, and nobody interrupts in that five minutes. No one is allowed to question anything that you say. They’re not allowed to have an opinion before, during or after. Go through the group and do this, and someone has to be taking notes. If you record it, obviously that’s going to be a lot more simply because everything is already there, but it’s really helpful for one person in the family to take notes about what that person said. It doesn’t have to be exact, but if you can keep a running record of that, it’s really helpful. The fact that someone gets to speak without being interrupted or without judgment is vitally important for this process to work, because everybody’s voice needs to be heard.
If you do decide to include your loved one in the meeting, allow them to speak. Allow them to speak in the beginning, and I would give them a good five or ten minutes. Allow them to speak without any interruption, and then allow them to speak at the end without interruption and without judgment, because you want to really listen to see what is really of concern to them. Again, taking down the information, writing it down, and then sending that information to everybody so everyone understands what this person things, etc. Really keeping an open mind during these discussions is also very important.
The next thing I want to talk about is if your loved one or spouse, parent, etc, is going to be staying in the home by themselves, is there something that you can put in place that will assure them that, number one, they’re being supported, and secondly, can they maintain their independence without endangering themselves? That is super important. You really want to discuss this with the person also, and that’s of course if they’re able to do that. I’m not talking about a patient who has Alzheimer’s or dementia or is past that point. We’re talking about somebody who probably has a physical disability, some type of mobility issue, maybe they’ve had a stroke, but they’re still with it.
What are the things that you can put in place that will encourage them to be able to be independent but also be safe? That might be guardrails in the bathroom, things that help them with mobility. Is that a walker, a cane, a wheelchair? Is it a Life Alert bracelet or necklace that there’s a monthly subscription to that connects them with a place or 911, so if they have a fall, if something happens, they’re able to get help if a family member is not around. Those are just certain things that you can do. Another thing you might want to think about is is know this sounds really crazy, but check your floors. Are there throw rugs that might make them slip? That’s a big deal, a really big deal. We often don’t think about that, but with the elderly, especially if they’re using a walker or a cane, oftentimes they’re not aware of the rug being there. Sometimes their balance is off, and if they slip on a throw rug, they’re going to go down and possibly break a hip or hit their head, so that is something that you really do want to consider.
In the bathroom, are things readily available to them? Can they reach things easily? Can they get up and down from the toilet seat easily, or should you have a grab bar there for them to assist themselves? Do you need to have a raised toilet seat so they don’t have to sit down so low? These things are available at pharmacies and you can easily get them. When they are taking a bath, do they need a shower chair? Because a shower chair, then, sits right in the tub or in the shower. They don’t have to be standing up. It’s going to be easier for them and much more safe. Those are some really simple things. In the kitchen, do they have available to them pots and pans, bowls, forks, knives that are easily accessible? Do you need to move those things out into the countertop so they’re not having to try to get down into a cabinet or reach up into a cabinet to get those things that maybe they’re not able to get to as easily anymore?
Those are the things that you have to think about when they’re in the home by themselves. Also having daily check-ins with a family member or friend. Do you have a neighbor that can check on them maybe once a week just to find out how everything is going? How are they getting their food? Are they able to prepare their meals? Can they prepare meals easily? Is it dangerous for them to be near the stove? These are all the types of things that we often don’t think about until we run into a situation, and then we’re like, “Oh my gosh. I can’t believe it. Mom burned herself because she wasn’t able to reach the salt behind the stove, and she wasn’t paying attention. Now she’s got a burn on her hand.” These things happen all the time, so we’re just trying to prepare you for that.
Another thing that oftentimes we don’t think about is hearing. Oftentimes hearing can be impaired as a person ages, and after a while we start to think why isn’t mom or dad listening to me? Why am I always having to repeat myself? It’s not about you. It’s not about you. Oftentimes, their hearing might be impaired and we just don’t know it. They don’t realize it either, so when you tell them something and then the following day, they don’t remember, they could be saying, “Well, I don’t remember you saying that,” when in reality what they’re really telling you is “I didn’t hear that. I actually didn’t hear you say that.” How do you go about getting a hearing test? The first thing I would do is have them go to their general practitioner and have them checked out. It could be as simple as wax in the ear. That’s the first thing you need to look at is you have the doctor look into their ears and make sure there isn’t wax. If there is wax and the wax gets cleaned out and everything is okay, then you’re good to go.
If, however, the hearing issue continues, before they get to the point where they will not maybe want to cooperate with going to a hearing place, get them in for a check. You cannot believe how this can help out. Now, I am going to tell you that I’ve had plenty of experience with this with my father for one. Not my mother because she always had very good hearing, and she passed away before hearing ever became an issue, but I also have this issue with my mother-in-law, and god bless her, she was absolutely wonderful. Sharp as a tack almost to the end. She was 96 when she passed, but I had been trying for years and years to get her to have her hearing tested, and she kept saying to me, “Jenny, my hearing is fine. There’s nothing wrong with my hearing.”
I really should have insisted more because by the time she ended up getting a hearing aid, she was really not physically capable of handling those very tiny batteries that you have to put into the hearing aid. I believe now that hearing aids are much smaller and more easy to handle, but again you have to think about that even if it’s something tiny that goes into the ear. Is the elderly person able to really physically handle that? Do they have the mobility in their fingers to be able to handle a tiny hearing aid? It may be that they need something that’s larger so they can actually handle that? Somebody needs to followup with it, and I will tell you that if you go for a hearing test and the recommend that you get a hearing aid in both ears, get it in both ears.
My mother-in-law, I didn’t take her for the hearing test. Her son took her. She was 90 by the time she got there, and she insisted that she only needed one. Honestly, it didn’t really work very well because she should have had a hearing aid in both years. After a while, if they’re not encouraged to wear the hearing aid, oftentimes they’ll give that up, so the sooner you can get a parent in for a hearing test, the better off you are. I’m talking about in their seventies would be a great time. Even if you have a parent in their sixties, you can start the conversation now. There seems to be a real, I don’t know what it’s about, but people think hearing aids are terrible. I don’t want a hearing aid, etc. it’s no different than a pair of glasses. I really don’t know what the big thing about hearing aids is. Now days you can’t even see them when most people put them in. That’s something I really want to address because hearing is so important. If they can’t hear and they feel like maybe people are ganging up on them, they’re not going to tell you that. They’re just not. They’re too embarrassed.
Here’s another thing to really consider, and this is vitally important, and I cannot stress this enough. Mouth care. Mouth care for the elderly is vitally, vitally important. Oftentimes as we age, our teeth do start to deteriorate. Maybe a patient hasn’t seen a dentist in over a year. You really need to get your parent in for a dental check. This is so important because if they need a bridge, if they need dental implants, if they need dentures, you want to get that process started. You want to get them used to mouth care and the importance of it. The reason I tell you this, this is from personal experience again, and I am a nurse, so mouth care in the hospital was always overlooked for patients and it still is. But when a person’s teeth are not functioning well, if they’re deteriorating, if they have toothaches that are not addressed, it affects eating.
When your eating is affected, it affects your entire health system. So I will tell you from experience that keeping up with the dentist is just as important as keeping up with your doctor because, again, there’s a lot that a dentist can do for elderly patients to make sure that their dentures are fitting properly, bridges are fitting properly, that they get the care they need, the mouth care they need, because if your mouth is affected, you don’t eat properly. Oftentimes older people have a difficulty in chewing harder things like nuts or seeds. Their diet may have to be slightly changed for that. Maybe softer foods have to be introduced. It could be that foods need to be cooked more so they can eat and chew more comfortably. I cannot stress this enough. I cannot stress this enough. This is so important.
I know with mouth care in the hospital, and if you have a parent or loved one who is in the hospital, please be sure that mouth care is being done. It is often overlooked in the hospital. Think about it. Your patient is lying in the bed, your loved one is lying in the bed. They may be breathing through their mouth, they may have oxygen on. All of that dries out the mucosal membranes and causes all kinds of issues. When we don’t have enough saliva in our mouths, bacteria is much more readily formed, so if saliva protects us, it really protects the mouth from bacteria, so it’s super important that your loved one does not have a dry mouth or dental issues. You can buy mouthwash over the counter that help the production of saliva. I think there’s one called Act. You can try that. I think there’s also, if you google it you can probably make your own, and that would save money as well.
I’ve introduced how to talk about your loved one with your family members. I would suggest that you probably set a time about every two to three months to revisit what your parents, loved one, spouse, etc, is doing, how they’re doing, how they’re progressing. Do they need further care? Remember, be as nonjudgmental as possible, because it’s not about you. If you can remember when you are speaking about your parent or loved one, always put the patient or the loved one first. Keep repeating that to yourself. This is the care that my loved one, my spouse, my parent needs. It’s not about me. It’s about what they need. We’re going to address your self-care in a separate podcast dealing with elder care. That will be the one following this one.
We’ve talked about family meetings, making decisions. Now, what if you have a parent or a spouse who does need further care, more than you can possibly give. Maybe you’re still working full-time. Maybe you’re just exhausted and you need the help. Maybe you need physical help. You’re not able to physically handle the person. So, there are many, many avenues that you can go, and I as a nurse and a daughter, daughter-in-law, I have been through much of this. Actually, I’ve been through most of it. I have been through assisted livings, nursing homes, hospital visits, doctors, dentists. I’ve run the entire gamut, so I’m talking from experience. This is something I have been through for, oh my goodness, about 20 years, and I’ve lost both of my parents and my in-laws as well, so I am now, we consider, a middle age orphan. I have been down this path, and I will tell you that it can be very challenging. Sometimes it can be very overwhelming, but there is support. You’ve got to reach out for support. This is vital.
Even if your parents are in their sixties now or approaching 70, you may want to start to think about gathering information, even if this may not happen for three to five years down the road. The more prepared you are, the easier the decisions and the path will be for you and for them as well. You also want to begin the conversation. “Hey, mom, hey, dad, have you thought about downsizing? Have you thought about what you’re going to do in another five years? You’ve had a hip replacement. You’ve had a knee replacement. Your mobility is more limited. We’re concerned about you being able to maintain your independence for as long as possible, and we want you to know we’re behind you and we support you.” Start having the conversations. There’s nothing wrong with just having the conversations.
If you are in a place, though, where you do need to start making those decisions, you may want to consider looking at different places. Okay, how about do I need an aide in the home to help my parent, spouse, loved one versus having them go into some type of a senior housing or assisted living? What options are out there? Start checking them out. You’ve got to look at pricing. Does your spouse, etc, loved one have long term care insurance? If they do have long term care insurance, find the policy. See what it says. Long term care insurance is all different. The one that we had for my father, which he opened way back when they first started only covered nursing home. That was it. There wasn’t anything else, so I know some of the long term care insurance policies now include an aide for the home. Some include one in assisted living. Of course, nursing homes are usually covered, but you also have to know what that time is. Look at the policy. See what’s there.
You may also want to check out to make sure that your parents have a financial power of attorney, a medical power of attorney, do they have a will, and we will also be addressing all of that in a separate podcast. I’m going to have a healthcare attorney on at some point, and we will address those issues as well. But if, just for now, if there is nothing in place, you may want to seek out an attorney or at least start to get information. What happens if my parent is not able to respond? Is there someone who can vouch for them, who can answer for them in the hospital? That’s super important. Also, know there is a difference between a financial power of attorney and a medical power of attorney. There is a difference. If a family member has a medical power of attorney, they don’t get to make financial decisions for the parent or the loved one. That’s a separate power of attorney, so try to determine that. If there is a will, is it registered? Is the power of attorney registered? Making sure all of these legal things are taken care of. Start working on that now. The more you do in advance, the easier this is going to be when the time comes.
Also, when you go to check out the different senior housing and assisted living, don’t think in the moment. Don’t think, “Oh, this is what my parent needs right now. This is really cool. They have a swimming pool, they have a tennis court, etc.” You want to think three to five years or ten years down the road. Is the place you’re looking at affordable? Do they have care beyond assisted living, so if they need to go in a nursing home, can they move from that assisted living into the nursing home that’s already there, or that facility does not have one. These are things you need to consider. If you’re considering in home aid, look at the different prices. For gosh sake, look at the qualifications of the person that you’re hiring. Make sure they’re vetted carefully. Do a criminal background check. This is so important, and don’t hesitate to think about setting up security cameras in your home when that aide is there.
Maybe your parent only needs an aide every day, but maybe just for a couple hours a day. Somebody needs to do that research into how to find that aid, because there’s all different kinds of aids out there, so you want to make sure that somebody is qualified and is going to work with your parent. Are they companionable? You don’t want an aide that’s not going to treat your parent well, or maybe your parent just can’t get along with them. Those things are really important, so I know this is a ton of information that I am getting out today, but I really want you to be aware of this, because this is really all of the things that you need to consider. This isn’t all of them, because there’s a lot more involved when care taking becomes increasingly necessary for your spouse or your loved one, etc. It is going to take a lot of your time regardless of whether you have an aide involved or not, because they are your family members, and we can’t help it, but we love them. We want to take good care of them.
That’s how most of us are, so when you start to consider these things, if you have questions, you can always send me a question at Jen@abridgetowholeness.com. I will answer on the email, or you can always Facebook page me on my Facebook page, which is under Jennifer Crisp RN Whole Health Educator. Message me. I’ll get back to you. I can’t give a ton of information, but I can probably guide you in this, and you want to make sure that your questions are clear because then I can probably send you to the right place. You can google lots of information online about elder care in your area. You can look at the Department of Social Services. There’s often an agency that deals with aging and the elderly population, and that’s a really great place to start because they have so much information out there. I know it differs from state to state, and also from county to county. There’s usually an ombudsman in your county that can act as a liaison for you if you also have any types of issues with a facility that your parent is currently in. That’s also something to consider, especially if you’re having issues about proper care of elder abuse or neglect. Those are all things that you also need to take into consideration.
Let’s summarize this, what we’ve done in this podcast, and the next podcast I’m probably going to get into more of what to look for in a facility for seniors. There are things that you do need to be aware of when you’re looking. You want to ask certain questions, and you want to know how to take a tour of a facility beyond what they show you. You need to know what to look for, and as a nurse and a healthcare advocate, I’m going to be able to give you that information. So we can also address some of the insurance information about Medicare and maybe what long term insurance policies cover and do not cover if you’re interested in that as well.
We went over family meetings, having a family meeting, establishing rules, allowing each person to speak for five minutes uninterrupted with no judgment and no response afterwards. Someone to take notes so that you begin to form a plan for your loved one. Is your loved one able to maintain their independence in their home safely? That’s another question that really needs to be looked at. If they want to stay in their home for a while while everything else is going on, what are the things you can put in place that allow them to stay in the home independently and safely? That could be grab rails in the bathroom, on the steps, an additional handrail going up and down the steps, a raised toilet seat, making things easily accessible for your loved one, pulling out the pots and pans, things that they need so they’re not digging into low cabinets or having to reach high above. Do they need a walker or a cane or a wheelchair? Are the bathrooms accessible? Do they need a shower chair, raised toilet seat? Do they need a Life Alert? Can they have a neighbor check in on them periodically to make sure that everything is okay?
Have their hearing checked. If you feel like they’re not listening to you, is it really that they’re not listening, or maybe they have to have a hearing aid. Taking them to their general practitioner, starting that conversation. Make sure they look in their ears and make sure the wax is cleared out. That might be the only problem, but maybe they need a hearing aid. Setting them up for a hearing test, looking at the different types of hearing aids, something they’re going to be able to handle themselves. Then we’re talking about mouth care, the importance of dental visits. I cannot stress this enough. Making sure that they’re comfortable eating. Can they chew their foods properly? Are they swallowing okay? Having the dentist address those issues.
Now, we are talking about patients who are with it. We’re not patients who have dementia or Alzheimer’s. That’s for another podcast. If we’re talking about your parents maybe looking at assisted living or some type of senior housing, what it is that you want to look for. Is it close to you? Are they out of state? Can somebody else do that for you? Those types of things, you want to start to just gather the information. Go online and look. Look at Department of Social Services, Department of Aging in your area, looking at an ombudsman as a liaison. All of these things need to be taken into consideration.
The next podcast will address more of what do you do when you do have a loved one or a parent or spouse who you think is cognitively declining, and how do you address that? This is Jennifer Crisp with A Bridge to Wholeness. I hope you enjoyed this podcast. If you did, please share it with family and friends. We’re on iTunes and Stitcher. Once again, thank you so much for tuning in today.
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