Stages of Senior Care: Your Step-by-Step Guide to Making the Best Decisions (FAMILY & RELATIONSHIPS) - Softcover

Hogan, Paul

Softcover

ISBN 10: 0071621091 ISBN 13: 9780071621090

Publisher: McGraw-Hill Education, 2009

Synopsis

A USA Today BESTSELLER!

"Informative. Complete. And practical. This book will guide family caregivers through the surprisingly complex world of senior care."
―MEHMET OZ, M.D., New York Times bestselling coauthor of YOU: The Owner's Manual: The Complete All-in-One Care Guide

Choosing the best care for your aging parents and other seniors in your life is not only complex, with multiple options available, it's also highly personal and often emotional. This essential resource―written by the founders of Home Instead Senior Care, the world's largest provider of nonmedical care for seniors―guides you through a comprehensive range of things to consider, step by step, so you can make better informed decisions and be confident that the senior in your life is receiving the best care possible. Checklists and diagnostics will help you:

• Decide if at-home care is the right choice for you and your loved ones
• Evaluate the pros and cons of retirement communities, adult care centers, nonmedical caregivers, assisted living facilities, nursing homes, and hospice
• Determine the costs of senior care options and find helpful support networks

"This is not just another book about caring for aging parents. It's a great reference you'll use again and again. Stages doesn't shy away from the hard questions. Rather, it shows you how to confront them."―SUZANNE MINTZ, President/CEO, National Family Caregivers Association

"Recognizing that there is no one-size-fits-all solution, this salient volume compassionately addresses a full range of hard-to-discuss subjects."--PUBLISHERS WEEKLY

All of the authors' profits from the sale of this book will be donated to the Home Instead Senior Care Foundation.

Paul and Lori Hogan founded Home Instead Senior Care in 1994. Now with 850 offices in 15 countries, Home Instead is recognized as a global leader and authority on senior care. Visit them at www.stagesofseniorcare.com.

About this title

About the Author

Paul and Lori Hogan co-founded Home Instead Senior Care in 1994. The Home Instead Senior Care franchise network has grown from one franchise in Omaha to more than 800 worldwide. The company is the global leader in non-medical, in-home care for seniors. The Hogans have won awards for their franchise business model.

Excerpt. © Reprinted by permission. All rights reserved.

STAGES of SENIOR CARE

Your Step-by-Step Guide to Making the Best DecisionsBy PAUL HOGAN LORI HOGAN

The McGraw-Hill Companies, Inc.

Copyright © 2010 Paul Hogan and Lori Hogan
All right reserved.
ISBN: 978-0-07-162109-0

Contents

Chapter One

A Whole New World

The realization comes unexpectedly and suddenly; or it's a gradual awakening that can no longer be ignored. Yesterday you were your mother's daughter, or your father's daughter, as you have been all your life, through all of life's passages—but the passages were always yours. You were the one who was a disruptive three-year-old, compliant ten-year-old, rebellious adolescent, overconfident college student, confused novice in the workplace, cocky associate director, nervous newlywed, and then a sometimes-overwhelmed parent of your own three-year-old.

Through it all, your mother never changed. She was the rock, home base. Your tumultuous spinning from stage to stage may have exasperated her from time to time, but she rarely showed it. She was the fixed point in your small universe, the one you could always rely on to get you out of that impossible jam, that catastrophic situation, or so it seemed at the time.

That Was Yesterday

Today is very different. This morning you drove to your mother's house for a routine visit and found her sitting in her car in the driveway, making no effort to move the car or get out. When you asked her to roll down the window, she did, and she recognized you. But she had no idea where she was or where she was going.

The episode confirms a truth you had been trying to hide from—your mother's growing detachment from the world around her. On your last several visits, her home has been in disarray, extraordinary neglect on the part of a woman who had been a diligent housekeeper to the point of obsession all your life.

Or perhaps the realization that your parents are no longer your protectors but now your dependents comes with your father's spinal injury. He was always Mr. Fix-It—electrician, carpenter, plumber, roofer all in one. Not only did he take care of your parents' home, he was the one you called when your furnace collapsed in midwinter, your own husband far less adept with tools. Now your father is likely to be a semi-invalid for the rest of his life, confined to a wheelchair much of the time.

Who Takes Responsibility?

The world is now turned upside down. You have suddenly become your parents' parent. And you realize that the coming years are going to be extremely challenging. How do you talk to your parents about their changed lives and bring them in on the decision about what kind of care they need? How do you engage your siblings in sharing the responsibilities? Which sibling should be the health care proxy, and should he have absolute authority?

Who should manage the finances and protect your parents' assets? How do you distinguish between a good assisted living center and a bad one before your parent is already in residence? How do you know which option of the senior care continuum best suits you parents' needs now? What information do you need to make the best decisions about care options? We will address these and many other important issues throughout this book to help you make wise and responsible senior care decisions.

You are understandably devastated by the realization that your mother or father is failing. The fear had crossed your mind from time to time in recent years after they reached the age of seventy, but you pushed your concern aside in favor of more immediate worries, like college tuitions for your children. You are likely feeling guilty because you hadn't been more insistent that your parents buy long-term care insurance and create advance directives. You are afraid that the decisions you make in the coming months are going to shorten your mother's life, or worse, make her final years miserable.

You Are Not Alone

Also, you may feel angry—angry, in large part, because you feel that you are alone, that you must manage your mother's or your father's care by yourself, perhaps with only grudging assistance from your siblings.

Fortunately, that is not true. You are not alone. The enterprise of caring for the elderly has grown prodigiously in the past few years. Which isn't surprising. The senior population in the United States is increasing at an astonishing rate. Some 38.7 million Americans are now sixty-five or older. That population is expected to more than double in the first half of this century, from 35 million in 2000 to 88.5 million in 2050. (See Figure 1.1.) The fastest growing part of the U.S. population is the very old, that is, those over eighty-five. That group is projected to double from 4.6 million in 2002 to 9.6 million in 2030—and double again to 20.9 million in 2050. (See Figure 1.2.)

Moreover, it is not just the United States that is experiencing this huge growth in its elderly population. Aging is truly a global phenomenon. The population of the United Kingdom over eighty years old has increased by more than 1.1 million between 1981 and 2007. People seventy-five and older now constitute 10 percent of the population of Japan. In 2007, people sixty-five and older made up 13 percent of Australia's population; by 2056 those over sixty-five are expected to constitute 23 percent or more of the population. In many developing countries, especially those of Asia and Latin America, the elderly population is expected to grow by as much as 300 percent by 2025.

An Expanding World of Care Choices

Fortunately, however, a flourishing senior care industry is prepared to help take care of them. In the United States alone, the size of the home care market in 2007 was more than $57.6 billion. There are currently about 16,000 certified nursing homes with some 1.4 million residents. Also, according to the National Center for Assisted Living, an additional 1 million seniors live in up to 38,000 assisted living residences, which provide some help with daily living but not around-the-clock nursing care. An even larger group of Americans with long-term health problems, about 7.6 million of them, remain at home suffering from acute illness, most of it related to aging. They are supported by a cadre of 83,000 caregivers, who visit them in their homes, cook meals, do light housework, and provide companionship.

Among the many others who can be called upon to help the elderly are 7,600 geriatricians (physicians specializing in the care of seniors) and about 4,400 elder law attorneys. Hundreds of churches and synagogues across the country now sponsor adult care centers and other programs to help the elderly.

So, you are not alone. Indeed, you have entered a heavily populated and complex new world that is changing rapidly. Professionals ranging from research scientists in their laboratories to hands-on caregivers at the bedside learn more and more about the care of the elderly and how to apply those lessons. What you must do is learn how to find your way through the maze of services that are available and how to determine which are best for you and your parent. And you need to be armed with information to avoid the misunderstandings, deceptions, conflicts of interest, and misleading information that develop in any industry—the senior care industry sadly being no exception.

The Evolution of Senior Care

Throughout history, families, both immediate and extended, have borne the primary responsibility for taking care of their elderly, just as they do today. Elder care institutions and organizations beyond the home appear to have been rare before modern times.

Still, a few advanced societies through the ages may have recognized a community responsibility for the elderly. One of those societies was the Byzantine Empire. Weak and ill older citizens were sometimes cared for in special infirmaries, called gerocomeia, according to several researchers at National Athens University in Greece. In the twelfth century, Emperor John II Comnenus established the most famous of the gerocomeia in the Constantinople monastery and hospital of the Pantocrator. In their heyday, these forerunners of the modern nursing home operated all over the empire, mostly in or near the monasteries. They were highly esteemed, and the governor of the institution seems to have been a person of real importance.

Centenarians: Expect More, Many More

The remote corner of the federal government known as the White House Greetings Office is becoming a busy place. That's the desk from which the president sends good tidings to Americans who have reached significant milestones in their lives, including fiftieth wedding anniversaries and hundredth birthdays. The number of centenarians in the United States jumped from some 50,400 in 2000 to more than 84,000 by the end of 2007. That's an increase of 67 percent. By the year 2040, the number of centenarians is expected to top 580,000, or about the equivalent of the current population of Washington, D.C.

The evolution of community participation in elder care was more complicated in many parts of the world and not such an honored undertaking. As an example, for several centuries in England, seniors were subject to the country's Poor Laws, which often left them with "a stark choice between destitution and the workhouse." Indeed, according to the 1901 census, more than 208,000 people were residents of workhouses in England and Wales.

German Chancellor Otto von Bismarck pioneered the recognition of seniors as a group worthy of special protection by instituting an old-age social insurance program in 1889. Other developed nations followed. For instance, the 1935 passage in the United States of the Social Security Act addressed the pressing issue of long-term economic security for the country's seniors—a population whom President Franklin Roosevelt said previously may have "spent their remaining years within the walls of a poorhouse." Thus, the Social Security Act may have played a major role in the evolution in the United States of the proprietary nursing home.

Grandmother's Few Choices

When your mother and father were faced a generation ago with the challenge of how to care for your failing grandmother, they had only a few choices: They could leave her at home and set up shifts with other relatives to bring her meals and help with chores. They could bring her into their own home with all of the disruption that move would entail, weighed against your parents' satisfaction in knowing they were demonstrating their great love for her. Or, they could send her to a nursing home, where the care would be professional, but she would feel at sea, perhaps abandoned.

Rewarding Experiences

Taking care of your aging parent does not have to be a crushing, dispiriting, or impoverishing experience. Let there be no doubt, though, it will end, almost certainly, with the death of someone you love very much and with all of the accompanying grief. But before that inevitability, there can be rewarding experiences that will equal any of the other high plateaus in your previous relationship with your mother or father.

Ruth, one caregiver, told us, "Quite honestly the last eighteen months of Mother's life were wonderful. My father had been the social one, and he and Mom spent most of their time together. When Dad died, my sisters and I would take Mom for girls' afternoon outings to lunch or the movies. We'd take turns bringing meals to her home. Those days with Mom were among the best our family ever had."

This book will help you experience similar bonds and achieve insights into your relationships with your parents and siblings. This is the book of best endings. But let us be clear. This is not a medical book. It will not help you understand in detail your parent's disease or prognosis. Moreover, you will still need your Bible or other spiritual resources and religious and family counselors, other professional therapists, and mentors for guidance and comfort.

But as a practical and comprehensive guide for understanding the world of senior care and navigating through all of its challenges as your parent's needs change, this may be the most valuable book you could read.

In the years since your parents had to make that fateful decision for their own parents, the field of senior care has matured far beyond what your parents would have recognized as alternatives.

Taking Advantage of the Advances in Care

Science's knowledge of what actually happens to our bodies and minds as we pass into old age has grown exponentially, producing therapies undreamed of years ago and dispelling many of the myths about old age. Those advances have also allowed seniors to live longer, thereby leading to more options in care.

Elder Gender

Throughout the book we refer informally and interchangeably to your loved one as "Mom" or "Dad," "him" or "her." We use the female form more often than the male, however, and that is deliberate. Women live longer than men. Indeed, over the age of eighty-five, women outnumber men by a ratio of 2.3 to 1. Typically, although not inevitably, as a married couple ages, the husband, likely a few years older than his wife, becomes frail before she does. She often cares for him with relatively little outside help until he passes away. Then she is left alone, and as she becomes frail, she needs help from outside caregivers, either family members or professionals.

For example, senility (or cognitive decline), it is now understood, is not a normal part of healthy aging. There are certain changes in cognitive health that will occur as people age, such as a slower learning pace. However, cognitive decline may be prevented, or at least forestalled, by relatively simple measures, such as remaining physically active, controlling high blood pressure, and regularly engaging in social activities. Alzheimer's, on the other hand, has been recognized as a specific aging-related disease, and although there is not yet a cure (or a proven means of prevention), billions are being spent on its research, and the treatment of Alzheimer's patients has greatly improved.

In previous eras, the infirm were generally encouraged to go easy on themselves physically. However, we now know that physical activity can improve health and quality of life for people of all ages—including seniors. Aside from being better able to fight chronic diseases, seniors who exercise have stronger hearts, their muscles are more fit and flexible, their bones and joints strengthened, and their moods enhanced. Exercise helps decrease the need for hospitalizations, doctor visits, and even medications.

Moreover, in part because of these advances, seniors have many more options than staying home alone, moving into a grown child's home, or going to a nursing home. Those choices and how to make them are in large part the subject of this book. (For a brief look at what lies ahead in this book, please see the box "Senior Choices" later in this chapter.)

Ask Questions and Be Flexible

The proliferation of choices is a wonderful boon, because it will greatly lift the quality of your loved one's life as well. The variety of choices, however, produces a weight of its own. There is no single option that is right for all families at all times. Indeed, there is likely no single option that will be right for any family throughout the course of any senior's aging.

The family has to be much more flexible than it was in the era when the choice was binary—home or nursing home. The family has to ask more questions, separate superficial differences from real ones, and be prepared to modify or even reverse decisions already acted upon if circumstances change or if a choice isn't working out as hoped.

Adapt the Home (and Keep Adapting Your Care Plan)

Generally, there is a continuum of care that begins with the elderly family member staying at home with some modifications of the surroundings, such as grab bars in the bathtub and the replacement of doorknobs with easy-to-grip handles. Your mother may be well cared for in her own home with visiting professional help for a long time before finally moving to a nursing home or assisted living facility. Conversely, she might spend time in a nursing home because of a broken hip, say, but recuperate sufficiently to return to an assisted care facility or her own home.

How do you, she, and other members of the family make those choices? A wrong decision, or the right decision delayed, can have terrible consequences. The number of variables can be bewildering. Obviously, the senior's wishes are a priority consideration—and overwhelmingly, seniors say they want to stay at home until the ends of their lives. In fact, a recent AARP study indicated that 89 percent of Americans aged fifty or older want to age in place—that is, remain in their own homes as long as possible.

However, many seniors also express concern about being a burden to their children or grandchildren. In fact, for many older adults—whose residences represent their single biggest assets—one of the most common plans is to leave their homes to future generations, thus providing adult children and grandchildren with a substantial financial legacy.

(Continues...)

Excerpted from STAGES of SENIOR CAREby PAUL HOGAN LORI HOGAN Copyright © 2010 by Paul Hogan and Lori Hogan. Excerpted by permission of The McGraw-Hill Companies, Inc.. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

Edition details

• Publisher: McGraw-Hill Education
• Publication date: 2009
• Language: English
• ISBN 10: 0071621091
• ISBN 13: 9780071621090
• Binding: Paperback
• Number of pages: 304