1. I am beginning to notice some changes in my mother’s ability to manage on her own, but I am not sure which changes I should worry about. When is it appropriate to intervene?

It is most important to determine what changes are occurring and the reasons that these may now be issues. Changes that have happened very quickly, such as disorientation and increased confusion or rapid weight change, should be addressed immediately by a health care professional. Other changes, such as loss of vision or hearing may happen more slowly, but now are interfering with your parent’s ability to live safely and independently. It is important to determine which changes are occurring because of physical limitations (arthritis, flexibility, weakness, etc.) and which are from cognitive declines (memory loss and confusion). Often, changes in physical capabilities can be overcome with adjustments to the home environment or by adding adaptive equipment. Cognitive declines may require increased supervision.

2. How do I talk with my parents about their plans for the future?

I am not sure if they have any legal planning tools in place to help make decisions about their care. It may be wise to begin talkingbegin talking with your parents about these issues as you share your own needs for some legal planning. Do not ask your parents to sign up for anything you are not willing to address. Having a will, Power of Attorney and Health Care Directive in place, better protects us all. Offer to join your parents at an attorney’s office to discuss these documents together. Another way to begin exploring these issues is to make it less personal by discussing a situation that may have occurred to a friend or bringing a newspaper article to their attention. Consider how your family has addressed difficult issues together in the past and how you communicate information as a family.

3. Are there things that I can do in my parent's home to make it safer and keep them as independent as possible?

It is important to ensure that the environment is well lit both inside and out. Having motion detector lights in both locations can be beneficial when someone comes home after dark or needs to get up in the middle of the night. Grab bars by the shower and commode also can be beneficial. You may wish to consult a care manager or home care agency’s occupational therapy department to complete a home assessment.

4. How much and what types of information should I share with my dad who has dementia?

If your parent has had a comprehensive assessment completed at a clinic, it should indicate what areas of cognitive thought are most affected. This should help guide your conversation. Plan talks around your dad’s schedule. If morning is his best time of day, make sure this is when you have a discussion. If your dad has no sense of time, then it will be frustrating if you discuss time frames. Never give false information; this could lead to distrust and may make it difficult for him to follow your lead in the future.

5. When do I need to think about moving my parents into an assisted living facility?

There are a variety of reasons why people move into assisted living and housing-with-services facilities. Some want to increase social opportunities and access to services. Others want to ensure there always is someone available to provide or coordinate care for the senior or disabled person. Some people move because their home is not accessible and they can no longer access second level bedrooms and bathroom. A care manager can assist your family in determining what type of care facility best fits your family’s needs for both the short term and the future, as needs change. A care manager also can develop a plan of care that lists costs associated with remaining at home or moving into an eldercare facility.

6. What are the best services to put in place to keep Mom and Dad comfortable and safe in their own home?

There are a variety of services available to safely keep people in their home. These range from emergency response systems and home-delivered meals to home care services. In addition, adaptations can be made to assure home safety and accessiblityaccessibility. Because every situation is unique, often it is best to have a care manager visit the home to determine the types of services needed and costs associated with each. The care manager also can help determine which providers offer the best care and fit within your parents’ financial means. If you wish, the care manager can arrange for and oversee services.

7. How are senior services paid for? Will Medicare cover someone coming to give my parents a bath or clean their home?

The majority of home care or home management services are paidare paid for by the individual or family. Medicare covers in-home care when someone is home bound and needs the services of a skilled provider. Examples of Medicare-covered care may include, but are not limited to, services provided after a hip fracture or incident that requires physical or occupational therapy, or when a new diagnosis requires teaching use of equipment or medication management. Contact a home care agency that is certified under Medicare for help determining coverage levels. If a parent requires help with daily living needs such as toileting, transferring, dressing, eating or home management, assistance may be covered by a long-term care insurance policy. Some individuals may be eligible for services through county providers based on their assets and income levels.

8. My parents live in another town and I can't get there often. Are there things that I should watch for or something that will make long distance care giving easier?

If you don’t have Internet access, keep a copy of your parents’ local yellow pages handy at your own home. Then if they have an urgent need, you can connect them with local resources. In addition, ensure that you have copies of their legal documents, particularly if you are designated as the Power of Attorney or Health Care Agent. Know the make, model and license plate of their cars, in case you are not able to locate them and need to report this to authorities. You may choose to use the services of a local care manager who periodically can check-in with them and keep out-of-town family members informed of any concerns. The care manager will know the specific services offered in your parent’s town and can make recommendations for quality service providers.

9. My sister and I can't always agree what is best for our parents. How do we decide?

Let your parent’s wishes and life choices guide you. If your parents haven’t expressed their preferences, review how they have lived their lives and how they took care of the generation before them. You may want an independent care manager to meet with your parents and other family decision makers to discuss all the options available. Individually, you also should do a self-inventory and determine how much your wishes for your own health care are guiding your decisions for your parents. Remember that this is about your parents and as long as they are making safe choices, you do not have the right to override them.

10. Should I promise Mom that she will never have to go into a nursing home?

No. You never should make a promise you can’t guarantee you can keep. There are some times where a move to the nursing home is the best option for all involved. Nursing homes can provide excellent 24-hour care in a setting geared for those with cognitive and physical limitations. Let your mom know that you always will try to accommodate her wishes, but there may be times when a nursing home is the best choice. Reassure her that you will include her as much as possible in determining which facility best meets her needs. 10. What should I consider before moving my parents into an assisted living facility or senior housing? Understand what services are included in the monthly rent and what is considered extra services. You also will want to ensure that if your parents’ needs increase and you must purchase additional services, that they have the finances to cover these additional costs. Determine what level of care the facility can manage at the top range. Not all facilities will care for clients with cognitive issues or physical declines that require ongoing assistance. If their facility doesn’t offer skilled nursing care, you may have to move your parents when their care needs increase.

11. What is a health care directive?

This is a written document that allows individuals to disclose their wishes around health care and to appoint someone to ensure that these wishes are followed if they are unable to communicate. In the past this document has been called a “Living Will.” Individuals can instruct how they would want to be treated at end of life regarding pain issues, cardiac resuscitation and other interventions or treatments. Some health care directives also allow individuals to specify their wishes around health care ethics.

12. Is there someone who can help me find resources for my aging father and put a plan together to help him stay in his home?

A care manager can help families and clients understand needs that are changing due to aging, disability or disease. Care managers can help navigate the maze of care options and develop a plan of care based on present condition, environment, care system, financial means and client wishes. Care managers also identify potential issues, taking these into account when developing a long-term care plan.

13. Sometimes I’m talking on the phone with my mother and she asks me about my job. Then right in the middle of my answering her question, she interjects a totally unrelated topic like what she did that morning or her physical health. Is this normal behavior or should I be concerned?

This may be occurring for several reasons. Sometimes older individuals have hearing issues that may make it difficult for them to discern when a conversation topic has ended. Your mom may mistake a pause in your speech as the end of one topic, giving her the chance to move onto something new. Look at her behavior in whole, not as individual incidents, unless the change is drastic in nature such as being disoriented or not being able to recognize a person, place or thing. A drastic shift in abilities could indicate a medical condition.

14. My father always has been a daring driver, but since he reached his 80s he has become much more aggressive in his driving. He cuts in and out of traffic and sometimes comes very close to having an accident. He is the only driver in the house. What can I do for him or say to him that will encourage him to slow down?

This is one of the most difficult discussions to have with a parent as it may lead to taking away what they consider their biggest link to independence. However, ethically if you are aware that he may be endangering others, you must act. You may give him the option to taking a driver assessment program and let the professionals determine his level of driving ability. Often these programs make suggestions that do not include taking a license away. However, if they believe he is a danger on the road they will make the appropriate contacts to begin the process of removing his license. You also can ensure that he can access the community programs he most cherishes. Hire someone to take him to social engagements or use your visits to transport him. Arrange for him to be connected to a senior transportation company.

15. I live more than 1,000 miles from my parents. Whenever I visit them I notice how much their health has declined. I enjoy my visits thoroughly but when it’s time to go home, I leave completely depressed because I know I’ve lost a little bit more of what they used to be. Do you have any suggestions for combating this overwhelming sadness?

Although your parents are still living, you need to recognize that you have lost parts of what has defined your relationship in the past. You may not be able to engage in the same type of activity or conversation that you once did and this brings out normal grief. Make sure you share your story with others who understand and that you continue to take care of yourself and your own family. If you believe the sadness is taking away your ability to function at the level that you want, you should consult a professional in the mental health field.