I recently spoke to Helene Bergman, the founder and director of Elder Care Alternatives, about the challenges faced by seniors and their caregivers. Helene is a certified geriatric care manager and is on the board of directors of the National Association of Professional Geriatric Care Managers.
Q: You have said that with “consistent and superior care and support” any senior can remain at home throughout life. Please explain.
A: I have managed the care of seniors with significant health issues who successfully remained at home for over a decade. However, to do so requires quality direct caregiving and other factors like adequate financial and social supports.
To design an appropriate care plan tailored to the senior’s unique care needs, we initially provide an assessment to better understand the senior’s medical and/or cognitive disabilities and to identify the supportive systems available to them. If there are family and/or friends, their roles are maximized to improve the senior’s quality of life. We link those with substantial finances to community resources, and we help others with limited finances secure Medicaid for home care. The seniors who fall in the middle class, with just adequate finances to cover their expenses, face greater challenges to remaining at home. Fortunately, in recent years, I’ve seen more situations in which long-term care insurance has eased the way for them.
There are other considerations, especially if the senior applies for Medicaid or even uses a private agency for home care. Does the senior’s residence lend itself to home-based care? Is there a separate sleeping area for the hired caregiver? Can the senior ambulate adequately or is a lifting device (Hoyer lift) necessary. These factors can negate eligibility and precipitate premature placement in a facility. However, if the senior can afford to pay privately for home care, even a studio apartment in New York City can be made adaptable, and the senior’s wish to remain at home can always be accommodated.
Q: Please talk about quality of life when an individual is faced with acute health problems.
A: Quality of life is a significant ethical issue for the senior and family caregivers. The question is whether to adhere to a “wellness” regimen vs. experiencing “pleasure.” I know of an instance where a senior was recently diagnosed with diabetes, yet gourmet food and wine had long been central to his lifestyle. Enforcing a strict dietary regimen would make him miserable, and his loved ones are struggling to balance medical advice with his way of life.
These decisions are very subjective and there is no right or wrong. If the senior is cognitively intact, the decision should be his or hers. If the family must make executive decisions for a senior with dementia, they need to ensure that they don’t unconsciously project their own preferences when trying to envision what their loved one would want.
Q: What other tips can you offer family caregivers?
A: Be proactive—don’t wait for a crisis. Have open discussions with your family members about how you will handle the possibility that parents will require significant care sometime in the future.
Become knowledgeable concerning your loved one’s medical and financial affairs. Know the names of doctors and have your name placed on the third party notification list for various insurance policies. Be in contact with your family member’s financial planner, broker and accountant so that they know who you are and will be willing to speak with you in the future, if necessary.
Finally, use this experience to begin planning for your own senior years.
Thanks, Helene. These are issues that most families will face at some point. I hope that your insights will be reassuring to individuals who are planning for, or currently experiencing, the changes that accompany the aging of a loved one.
