5 Crucial Senior Home Care Options For Your Parent During The Pandemic A Comprehensive Guide For Parent Care

By: Rosemarie Tamunday Casanova

senior care options cover design
Graphic Artwork by Tom Banogon

This Comprehensive Guide for senior home care provides you with a complete resources on the characteristics of various caring alternatives for your senior parent especially in times of the Pandemic like COVID-19.

It explains the various senior home care alternatives such as Independent Living and Home Care versus other living facilities like Independent Facilities, Assisted Facilities, and Nursing Homes. This will help you to decide intelligently on what care options is appropriate for your senior parent, making sure that they are safe and protected most especially during the pandemic crisis.

World Health Organization (WHO), describes a pandemic as the worldwide spread of a new disease. It first starts with an outbreak in a local area and when it spreads to a wider area like a country or a region it becomes epidemic. When the epidemic spreads throughout a significant part of the world, it becomes a pandemic.

During the pandemic, according to study, adults 60 years and older are severely vulnerable to illness compared to other age groups because they have a weaker immune system to fight the disease. Most especially if they are already suffered with preexisting medical conditions like heart disease, lung disease, diabetes or cancer. This condition can become severe and deadly if not treated well. So If you’re caring for a senior loved one during the pandemic, you might be worried.

The information found on this article will help to reduce your worry by giving you opportunity to assess the situation and gives you idea of what level of care is needed, what are the different care alternatives, and which one is suitable for your needs during this difficult time.

Related: Everything You Need to Know About COVID-19 and How to Protect your Elderly from It?

Introduction

In many parts of the world including Asia, Europe, and America, the population of individuals aged over 65 years is on the high. It is projected that the older adults will soon outnumber children in a few years.

The elderly (over 65 years) individuals make up about 16% of the American population. This figure is expected to reach 22.1% by the year 2050 and this is not unrelated to the increased life expectancy.

With the increasing number of the aged population comes a greater demand for healthcare, in-home care giving, as well as assisted living facilities. Today in America, there are about 40 million unpaid caregivers of individuals aged 65 years or more.

elderly couple sharing moments with each other in the park

Even in the best of situations, it can be a daunting task caring for your aging parents, especially if a crisis occurs when it is least expected, leaving you with no time to adequately adjust and make suitable plans. This crisis may be in the form of a sudden illness or an accidental fall.

In the absence of a sudden crisis, there are still certain circumstances that would warrant you to pay close attention to your parents and begin to find out about the caregiving process.

There is an urgent need to be prepared for any eventuality as advanced planning tremendously reduces the burden of care on you and your entire family.

This book serves as a valuable, practical, and informational resource to aid you and your entire family as you come together to make plans for your aged parents during this very meaningful phase of their lives.

Part I Assessing The Situation

A careful assessment of your parents' situation is very important not just in determining your present action, but could also serve as a benchmark for future plans. You will need to ask a lot of relevant questions and get answers to give you a complete picture of the physical and mental health capacity of your parents.

Are there areas where they require assistance? Have you noticed any changes in their health? Are they just as capable of carrying out day-to-day activities as they used to be? What about their living conditions? Is it still suitable? Do you find that you or any of your other family members are being called upon more and more often for assistance? Do they require assistance bathing, getting dressed, brushing their teeth, or eating?

In order to care effectively for your parents, you would have to have an understanding of what is on ground. Relevant information that you should have about your parents include;

Information Concerning their Health

This involves finding out as much as you can about any illness they have whether acute or chronic. Are their illnesses temporary or easily treatable? Will they require a long hospital stay or a prolonged rehabilitation time? if so, what plans can be put in place to assist them in the short-term and also the intermediate and long-term?

Available Resources

You need to evaluate the resources available for care. Can you shoulder the burden of care by yourself? How would the situation affect your own life and your responsibilities to your own family? What options exist to help in this regard such as government health programs, community backup services, your parents finances, etc?

What are your Parents' Desires or Prior Plans for this Latter Part of their Lives?

Do they have wills drawn up? What about advance directives regarding their health?

Would they both need to be moved into a care facility? If yes, what available care options are best suited for them in order to allow them co-habit as peacefully and naturally as possible? If only one parent will be moving, then what are the policies of the care facilities being considered as regards privacy, visitation, outside trips, etc?

The reason for this assessment is so that you can have an idea of the scope of care that your parents will need and be able to determine your limits.

A doctor holding the elderly's hand

Signs that you Should Start Getting Involved

When is the right time to step in and help your parents? This is a bit tricky as there is no single best time or place. It all boils down to your peculiar situation and of course, your sense of judgement.

While there are no hard and fast rules, red flags certainly exist which are sure indicators that your parents may need assistance.

Some of them include: diet changes, loss of appetite, and weight loss. They may not cook or eat as often as before and while this may just mean that they prefer to order or eat out than spend energy cooking, it may also be a sign of depression especially if they're losing weight too.

Easy forgetfulness such as not remembering to pay the phone or gas bills, forgetting the route back to a home they've been living in for several years, leaving the cooker on, etc. This might be early signs of dementia and should be well evaluated.

Pay attention to their personal hygiene. Have they become uncharacteristically unkempt and unclean? Do they have bad teeth, a reduced sense of taste or smell? Do they remember to take out the garbage, or keep the fridge clean and well-stocked with fresh and unexpired food?

Other red flags include: limping, poor coordination, leg or feet swelling, visual, speech, or hearing difficulties, difficulty in keeping up with medical appointments or taking medications, uncharacteristic mood swings, etc.

Once you have identified the need for assistance, then your next step should be to step in as tactfully as possible. Your parents may have been used to their independence and may be initially reluctant to admit that they are no longer capable of holding up by themselves. You can broach the subject as carefully and naturally as possible. You could also enlist the help of a close relative or trusted friend who can offer expert advice and counseling.

At this time, you should also start getting organised in terms of the health, financial, as well as legal implications of providing care and assistance to your aged parents.

Related: Top 10 Warning Signs an Aging Parent Needs In-Home Care Support

Part IIWhat level of care is needed? What are the different care options?

Having a thorough assessment of your parents' situation as discussed in the previous chapter is important in order to make an informed decision about what level of care your parents need.

Apart from your own assessment, you may consider getting a geriatric care specialist to give you a professional opinion and an overview of your current situation.

Salient points to consider are:

How Much Independence Can your Parent Handle?

This is one of the most important things to consider when it comes to deciding what level of care your parents need. How effectively can they carry out their activities of daily living (ADL) such as self-feeding, dressing, bathing or showering, functional mobility, personal hygiene, toilet hygiene, etc.

There are varied care options for the elderly but a major distinguishing factor for the different categories is how much independence their residents are allowed.

If your parents need help bathing and moving about the house for example, then the independent living facilities are obviously not an option. In the same vein, if they are perfectly able to cook and keep a neat house, then there is no use sending them to a nursing home.

Medical and Health Needs

This is another important point as the available elderly care options offer a varied range of medical services -- from casual home health appointments to 24-hour live-in care as seen in nursing homes.

Do your parents have any pertinent health needs? Are they on any medications that require daily reminders or supervision?

An elderly person who is diabetic and on insulin will definitely need special care if they also have Alzheimer's disease! A geriatric specialist can help you in this assessment.

What Can You Afford?

At the end of the day, your budget goes a long way in determining what decisions you eventually make.

Compare the cost of having your parents at home with the necessary upgrades for their safety with that of having them stay at elderly living facilities or nursing homes.

Your parents may have acquired long-term care insurance. Also they may qualify for government programs such as medicaid, medicare, or pension benefits for veterans.

You can enlist the help of a financial planner and an elder lawyer to sort through this. You can also ask experienced friends for recommendations, or you can contact the National Association of Geriatric Care Managers.

Alternatively, if your budget is tight, try contacting the local office in your Area Agency on Aging who should be able to send you a case manager for a free assessment.

elderly couple taking some advise from the health advisor

What are the Different Care Options?

There are several types of elderly care available to families in the US, and they are basically in two broad categories:

Family Provided Care

This is more or less care provided in two ways but with variations on the theme. One way this can happen is that your parents remain in their own homes and have family members who provide care. The second way is to have your parents move into a family member's home.

For either of these two options, professional health care workers can be arranged to offer in-home services when needed. In-home workers can be companions, homemakers, personal care support, etc.

Adult Day Care

This is essentially for people who require a caregiver but the caregiver is unavailable for that day, or taking a break, pretty much like child day care centers.

Independent Living Facilities

These give seniors the opportunity to live independently and at the same time, be a part of a community that offers residents recreational and social opportunities, including sometimes, transportation services. This is very beneficial in preventing social isolation and depression, a very common condition in this age group.

Assisted Living Facilities

They are residential-styled facilities that comprise essentially independent living arrangements together with assistance with activities of daily living. Social and recreational activities are also available and sometimes, basic health services.

Nursing Homes

These facilities provide around-the-clock care offered by licensed health care professionals such as registered nurses (RN), certified nurse assistants (CNA), nurses' aides, etc. Some of them offer health care services ranging from basic, skilled, to sub acute care.

The choice of a care option can be tasking but knowing exactly what is needed, what is affordable, and what your parents prefer, helps a lot in the decision-making.

Part IIIHousing alternatives: Independent Living and Home Care

Whether you are looking for independent living, assisted living, or home care, there are many options available to you. Generally, seniors don't get thrilled with the idea of moving away from their homes, preferring to stay independent as long as possible. Here, we will consider the options available that allow varying degrees of independence.

Independent Living

This alternative offers the highest degree of independence to your parents. If they are quite capable of completing a majority of their daily tasks by themselves, then you should consider letting them remain in their own homes.

In some situations, all that is required is a few home modifications and upgrades and with the necessary arrangements, your parents can live at home and you get to spend a lot less money than it would cost you to move them into a facility.

Bear in mind that the wish or desire of your parents to live at home is not enough to let them. A careful assessment of their capabilities is needed as discussed in previous chapters.

Unlike before when nursing homes seemed to be the only option for seniors requiring some form of help, a lot of options are now available. Now if a senior does not have special medical and health needs, they do not need to be moved to nursing homes. Any basic assistance they require can be arranged to be offered in-house.

caregiver visiting an elderly for the in-home care service

What Elderly Care In-Home Services is Available?

Choosing the independent living option does not mean that your parents don't have access to elderly care assistance.

On the contrary, there are a lot of options available and some of them include:

Basic In-Home Assistance

Here, you can arrange with a service provider to send their staff in to assist with things like meal preparation, housekeeping, laundry, personal hygiene, toilet hygiene, medications administration, etc.

In-Home Health Care Assistance

You can arrange to have the health needs of your parents attended to by healthcare workers. In-home health care workers can be health aides, nurses' aides, certified nursing assistants (CNA), etc. These healthcare workers can help with personal care, medications, and feedback on health status to primary caregivers. They can be hired directly through licensed agencies.

Financial Planning Services

Keeping track of things like paying the telephone, gas, and home rent bills can be challenging for your parents. You can seek for financial planners to help co-ordinate your parents' affairs regarding insurance, estate planning, income tax, retirement plans, and investments.

Companionship Services

You can hire companions to provide psychosocial stimulation for your parents when you are not available.

Some of these services can be hired independently or through agencies, with each option having their pros and cons. Agencies are more likely to provide well-trained and licensed workers who mostly undergo continuing education. You also don't have to worry about getting backup aides, or handling of payroll taxes as the agency can take care of this.

On the other hand, independent workers are more flexible with service hours, and also with duties specifications. However, you are likely going to have a say on the choice of who gets sent to your family and the burden of becoming the accidental employer for Independent Caregivers are imposed upon you.

Skilled Services

Rehabilitation services; such as Physical Therapy and Occupational Therapy can be gotten at home. Registered Nurses, Social Workers, Speech Therapy are also available through a Medicare/Medicaid Certified Home Care Agency. Through the use of caregivers under a Licensed Home Care Agency, they can collaborate this for you and know when your parents can benefit from skilled services.

Home Care

An alternative to having your parents stay at home is moving them to your own house or that of a family member. This might be considerably preferable to them than moving into a facility.

They have access to the same elderly care services that are available to them just as if they were living in their own homes. On the occasions where you would not be available at home, an added service is the adult day care.

An elderly sharing moments with her grandaughter

Adult Day Care

Adult day care offers elders care and supervision in an organized setting during daytime. This is suitable for seniors who don't need round-the-clock care and who at the same time, are not quite safe to stay home by themselves all day long. It can be a form of respite care to allow caregivers work during the day.

Adult day care programs provide social interaction as well as medical care if needed. They are usually offered in various facilities likes senior centers, nursing homes, and community centers.

Safety Considerations for Independent Living and Home Care Options

Whether your parents remain in their own home or move to a family member's, there is need for the home to be made as safe as possible to prevent falls and other accidents which elderly people are prone to.

This would involve home upgrades, modifications, and installations, and while they may cost you a bit, are definitely worth your while.

Part IVLiving Facilities: Independent And Assisted

In recognition of the increasing need for long-term care of the aging population, a lot of service agencies now provide a variety of elderly care services to help the seniors stay away from institutions as much as they can.

Depending on how much independence your aging parents can afford, and how much assistance they need, support from the family, friends, and local programs are sometimes not enough.

This is where elderly living facilities come in to cater to the long-term care services that seniors may need.

These include: independent living facilities, assisted living facilities, nursing homes, as well as continuing care retirement facilities. While some of them provide housing and housekeeping only, some others provide personal care assistance, and medical and health services in addition.

Independent Living Facilities

These are usually small, private facilities, apartments, or complexes typically within a senior community. They provide some assistance such as transportation services, recreational, and social activities.

The rooms can be private or sometimes shared, depending on preference and the residents are assisted with certain activities like household chores, preparation of meals, personal care, etc. Caregiving staff is always available. However, nursing and medical care are usually not.

Evaluating your parents' needs will help you decide if this is a good fit for them. If they are mostly able to carry out their activities of daily living (ADL) such as bathing, toileting, dressing, eating, and functional mobility, but have trouble completing tasks like cooking, laundry, housekeeping, etc, termed instrumental activities of daily living (IADL), then this is likely suitable for them.

Find out what type of services are provided by a facility being considered and if they are what your parents need. Most of these facilities provide opportunities for social interaction, education, physical activity, games, sports, and even faith-based activities, allowing the elderly individual to live a thriving, holistic, and balanced life.

Assisted Living Facilities

This option of care is perfect for seniors who require assistance with daily activities but not to the extent of that which is provided in nursing homes. These facilities typically provide comprehensive help with daily tasks, supervision, and care services that are just short of skilled medical care.

This however, is combined with an independent living arrangement where the seniors can stay in their own apartments or rooms and also enjoy some form of communal living such as shared meals.

Just like in independent living facilities, there is assistance with instrumental activities of daily living (IADL), but with activities of daily living (ADL)as well, the major difference being the availability of some level of basic health services, and the presence of supervising staff all day long.

They are made to have home-like settings as much as possible and encourage residents' independence. Bear in mind that the costs of supportive services like help with bathing, brushing, laundry, meal preparation, companionship, etc are not covered by most health insurance plans except under very special circumstances.

Woman accompanying her mother inside the building facility

Things to Consider When Choosing a Care Facility

It might not be easy to keep all of these questions in your head as you visit, so feel free to have a note with you and don't hesitate to ask for any clarifications where needed. It is your right to know as much as possible about where your parents are going to be spending a good part of their lives, and it is perfectly okay to want to ensure that only the best care is made available to them.

Part VNursing homes

Also referred to as skilled nursing facilities, nursing homes provide a varied range of medical, health, and personal care services. They are suitable for seniors who are no longer able to cater for themselves and typically have some sort of debilitating medical condition such as serious cognitive impairments, physical fragility, or impaired functioning abilities.

Nursing care typically focuses more on the provision of a higher level of medical care than most other assisted living facilities and this care is available round the clock. The care provided in nursing homes is delivered by health professionals like registered nurses (RN), licensed practical nurses (LPN), nurses' aides, etc. Some of them have visiting doctors and other health professionals as well.

There are different levels of care offered by nursing homes but they all generally comprise boarding, 24-hour monitoring, meals, personal assistance, and nursing care services.

While some medical services may be provided for a short-term stay, for example during recuperation after hospital admission, some other varied range of longer-term rehabilitation health services are available such as:

female nurse assisting the elderly patient inside the nursing room

Categories of Nursing Care

There are three general categories of care offered by nursing homes:

Basic Nursing

Comprising provision of residents with assistance in carrying out activities of daily living. This is usually done by licensed practical nurses or nurses' aides.

Skilled Nursing

More skilled care provided by registered nurses and also including the additional rehabilitation services mentioned above by other health professionals.

Sub-Acute Nursing

Here, the most comprehensive care is made available including medical treatments offered on a weekly or daily basis, as well as the review of care carried out by medical staff.

In order to aid smooth running, some nursing homes also have on-site pharmacies, radiological services, and laboratory services. As part of special service delivery, hospice care are also available in some homes, while some offer specialised care for individuals with medical conditions like Alzheimer's disease or other forms of dementia, Parkinson's disease, etc.

Nursing homes can be designed in two ways:

Home-like; made to look and feel like the home environment with typically greater freedom and independence allowed, reflecting in their more flexible daily schedule of activities, and interactions among residents and staff.

Hospital-like; These are more similar to hospital settings with typically more stringent schedules and less freedom. It is designed for a more advanced category of care such as sub-acute care.

While these are the general expectations, you would have to physically check each facility out to be sure what type of service they offer rather than assuming based on appearance alone. Generally, the cost of nursing home care would vary based on the category of care they offer, as well as the location. Unlike assisted living facilities which are not federally regulated, nursing homes have federal regulations but are licensed by the state.

Nursing Homes; A Last Resort or Not?

For a lot of Americans, the term "nursing home" is often greeted with apprehension or dread. Most people feel they would rather not take the option if they can avoid it. Why are there so much misconceptions regarding nursing homes? It could be as a result of the bad impressions people have of them from times past. Quite unfortunately, some of them even today continue to give a negative impression. But is this enough to view nursing homes as a last resort? Certainly not.

There are today, a great many nursing homes which offer excellent care services for seniors who need exactly such levels of care. As the focus continues to increase towards rehabilitation and recovery, nursing homes now feature a diverse population of both young and older people. Considering the burden of elderly care on American caregivers which according to a recent study, demonstrated a higher level of stress, impairment in productivity, insomnia, and depression in them, the availability of nursing homes should be viewed with the requisite gratitude it deserves.

Choosing among the different care options boils down to a careful and detailed assessment of the level of care your aging parents need, how much independence they can handle, your financial capacity, and of course, a careful appraisal of each facility being considered.

It might seem challenging at first but enlisting help from other family members, trusted and experienced friends, as well as geriatric care professionals certainly helps to ease the burden, and when you eventually decide together with your parents who they are meant for, rest assured that you have made the right choice towards providing them with the best possible care.

Some photos courtesy of Pexels


ROSEMARIE TAMUNDAY-CASANOVA, RN, BSN, MHA

Rosemarie is a certified critical care registered nurse, has a degree in Legal Nurse Consulting and a Masters Degree in Health Administration. Rosemarie has extensive background in nursing from acute care, home care, nursing education and health care management and administration. Her longest career was a critical care nurse for Veterans HealthCare Administration. She is an approved Home Health Training Provider for Alzheimer’s Disease and Related Disorders (ADRD) by USF Training Academy on Aging.

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