How Do I Know It's Time for In-Home Healthcare? (Part 1) - Elder Care Channel

How Do I Know It’s Time for In-Home Healthcare? (Part 1)

If you’re like so many in the “sandwich” generation, you may be managing your career and handling your children’s education quite well. However, you might have an aging relative or your own parents who soon may need extra help in their care too.

As I have shared in other articles, my father’s health began declining about three years ago when we noticed he was falling more and more. There were different theories about this from various doctors, including being medication related, but we learned that he was having several “mini” strokes, each time leaving him more and more debilitated. Still, when these problems started, he seemed okay to us. But I think if I had the information I’m providing you below, I would have been more proactive.

The decision of whether your elderly parents or loved ones need to consider either in-home health care or independent or assisted living is multifactorial and can be very subjective. Could there be a more objective way to help with that difficult decision?

I looked at several Medicaid programs from different states and tried to synthesize some ideas and grading systems. However, I think after you read some criteria, you’ll get the idea to form a general idea of your own on how your elder parents match up, and hopefully, you can share some of these ideas with your physician or prospective caregiver.

Any elderly parent or loved parent could almost automatically be considered for home health care or long-term care if they have a severe impairment with decision-making skills or serious and symptomatic behavior problems.

Behavioral Impairments

One of the following behavioral symptoms or conditions, which occurs frequently and is not easily altered:

  • resists care
  • verbally or physically aggressive behavior
  • shows inappropriate behavior that puts self and others at risk and who needs more than verbal redirection to interrupt the behavior
  • wandering
  • disruptive or self-injurious behavior
  • socially inappropriate behavior,
  • poor hygiene,
  • short and long-term memory loss,
  • ability to understand others,
  • poor decision making,
  • confusion, and
  • orientation to time, place and person.
  • poor compliance with medication regimens (e.g., determining sliding-scale insulin dosages)
  • general self-neglect

Again, if they exhibit any one of the behaviors such as these to a serious degree, you should consider a caregiver for supervision and care and have them speak to their physician, perhaps with your accompaniment.

Decision Making

Decision-making has been demonstrated to decline with age. In fact, studies indicate that elderly people can be highly functional, yet still make poor decisions. Your parents’ finances compromise an area in which good decision making can be critical. A simple choice could be how and when to pay a bill. Complex choices could involve the creation of wills, trusts, or powers of attorney, changes in investments, transfers of property.

In one study they found that, though in general elder adults are less risk-seeking than younger peers, they sometimes make costly and inconsistent financial choices than younger subjects. These deficits probably also could spill over into other areas of their well-being, such as choices in their health or nutrition.

Assessing your elder parent’s decision-making process can be very subjective, but there may be some helpful guidelines.

  • Can they reason and understand information related to their decisions?
  • Can they appreciate the consequences of their decisions or lack thereof?
  • Are they consistent with their decisions over time?
  • Can they express their decisions?

A serious deficit in decision-making skills could actually be life-threatening. Imagine, for example, that one of your parents decided not to pay their electric bill because they thought it was too expensive. This would be a lapse in judgment resulting in a deadly scenario of having no heat. I hear of such cases on several occasions. Because of that, should you suspect your parent of having poor decision-making skills, getting someone to evaluate your elder parents or loved one in this regard is very important for their safety and well-being.

There are other criteria that should be considered in your parent’s ability for self-care, including memory and functional abilities. Learn more about the decisions involved with in-home health care.

Continued in Part 2