The United States is in the grip of an eldercare crisis. Not only is there a shortage of nursing home beds, but nursing homes are financially out of reach for many, and known for low-quality care. In fact, as concerning as the circumstances surrounding eldercare facilities was before the pandemic, the spread of COVID-19 among vulnerable individuals in these settings only underscored families’ anxieties. All of this raises the high-stakes question of what to do if your elderly family member is in need of care.
Aging In Place
One of the most significant trends in senior care and aging today is the shift toward aging in place. People want to remain in the homes where they’ve lived for years, which may even be the homes where they raised their children and celebrated countless holidays and family milestones, but our homes aren’t designed with the access needs of most elderly people in mind. That means you need to consider a number of factors, but especially safety.
Among the different factors you should address if your elderly relative wants to remain at home is whether the environment includes any undue risks. Can they safely go down stairs without falling or get in and out of the shower? Can they cook for themselves and manage their own medication? Depending on the answer to these questions and other similar concerns, you’ll be able to evaluate whether the home is a suitable option and how much support they’ll need to stay safe.
In Your Home
Another popular alternative care arrangement for aging individuals is living with their adult children. This often happens when aging in place fails and has spawned the idea of a sandwich generation – adults caring for their parents and their own children at once.
Grown children often feel pressure to take on the care of their parents as their health declines and they need more support, and their efforts are made invisible because they aren’t part of the paid network of care professionals. These adult children, mostly women, are overextended and stressed by these demands, but may not be able to afford to place their parents in more formal care settings, or their parents may resist the idea.
Much like in situations where an individual is aging in place, when elderly adults move into their children’s homes, they often need to make a range of adaptations to make the environment safe. This adds to the stress and expenses of managing an aging parent’s care.
When there aren’t family members available to provide care and oversight, or when an individual’s health declines, some choose to hire home health professionals or personal care attendants to help with important tasks like activities of daily living (ADLs) and medication management. Much as there is a shortage of nursing home beds, though, there’s also a shortage of these aids. And, there’s also a great alternative – training and paying a family member to provide home care.
Many areas have programs that allow people to hire a relative as a caregiver, and that caregiver is paid via Medicaid just as any other professional would be. This is an valuable benefit, and one that can help people feel more comfortable receiving care, offer caregivers more technical and financial support, and alleviate some of the strain that can come from having to work one job and then come home and provide care to an aging family member.
Assisted living programs are an option for individuals who are still largely independent, but who may not feel fully comfortable living at home anymore, or who expect to see a steady decline in health and who will then require a greater amount of care. People who live in assisted living typically can perform their own ADLs, but their homes may not be ideal for an elderly person, and they may benefit from having a structured social environment and a moderate amount of day-to-day oversight from professionals who can help with grocery shopping or getting to doctor’s appointments.
Many assisted living facilities offer several levels of care so that, as an individual’s health declines, they can receive more support without having to change facilities. This means that some people can remain in these facilities for the rest of their lives, while others can stay for many years before having to receive full-time nursing care. They are often a good choice for elderly individuals and their families when there aren’t any serious health problems to deal with beyond the normal issues associated with old age. Still, while assisted living facilities typically aren’t as expensive as nursing homes because the residents are more independent, they may still be too costly for many families.
At the furthest end of the care spectrum are nursing homes which, despite their depiction in TV shows and movies, are typically reserved for individuals whose health prevents them from being take care of at home, even with support from a home health aid. What they’re not is a place for otherwise health, older individuals to spend time socializing.
Nursing homes are distinguished from other facilities by the wide range of services they offer, including the ability to assess an individual’s ADLs, provide various therapeutic supports like physical and occupational therapy, and provide important and even lifesaving modifications like providing thickened liquids for patients at risk of aspiration pneumonia or turning those with mobility limitations to prevent bedsores. Nursing homes also include sub-classes, like memory care facilities for individuals with dementia who may need specialized monitoring.
Though there are other fine gradations between various elder care options and services, these 5 are likely to serve as guideposts of sorts as you make decisions about what’s best for your family. And, importantly, always remember that you deserve support, even if that support is hard to find and that, if at any time you feel like your loved one isn’t getting the care they deserve, you can change course and try something else.
Their safety, comfort, and well-being should be a priority, along with your peace of mind.