After his last car accident (second one this year), the daughter says, “Hey Pop, maybe it’s time to hang up the keys and give up driving.” The father snaps back, “Mind your own business” as if the daughter is the enemy, not his deteriorating capabilities. Does this sound vaguely familiar?
Almost every family will eventually need to make decisions about how to care for a loved one as they age. Yet, many adult children are in a quandary. On one hand, they want to do everything possible to ensure their elderly parents’ safety. On the other hand, they want to respect their parents’ dignity and right to live their own lives.
So they hover on the sidelines until one of two things happen. One, they desperately hope that Mom and Dad will one day have an epiphany, and realize they are getting older and could benefit from some help (don’t hold your breath). Or two, there’s a sudden event, such as a fall resulting in a broken hip, or a car accident that makes assistance necessary without further debate.
Experts say that the child’s success in ensuring the parents’ safety may be determined by the strategy the child employs, i.e., it’s important to appeal to the parents’ sense of pride. The child must communicate to the parent that he (or she) is an ally, not adversary. Furthermore, the child must fully support the parents’ desire to live independently as long as possible.
But it’s important that the child also raise the prospect that accepting some help would allow them to do more of what they want. “If we can get someone to help clean the house and/or mow the lawn, you could conserve energy and go visit your friends at the senior center more often.” In other words, with a little help, we all achieve more and go further.
If the “We become more, not less” approach doesn’t work, you can try some psychology. For example, the child can appeal to the parent’s sense of pride, i.e., our parents have been our role models our whole lives. The child’s eyes are still upon the parent. How Mom or Dad handles old age can affect how the child approaches old age.
Receiving care graciously is equivalent to getting old gracefully. If the parent can display acceptance and resolve in receiving care, it would provide the child with a model of graciousness in the face of physical and cognitive decline. However, if the parent persists in practicing denial and refusal, the lesson learned is that old age is to be bitterly fought, rather than adapted to and embraced.
My hat’s off to any adult child who is the primary caregiver to an elderly parent. But for many families (perhaps most), there are two reasons why you may want to look into hiring an outside caregiver. First, the parent doesn’t want to be a burden on the children. Second, the child is just not up to the task. Here are some experiences from child caregivers:
• “Cleaning up pee and poop from the backseat of the new car or in public. You don’t know what to do first: help them not be embarrassed or clean it up. I don’t discuss this with anyone.”
• “Being ridden with guilt, but hoping fervently that my parent, who has no quality of life, will die. I don’t want to keep doing this!”
• “Seeing a parent of the opposite sex naked. You can never be prepared for that or discuss with family or friends.”
• “Dealing with those who say, ‘She was fine while I was there.’ My mother can get it together to seem perfectly fine and charming to other people in social situations, but around paid caregivers and me, she unleashes the full frustration of her sadness, rage and confusion.”
• “Being in charge of my mother-in-law’s personal hygiene, including her hemorrhoids. She isn’t even my mother!”
If you decide to hire a caregiver for your mom or dad, finding the right caregiver is often one of the most challenging and emotionally stressful decisions you will ever want to make. Just about nothing is more important than selecting the right people to care for your loved ones. Here are some questions to consider as you make your decision.
What help are you able and willing to provide? Be honest about what assistance you are able and willing to provide. Caring about someone and caring for them are different. Perhaps it’s best for you to spend your time with Mom and/or Dad providing companionship, rather than acting as primary caregiver.
Instead, you can transport your parent to the doctor, bank, shopping and other errands. Or you might be able to offer assistance paying bills, financial management and other record-keeping that you wouldn’t want to entrust to an outside caregiver. Or you can help them participate in hobbies and other interests.
If you’ve got siblings, ask for help. Studies have shown that as a primary caregiver, your health suffers. Your marriage will also suffer. Don’t be such a martyr. ASK for help — what assistance are they able and willing to provide? If there’s little assistance being offered from your siblings, go to the next question.
What needs must be provided by outside help? When evaluating needs, start with the six basic activities of daily living (ADLs): eating, bathing, dressing, toileting, mobility, and continence. From early in the morning through the next morning, is the elderly parent able to:
• Feed himself?
• Properly bathe himself?
• Dress and undress safely?
• Use a toilet or bath seat without assistance?
• Stand from a lying or seated position?
• Transfer to and from her wheelchair?
• Control bowel and bladder functions?
Now that you have a good idea of the care you’ll need, you will need to decide whether to hire a caregiver privately or find a caregiver through a licensed home care agency. A common misconception is that caregivers can be paid “under the table” or as “independent contractors” at a substantial savings over using an agency.
Although this may be the least expensive option, there are a number of potential liabilities that you face as the employer of an independent caregiver. Before you leave Mom or Dad with just any Tom, Dick or Harry you found on the church bulletin board, what about background checks? What about drug screening?
Do you know that if your privately hired caregiver (employee) fails to claim or pay appropriate taxes the liability falls back to you as the employer? Also, what about tax withholding, workers compensation, and unemployment compensation?
For the vast majority of families, choosing a quality home care company is a good choice to find a fair balance between cost, value, and risk. Home care companies, as a rule, should perform criminal background checks and substance-abuse checks. Some companies will allow you to interview a caregiver prior to them working in your home.
Also, any good home care company should try to match the personality of the caregiver to the personality of the client. A quality home care company will attempt to identify the best match based on a number of criteria, one of which is personality. And if a personality conflict exists, they should be willing to replace the caregiver.
Final word of advice – you are making one of the most important decisions of your life – shop around. Fees and services will vary. Ask questions and be sure to ask for references. Unfortunately, many families don’t know how to “shop” for home care. The only question they usually ask is “What do you charge?” That is not enough.
Judd Matsunaga, Esq., is the founding partner of the Law Offices of Matsunaga & Associates, specializing in estate/Medi-Cal planning, probate, personal injury and real estate law. With offices in Torrance, Hollywood, Sherman Oaks, Pasadena and Fountain Valley, he can be reached at (800) 411-0546. Opinions expressed in this column are not necessarily those of The Rafu Shimpo.