Middle Aged Kids in the Middle: Caregiving 2.0

The kids grow up and go their own way. Time to breathe a sigh of relief. However, if you’re lucky enough to have parents still alive, your caregiving days will not be over. Now in our much later years when we are trying still to work and enjoy our new lives as singles--whammo! The caregiving demands spring up anew. But this time around, it’s very different. 

As anyone who has been in our shoes knows--caregiving is rarely easy at any age--putting aside your own needs, listening and being empathetic, answering frantic phone calls in the middle of the night, cooking, cleaning, running errands, shopping, and accompanying your charge to various doctors. We both faced duties as the traffic-cop of our elderly mothers' care—finding aides to watch them during the day, overnight or 24/7, and then answering their barrage of questions daily.   

Margaret's mom sadly died at age 92 having spent the last year in an extended care facility. Before that, she lived independently. After a serious fall, the parade of professional aides kept coming and going began. Her mother didn't like this one because she was overweight or that one because she wasn’t “clean enough” or had low energy. Anger at losing her independence was really underlying her criticisms.

Barbara's mom, now 97 and living independently, had a mild stroke that has required bringing in full-time care temporarily and getting her good medical care and therapy to help her regain her sea legs to walk and speak clearly, since she has developed a slight slur. 

On a recent morning before 7 a.m., Barbara's mom called to say, "You have to get this caregiver out; she's impossible, telling me she's making herself a cup of tea and not even asking me!" Barbara tried to calm her down and explain she couldn't get her out until the next day. She asked her mother to be a good sport and relayed, "I called the agency and asked them to bring in someone new but it takes time." Another caregiver told Barbara what she wanted to eat: "I need whole fat plain yogurt from Fave, Evian bottled water, avocados, and..." The list went on and on and the choices and prices seemed a bit demanding. Who was taking care of whom?

Pick a skilled, compassionate caregiver. You can find competent, skilled and bonded help by going online and searching for the word “home health care” and similar terms, often through a licensed agency. Inquire about hours someone is available, fees per hour or day; responsibilities you need covered—healthcare such as checking blood pressure several times a day or weighing the patient, plus household chores like cleaning, light or heavy cooking, picking up groceries and prescriptions; hygiene—helping the person go to the bathroom and bathe (can she lift the person?), speaking a certain language and decent communication skills, and so on. You might also encourage the caregiver to keep a daily journal of medications administered and when, activities and interactions with friends and family, and overall health and attitude.

Ask if there’s an initial charge, how the agency deals with any problems—if the chemistry doesn’t fit or the person is too demanding regarding their accommodations, and so on. Some agencies will be flexible and let you start with someone for a set number of hours and days and decrease it if your loved one gets well. Or you can also ask friends and family for a name and try out that person, though you might need a back-up for emergencies, an advantage of an agency, which has a long list of possible candidates to call on. The independent living community in which Margaret’s mother lived had a personal care division able to dispense caregivers as needed. The agency Barbara called got someone in within 24 hours and listened carefully to requests. 

Be sure documents and more are signed and up-to-date before a crisis hits. Keep important phone numbers such as doctors and the kids posted on the refrigerator. The caregiver is only part of your challenge. Be sure you have the following documents in a safe place--in a cloud, printed and stored in a safe deposit vault, and also on a disk so they’re ready to go when you need access: 

• Your parent's or spouse/partner's Social Security number. Many insurers require this information right off the bat, plus phone number, address, and birth date.
• A credit card. You need this or a checking account to order groceries and pay help, buy medical devices such as a blood pressure measuring cup, bed rail, and medications.
• Medicare, supplemental health insurance card and drug plan cards. Again, you need these when accompanying your friend or family member to a doctor.
• Copy of a long-term insurance plan. If the person has purchased this type of insurance, have a copy and know when it kicks in—after 30, 60 or 90 days and other details.
• Names, phone numbers, and email addresses of their lawyer, accountant, physicians, and financial planners. Alert them if there are health changes, and be sure you are on all the documents needed which may require a signature and even having a notary to sign it and watch you sign it. If not, you may not have access to information you require. Again, it’s best if you check with these professionals long in advance and periodically update documents and signatures according to the state regulations.
• Durable power of attorney. This document allows you to make financial decisions with someone else’s money.
• Health care power of attorney. This document allows you to make healthcare decisions for someone else who may perhaps be unconscious or no longer thinking clearly.
• Living will. This document expresses the other person’s wishes when they face a terminal situation since again they may not be able to communicate and state, “Please, do not resuscitate.” This covers who gets what and when and how? You really wanted the silver? Too bad literally if Mom made a list and deemed it was going to Junior; you got her portrait, instead.
• Trust(s). This enables someone else—a third party—to make decisions for a beneficiary after someone dies. Perhaps, a grandchild receives an inheritance of $1 million but the person who died—the grandmother--had determined and stated in the trust that only $100,000 was to be given each year to protect the assets from being depleted foolishly in one fell swoop.
• Medical protection device that’s worn around a neck and make sure it’s waterproof. These come in all sorts of variations—some require an upfront payment, others just a monthly charge; some require a commitment of three or maybe six months. Some alert a local emergency room and others a family member; some go off if the person falls or only if the person calls a special number or presses a button. It’s best to go online and read and compare various medical alert programs. Barbara’s mom wants to give up having an aide at night; to do so Barbara and her grown daughters have said she first must have a good medical alert device on hand.
• And in an emergency, have a chain of command. Margaret’s mother’s chain of command was to initially call her primary care physician. Next Margaret was to be called immediately for she had power of attorney for her mother’s health. Then, take her to urgent care if nothing serious or call 911 and take to the emergency room (list hospital preference and tell the EMIs). And in her mother’s case, she didn’t want to be resuscitated (DNR) or intubated—no feeding tubes or heroic measures. 

• Beware of senior financial abuse. Betsy Gold, co-founder, LeanOnWe, says, caregiver abuse accounts for $6.67 billion in annual losses. “Caregiver abuse depends on a trusting relationship with the senior whether a grown child or family friend who frequently ‘borrows’ money, removes valuable items from the home or the lawyer who takes advantage of an aging client.” Gold suggests reviewing financial statements on a regular basis, view any loss as a red flag—a sign of vulnerability, and limit exposure to financial predators who call or email. Never ever give financial information in an email or over the phone.

Equally important: take care of yourself, too. Without rest and care, you’ll be worthless as a caregiver or help to a caregiver and your loved one. Handling a loved one’s care can prove physically and emotionally draining. You need breaks, so if you become the primary caregiver be sure you have backup help and time off for good behavior. 

At times you also will need a shoulder to lean on and listen to you complain and cry, so figure out which friends and family are there for you or if you need a mental health therapist. You also want to be able to keep up your own routine as much as possible whether writing, exercising, cooking, reading, and seeing movies, which will help keep up your spirits and energy. 

A tip: Hiring a professional caregiver can be pricey and often the elderly balk at spending the money or simply don’t have it to spend. Today Show financial expert Jean Chatzky and the Cleveland Clinic’s chief wellness officer Dr. Michael Roizen, co-authored “Age proof: Living Longer Without Running Out of Money or Breaking a Hip.” In the book, they explain the vital connection between health and wealth—giving readers all the tactics, strategies, and know-how to live longer, healthier, more lucrative lives.