In-Home Care Strategies: Post 1 of 3

A young man with an elderly woman in a wheelchair.

After we made the decision to keep my Dad at home, I learned quickly how much management is involved. As you navigate your own family’s decisions about in-home care, I think a good framework focuses on two dimensions: “activities of daily living” and in-home coordination.

“Activities of daily living” or ADLs help define how independent a person is. For seniors, critical ADLs include bathing, dressing oneself, preparing food, feeding oneself, and taking one’s medications. The more ADLs that your family member needs help with, the greater the effort will be to coordinate a patchwork of in-home care. My Dad needed help with all of the ADLs I’ve mentioned here.

In this post, I’ll cover in-home health aides, as well as what I call “the little ADLs.” In the second post in this series, I’ll discuss food and nutrition. In the final post, I’ll cover doctor’s appointments and medication management.

Coordinating Home Health Aides

Most communities have agencies that provide home health aides. Many of these are franchised businesses. For new clients, many agencies will send out a higher level individual (perhaps with nursing credentials) to evaluate your parent’s situation. Don’t be surprised if you are asked to provide a deposit upfront equal to the cost of three or four weeks of services. Here are a few takeaways from my experience:

  • You may need to fire people until you find ones that are a good fit. This was one of the biggest challenges for me and I suspect I’m not alone. Unfortunately, caregiving is a low-paid job. As a result, it’s not uncommon to get home health aides who would rather sit around and check their smartphones or “chat” than do meaningful work. I had to “fire” more than one aide until we found ones that were a good fit both from a personality and work ethic perspective.

  •  Your parents may not want strangers in their home. My Mom would only tolerate the aides that she knew and she only wanted them three times a week for three hours at most. As a result, when aides called in sick or just didn’t show up, my Mom refused to have a new aide come as a substitute. That always caused a lot of stress because it usually meant that my Dad didn’t get bathed or he didn’t get to his adult day program.

  •  Be clear about what you expect the aides to do. The aides that helped my parents assisted my Dad with bathing and brought him to the local adult day program and the barber. They also did grocery shopping for my Mom and would bring both my parents to the local mall – Mom shopped and Dad had lunch in the food court with the aide. Your mileage may vary — I personally never had much luck with home health aides doing any sort of light house cleaning.

The “Little ADLs”

In addition to the “big” ADLs like bathing, food, and dressing, there are several little things that are easily overlooked, such as trimming of finger and toenails, haircuts, etc. Fortunately, our town’s Senior Center offered a periodic podiatry clinic for a minimal fee. Either I or an aide would bring my Dad there to get his toenails trimmed. With regard to fingernails, I had an aide bring my Dad to a local nail salon that would do a basic nail trimming for less than $10. We usually bundled the nail trim with his regular haircuts at the barber shop.

Remember: Everything is a Tradeoff and Perfection is Unattainable

In my case, my parents valued staying at home above many other things. That meant making tradeoffs. I did the best I could and some things were far from perfect. For example, their nutrition wasn’t ideal – they ate a lot of frozen meals that were high in sodium and a lot of ice cream. They didn’t eat enough fruits and vegetables. On some days, I don’t think my Dad got all his medications. In fact, when I cleaned out their house, I found little foil wrapped packages of pills hidden all around that my Mom forgot to give him.

We all tried to keep the boat afloat as long as we could. None of our lives were perfect, but it felt like the benefit of being at home was greater than the penalties that we all paid in different ways, until we couldn’t do it any longer. Eventually, my parents’ circumstances declined to the point that my Mom recognized that she could no longer manage with my Dad at home any longer. Then we entered a new phase focused on memory-care assisted living, assisted living, and skilled nursing facilities.

No matter what your situation, caring for an elderly parent isn’t an easy path. I share these thoughts not to discourage you from keeping an elderly family member at home, but to set your expectations and help you create your own roadmap.

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