Honoring dadâs wishes while worrying about the next decision.
The situations caring for my dad in the hospital, nursing home, and then memory care assisted living seemed to pile up into a mountain of stress.
At the end of the day I realized . . . I need to give it up.
Not give up, but give it up. To God.
I was out of my regular rhythm and resorting to quick âarrowâ prayers instead of praying Godâs promises and finding refuge there.
God is constant even when our circumstances are not.
We wanted you to have this Prayer Card to find encouragement as you pray for an older adult. It contains four pocket-sized Bible verses to cut apart and tuck into your mirror or keep in your car.Â
Now may the Lord of peace himself give you peace at all times in every way as you help your senior in their waning phase of life.
Debbie McDonald is the Founder of Ways & Wane, an online platform that helps you help your aging parent. She lives in Northern California with her husband.
Three Assessments, Three Checklists and Three Helplines. Receive the elder care answers you need.
I felt incompetent.
I didnât know where to find help for my mom . . . how to sort through the âmore careâ options she needed.
I wasnât used to this feeling and it made me want to retreat into work or Netflix.
Making decisions about elder care is one of the toughest jobs that face an extended family. Families are faced with new elder care services, industry-specific jargon, and a number of alternatives that appear to be similar, but may have differences that will significantly impact the care your family member receives. After factoring in family dynamics and other emotional issues, many family members who are the decision-maker can become overwhelmed and unable to move forward.
Maybe you need to help an elderly person suddenly or maybe you are just starting to get a sense that your elderly friend or parent needs more help and elder care than they are admitting. Either way, it is hard to know where to start and even what questions to ask.
Step by step, youâll discover WHAT questions to ask and how to get answers.
Assessing your seniorâs situation through identification of specific behaviors outlined here
Making a list of your seniorâs specific needs using the provided checklist.
Call free helplines listed below for answers related to elder care.
Assess your seniorâs situation by looking for where they need help.
Itâs easy to miss warning signs because we want to remain hopeful and frankly, sometimes weâre not sure what to do.
Look around at their environment. Is the house dirty? Are there to do lists that never seem to get done? Food spoiling in the refrigerator?
Assess their current social habits. Have they stopped leaving the house or doing the things they used to enjoy?
Assess their paperwork and financial situation. Are there piles of unopened mail? Letters from collection agencies?
Look at your senior closely. How is their hygiene? Are they eating? Is their personality different?
Think about their responses. Are they unable to do things that used to be familiar to them? Do they have trouble following directions?
2. Make a list of what services your senior may need.
Itâs helpful to know the phrase âActivities of Daily Living (ADLs). The term gets thrown about in the elder care industry and is used to determine how much and what kind of assistance is needed for in-home care, at assisted living facilities and at nursing homes. The five ADLs are:
Bathing: personal hygiene and grooming.
Dressing: dressing and undressing.
Transferring: movement and mobility.
Toileting: continence-related tasks including control and hygiene.
Eating: preparing food and feeding.
Which of the activities above do they need help with and to what degree?
3. With their needs in mind, call these three free elder care helplines: 2-1-1, the Caregiver Action Network and the Eldercare Locator.
Since now you have an idea what help is needed, you need to get answers from a trusted source. Online searches reveal sources paying to get your attention, but how do you know if you can trust them? The top results from an online search typically cover only one area of senior needâhousing (specifically assisted living.) Itâs easy to get lost in clicking links and trying to figure out what each service offers. Donât waste your time.
Just call these three free helplines that can give you elder care advice. Talking to these advisors would have given me a starting point to getting more help for my mom.
When you make these calls, start by explaining your situation.
Then use this checklist of questions to navigate the conversation. The list includes questions about transportation, medical devices such as walkers and wheelchairs and canes, financial assistance, housing recommendations (assisted living, nursing home, etc.) and meals.
Call 2-1-1.
2-1-1 is government-funded, but it is not just for the poor. The operators can give you information about support groups, nursing homes, assisted living and other specialized housing options and caregivers.
2-1-1 gives you names and numbers of local companies, nonprofits or agencies that will provide the services your senior needs.
2-1-1 is open 24/7 and available by phone (best) or chat at 211.org. They report that 94.6% of the U.S. population can access a local 2-1-1 center. My call was answered quickly by phone.
Normally, your local Agency on Aging is a great resource through their Eldercare Locator. But because of the pandemic, they are only offering emergency food help.
If you want to try, contact the Eldercare Locator online or by calling 800-677-1116, Monday – Friday, 9am – 8pm EST.
This government service provides geriatric care consulting for free. They can offer information about transportation options and in-home care support (bathing, dressing, sitter services, preparing meals), home modification and caregiver support/respite. They can also inform you about other local caregiving services, like those provided under the National Family Caregiver Support Program. Find your local office number on their website by easily adding your zip code.
If your senior is a war veteran, find out about eligible benefits from Veterans Affairs.
With the Veteran Affairs Caregiver Support Line â 1-855-260-3274 â assistance is just a quick phone call away.
Whether you’re in need of immediate assistance or have questions about what services you may be eligible for, the caring licensed professionals who answer the support line can:
Tell you about the assistance available from VA.
Help you access services.
Connect you with the Caregiver Support Coordinator at a VA Medical Center near you.
Just listen, if that’s what you need right now.
The VA may also offer caregiver peer support, adult day health care, home-based primary care, skilled home care, homemaker and home health aide program, home telehealth, respite care and home hospice care.
Donât get derailed by pursuing rabbit trail links through a general online search or get pulled into a recommendation by a biased source. To summarize, here is your âCare for Elderly Action Plan.â
This one tool shows current data on COVID-19 cases for nursing homes.
When my dad needed a skilled nursing facility to rehab from a traumatic injury, my first call was to a few friends who had first-hand experience with local facilities. My second action was to visit in person. However, I should have started with the data.Â
Data is even more important during COVID-19. While nursing home residents make up just 1.2 percent of the United States population, they account for about 40 percent of Covid-19 deaths, according to the New York Times.
This one tool can help inform your decision. Propublica, an independent nonprofit newsroom, offers an investigative tool to discover reported deficiencies, including COVID-19 cases, within nursing homes.Â
Some of the homes have been cited for putting residents at âimmediate jeopardyâ of harm or death, our analysis showed.
And many of the affected homes have been previously written up for violating federal standards. Thatâs true in California, New Jersey and New York.
We introduced this resource in 2012 as a way to search through tens of thousands of nursing home inspection reports to find problems and trends.
You can easily compare the nursing homes in your state based on how many times they have been cited for violating infection control protocols in the past three inspection cycles (roughly three years). Weâve also added data from The Washington Post on homes with COVID-19 cases.Â
The Nursing Home Inspect Tool shows this dashboard:
The dark red states show the highest rate of infectious disease rates in the nursing homes. Click on New York on the âInfection-Related Deficienciesâ map and you get the report below, showing that 90% of all nursing homes in the state have had at least one case of COVID-19.Â
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ProPublicaâs reporting tool also shows that some nursing home chains seem to have higher rates of cases, as well. New Jerseyâs CareOne facility had a consistently higher percentage of cases than other chains in the state.Â
Looking at these numbers may inspire us to consider more in-home care optionsâor at least to let data play a part in our decision.
Medicare stopped paying for my dadâs rehab care at the nursing home. 100 days had passed and he wasnât âprogressing enough with his physical therapy,â which meant Medicare wasnât going to pay any longer. We needed to find a place for my dad who still needed a lot of care, nearly 24/7 mainly because of injury induced dementia combined with his invincible spirit⊠âI was just practicing walking without my walker.â
If we were going to move my dad into anassisted living homeI needed to know heâd not only be safe, but very well cared for and well, as happy as possible. How were we going to do that?
In Washington state, the Department of Social and Health Services allowed me to search for living options based on zip code as well as for facilities that accept Medicaid. Once I had a list narrowed down, I could view the âReports and Inspection Lettersâ which allowed me to see the facilityâs history of Inspections, Investigations and Enforcement Actions. This information helped narrow my list. From there I called to check on availability and get a sense of who was running the home. If it seemed like a possibility, I scheduled a visit. Through this process I was able to find what ended up to be a good fit for our dad.
To understand more about assisted living homes, here are some key assisted living facility stats from the National Center for Assisted Living
You can check facility care reports with your state agency. Find out what that is in your state at after55.com
As you visit facilities, itâs helpful to keep track of the information in a Housing Comparison chart.  Â
May you find joy in loving one another well!
Elizabeth Dameron-Drew is a contributor toWays & Wane. She walked closely with her own father through his years of waning. She lives near Seattle, Washington with her two teenage sons, husband and two rescue dogs. When sheâs not working on this platform sheâs probably creating books, sewing, or vacuuming, or cooking while listening to the rain and thinking about her next creative endeavor.
I don’t have the exact date my dad became initiated into the Tennis Ball Walker Club. I do know it wasn’t something he aspired to join and he didn’t opt for any of the swag.
You can buy the walker, but it doesn’t come with the tennis balls for the two back legs. You get to add those yourself and hope that the utility knife used to slit them open doesn’t cost you a finger.
My dad thought the shiny black kind with wheels would be better for him, but his physical therapist said he’d have to work up to that kind. It turns out there are several different kinds of walkers for different kinds of situations and needs.
So in case you thought all walkers were created equally, hereâs some valuable information on walkers as well as where and how to choose one that will help keep your senior mobile and safe.
Understand the different kinds of walkers
Mayo clinic has this very helpful slide show: âTips for choosing and using walkersâ
Educate yourself about best practices for using walkers (as well as gait belts, canes, etc.) Watch this 20-min training video.
Find gently used walkers and other equipment at a local nonprofit. With a quick online search I found Bridge Disability Ministries. Itâs local and has equipment available for a suggested donation.
You can also post your need on a local âbuy nothingâ type of Facebook group or your neighborhood Facebook group. Neighbors are generally glad to gift or loan equipment.
Who wants to be in a nursing home or assisted living facility? My dad certainly didnât.
But I couldnât quite figure out how to manage and afford the care that he would need at home. At the time, I couldnât quit my job to provide that care myself. Maybe I should have. But thatâs another story.
When searching online, it is hard to find an unbiased source. It turns out that it may have been more possible than I imagined to find home health care with the community resources already around me. Drumroll, please . . . this is the one unexpected source of local homecare referrals, even in these crazy times.
Call your local hospital and nursing home social workers.
Ask them for homecare referralsâeven if your senior is not in the facility currently. Sounds simple, right? But itâs a gem.
Social workers can provide the following facilities:
A referral for home health services like physical therapy (covered by Medicare for a limited time.)
A referral for a homemaker evaluation. The agency will send someone to your seniorâs home to discuss services that are needed. After an authorized agency makes their free evaluation, your state may provide caregiving services at no cost.
Their âpreferred providerâ list of caregivers (which you would pay for out-of-pocket.)
After narrowing your list, use Medicareâs checklist to interview each agency. Their list includes questions like:
Do you have staff available at night and on weekends for emergencies?
Can you explain what my insurance will cover and what I must pay out-of-pocket?
Do you do background checks on all staff?
Also ask specifically about the sanitation and protection protocols they use during COVID-19.
Blessings as you help you senior well in these challenging times.
He careened around the grocery store aisles driving the scooter they provided. I followed, picking up fallen cans and apologizing to shoppers who jumped out of his way.
My 80-year-old father was a home chef who was thrilled to put the dinner of his choice in his basket: ribs, asparagus and potatoes.
Sadly, those same ribs, asparagus and potatoes were molding in his fridge two weeks later.
Why didnât he cook them? This really struck me because he loved to cook. Looking back, there were many reasons that all came down to . . . he just needed more help.
I think too, he was pretending that he was more capable than he truly was. We didnât know that in the next year he would develop dementia and live in a hospital ICU, a nursing home, an assisted living memory care unit and a senior group home.
Look for these warning signs in our own seniorâs home. Your elderly mom or dad may need more help than they are letting on.
Environment
The yard or house is not maintained.
Thereâs nothing to eat in the house.
The fridge contains expired or spoiled food.
Potholders or pans contain burn marks or a burning stove is left unattended.
There are multiples of the same item–10 bottles of ketchup?
Your senior has traffic tickets or the car has dents.
The carâs warning lights are on–gas, oil, check engine.
Social
Your senior stops doing the things they used to enjoy.
Your senior is spending days without leaving the house.
Your senior would benefit from someone checking on them every day.
Your senior complains of feeling lonely or abandoned when you are away.
Financial
Piles of mail in various places.
Unopened personal mail.
Increased thank you messages from charities.
Letters from banks or creditors.
The mail is unopened or bills are unpaid.
Up Close
Your senior is unsteady, wobbly, dizzy or very weak.
Your senior is looking unkempt, skipping showers, forgetting to shave.
Your senior has gained or lost weight, potentially having difficulty with cooking or shopping.
Your senior refuses to take medications or seek medical treatment.
Their personality has changed, become irritable or quiet.
To do lists that never seem to get done.
The house is overly cluttered.
Your senior is recovering more slowly from injuries or surgeries.
Cognitive
Your senior misses appointments, gets lost, forgets important information.
Your senior has difficulty performing familiar tasks.
Your senior substitutes unusual words
Your senior forgets recently learned information.
Your senior puts items in illogical places.
Your senior loses initiative and becomes passive or lethargic.
Your senior has trouble following directions.
Is it time to have a gentle conversation with your mom or dad about assisted living or in-home care?
Find templates and comparison tools for that housing or in-home help with the Digital Social Worker tool. It is full of curated links and to help you compare in-home care, a nursing home or assisted living options.
If you want the Warning Signs Checklist from above, download it here.
Now may the Lord of peace himself give you peace at all times in every way as you help your senior in their waning phase of life.
I walked out to greet my 80-year-old dad as he pulled into my driveway in his Dodge Journey. I couldnât help but notice that his side mirror was hanging by a wire.
âDad, what happened to your mirror?â
âIâm not exactly sure . . . â came back his reply.
NOT EXACTLY SURE?!
The Dodge was looking tattered as this was the third bump and scrape in a month. Should my dad still be driving?
Was he a danger to himself and to other people on the road? And if so, how could I get him to stop driving? As a professional landscape photographer and outdoorsman, he regularly âhit the road.â
As it turns out, he didnât stop driving until he was hospitalized after a fall and was diagnosed with trauma-induced dementia.
I discovered that it is difficult to get a license revoked. Here are 5 things to know about senior driving safety.
DMV testing of seniors varies by state. This AAA list shows state requirements for elderly driver testing start at age 70, 75, 80 or in some states, not at all. The DMV tests may include eye tests, reaction tests or road tests.
Your seniorâs doctor may recommend that he or she does not drive and some states actually have physician reporting requirements if they feel it is medically unsafe for the person to drive. My dadâs doctor told him he couldnât drive for six months after he had a seizure. That didnât stop him from driving.
Some people adopt creative approaches to making the car ânot available,â like unhooking the battery or having a friend or family member âborrowâ the car.
Keep in mind that driving and independence go hand in hand. For some seniors, losing the ability to drive is the point they move to assisted living or a nursing home. According to a Gerontologist magazine study, âPhysician reporting laws and age-based licensing requirements are often at odds with older driver’s need to maintain independence. Physician mandates do not yet yield significant older driver safety benefits, possibly to the detriment of older driver’s well-being and independence.â
This American Geriatrics Society Driver Safety interactive quiz will give you suggestions for monitoring your seniorâs driving safety.
Walking that line between independence and safety sometimes feels like a tightrope.Â
Now may the Lord of peace himself give you peace at all times in every way as you help your senior in their waning phase of life.
With the help from the nursing home physical therapist, I determined that Dad needed the following items at his new home, a memory care assisted living facility.
We found all these items for a total of $125. Follow these steps and see if you can dig up a free walker or wheelchair!
Call your local Center for Independent Living. My local center is called FREED Center for Independent Living and they have a âlending libraryâ of walkers, wheelchairs and other assistive devices. They didnât have a wheelchair for me but they gave me a walker, a shower bench and a toilet seat riser.
According to Medicare, Medicare Part B (Medical Insurance) covers power-operated vehicles (scooters), walkers, and wheelchairs as durable medical equipment (DME) if the doctor treating your condition submits a written order stating that you have a medical need for a wheelchair or scooter for use in your home.
Look on NextDoor.com. I didnât think of it for a wheelchair, but did get a $500 composter from a neighbor for free.
Look on your local Craigâs List. We purchased a wheelchair from a nice woman who bought it for her husband and didnât need it anymore. But we didnât know to ask for adjustable arms,which leads me to the next point.
Be aware of the adjustable features you may need. Many doctors and hospitals offer a free âfitting sessionâ for a wheelchair or walker.
And a final tip . . . the seat really needs a cushion if your senior is sitting in it for any length of time.
Now may the Lord of peace himself give you peace at all times in every way as you help your senior in their waning phase of life.
*We may earn a commission for products recommended, but we only mention products that were truly important for our father.
The very day my dad was set to move into a charming little rental house, he fell in my bathroom and broke his hip. As the paramedics were arriving, I asked my teenage son to search online and print out a healthcare power of attorney form.
Of course, getting this form signed had been on my to-do list. The current form listed his ex-wife who lived in a different state.
We found one, printed it, and asked the paramedics to be the two witnesses required. (Apparently, they are not allowed to do that.) At the hospital, we ended up asking my dadâs roommate and his wife to sign as the witnesses. Two complete strangers!
I am part of the sandwich generation. I work and have children and young adults Iâm raising. I am an educated professional, and yet I didnât know where to look for this form. Unfortunately, this form was necessary to use for my father many times in the next year.
Is this the right form?
It can also be called a Durable Power of Attorney for Healthcare, Healthcare Proxy or Living Will. Even though the titles for the document vary, advance directives give directions and responsibility to make healthcare decisions if someone becomes unable to do so. An advance directive gives an older adult a voice in their health care should they become too sick to make their wishes known, stating what kind of care they do or don’t want. This can make it much easier for family members to make tough health care decisions for them.
You may be in one of these two situationsâŠ
The older adult is independent, but you are the one who would step in should there be an emergency
You are already in a caregiving role for an older adult
For those with independent older adults:
Hereâs your assignment: Find out where the power of attorney is and what it says. However, you donât want to send a message of âyou arenât in your right mindâ or âyou havenât prepared wellâ or even âIâm taking over.â
Try a strategic approach to this question, like the following:
âI have a new benefit at work and theyâve given me an assignment of making sure I understand the health management wishes for those I love. I am curious about your healthcare power of attorney. Can you tell me if youâve done that and if so where I could find it should I need it?â
If they are willing, ask how recently it was completed and if it has the required signatures. It’s a perfect time to hear about their wishes. If you really want to level up, the person responsible for carrying out those wishes should make a copy of the POA.
For current caregivers:
If you donât already have a healthcare power of attorney paperwork completed for the older adult itâs important to do. Why?According to the American Bar Association, having this completed allows you to do things like:
Talk with the medical team about treatment choices. Ask questions and get explanations, so that you can understand the patientâs medical condition and treatment options as much as possible.
Asking for consultations and second opinions from other doctors.
Consent to or refuse medical tests or treatmentsâincluding life sustaining treatment in many, but not all, cases.
You donât need to contact a lawyer to get this form. However, if the older adult has not chosen a medical decision maker already and they are not able to make their needs known you will need to get an attorney to establish who has the DPOA. The National Academy of Elder Law Attorneys is one resource.
You can get a free power of attorney version for your state at Prepare for Your Care or through the American Bar Association. Or Search online: Durable Power of Attorney form for (insert name of your state here). The form itself will outline which signatures are required in your state.
Lastly, make sure you can find the healthcare power of attorney when you need it.
Place a copy of the healthcare power of attorney in a secure location (firebox or safety deposit box)
Place a copy of the healthcare power of attorney in a folder by your door, ready for an emergency. If you want a stylish medical document planner to place it in, the Ways & Wane GoKit is a great solution.
Take a picture of it with your phone and organize it in an âEmergencyâ folder in your Photos.
May you joyfully prepare so that you can calmly navigate this waning stage of life.
Machines beeping in the hospital ICU.
He careened around the grocery store aisles driving the scooter they provided. I followed, picking up fallen cans and apologizing to shoppers who jumped out of his way.
