We had waltzed around our parents’ need for help because they both resisted “intruders” in their home. A time usually comes when parents, one or both, must be helped to understand that some kind of help is needed for their survival. “When” is the ambiguous and uncertain question. The decision must be made with consideration for both the caregiver and the one considered “the patient.” 

When our father died we knew our mother could not live independently. The issues were rooted in both her serious memory loss and the nuances of diminished judgment. These changes had produced uncertainties about her meals, bills, housekeeping, dressing appropriately, safety, and medication; actually, all of living. At the time, resources for helping were not as numerous as they are now. Nor were the internet sources as well developed.  Even though resources are now abundant, even this reality may make the search for help more difficult and a frustrating labyrinth to navigate. 

Our family care plan was developed in a crisis mode because mother was left alone when our father died. The plan consisted of these elements:

·         A community agency that functioned as a locator of homemaker services and live-ins;

·         A live-in helper who lived in the home five days a week, a type of arrangement very difficult to put together and keep in place;

·         And four siblings who provided weekend care on a rotation basis. 

This arrangement lasted seven years but was very expensive and challenging, both to manage and to fulfill as individuals with heavy “other” responsibilities. We evaluated the circumstances often and adjusted accordingly.  

Everyone wants to live at home as long as possible. This is often a viable option when steps are taken to ensure the loved one is getting dependable assistance. Usually it starts by searching out non-medical services through local agencies such as the Area Agencies on Aging (AAA) or the Alzheimer’s Association. 

The American Association of Retired Persons (AARP) defines two main types of in-home care agencies (AARP.org):

·         Homemaker services for household duties and non-medical personal care.  This could include help with preparing meals, bathing, dressing, or moving around the house. Depending on the state these may or may not be licensed. These services are usually private pay. 

·         Health and medical care, provided by home health agencies. State and federal laws regulate these agencies, and in-home programs often are Medicare and Medicaid certified. In many cases these agencies can get paid for providing home health services. Caution: Payment depends on proper authorization by medical personnel managing your loved one’s health care, and state/federal laws.

The AARP web site also provides a complete discussion of very important questions to ask agencies you are considering as service providers. You will want to ask questions about the agency itself and the potential caregivers who will have contact with your loved one.  

Do not relent on requiring strict qualifications and hiring processes for anyone you are considering as a caregiver. These include skill competency, background, criminal history, experience records, and safety training. 

The AARP web site offers questions to consider in vital categories:

·         Licensing and services

·         Staff skills, insurance, bonding, and no-shows

·         Costs, Medicare/Medicaid, billing, and sliding scales on costs

·         Quality measurements, including inspection, client complaints, and individualized care planning

·         Paying for services such as private pay, Medicare/Medicaid, or insurance including medigap, long-term and others

Other web sites helpful to this critical and essential search are:

·         Eldercare Locator at 1-800-677-1116; eldercare.gov; and alz.org

·         BenefitsCheckUp.org  This web site requires answering confidential questions to access information about resources that might be available to you 

While the in-home care option seems attractive in many ways including the emotional comfort level of the loved one, it is complex to keep the pieces together and is not necessarily less expensive than other care options. Help to the primary caregiver is substantial, but places on him/her a management role that may be highly stressful.