Juggling the demands of home and work has never been more complicated. Grown children often live far from their aging parents. Women, the traditional family caregivers, are in the work force more than ever. And it is not uncommon for middle-aged people to have children still at home at the same time they are caring for their aging parents.
If any of this sounds familiar, you are not alone. One in five households is caring for an older adult. The good news is, a variety of programs can help pull together the assistance you need.
One of the biggest issues in getting help is overcoming your own feeling that you are supposed to do it all. (Or your parent’s pressure that it needs to be you.) Part of working with your family member as a team includes being honest with yourself and honest with your parent about what you can and can’t do. Then you can solve problems together to find workable solutions that meet everyone’s needs.
You can make your life easier, and find the help you need more efficiently, if you consult with a care manager. These professionals know the local programs and eligibility requirements. They can save you time and money.
A care manager can
make a home visit to discuss concerns with your parent.
conduct a complete assessment of needs.
make recommendations tailored to your parent’s preferences, resources, and support system.
hold a family meeting to build consensus.
To learn more about care managers, give us a call at 928-300-0172.
Below are some tips for creating support systems that can help your aging parent stay at home for as long as is safely possible:
Family members who have cared for a loved one for a long time acknowledge that they are able to do a better job when they accept help from others. Even when they enjoy the process, it can still be a lot of work. And caring for an aging parent may go on for an extended period of time. You need to pace yourself. A willingness to accept help is the first step.
For many family caregivers, noble but inaccurate beliefs can create obstacles to getting help:
“I should be able to do this by myself.”
“It’s selfish to think of my own needs.”
“My [brother/sister/cousin …] won’t do it the right way.”
“Dad won’t let anyone help but me.”
If these sound familiar, you are not alone. Beliefs such as these, however, represent an unfairly distorted view. They don’t take into account the realities of modern life. And they can interfere with your ability to care for your parent for the long term.
If left unchecked, such beliefs lead to depression and burnout. In fact, family caregivers have a much higher incidence of depression and greater health problems than their noncaregiving peers.
You can learn to pace yourself and accept help by combating these distortions. Professionals in cognitive therapy say the simplest way is to recognize negative self-talk and offer yourself an alternate view. For instance:
“Should Statements.” Idealistic thoughts focused on how things “should” be rather than on adapting to the realities of a situation.
Alternate perspective: Instead of “I should do it all,” remind yourself, “I would prefer to do it all, but that’s not possible. It’s better that I get help than exhaust myself and do a bad job with Mom.”
“Labeling.” Applying false or harsh judgments on yourself or others.
Alternate perspective: Instead of “It’s selfish to think of myself,” remind yourself, “I am not selfish. I do a lot to care for Pop. But I need to pace myself for his sake as much as mine.”
What inaccurate beliefs might you be holding that keep you from getting help? How might you change your self-talk about them? Provide an alternate perspective?
Caring for an aging parent has many rewards. But that doesn’t mean you don’t need a break now and then to recharge your batteries. Many family caregivers don’t take needed breaks because they worry that others won’t do a good enough job in their place.
Although concern for your parent’s comfort and safety is appropriate, it’s also important to distinguish between real threats and a tendency toward perfectionism. For instance, it’s not uncommon for one sibling to feel like none of the others help. At the same time, the other siblings feel there “isn’t enough room” for them to pitch in because the primary caregiver is so particular about if, when, and how things get done.
Voltaire once said, “The perfect is the enemy of the good.” If you are having trouble getting, or allowing, others to help, you might want to consider the following:
Is a hot dinner every night necessary, or could Dad be just as satisfied by a hearty sandwich?
Your sister might not do your mom’s hair just right, but the tradeoff may be an opportunity for a rekindling of their relationship.
As a compassionate friend, what advice would you give someone in a situation similar to yours?
If the perfect is getting in the way of the good for you, it can be hard to let go. The stakes seem very high. Be gentle with yourself, and look at these tips from researchers in the field of perfectionism:
Start small. Ask someone to take over a routine task, such as picking up a prescription.
Consider it an “experiment,” not a permanent change.
See what happens. If things don’t go as planned, were the errors life threatening for your loved one or simply irritating for you? Would practice or more information have enabled the helper to do better?
Were there any positives to the situation? Did they have value?
Try again. Don’t expect it to be easy the first time. As with any learning process, the more you do it, the more comfortable it will feel.
How does the perfect get in the way of the good in your caregiving life? Start small. As an experiment, what little task are you willing to ask for help with?
Okay. You’ve decided it’s time for some caregiving help for your parents. The next obstacle may be that Mom or Dad wants “only you.” Part of working together as a team is learning more about your parent’s priorities. Ask him or her to tell you why they don’t want help from others. Concerns may include:
Safety. Fears about “strangers” can be addressed by seeking helpers from your family member’s natural community: friends, church, or neighbors. A licensed and bonded home care agency provides screening for drugs and criminal history. If you are thinking you might hire someone privately, please read our article below about hiring help yourself. Another option is to hire a care manager to help you find safe, professional caregivers who have had special training in elder care.
Cost. If your family member does not have many resources, he or she may be eligible for free or low-cost services. Go to www.benefitscheckup.org to see what may be available locally. A consultation with a care manager often pays for itself, because these professionals know of many services available to veterans, railroad workers, and other special groups.
Dignity. It may be difficult for Dad to admit a need for assistance. You can spare his pride by emphasizing the benefit to you. For instance, tell him how much the extra help would relieve your worries and make it easier for you to sleep at night.
If your parent remains resistant, it may be necessary to set limits. State specifically what you are able to do, and offer suggestions for the things you cannot do. Start small and whenever possible, involve your family member in choosing who will help and when they will come. For example:
“I know you feel most comfortable with me, but John wants to participate, too. Let’s have him come one day next week, just to try it out. What day would work best for you?”
“I can help on the weekends. But that still leaves Wednesday, which I can’t do. Of the two agencies we interviewed, which one did you like best?”
A care manager can assist in this process by helping you define the issues and then facilitating a family meeting.
Why do you think your loved one wants only you? Safety? Cost? Dignity? How might you address his or her concerns and still express your need for help?
Some tasks are more than one would ask a friend or unskilled helper to do. But bringing a meal or taking your parent shopping is simple. And even having one less thing on your To Do list can be a big relief.
Family caregivers often report the most difficult part is the act of asking someone to help. That’s understandable. We’re all busy. You don’t want to intrude. Friends and relations even say, “Keep me posted, and let me know if there’s anything I can do.” But it’s hard to remember and follow up when the time comes and you realize you could use a helping hand.
With the Internet, tools are now available that can help everyone stay more connected. One especially useful tool is a simple, free, online calendar service offered by Lotsa Helping Hands, a nonprofit technology company.
Lotsa Helping Handsallows you to create a “community” of interested individuals. You enter their names and email addresses into your account and can easily send updates about your loved one’s condition. (For those familiar with the Internet, this online service is like a private, family blog.) You can upload photos. People can write back. Conversations can occur online. Only people you have authorized to be part of your online community will have the login information needed to participate.
The calendar tool is what makes Lotsa Helping Hands special. No longer do you have to make embarrassing phone calls asking for help. No more leaving messages and getting three positive responses. Then you have to call two people back and say no, but ask them to please respond next time…
With Lotsa Helping Hands:
You post an errand on the calendar (e.g., take Mom to hairdresser, Weds. 3:00).
You send an email request to people in your community.
A community member willing to help clicks on the task on the calendar.
Anyone coming after that sees the task is taken.
You and the helper receive an email confirmation.
Email reminders are sent to you and the helper a week before and the day before the task.
Now when someone asks, “Is there anything I can do to help?” you can reply, “Yes, give me your email address. I’ll keep you updated on Mom. And if we need something, I’ll send you an email.”
No fuss, no muss. And to top it off, there is no charge to open an account at Lotsa Helping Hands. It’s free!
Services received in the home are divided into three types. Which service you choose depends on the level of staff training needed. Requirements set by Medicare may also determine which type of service will be covered.
Home health care. This service is provided by nurses and other medical professionals.
Home care. This service is provided by nonmedical staff.
Hospice care. This service is specifically for persons with a life-limiting condition. Services are provided by nurses and other medical professionals.
Home health care is skilled medical care given to help an individual regain their health. Typically, home health care is used following a hospitalization or surgery. The role of the staff is to assist homebound patients with a complicated medical condition that can be managed or improved. A doctor’s order is required.
Home health care is short-term care. It normally involves a few visits over several weeks. For instance, a registered nurse, a physical therapist, a speech pathologist, or an occupational therapist may make hour-long visits once or twice a week. Although the doctor orders home health care, you have a choice as to which provider you hire.
Home health care is covered by Medicare or other health insurance, but there may be requirements for eligibility, such as a recent surgery or hospital discharge.
If your family member needs 24/7 access to medically trained staff, home health will not cover it, and it’s very expensive to hire a registered nurse 24/7 for home care. A skilled nursing facility is the most affordable option. Medicare and most insurance will pay for a skilled nursing facility for a limited time. A doctor must determine that your family member needs round-the-clock access to medical attention. You have the choice as to which facility to use.
Whether you need home health care or a skilled nursing facility, a care manager can help you select the company best equipped to deliver the services your loved one requires.
Home care is nonmedical care to help a person remain in their own home. There is no need for a doctor’s order. Nonmedical home care includes
personal care (such as bathing, grooming, and toileting)
dressing and undressing
assisting with walking
transferring in and out of a chair or bed
visiting and companionship
Nonmedical care does not mean the caregiver lacks skills. The individual caring for your family member needs to understand the basics of elder care. Although certification is not necessary, many in-home care providers are certified nursing assistants or home health aides. They may have gained their initial training and experience in a nursing home. Now they prefer to work one on one with clients in the home.
Nonmedical care at home can be vital to keeping your parent independent and safe. Unfortunately, health insurance, including Medicare, does not typically cover nonmedical care. If your family member has long-term care insurance or veterans benefits, nonmedical home care may be covered. And there are a few Medicare Advantage plans that might offer it. Check your family member’s policies or contact the Veterans Administration for details.
A care manager can help you save money. After meeting with your parent and conducting an initial assessment, the care manager can make several suggestions. They will create an individualized plan. Often there are options available that provide less expensive alternatives to in-home care. For instance:
Automated medication reminders
Community resources, such as home-delivered meals or local transportation services
Safety equipment, such as a ramp or grab bars
A personal alert system should your family member fall
A move to an assisted living facility that offers a more home-like setting than a nursing home does, and has round-the-clock access to nonmedical care
Some nonmedical home care may be available for persons with low income. If your parent is on Medicaid or Supplemental Security Income (SSI), contact the local Area Agency on Aging. The state Medicaid office or local Veterans Service Office may also be able to help. Hiring a care manager who knows community resources may be the most efficient way to find low-income services. A care manager can determine whether your relative is eligible for local programs. In addition, they know whether a waiting list is in place and how best to apply.
If your loved one does need in-home care, a care manager can help arrange these services in a cost-effective way. Give us a call at 928-300-0172. We’d be happy to talk to you about ways to save money while meeting your loved one’s needs.
Hospice care is skilled medical care for individuals with life-limiting illnesses. Like home health care, hospice involves weekly hour-long visits from a team of medical professionals. Both the patient and the family have access to the team’s support services. A doctor must recommend hospice based on a diagnosis of an incurable condition. In addition, the doctor must estimate that the patient has six months or less to live.
Hospice care emphasizes quality of life. The focus is on keeping the
patient comfortable emotionally, physically, and even spiritually. Nurses and physicians help manage difficult symptoms (pain, nausea, fatigue). Social workers and chaplains assist with emotional and spiritual issues (anxiety, depression, spiritual distress). Nurse aides come several times a week to bathe and groom the patient. And a volunteer is available to give family members a few hours off each week.
Hospice does not hasten death. In fact, there are studies that demonstrate hospice care often results in people living longer—as well as more comfortably—than they would have lived without it.
Most people wish they had received the support of hospice earlier in their condition. Patients on hospice understand that their condition does not have a cure. They are willing to forego curative care. Instead, they wish to focus on improving the quality of the time that remains to them. Hospice is available for 6 months, but can be extended if the patient lives longer.
Hospice is for more than just cancer. Most people think of hospice in terms of a cancer diagnosis. In fact, hospice can provide powerful support for individuals with other incurable conditions, such as COPD, congestive heart failure, and advanced dementia.
Hospice care is 100 percent covered by Medicare. If you think your loved one has a life-limiting disease, ask the doctor if hospice is appropriate. If so, you have a choice of hospice providers in your community. A care manager can help you select the one that has services tailored to your family member’s condition.
Which of these services seems the most appropriate for your situation? Home health (medical)? Home care (nonmedical)? Hospice?
Hiring someone directly has many risks and many responsibilities. Make sure you are well informed. Simple as the caregiving job may seem, being an employer is not easy. And bringing strangers into the home is not a small matter. You may want to have a home care professional (a care manager or a home care agency) do the hiring for you.
Here are some things to keep in mind if you hire someone yourself:
Criminal background checks. You want to be sure that the person coming to your loved one’s home does not have a history of elder abuse or run-ins with the law. Even the nicest seeming people can be trouble. Con artists typically have winning personalities.
Drug screening. You want to be sure that the person caring for your loved one is mentally sound. You don’t want someone in the house who is working while under the influence of drugs. If you decide you want to require drug testing, be prepared to pay for the expense.
Home security. From protecting Mom’s valuables to arranging for a key, there’s a delicate balance between convenience and caution. (Experienced home care professionals have systems worked out to make sure your family member’s home is appropriately protected. They know how to minimize hassles for your parent and the caregiver while providing security for your loved one’s assets. They are usually required to also have insurance against a possible theft.)
Training. How do you know if the caregiver really knows and understands elder care? Can they handle an emergency and make good decisions? Do you have the time to verify training and educational certificates? Just because a person says they have done something before, doesn’t necessarily mean they have. Sadly, competence is hard to verify unless you are experienced with recruitment and hiring. (Home care professionals test for competency. And many provide training opportunities for their employees.)
An honest accounting of hours. Unless you are present much of the time, how will you know that the caregiver worked the hours he or she bills for? If your loved one is unwell or has memory problems, he or she may not be able to monitor time spent providing care. (Home care professionals have systems in place to confirm the hours worked.)
Quick replacements if the caregiver is sick. By hiring the caregiver directly, you are the employer. As such, you need to be ready with your own “Plan B” in case the caregiver is unable to come to work. Is your parent safe without assistance for a day? Two days? Three? Or is he or she dependent on the caregiver for meals? Medication reminders? Supervision to make sure the stove is turned off, or that your loved one does not wander? Once you become the employer, you have to not only hire the employee, but also be ready with an alternate plan if your employee gets sick.
Protection from lawsuits if the caregiver gets hurt. If you hire someone on your own, he or she may file a lawsuit against you if there is an injury on the job. As the employer, you are required to pay Workman’s Compensation Insurance to cover potentially disabling incidents. Without it, your assets are at risk because you are individually liable.
Social Security and other taxes. As an employer, you are responsible for Social Security, payroll taxes, and unemployment insurance. There are many legal obligations, deadlines, and penalties if you do not comply. To hire someone legally as a contractor, rather than as an employee, their terms of engagement must fit the criteria of your state’s Labor Code. A person may say he or she is an independent contractor, but that claim can be called into question if you set the days, hours, and duties. If they do not qualify as an independent contractor and they are being paid without taxes being withheld, it is against the law. If it is found that you or your parent were the employer, you must pay all back payroll taxes plus penalties. You might even have to appear in court. If you plan to hire help directly, check with an accountant to find out what your tax responsibilities are.
Discipline, hiring, and firing. Would that all employee/employer relations were trouble free. Unfortunately, they are not. Your employee will need some training. There will be a period of getting used to each other. Your loved one will have preferences, and so will you. Communicating these priorities effectively is an art. Enforcing them is an even more delicate art. Then there is the matter of compatibility. Not all personalities are a good fit. If differences are irreconcilable, letting an employee go is yet another art, though one that may have legal and financial ramifications. Make sure you understand the state and federal laws about this subject. Moreover, if/when you do let someone go, depending on your loved one’s needs, you may have to have someone else chosen, screened, and ready to put into place, perhaps even the next day.
Hiring help directly is certainly an option, but it is not as simple as it may seem. This is why many families turn to a care manager. Whether he or she offers home care services or works closely with an agency, a care manager can explain the legalities and help you be sure you are covered.
How will you address issues such as payroll taxes, workers’ comp, and background checks? What about when the caregiver is sick and cannot come in?
My sisters and I were struggling with living in different states than our parents, and wanting our parents to continue living in the home that they built together. Our father is experiencing dementia and our mother is his caretaker, but is also declining in health. Bonnie and her team have been instrumental in allowing them to continue to stay at home by coordinating care for our mother. They attend appointments, assist with transportation, and communication for us. Bonnie is a fabulous resource for knowing providers, home care agencies, and other resources in the community. During Covid she was instrumental in getting our mother treatment in the hospital and being her advocate we none of our family was able to be with her. Bonnie has gone above and beyond several times. I truly don't know what we would do without Bonnie and her team. I don't think mom and dad would be able to be in their home. I could not recommend Arizona Care Management Solutions more.
When it became clear my mom was rapidly declining due to alzheimer's, and in an unsafe living situation, finding Bonnie from AZ Care Management Solutions was a literal God-send to our family. For months, we were beating our heads against a wall, as we had no idea how to proceed, searching for answers, as we were battling a very controlling/abusive husband as well. When we finally found Bonnie, she took a personal interest in my mom. She listened to our issues. She gave us direction, advice and calmed our hearts with her care and expertise. The very next day she was at my mom's home assessing the situation. She then took the time to work with us on a rapid plan of escape for mom. Bonnie then coordinated, and was on scene with us with APS and PD during the rescue. After getting mom to safety, Bonnie directed us to excellent legal counsel for mom's finances, getting her the best care possible, and ensuring all was legal from her escape to conservator/guardianship. Bonnie's knowledge, experience in this arena and love for others made her and AZ Care Management Solutions a literal life saver for my mom.Since my mom needed 24 hour care, we put her in a very nice care home, and hired Gina from AZ Care Mgmt Solutions as an advocate, who also has a heart for others, and has been seeing my mom twice a week to check on her status, entertain, play games, paint fingernails, coordinate outings, etc. This take tremendous pressure off of us, who can't get there as often. Gina also has natural ability and experience to relate and connect with alzheimer's patients that we don't. My mom loves Gina, and would not have adjusted nearly as well to the change without Gina's help.Thank you and God Bless all of you at AZ Care Management Solutions.
AZ Care Management Solutions sponsored a caregiver day of renewal on 5/6/23. A vendor fair, chair massages, and presentations along with a light breakfast, lunch and giveaways were included. Thank you!
After my mom fell and broke her hip, I was alone in trying to figure out how to best care for her in this maze of what is the senior health care industry.I had been trying to pull together what felt like 1000 pieces of disparate information......places to see, insurance companies, doctors to call, forms to be filled out, questions to answer. I was completely overwhelmed and under much stress.I am so incredibly thankful that I finally called Bonnie and scheduled a consultation. She was clear, knowledgable and so understanding. She immediately started making phone calls to find out the answers to some of my questions, and knew the answers to the other ones.I ended up asking her for further help and I will be forever grateful I did.She helped me move through a very difficult time with her knowledge, presence and help. She was there when I needed her and she knew exactly what to do. And she is fair, compassionate and has great integrity.My mom is now in a perfect place for her, and it all happened with as much ease as was possible.Thank you Bonnie, and everyone else we interacted with at AZ CareManagement.I don't know how I would have managed this journey without you.
Bonnie and Bob at Arizona Care Management went way above and beyond in helping me place my sister in a care facility to live out her last few months. Bonnie set up a medical transport from Newport Oregon to Arizona so that my sister could spend her final days looking at the beautiful scenery she cherished so much as a park ranger. The home in Cottonwood was well staffed and professionally managed and Bonnie and Bob made sure everything ran smoothly as I am on the east coast and care coordination was difficult to manage for me. Thank you both again for all you have done for my sister and our family during this difficult time.
I own two assisted living homes in the area and have worked with Bonnie, Bob and their staff several times. They always have the best interest of their client in mind when finding a long term solution for the family. It has always been my pleasure to accept one of their clients into my home. They continue to stay in touch with the family and assist them with any need they might have.If you are in need of an Elder Care advisor, I wholeheartedly recommend Arizona Care Management Solutions! If you live out of our area, you can count on them to fill in when you can't be here in person!
I live in Massachusetts and my 92 year old dad lived in Sedona. I was called in to take over his care because he could no longer live independently. I literally did not know where to turn. A social worker recommended Bonnie and her team to me. What a relief. They helped me get the necessary paperwork to handle his affairs while also finding him a safe and loving environment where he got the care he needed. He thrived there for nearly 6 months. During that time, I was kept abreast of his health and care by Holly. He enjoyed his visits with her and the treats she brought with her! I highly recommend Arizona Care Management to anyone needing help with their loved ones. They are excellent and I’m so glad they were recommended to me.
As the owners of GENERATIONS SENIOR LIVING LLC, we have the opportunity to work with Bonnie, Bob and the rest of the team at AZ Care Management Solutions with some frequency. Bonnie is absolutely the hardest working person we know! She has the knowledge base and the support team behind her to truly advocate for your loved one and they do a very good job! From assisting with POA paperwork, in-home care, assisting with MD appointments, or actual placement of your family member into a facility...... these guys can get it done!!! We highly recommend them.... Josh and Jamie Elliott
Most of us do not have any experience or training on how to make decisions or select assisted living accommodations. This group was a life saver in selecting a care giver, legal restructuring and finding a home. This was my first time dealing with dementia and I was guided down the path with their professional staff.
When I was having a hard time getting my dad's assisted living place to respond to his needs Gina stepped in with a firm hand and made things happen on Dad's behalf. She is kind, dedicated, tenacious, and extremely experienced and knowledgeable in this field. Bonnie has helped facilitate communication between me and a family member from whom I am estranged to make sure that all family members have access to the information about Dad that they want to have. AZ Care Management has been absolutely VITAL to me in helping me get difficult things done for Dad. I can't imagine navigating these challenging waters without them.
When our daughter was moved to Cottonwood for more extensive care, my husband and I were not able to travel for frequent dr. visits. We were not able, because we are both in our 80s, to visit as frequently as we wanted. AZ Cares takes her to appointments. They also provide very personable and capable assistants who take her on outings to provide social and emotional support for her in our absence. I cannot praise them enough for the support and help they have given our daughter and us. They are a blessing to us!
Arizona Care Management Solutions did a great job keeping my mom as safe as possible in her home for the last year. Once Gina came on board, she managed to do what I thought would be impossible - she convinced my mom to transition to living arrangements that would provide the care she really needed! Gina held her hand every step of the way, even through some VERY challenging situations. This lady has a heart of gold and can get things done!
As a Geriatrics/Internal Medicine specialist I relied on Bonnie and staffto find the best outpatient care for our patients. Her heart is passionate for the care of our seniors, and regards that as her mission in life. And I wasalways confident that Care Management Solutions would find the bestoptions for our families. God bless her! Dr. Paul C. Hanson of Cottonwood Internal Medicine
Bonnie, Bob and the team at AZ Care Management Solutions simply go above and beyond as advocates for seniors. Whether you may need assistance coordinating care, evaluating local facilities for placement, creating a plan for aging well or many other elder care services, you will find no organization more qualified or prepared to assist you than AZ Care Management Solutions. As a local Medicare insurance broker for several years, it is paramount that my clients have the right people in their corner. I have - and will continue to - recommend Bonnie and Bob and their team to any of my clients without hesitation.