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Many older people arrive at a point where they need to move out of their own home into another living situation. This can be a very difficult decision to make, since many people plan to live out their lives in their current homes. It helps to think about and discuss housing alternatives before the need arises.

When possible, these decisions should be made with input from all the family members. You might do the research about options, and then openly discuss with the whole family the advantages and disadvantages of each option. It is normal for people to be resistant at first to moving away from a home they have lived in most of their adult life. But when housing repairs and yard work become more troublesome than enjoyable, they may begin to see advantages of other options.

It is important that you first consider all the options available to keep the person in his or her own home, since getting help that will allow the older person to stay at home may be preferable for that person and for you. If remaining at home is not feasible, you should then explore types of places that are available to help them relax and live in a place that can be supportive of their needs.

Moving in with children is one option that can have many effects on your family. This decision requires careful evaluation by all the parties involved. Family members need to be careful not to make this decision too quickly. Sometimes relatives think this is what is expected of them, even when it is not a good option. To decide if moving in with you is a good idea, you might ask yourself: Will the person continue to have choices about various activities, such as church-going, visiting friends, or having friends visit them? Is your home big enough for comfort and to protect the privacy of the whole family, including the aging family member? Are the needed community resources available to support this arrangement? Can needed services be provided in your home? What effect will caring for an older family member have on you and the rest of the family, particularly if you are employed or have other major responsibilities? Do you truly want to have the family member in your home, and does that person want to be there?

Taking the time to think about all these things and discuss them with others may help in making a decision that everybody can comfortably accept. If it is determined that moving in with relatives is not a good idea, there are a number of options to be considered depending on the needs and desires of the older person and family.

Senior Citizen Apartment Residences generally offer the security of having other residents and staff around. They usually serve at least one meal in a group dining room and provide other services such as recreational activities and transportation. However, the residents must be capable of general self-care and they must usually bring their own furnishings. Call your local housing authority or Area Agency on Aging for possibilities in your town.

Board and Care Homes provide more support than an apartment. Known by such names as “rest homes”, “domiciliary care”, or “sheltered care homes”, they usually provide room, meals, utilities, housekeeping and laundry in a supervised shared facility. Managers are available throughout the day to assist the residents as needed. They are usually small, housing fewer than 30 residents. Board And Care Homes must meet certain standards to be licensed by the state. Contact the Area Agency on Aging or the Department of Social Services in your area for further information.

Foster Care involves an unrelated family caring for a dependent person. The person moves in with the foster family and they commit to meeting all the basic needs of the elderly individual, including all personal and medical care needs. To see if this option is available in your community, contact your local Department of Social Services.

Life Care Communities offer all the benefits of home and more. The difference between life care communities and boarding or rest homes is in their commitment to provide care regardless of how ill the person may become. Health care services and a nursing home are on the grounds and immediately available when needed. However, costs are very high, leaving this option only for those who are financially well off. Some Life Care Communities have experienced financial difficulties, so it’s a good idea to check out the financial soundness of the community before making this choice.

If your relative moves outside the home, your relationship will change. Someone else will now be taking responsibility for part of their care. You must find a new role for yourself and deal with the loss of the roles that you might have had. While others may not be able to do everything as well as you can, be supportive of their doing it as well as possible.

So take some time to research what housing options are available before they are needed. Talk it over with all the people who will be involved, and work together to decide on an acceptable course of action.

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If your relative moves outside the home, your relationship will change. Someone else will now be taking responsibility for part of their care. You must find a new role for yourself and deal with the loss of the roles that you might have had. While others may not be able to do everything as well as you can, be supportive of their doing it as well as possible.

So take some time to research what housing options are available before they are needed. Talk it over with all the people who will be involved, and work together to decide on an acceptable course of action.

If you have a parent or older relative that lives far away from you, it is sometimes difficult to know how you can help them when they become ill or infirm. You may not be able to leave your job or family to provide regular care. You can help them get what they need, even if you can’t be there all the time. But it does take some careful planning to make the best use of your time and take care of their needs. It is especially important that you talk with your older relatives to determine what their needs are. Don’t simply assume they need your help when, in fact, they don’t.

Once you have made an initial assessment of how your family members are doing, then you need to see about ways to help them in a way that is consistent with their desires and their ability to remain independent.

You might see if there are ways to get a better return on their savings to provide more financial security. Help them set up direct deposits and automatic drafting of bill payments to make it easier for them to manage money. In some instances, a joint bank account with your family member can be helpful so you can make sure that bills are paid. If your family members are unable to handle financial matters, you might obtain a durable power of attorney, giving you the right to manage their assets.

See if people who are already helping care for your family members can do any more. If not, you can consider a private care manager, if available in their community. For a fee, private care managers can help assess needs and make arrangements for needed care.
It’s always a good idea to remain in close contact with whoever is helping care for your family members through phone calls, thank you notes, and holiday cards. This keeps lines of communication open, making sure that you can get in touch with them when you need to, and lets them know that you are concerned.

Ultimately, you may want to see if relocation of the family member closer to you is desirable. However, this can be very disruptive and difficult for an older person, and should only be done when other options are not possible.

While you may not be able to do all you wish for your family member who is far away, there are many things you can do. Also, you should remember that many things you may have difficulty doing from a distance may also be just as difficult if done in your own community. Working together with your family member is the key to making sure that your efforts are most effective … and appreciated.

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In most communities there is an Information and Referral Service that may be called such names as “First Call for Help”, “Information and Referral”, or “Information Hotline”. These services can help you discover what services in the community are available to meet your needs. Look in the phone book to see if there is such a service in your community. When you call, tell them what types of services you may need. They will then give you phone numbers of agencies in your community that can help you.

Think of family, friends and neighbors you know who have been in similar situations. Call on them and use their experiences. Also, often people you know say they would be willing to help. When they do, write down their offers and how they can help so you will remember to use them.

Local public libraries are a great source of information. Also, if there is a college or medical school near you, see if you can use their library. Some libraries allow you to do your own computer search, sometimes for free. Computer searches can allow you to print the titles and basic content of all the recent articles written on particular subjects such as Alzheimer’s Disease or Heart Attacks. You can read about disabilities, view video materials, and get information about local services. Do not hesitate to ask librarians for help, that’s their job.

Some organizations that provide treatment for people with disabilities also provide case management services, meaning that they help the person by linking them up with other service agencies and help them work through the bureaucracies that sometimes make it difficult to get the help they need.

In addition, there are often advocacy groups that can help you. For example, the Gray Panthers or the Alzheimer’s Disease and Related Disorders Association can help support you, help service agencies be more responsive to your needs, and work towards getting more services available to you. Contact your local Information and Referral Agency for the names of any advocacy organizations that can help you.

If you are responsible for caring for an older family member, support groups can help you deal with the stresses of caregiving. They can help you realize that you are not alone that others have similar problems and concerns. You may also discover that you are doing a good job. Support groups can be found through an information and referral agency, the telephone directory, or the local daily newspaper.

Several specific agencies you should know about are: The Area Agency on Aging, which is responsible for planning services for older people, and knowing what services are available to help you and your family member. They also have useful publications about particular services in your area.

Case Management Services can help match your family’s needs with available community service. They connect you with resources, act as your advocate and help you function in an independent manner. Some public agencies like the Department of Social Services provide case management services to their clients as an ongoing part of their care, while private case managers charge a fee. Community Mental Health Services can help you and your family with supportive counseling to help you deal with the stress and mixed feelings associated with caregiving.

Help finding a doctor can be obtained from county medical societies, local hospitals, and through clergy and friends.
If you need health services brought to your or your family member’s home, Home Health Care agencies provide services like skilled nurses or aides, speech therapy and physical therapy. There is cost associated with these services, but under certain conditions, Medicare, Medicaid, and other types of insurance will pay for some home care services. Call your local Health Department or Community Hospital for information on their home care services, or look up “Home Health” in the Yellow Pages.

Homemaker or Chore Services are sometimes available to help people at home with daily tasks, such as shopping, cleaning and cooking. Some government agencies provide homemaker services at low cost to people in financial need, and private businesses also supply homemakers for a fee.

Respite Care allows a caregiver time to leave the home and pursue other activities while a trained person cares for the family member. The person may come to your home or you may take your family member to a respite center. Sometimes churches provide this kind of help.

If transportation is a problem for your older family member perhaps to go for doctors visits or therapy sessions, The Red Cross, Cancer Society, or other organizations may provide transportation. Or your town itself may have a special transportation service. Check with your local bus company about any special transportation services it may provide.

There are numerous other services that may also be available to you. Find out by calling your local Social Services Department and other public and private agencies.

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Making a decision about placing a loved one in a nursing home can be one of the most difficult decisions a family can make. Careful planning by the family can help you make the best decision possible. As you think about using a nursing home, it’s important to remember that sometimes a nursing home is the right place for a loved one. Remember, not all nursing home placements are permanent. Sometimes people discharged from the hospital are not quite well enough to return home without some additional rehabilitation. In these situations, nursing homes can be helpful as a short-term option.

In other situations nursing home care becomes necessary as a permanent place to live. In most cases the person being placed permanently is very old and very sick. Sometimes the demands of caregiving are so great that even with help from others you just can’t give the needed care. When this is the case, it may be better for you and your family member to let somebody else give full time care in a nursing home.

So how do you know when this time has come? Fortunately, these changes usually don’t occur suddenly, but they may be hard to see because they are so gradual, or because you just don’t want to accept them. Maybe it has become more and more difficult for the person to be out of bed. Or maybe you find that you are stretched to the limit and still not able to provide the care needed. When this happens, you need to plan ahead. If possible, you want to avoid making this decision in a “crisis” mode. Planning ahead can reduce your stress and help you make the best decision.

As soon as you see signs that the family member is beginning to have difficulty caring for him or herself, you should start making plans. In fact, even sooner is often better, when you can involve all family members, including the person who may be placed, in the decision-making. You need to become familiar with where the nursing home facilities are, what they offer, and how friendly the staff seems. And you may need to get on a waiting list. You should take the time to look at costs and the kinds of payment available, including Medicaid, Medicare and private insurance.

You may be fortunate enough to have private insurance covering nursing home care. This kind of insurance is often very expensive and not always available. Before you purchase such a policy you need to thoroughly understand what it covers and what it doesn’t.

As you plan ahead for nursing home care, it’s important to remember that caring for your loved one doesn’t end with nursing home placement. Instead of providing direct care, your role may shift to that of advocate or guardian. Your family’s involvement will still be important. If nursing home staff see your interest, it tends to increase their interest also. Even though your family member is in a nursing home, you can and should continue to involve your loved one in various parts of family and community life to help them continue a meaningful existence and maintain their connections to the family and others.

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Most nursing homes still only provide the traditional types of care and services, that is, caring for the elderly who are in need of long-term placement. These patients need skilled nursing care and services around the clock or less nursing care but supervision and custodial care. But there are now nursing homes that provide a new level of care called “subacute” care. Subacute care involves a higher degree of nursing care and therapy or rehabilitation. Many people are being discharged from the hospital much earlier; therefore, they are much sicker. These persons are sometimes too sick to be discharged to home, so they go to nursing homes. Most of the care in these subacute care units is provided by Registered Nurses rather than Licensed Practical Nurses because they are more highly trained. Although nursing homes usually provide therapy or rehab services such as physical therapy, occupational therapy, and speech therapy, persons needing subacute care may require one or more of these types of therapy several times a day, six or seven days a week.

You might ask why these individuals who require such heavy nursing care or therapy aren’t being kept in the hospital longer. For several years now, doctors and hospitals have been required to follow strict standards for discharging people from the hospital, depending on their diagnosis or illness. They are required to discharge the person as soon as possible if the care they need can be provided in a setting that is not as expensive as the hospital. Though nursing home care may be relatively expensive, it is much less expensive than hospital care and services.

Most nursing homes that provide subacute care have designated or set aside a special unit to care for these types of patients. Here the staff is trained to take care of sicker patients. There are a variety of diagnoses or illnesses that may require subacute care. These may range from recovery of major surgery or serious illness to recovery from an accident. The length of stay in the nursing home is often shorter than the traditional stay usually only a few weeks to a few months and the chances of improvement or recovery is usually good. Visitation in nursing homes is not as strict as that in the hospital and you would be able to not only visit but, if you wish, participate in the care of your family member.

If the goal for your family member is to go back home, it is necessary for them to function as independently as possible when the do return home. Recovery and rehabilitation in a nursing home may provide the necessary care that will allow them to do so. Besides helping them feel good about themselves, it also makes your job as a caregiver much easier. There is also a great deal of teaching that takes place in this type of setting so you and your family member will be comfortable and knowledgeable about the care needed upon discharge to home.

How will you know if your family member needs subacute care? Hospital discharge planners and the doctor will evaluate the patient’s needs and chances of recovery and help determine if this type of care is necessary and appropriate.

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If an older person is living independently or has moved into your home, there are things that you can do to make the home safer and reduce the chance of accidents.

First, take a tour of your home and take notes for each room. Four major concerns you should attend to are lighting, floor covering, furniture and furnishings, and temperature.

Lighting – Good lighting can prevent accidents from occurring. Good lighting would include: lights at the front and back doors and all other house entrances. Light switches should be easily reached and easy to operate. (You may need to use extension devices or have an electrician lower the switch, if necessary). There should be light switches at the entrance to each room to prevent walking in the dark. You might consider motion activated lights instead of switches for hands-free operation. Install three way switches to provide better access and control of lighting especially in stairwells and corridors. Use automatic night lights in halls or bathrooms to keep these areas from being completely dark. For reading, be sure the bulbs are bright enough, and there are enough lamps for adequate lighting. And for emergencies, flashlights with fresh batteries should be kept in easily reachable spots around the house.

Floor Covering – The type of floor covering can contribute to falls a big problem for some older people. If your family member has a problem with walking, consider using low pile carpet and reducing padding to provide a more solid footing … and nail down the carpet if necessary. Get rid of scatter rugs which can slide under foot, and place non-slip treads on stairs both in and outdoors. Remove doorsills between rooms if they create an obstacle to wheelchairs or walkers or increase the possibility of tripping. Avoid highly waxed wood floors which are slippery. And, keep floors free of extension and electrical cords and other clutter that may be tripping hazards – especially in corridors and foyers.

Furniture and Furnishings – The right type of furniture in the right place can be a big help in providing for the safety and comfort of the older family member. You should make sure the furniture is arranged to allow room for walking, especially if a walking aid is used. And use furniture that won’t tip over in case the person needs to hold on to it. Eliminate chairs with wheels or remove them. Use chairs and beds that are high enough to get in and out of easily and that have arms and cushioned seats.

Temperature Control – Maintaining a comfortable temperature can help a person feel better and stay healthier. Ask the person what is comfortable for them. Don’t judge by your own feelings because older people have different tolerances for heat and cold than you do and may feel uncomfortable at temperatures that are comfortable to you. Provide air conditioning which can be vital to people with breathing problems. Avoid extreme heat which causes drowsiness and dryness of mouth and nose, and if necessary, use portable humidifiers to eliminate dryness in the air. Label the thermostat with larger lettering and numbers and use tape to show which direction the control needs to go to increase and decrease the temperature. You may need to put a light near the thermostat to make it easier to read.

There are two rooms that need special attention: the Bathroom and the Kitchen. Bathrooms can be very hazardous, but there are a number of things that can be done to make the bathroom safer. Use wall-to-wall low pile, rubber backed carpets that don’t interfere with walking aids such as walkers and canes. Use strong towel racks and shower curtain rods that won’t break down if used for support. Put in grab bars along the tub wall, on the side of tub and near the toilet. Use a rubber mat or other non-slip surfaces in the tub, and if needed, install a permanent seat. Install a hand-held showerhead to help the person control and direct water when bathing. Change the faucet on the sink to one that has separate hot and cold-water handles that are easy to turn. Lower the hot water temperature to avoid scalding 110 to 120 degrees is plenty hot. Elevate the toilet seat to make getting up easier and make sure the toilet paper is in easy reach.

The Kitchen also has many hazards and care should be taken to make it as safe as possible. You might want to keep the stove light on all day if the kitchen tends to be dark. The most often used supplies and equipment should be stored in easy to get to places. Keep this room brightly lighted but non-glaring. Use “D” shaped pull handles for drawers instead of hard-to-grasp knobs, and make sure cabinet doors and drawers open easily. Have microwave and toaster ovens available for convenience and give instructions about how to use them. You may need to post instructions nearby for quick reference. If practical, use wall racks to hang things in easy to use locations. Place rubber mats or racks in sinks to prevent breakage when less-steady hands drop things. Replace heavy pots and pans with lighter ones. And if you have smoke detectors which you should be sure they are not too near the cooking area where they might be set off by normal cooking activity. If they are triggered too often with normal activity, you may be tempted to disconnect them and defeat their purpose.

With some care and attention, you can help your family member be safe whether in your home or theirs.

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Older people use more medication than any other age group. Because medicine affects older people differently than it does younger people, it is especially important to make sure these medicines are taken at the right time and in the right dose.

Normal body changes that accompany aging can mean that medicines can build up, causing a longer and more powerful effect than expected. Understanding these changes can help prevent problems. For example, with age, the liver gets smaller and less able to break down medicines, causing them to remain active in the body longer. Sometimes this can lead to excess medicine building up and causing a drug overload or reaction. Taking sleeping pills every night could cause a person to be groggy and sluggish all day long due to medication build up.

The total amount of blood in the body decreases with age. Because there is less blood available to dilute the amount of medicine taken, the medicine traveling through the body is distributed in a much higher concentration, possibly causing unwanted side effects.
Older people also tend to have a much higher concentration of fat and less muscle. Medicines may be stored in these fatty reserves instead of circulating through the body. This may change the action of the medicine and cause unexpected side effects.

Because different medicines work in different ways and many older people take several different types of medications, elderly persons are particularly at risk for drugs interacting in ways that are harmful. Therefore, it is particularly important that doctors who prescribe medication know about all the medicines (prescription and over-the-counter) that a person takes. You should know what each medicines is, carefully follow the doctor’s orders, and watch for changes in your family member that may be caused by medication.

You need to know the name of the drug and why it is needed, how often it should be taken and for how long, how the person should feel when taking it, any possible side effects and what to do about them, possible interactions with any other medicines being taken including non prescription drugs and are there any special precautions or restrictions to be observed, such as no driving or no alcohol or avoiding certain foods. As a reminder and safety check, it is wise to keep a written log of all medicines taken prescription and over the counter drugs including the information just described. The log can in any form that is easy for you to maintain, such as in a notebook, or on index cards.

If your family member has trouble remembering which medicine is to be taken and when, you might try placing all the pills that are to be taken together at specific times of the day into individual plastic pill boxes. Just write the times the pills are to be taken on the top. This can keep the person from taking the wrong medicine at the wrong time or forgetting whether or not the medicine was taken.
Taking medicines safely is important for everyone, not just older persons. Here are some other tips for taking medicine safely: Do not borrow or give prescription medicines to others. Do not double the dose if you missed the last one. Talk to your doctor before you stop taking a medicine some medicines must be taken in their entirety to be effective or may cause problems if stopped abruptly. Throw away all old, unused prescriptions. Store medicines in a convenient place, avoiding extreme heat and humidity. Talk to the doctor before taking over-the-counter medicine, especially if you are taking other medications.

Remember, all medicines must be taken properly and safely. If you have any questions, ask you doctor, a registered nurse, or a pharmacist.