Does Mom Need Help?
“Does Mom need help?” She says she’s fine….
Mom just doesn’t seem herself these days. She seems more withdrawn and pensive. While she used to participate in activities with friends, she doesn’t anymore. She seems to have everything under control. Now that dad can’t drive anymore, she brings him where he needs to go. In fact, dad has been a little forgetful lately, but mom is doing a great job making sure he remembers to take his medications. I’ve talked to my brother and my sisters about our parents. We’ve been very concerned, especially after dad fell last week. We have been wondering if maybe he needs more help. I talked to mom about it, and she tells me not to worry, they are fine……”
This is a typical scenario for many families struggling to do the right thing. As adult children are raising their families and involved in their careers, there is growing concern for the well-being of their aging parents. What can concerned adult children do?
First of all, evaluate the situation. Many times there is one parent who is healthier than the other. In my example it is Dad who is starting to show signs of decline. Increasing forgetfulness is a sign of cognitive decline. An inability to drive puts the responsibility on Mom. Frequent falls is a sign of decreasing balance or mobility. Mom is doing what many wives do; she is stoically shouldering the caregiver responsibilities and taking care of Dad. While she is doing what needs to be done, being a primary caregiver puts her own health at risk. All too often, Mom can sustain until a crisis occurs. The issue then becomes even more complicated because if something happens to Mom, what will happen to Dad?
The time to intervene is before the crisis occurs. One of the obstacles to intervention is that parents don’t see the need. They can also be resistant to being told what to do by their children. And finally, most parents do not want to burden their children with their problems.
What can be done?
Communicating with an aging parent is a delicate situation. Parents, by their very nature, are the adult authoritative figure. Telling your parents what to do will probably be met with resistance. Furthermore, every individual has a right to make their own decisions, even if it is a bad decision. That is a human freedom and a right. In my experience, the best approach is to demonstrate and show them that help is needed. An example would be to use Dad’s fall as evidence in a conversation that indicates your concern, why you believe the fall happened, and the risk of Mom taking on all of the caregiving responsibilities on her own and then allowing them the control to make their own decision. If the response is “I refuse to use a walker”, show empathy and understanding by not nagging. They often will come to their own conclusion. The hope is that another fall will not cause an injury, but they have the right to decide. Having the conversation, you can be reassured that you did what you could do. It is important to remember that preparations are more of a process. Start small because “ a little bit is better than not a bit”.
In my illustration, Dad is functional. He doesn’t need help getting in and out of the shower. He takes care of his grooming needs independently. Other than a recent fall, he usually walks fine and has not needed a cane or walker. At this point in time caregivers are probably not needed. Because safety is the first concern, Dad should be evaluated by a physical therapist. This is easy and is covered by Medicare. His fall makes him meet criteria for an evaluation and all that is needed is a physician’s order. Most physicians are happy to order physical therapy because they know that one of the number one reasons for hospitalizations in people over 65 are falls with injury.
Another safety measure would be to install grab bars in the shower and by the toilet to prevent falls, keeping in mind that as we age it becomes more difficult to get up and down from the toilet. A medication review can also be done at this point to make sure that side effects are not contributing to the fall. Simple measures like these can help maintain Dad’s independence and prevent injuries. Additionally, most families will find Mom and/or Dad to be agreeable on simple solutions.
Averting a crisis by meeting Mom’s needs is the real issue in our illustration. Really, she is the one that needs support now. It is well understood that most seniors prefer to live their lives independently in the comfort of their own home. If Mom’s needs do not get met because she says “she’s fine” it could lead to a crisis requiring alternate arrangements that could include requiring 24-hour care or an assisted living facility, both of which could be costly.
So, the little bit that could to be done would be to identify tasks that could be removed from mom’s responsibility that she would agree with. In many traditional families, it is mom who takes care of household tasks such as laundry, cleaning, meal preparation, and grocery shopping. These tasks which were once easily done by Mom caring for a family can now be daunting later in life. Simple things like having groceries delivered to the home or signing up for Meals on Wheels are very helpful. I have found that a lot of moms are more than happy to give up those tasks. Hiring a housekeeper once a week is another solution that many are happy to agree with. Doing a little bit now before a crisis occurs can help to maintain independence in the home.
Mom should also be provided with support and recreation. In my example, Mom used to socialize with her friends and partake in hobbies. Now she is withdrawn and pensive.
Sometimes moms will give up their social life for fear of leaving Dad alone. Arranging a part-time caregiver a couple of times a week could ease her concerns. She could also sign on for a life alert system which are very effective for very little cost. Support groups are also helpful. Many seniors become isolated and feel alone. These situations are very common. Mom should know that she is not alone.
Communicating delicate matters requires an understanding and empathetic point of view. Parents may not want to be told what to do or have their vulnerabilities pointed out to them. Offering simple solutions is far less daunting than fearing the worse and pointing out potential for crisis. Starting with Dad will help Mom to see the need for assistance and start to make changes. Changes don’t happen overnight, and a little bit is always better than not a bit.