Who, what, where (continued)

As a member of the National Association of Professional Geriatric Care Managers, Miles specializes in helping older adults and their families select appropriate care services to enhance the quality of life for the aging. Services start with an in-home customized care plan. Often, the first step is bringing help into the home to keep the elder family member in familiar surroundings. Access to transportation can make a huge difference for someone who no longer drives. So can management of medications. Fees vary for private care managers, who can assess what’s needed, arrange for services, help with legal, financial and insurance issues and coordinate various government, private and community services. Geriatric care managers might charge from $250 to $600 to assess and develop a care plan, and hourly rates thereafter of $80 to $150 to coordinate care and communicate with the family.

Delicate situation

But how does one know when help is needed? It isn’t always obvious when it comes to today’s aging World War II-era seniors, says Ellen Costilla, a supervisor with the city’s Department of Senior Affairs. The so-called “greatest generation” regards home as castle, she says, and often is reluctant to ask for help-or pay for it, for that matter. Grown children living across the country might not be fully aware or might be in denial about their parent’s frailty or confusion. Miles adds that other telltale signs that a parent may need support are a loss of weight, neglect of grooming or skipping normal activities. Sometimes, however, there is little doubt the elder family member should no longer be living alone. A medical emergency such as a broken hip or a stroke often is the deciding factor. “A lot of what I end up doing is crisis management,” concedes Miles. “Many families need solutions and answers right away.” Family dynamics play a role as well. Siblings may have definite, but differing ideas about caring for Mom and Dad. But one thing is certain, say the experts: The earlier that families start planning care services or living changes for older adults, the greater the options. Indeed, many of the subsidized services and government-funded housing have waiting lists. “Just remember,” says Miles, “if the older person can plan ahead, their children will not be making these decisions for them.” While staying in the family home may be the preferred option, it isn’t always the safest or the most sensible, particularly if the older adult suffers from dementia or is isolate and depressed. Running a household, particularly a large family home, isn’t only expensive, but can be a never-ending circle of chores, expenses, maintenance and repairs. In considering whether a move is advisable, Costilla recommends clients ask themselves: “Is my quality of life good? Am I starting to feel overwhelmed in keeping up with expenses? How much am I paying in water and heating bills and property taxes? Is cooking for one too hard? Would shared meals be more enjoyable? Am I lonely?”Exiting a family home doesn’t mean the next step is a nursing home. There is a multitude of options between those extremes: retirement apartments, mobile home parks, or family homes in communities geared for seniors, life care communities offering varying levels of care, assisted care apartments, affordable city apartments and residential care homes scattered throughout the community. In recent years, the call for help comes as frequently from the worried grown children of older adults as from the senior. That phenomenon comes as little surprise to Costilla, who sees an array of new services geared to caregivers. These programs offer in-home counseling, ongoing support groups, respite care or retreats to ease the caregiver’s burden.

“The newest client in the aging network is the adult family caregiver,” Costilla says. “It might be a spouse or a child, but that’s who we get the most calls from.”