A Time of Transition

Housing options for the frail elderly are more numerous, but still a difficult move.


Albuquerque Journal

This year, Juanita turns 80. And this year, she may move from the small house in Barelas that she has called home for 50 years, the place she and her late husband raised their children and nurtured the grandkids.

Juanita could be me or you, our mother, sister, aunt or grandmother. Her story could be that of our father or grandfather. She is a composite creation for this story from the issues raised by people in this situation, their families and experts in senior care.

Juanita’s leaky roof needs repair. The winter heating bills are a financial burden even though she keeps the thermostat at 65 degrees Fahrenheit and she wears a sweater during the daytime. She has been forgetful about taking her medications recently, and she worries about falling when she takes a shower. Still, Juanita is loath to more even though her children have noticed the decline in her health and energy.

“The American dream is to stay in your own home—no matter what,” says Sharon Miles, a licensed master social worker and owner of Senior Care Options (seniorcareoptions.net), a private company specializing in family solutions for senior care challenges.

Juanita’s story resonates with Miles, whose own mother once needed more help to stay in her home than her working daughter was able to provide. Twenty hears ago, Miles’ mother landed in a nursing home, as she needed increasing assistance with bathing, meal preparation, transportation, and housekeeping and medicine management. Her mother’s journey into aging prompted Miles’ return to school to train as a geriatric care manager.

In 2007, Juanita’s options may be more numerous, but they still can’t be described as obvious or easy. She could move in with one of her children. She could stay in her home and rely on a home companion to come in several times a week to help with cooking, cleaning or bathing. She could be eligible for assistance that would make her home warmer and safer, starting with the installation of grab bars in the slippery shower. She could more to a retirement complex that offers assisted care.

Who, what, where

Her choices—any senior’s choices—may be numerous, but they’re far from clear-cut. Solutions hinge on income and savings, physical and mental health, availability of services and apartment openings, and even family dynamics. A good start to navigating the myriad of programs and community resources available to provide care for you or an aging loved one is the Albuquerque/Bernalillo County Department of Senior Affairs. As an agency administering local, state and federal funding, the department is a veritable library about resources from recreational programs at senior centers to assistance in securing subsidized housing for the elderly.

Want a list of grocery stores or pharmacies that deliver items to the home? Wish you knew more about volunteer options for active older adults? Need home-delivered meals? Wonder how to find an in-home companion several times a week for chores and socialization? Do you know how to access transportation services to get rides to doctor’s appointments? Wish you had a list of assisted care facilities within the metro area, along with the average monthly fees? The Department of Senior Affairs offers pamphlets and a “Quick Guide to Senior Services” with phone numbers and information about these resources and many more. For most every service offered by governmental agencies—many with incomes stipulations and waiting lists—there are private-pay options for those who can afford them, according to Miles.

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.”