Over The River and Through The Woods

That old holiday song is coming around again, and so it is time again for some thoughts on visiting with elderly parents or grandparents. Enjoy the Thanksgiving turkey, but keep your eyes and ears open for some telltale signs that grandma may need some help in managing her daily life. Those signs may be as simple as letters and business correspondence scattered about in no sensible order. It may be late bills. It is often unopened correspondence.

If you check mom’s daily or weekly pill box, you may discover that she is missing days. Or dad may seem to wear the same clothes every day. The refrigerator may have old food, or be very spare in contents.

These are warning signs that the parent may be in decline and need help, physically, socially or financially. It's not an easy thing to admit, or to discuss, as everyone wants to maintain independence and dignity, but approaching issues in a gentle, suggestion giving way may result in a surprisingly eager response from mom or dad. Do it after the turkey has made everyone full and mellow, but before they doze off.

What are the issues to broach?

First and foremost, the need for safety and care. If memory or dementia problems mean mom is missing her heart medications, then solutions may involve a relative or paid worker to monitor her in person or by phone.

There is a pill dispensing machine that can be rented or purchased. It will dispense a pill and beep when it is time to take the pill. It’s smart enough to sense if the pill is taken within a specified number of minutes, and if not taken it will pull the pill back into the machine, and automatically telephone a child or other monitoring person to notify them that mom has not taken the pill. That way, mom will not under medicate. The reason the machine takes back an unused pill is to prevent over medication. The dispenser is not so savvy that it can outsmart mom, if she takes the pill out and throws it away.

Falling may be the single biggest risk for any family, because a broken hip in a frail elderly person may end their ability to walk, and if they can't walk, then the chance of needing nursing home care rises dramatically. To minimize such risk, single floor living is important. If the washer/dryer is downstairs, bring it upstairs. No sense having mom prove she is still in Olympic class shape going down the cellar stairs with the wash basket in one hand and the soap in the other. The English kept their servants in the back room, so there is no reason we cannot put the washer/dryer in the closet in the spare bedroom. Expect resistance on this however, because such change is a symbol of decline.

Another risk for falling can be throw rugs. They are just an accident waiting to happen, because a toe catching an edge can lead to a fall. Don’t use throw rugs. And while you are at it, make sure the wall to wall carpet doesn't have bunches or ripples in it which could also trip a person.

Bathrooms are rightly considered the most dangerous rooms in any home, because of hard slippery services. Getting into and out of a bathtub can be aided with a simple transfer seat, and the risks of standing and slipping in the tub can be reduced with hand holds and a telephone shower at sitting level.

Another concern may be reduced social contact. This can come about due to reduced ability to travel, or dementia, or depression issues and make a person reluctant to join others for fear of not remembering names or events. Assisted living facilities might offer a ready group of people for socialization, and scheduled activities led by social workers who know how to encourage participation.

Next of concern may be financial and legal issues. Tread lightly and ask gently as mom or dad may not be ready to relinquish control of the checkbook. But sometimes a parent will welcome a child's help with bill paying and this can be the entrée to a beneficial discussion of where important documents are kept, and whether or not each parent has a durable power of attorney, a health-care directive, and a will or trust.

There may be no more critical documents than a power-of-attorney and health-care directive with the appointment of a health-care representative, because if mom or dad were suddenly incapacitated, those are the documents which allow the family to handle their financial affairs and health-care decisions, and protect their assets.

In many cases, parents feel much more comfortable having their children help them in addressing their needs as they age. The holidays may be the opportune time to make an appointment with a qualified elder law attorney to review and address your parents need for care, legal documents and financial planning, and learn about the various state and federal programs that may be available to help them stay safe and healthy at home for many holidays to come.

Having you there with them to help plan and decide on the necessary documents and planning strategies required for their care may be the best present you could give. Happy Thanksgiving.