"Aging in Place"—Weighing Caregiver Options

Many older adults wish to remain in their home of choice as long as possible. Here are three important elements to consider that can help you successfully "age in place."

When it comes to aging in place in one’s own home versus aging elsewhere, such as an assisted living facility, older adults—no matter what their condition—almost always want to remain at home. It is comfortable. It is familiar. It is home.

For someone with Alzheimer’s or other forms of dementia, aging in place is a viable alternative to living in a facility, and it comes with many considerations.  What can a family do to make aging in place a reality for their loved one with Alzheimer’s or dementia? Below we look at three overall elements—caregiving, safety, and health and well-being, to successfully age in place at home.

Caregiving

To provide caregiving for one with Alzheimer’s or dementia, families have multiple options:

• Family Caregivers: If a family is considering the option of being the in-home caregiver(s) for one with Alzheimer’s or dementia, it can mean reducing one’s work schedule, taking a leave of absence from work, or quitting one’s job. Leaving one’s job means loss of income, benefits, and professional status.
• Private Caregivers: In the absence of available family caregivers, privately hired caregivers, available through an agency or by contracting directly with a caregiver, are options. Private duty caregivers are either Certified Nursing Assistants or Home Health Aides.
• A Combination of Family Caregivers and Private Caregivers: this combination can work well for many, especially when family wants to be helping in the home and involved, but cannot do so on a full time basis. The professional caregivers might cover the weekdays, and the family caregivers the evenings and weekends.
• Local Senior Centers or Adult Day Care Centers: Enrolling your loved one in a program at the local senior center or Adult Day Center is another option. Senior Centers and Adult Day Centers are available in many communities throughout the U.S. Contact your local Area Agency on Aging to learn the local options.

Over the course of your loved one’s aging process, any or all of these options might be used. Because of this, if a family has privately hired caregivers, it can also be wise to maintain a relationship with a local agency, as one just may be needed in a pinch, or to cover caregiver vacations.

How Does the Caregiver Get Paid?
With agency-provided caregiving, payroll and benefits are managed by the agency. With this arrangement, the family pays the agency each pay period. When a family hires a caregiver privately, the family becomes the employer and manages the payroll and benefits.

Additional caregiving information is available at the Home Care Association of America website at http://www.hcaoa.org/.

Safety: A Top Priority

No matter where one lives, safety must be a priority. For a person with Alzheimer’s or other dementia, it will mean different things at different times in the progression of the disease, but it should include the following:

• Proper indoor and outdoor lighting, locks on doors, area rugs pulled up or taped down, and a clutter-free environment.
• A kitchen that is safe: the stove and oven knobs are covered to eliminate risk of turning the stove or oven on, sharp kitchen utensils are hidden and/or locked out of sight.
• The water heater set to a temperature no greater than 120 degrees, an emergency response system if still appropriate for your loved one’s ability, and use of a monitor to hear when he/she gets up during the night.
• A dementia friendly bathroom: a walk-in shower or bath, grab bars, a shower seat, and a hand shower.
• When and if the need comes, having a person to contact to install a ramp for wheelchair access.

For more detailed information regarding safety in the home, see our article on making your home dementia friendly.

Health and Well-Being

Health and well-being includes:

• Consistent medical care with primary care and specialists needed to manage your loved one’s care.
• Medication management and administration when your loved one can no longer safely manage them independently.
• Daily exercise—walking, gardening, dancing, tai chi, strength training, and stretching, to name a few.
• A comfortable bed at a safe height, or a hospital bed if one is more appropriate for their needs; comfortable clothing; and a favorite item that is soothing and relaxing.
• Socialization—including family gatherings; a few days each week at the senior center; church services; an art class; and other activities and settings your loved one enjoys. Create social events at home with family and friends, and encourage your loved one’s participation in the events. Provide help when they need it.

And You?

Finally, and every bit as important, is to remember that as a caregiver you will need respite—a break from being a caregiver. It is so important, and with it, you are likely to be a better caregiver, and a better you.