There is a phenomenon that takes place over the holiday season that all service providers for seniors are familiar with: Adult children coming home for the holidays and being surprised to find that their parents or loved ones are not doing well cognitively and/or physically. There is a deluge of calls from these adult children looking for immediate services – because they need to go back to their homes after the holiday is over.
Now you might wonder why this happens. Dutiful sons and daughters undoubtedly talk with their parents/loved ones over the course of the year. But here is the kicker – older adults at the early stages of dementia are able to maintain cognitive skills for a short phone conversation. Even if they struggle a bit – most adult children will make up reasons why they are struggling. But the truth of the situation is undeniable once they walk through the front doors and actually see their parents. Their physical appearance may be the first clue – they just don’t look as robust as they used too. If the older person has been open about health problems over the course of the year – then their physical appearance may not come as such a surprise.
First Glance
But if you look in the refrigerator and the food is sparse – or outdated, then you have another problem. As you start to go through the house you see dirty laundry, a general lack of housecleaning and the worse sign – a desk or table filled with unpaid bills. All of these signs come as a complete and devastating surprise. And, you don’t know what to do first.
So here is a little advice if you find yourself in this situation. First – take a deep breath. This will slow your brain down a bit so that you can get your bearings. Do not start yelling or get visibly upset. Remember that your parents are older adults who have had autonomy and independence all of their lives. They may not understand why you might be so upset and they most assuredly are fearful of losing their independence. That is why you are so surprised now – they hid their situation from you. Give your parents a big hug and sit down and have a cup of coffee/tea. If there is a routine you would normally go through – go through the routine. You are dying on the inside but you have to make your parents feel comfortable enough to be able to talk to them. Only if they feel safe will they open up to you.
Your Parents’ Finances
Go through the pile of bills or financial papers that are piled on the desk. You must make sure that there are no disconnect notices, past due bills that are old, important papers that need timely attention or even any scams that come through the mail. Financial skills are the first to decline – even before a diagnosis is made. Don’t just rummage through all of this by yourself. Ask your parent to show you what they have been doing. It is possible that they can’t be of any help and you need to take care of sorting all of this out yourself. That’s okay – but always ask them to sit with you while you go through their finances. This is the last bastion of independence and it is crushing to give it up. Some older adults will hide their finances because they do not want their children knowing about that part of their life. You need to take care of the most urgent matters first. Then you need to contact any financial professionals your parents associate with. And, a trip to an elder law attorney would be wise. Now if your parents have documentation that they assigned a Power of Attorney for Finances to someone or set up a trust – without your knowledge – you need to know. The most important part of this initial discovery process is insuring that your parents are protected and their financial partners are acting in their best interest. If you fill that role, then you need to make appointments with all of their financial partners to set up contingency plans that might be in place for you to assume responsibilities for their finances.
Medical Evaluation
You need to talk to your parent’s medical doctor. If this doctor wasn’t aware of their situation, then you immediately look for a geriatrician in your area. This doctor is a specialist in aging. Geriatricians not only examine older adults for physical conditions related to aging – but they also do a cognitive assessment. It is important to know what you are dealing with – not all behavior like this is due to dementia.
Your Parents Ability to Live Independently
After gathering all of this information, you have to now look at the ability of your parents to live independently. There are various assessments that can determine if your parents are able to care for themselves. IADLs are instrumental activities of daily living. These include skills needed to live independently – cleaning and maintaining a house, managing money, moving within the community, preparing meals. All of these skills are necessary to live independently with no outside help. And then there are ADLs – activities of daily living. There are six basic ADLs: eating, bathing, dressing, toileting, transferring (walking) and continence.
Chances are they would be deficient in IADLs at this point. That still requires some decision-making because they are not able to live safely by themselves. This is where the resistance will start to occur. Now – you are talking about their independence. No one wants to lose their independence. You have to have a thoughtful, gentle conversation about what’s next. You can’t just dictate what they are going to do. They are still people who now need help. They are not the disease that they might have. So please remember their personhood and be mindful of what they want. At this point you can go alone trying to figure out next steps or you can enlist the help of a geriatric care manager. These are extremely knowledgeable professionals who understand what your parents need and know the resources available to help you find it. Whether you parents are cognitively aware of what is going on or not – include them in all of the decisions that are being made. Ask them what they like and what they would like to do. Keep them part of the process and they will feel like they had a part of the decision-making. They will maintain some autonomy, dignity and self-respect if they feel it was their decision.
What’s Next?
As you can tell – this might be a process that takes much longer than your holiday visit. Do not force your parents to return to your home. Make arrangements for home care to come in to make sure that they are doing okay. They can take care of cleaning, meal preparation, etc. There are many non-medical agencies available to help your parents. Have all of their mail forwarded to your house so that you can pay bills. There are many tech options available too. You can do Skype calls or Facetime calls so that you can see them. There are PERS units – personal emergency response systems – that your parents can wear to make sure that emergency personnel are alerted if they should fall. There is a lot of new technology available to allow your parents to live at home safely and allow you to be able to monitor how they are doing.
Your life has changed. There are a lot of decisions that must be made and don’t believe that you have to make all of these decisions on your short holiday visit. Take the time to give your parents lots of hugs and love. This could turn out to be the most memorable time of your lives.
