With the graying of America, more families face tough decisions

In 1982, when Milwaukee-area architect Fred Poethig retired from the firm he and partner Bob Stuerwald founded in 1955, it was to the home he designed and built in Milwaukee. But as he and his wife entered their 80s, they had no family to care for them.
"We were doing well, but it got to the point that if something did happen to us, we only had each other," he says. "We wanted a place to live that also provides a broad spectrum of health care for the rest of our lives. After looking at a number of facilities, we chose The Village at Manor Park, and moved in November 1999."
Poethig is satisfied with his decision. "We have a two-bedroom unit in the independent living building called Wesley Park. We were actually able to move all our furniture here except our old kitchen table and chairs," he said. "We’ve got fine neighbors, I’m treasurer of the residence council and we’re happy here."
The Poethigs are among a growing population of people 60 years and older that has increased 170% in Wisconsin alone. While nine out of 10 of those people want to continue to live independently as long as possible, and most want to remain in their homes, many will need help to do so. That assistance most often falls on a close family member, such as a son or daughter.
"The National Alliance for Caregiving reports that family caregivers spend an average of 22 hours a week helping their elderly relatives or friends," says Jenny Rayl, president of Home Instead Senior Care, a nonmedical services franchise with almost 400 sites in America, Canada and Japan. Jenny and Steve Rayl operate three offices in southeastern Wisconsin (Wauwatosa, West Bend and Mequon).

Where to start
If you don’t have 22 hours to spare, there are places to turn. And most resources will point you to other services if theirs don’t meet your relative’s needs. One complete source of information is Senior Resources, a Germantown firm that publishes free guides on health care for older adults and senior housing options. You can call 262-253-0901 or visit its Web site at www.seniorresoucesonline.com. The guides are specific for different areas in Wisconsin.
The health care guide, for example, lists adult day services, care coordination firms, homemaker/companion services, home health and medical equipment resources, hospices, hospitals and skilled nursing facilities, and provides useful articles as well. It also has informational phone numbers for agencies, a national eldercare locator, and county departments on aging and benefit specialists.
A needed first step, however, is to determine what your senior relative’s needs are. Ideally, that can be done in a family conference where the older parents and their adult children can openly discuss:
— Whether all paperwork (insurance policies, will, durable powers of attorney, household inventory, etc.) is order and where it can be accessed;
— The parent’s wishes for living arrangements, now and in the future
— Finances available now and down the road;
— Any help required and acceptable to all parties;
— Medical conditions and how they’re currently being handled, plans if those conditions worsen, preferred doctors, clinics, hospitals, etc.

"These matters all need to be discussed and clarified over time or in one big session," suggests Miriam Oriensis-Torres, co-founder of Geriatric Support Associates (GSA), a care management firm in Milwaukee. "The trouble is, it’s difficult for adult children to switch roles and begin looking out for those who cared for them for so long. Understandably, older adults don’t want to admit they need help and often are resistant to accepting it. Sometimes a neutral third party can come in, assess the situation and make suggestions with more impact and acceptance than the adult child’s ideas."
Assessments by geriatric specialists are usually done at no or little cost and provided by care coordinators, such as those at GSA or non-medical service providers such as Home Instead.
County human services or elderly services departments also do assessments to qualify people for county benefits and/or for the state-funded Community Options Program (COP), but waiting lists can be long.
"The goal is to create a plan the older person will accept," Oliensis-Torres says. "We’ve found expectations vary. The son or daughter might have higher standards about the parent’s housekeeping, diet or social interaction, while the parent is perfectly happy. A neutral but knowledgeable ‘outsider’ can create a plan that may not cover everything the adult child or the caregiving firm thinks is needed, but act as a beginning. Change must be incremental; there’s no quick fix to alleviate all of the family members’ anxiety and concerns. Any first plan can be amended over time, and often is as the older adult gets more comfortable with having someone new come to their homes and a trust relationship is established."
She points out that it’s important to call in an experienced, well-trained person.
"In some situations, the older adult can’t perceive her real needs or the reality of the situations," Oliensis-Torres points out. "You need someone who can understand if the older adult is expressing his preferences and values or displaying a cognitive impairment."
If the initial assessment does point to a situation where the older adult’s welfare or health is threatened, people doing the assessments will act aggressively to find help for the person.

The next step
Once you understand what your parent needs and is willing to accept, financial and health factors will probably dictate if you can rely on volunteer organizations, often run by religious groups, or go with a paid service.
The Family Caregiver Support Network, which offers interfaith older adult programs, may be a good resource. You can reach it at 414-220-8600, and
find it and other such agencies at:
— www.living-options.org
— www.caregiversupportnetwork.org
— www.eldercare.com
Those sites also can be a wealth of information on elder care.
If you determine your parent only needs help with daily tasks, a care service like Home Instead may be the way to free your time and get the assistance your loved one needs.
"After our initial meeting with the older adult and family, we develop a plan of care, how many times a week a service is required, what things should be documented for the family, and specific services to be performed," Jenny Rayl says. "We match the person with one of our well-trained caregivers from that neighborhood, who knows the banks, stores, clinics, parks, etc."
Services vary from companionship, grocery shopping, transportation, meal preparation and light housekeeping to coordination of lawn care or home maintenance people, assistance with pet care, respite for the primary caregiver, or supervision while the primary caregiver is on vacation. "Some of our not-so-typical services are provided within a care facility to give the older person some needed one-on-one attention," Rayl says. "We can provide overnight care for those who may be in risk of falling, get people ready for bed, drive the senior to an adult day care facility, or do something simple like help put together photo albums, or take the person for a drive by the lake. Because we’re in the home frequently, we’ve even uncovered mail and phone schemes, and foiled the ‘con man’ from praying on a senior citizen."
For one of Home Instead’s families, the care services have stopped nightmares and tears for the primary caregiver, who is the wife of a Milwaukee area law firm’s senior partner.
A Glendale woman, who prefers not to be named in this report, was really concerned when her mother-in-law stopped going to the beauty shop, lost weight and was sleeping all the time.
"We knew we had to do something, so we called Jewish Family Services. They highly recommended Home Instead," the Glendale woman recalls. "Now Lorraine comes in from 10 a.m. to 1 p.m. every day. She does light housework, feeds Mom breakfast and puts out simple, explicit directions for preparing supper, grocery shops and finds bargains with Mom, and takes Mom to the beauty parlor. Mom thrives on the companionship. She looks better, takes the medicine I organize for her weekly, and is eating so well she’s gained back the weight she lost."
The Glendale woman believes the arrangement is a good compromise. "Mom is almost ready for an assisted-living facility, but she loves her apartment and doesn’t want to move. My nightmares and tears whenever I thought of Mom are a thing of the past. When I pop in to see Mom and Lorraine, they both get a hug now. And unlike many bills, Mom never balks about writing out a check to pay the reasonable tab for Lorraine’s services."
For more information on how to select a caregiving firm, see the adjacent box.

Getting more help
Care coordinators can help sons and daughters in a variety of ways. They’re typically trained as social workers experienced in eldercare.
"Some people ask us to act as a consultant to make recommendations about what the elderly person needs," Oriensis-Torres relates. "Other families want us to introduce services, monitor progress and tweak the plan. We work with everyone involved in that person’s life, too, to find appropriate resources, whether that’s financial, legal or medical; in-home and community-based care such as caregivers, delivered meals, transportation and adult day care programs; and a wide range of alternative living arrangements."
Time frames also vary. "If we assess the situation and put a plan of care in place, it may stay that way for six months to three years without our further intervention," she explains. "Then if something changes, the adult child will reinvolve us to find the additional services their parent needs. We can provide the continuity and background to whatever service agencies are required, saving the client family stress and time."
She adds, "Part of our service is emotional support for the family. For those in the area, we co-host a monthly discussion group on caring for an aging relative. If the family lives elsewhere and can’t visit often, they know we’re here to monitor the situation and respond to emergencies. We don’t have a financial relationship with any providers and won’t accept placement fees, so families can trust us to act on their behalf based on our judgment of what’s best for the older person."
To find a care manager in your area, the National Association of Professional Geriatric Care Managers maintains a Web site (www.caremanager.org). For more information, call 520-881-8008.

April 18, 2003 Small Business Times, Milwaukee, By Kay Falk, for SBT

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