Waiting too long

1. Waiting too long What Happens When the Decision to Move to Assisted Living is Delayed

2. What We hear • From the Elderly Person: • I want to stay in my house as long as I can • (and without adequate assistance) • I’m not ready for “this” right now • (“this” is synonymous with perceived loss of independence) • From the Adult Child(ren): • I want mom (or dad) to decide for him/herself • (I am afraid to overstep my bounds) • Dad (or mom) is doing ok for now • (and hopefully it will stay like this forever)

3. The Adult Child – Translated…. • We are waiting for a clear sign to tell us it’s time to get help for our parents. The signs we are hoping to see are: • Mom or dad will wake up one day and announce “ok, let’s go!” • Mom or dad will hire help on their own and without our intervention. • Mom or dad will remain at the current level of decline and not need additional assistance or placement. • Our parents will suddenly improve and we won’t have to worry about it.

4. The Elderly Person - Translated…. • We will ‘know’ when we are ready • We don’t want to face this decision • We don’t want to spend the money • We don’t want to lose our perceived independence • We have no idea what’s going on • Someone will be mad at me

5. The CLEAR SIGN – not what we thought it would be • The ‘clear sign’ you are waiting for will happen. But it won’t be what you expect. Most likely, it will be one of these: • A fall that results in an emergency room visit • An accident in the home • Mom or dad will be a victim of financial exploitation • Mom or dad will be a victim of physical or mental abuse • Inappropriate decision making when faced with a problem • Mom or dad no longer recognizes his or her children or grandchildren • A medical condition arises that could have been prevented and now needs hospitalization to correct (malnutrition, dehydration, infections) • The inability to take medications appropriately

6. The signs, explainedFalls This year, one out of every three older Americans will fall. Their injuries will account for almost half of new nursing home admissions and many will die within the year from complications. “One of the biggest fears is, if I tell my children that I fell or my doctor that I fell, they will think that I’m incompetent and can’t take care of myself and therefore I will go to a nursing home” The elderly will fall numerous times in the home but won’t report it because if they didn’t get hurt, it didn’t count!

7. The signs, explainedaccidents Falls account for 75% of all accidents at home. The elderly person was at home alone 79% of the time. • The bathroom – 29% • Living or sitting room – 18% • Kitchen – 14% • Bedroom – 11% • Dining room – 10% • Injury by sharp object – 8% • Ingestion of foreign object – 6% • Crush injury – 4% • Burns/scalds – 3% • Hit by/onto fallen objects – 3% • Electric shock – 1%

8. The signs, explained.Financial Exploitation and Physical Abuse • Financial Exploitation and Physical Abuse Elderly victims are often reluctant to report abuse because they feel ashamed…. and may even defend the abuser. That is because the perpetrator of abuse are generally family members (28%), caregivers (17%) or friends and neighbors (7%). Victims frequently rely on the abuser for some type of care-giving services at home and are afraid if the abuse is reported they will be placed in a nursing home.

9. The signs, explainedfinancial exploitation and physical abuse • Financial Exploitation and Physical Abuse • In an effort to appear independent, the elderly will often place their trust in others who offer hard-to-understand investment options; home maintenance; companionship and friendship.

10. The signs, explainedinappropriate decision making • True Story: A panicked son visits an assisted living community for placement options because his mom was found walking in the street mid-day in 112 degree weather because her air conditioner was not working and she didn’t know what to do. • True Story: An elderly man working on his front yard negotiated the ‘sale’ of his $40,000 travel trailer to a passing stranger who drove the vehicle away with a promise to bring back the money from the bank.

11. The signs, explainedmemory loss • Memory Loss • Families will ignore or minimize memory loss as a sign of normal aging until the day their parents are unable to remember their own children.

12. The signs, explainedself neglect and pet neglect • Self Neglect • Characterized by failure to take medications or taking them inappropriately • Disregarding health or safety needs • Substance Abuse problems (alcohol or drugs) • Hoarding • Under-nutrition, malnutrition and dehydration • In addition to self neglect, there is also the neglect of pets • Forgetting to buy food or feed the animal • Allowing the animal to relieve itself indoors or forgetting to walk the animal • Having an excessive number of animals • Disregarding the animals health needs • Physically abusing the animal

13. Band-aid solutions • Enlisting family members to take on the role of caregiver • Stress and exhaustion sometimes leads to abuse • Hiring unqualified caregivers based solely on price or convenience • Allowing the aging spouse to take on the bulk of the care responsibilities • Adjusted for other factors, strained elderly spouse caregivers were at 63 percent higher risk of death than non-caregivers

14. Outcome • Choices have become narrower • A discharge from a hospital stay or rehab leaves little time to plan • The family or nearest friend usually has 48 hours or less to find appropriate placement or in home help • The choice will be based solely on availability • The elderly person will have little or no say in where he or she will be placed

15. Outcome, continued • Costs are Greater • Placement in assisted living or qualified home care services after the crisis means level of care is usually higher and therefore more expensive. • Ancillary services such as physical therapy add to the costs. • Permanent disability or ongoing medical conditions require supportive services and equipment that add to the overall costs. • Assisted Living Services, when properly assessed and administrated, can prevent crisis and slow the addition of services which result in less money over time.

16. Outcome, continued • Quality of Life Diminishes • Isolation • Decreased Participation in social activities • Diminished communication skills • Loss of functionality • Loss of privacy

17. Qualified assistance • Choosing a qualified assisted living community or homecare giver before a crisis offers many positive outcomes. • Less Trauma • Avoid physical and mental breakdown • Preserves Assets • Lower levels of care needed • Avoids costly legal intervention • Allowing the elderly person to be his or her own decision maker • Still has the capacity to make an informed decision • Lives a significantly healthier lifestyle • Better Nutrition and meals • Properly administered medications • More social activities • More physical activities • Secure environments