Author Topic: In-sourcing eldercare - the good, bad, ugly?  (Read 2081 times)

Moustachienne

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In-sourcing eldercare - the good, bad, ugly?
« on: February 08, 2018, 12:50:49 PM »
As we've seen on other threads, figuring out how to best care for our aging parents is very complicated and there is no one right or wrong approach.  Time, money, distance, family history and dynamics all play huge roles.

DH and I are about to take his 90+ mother into our home for the duration of necessary medical treatments and their aftermath, maybe up to 3 months.  We'll assess after that. She has plenty of savings* but we reached this decision because we felt that family could provide a level of care and comfort that paid home help/care home just couldn't for this period.  We are recently retired, in the same city, with no children - all factors in us feeling able to do this. We will be getting home nursing and other health system support (Canadian system).  We will also hire some respite carers.  Co-ordination of all this will be a big thing.

So my question is to others that have decided to do this kind of "in-sourcing" for aged parents.  What's your experience?  What's been good?  What was tough?  What was unexpected, good or bad?  What kept you sane? :)  Judgement free zone, of course!  We are all just doing our best.

*MIL has over-saved by some magnitude and her inability to spend wisely on herself is one of the reasons we need to "take over" right now.  But damn, we appreciate that we can throw money at her problems when necessary without jeopardizing our own finances.


socaso

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #1 on: February 08, 2018, 04:17:09 PM »
We just went through this last year with my MIL. She was diagnosed with Alzheimer's. Initially my husband tried to let her stay in her house, which was her first choice. He had people coming by daily to provide care but was still getting information every day that she was not taking meds or eating properly. After a couple of months he had to find an assisted living home. It's much better, they make sure she gets all her meds and food and such. She's not that crazy about it but her main objections are with the other residents and not with the care she receives. Alzheimer's is known to make people have shorter tempers so I think we would have been facing her irritations in one area or another.

I wanted to help my husband but there was very little I could do because he was given power of attorney and other things like her medical directive. Once that happens there is very little any other person can do because the lawyers and doctors and such will only deal with the person who has been designated.

The whole thing was just sad. She doesn't have a lot of money and options were limited. I think the thing that helped my husband the most was that I just took over a lot of the home responsibilities so he could focus on her.

AMandM

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #2 on: February 08, 2018, 05:50:23 PM »
Based on my family's experiences, it's important to keep up activities of your own--seeing your friends, going to concerts, biking or hiking, whatever your current hobbies are.  Caring for a an elderly relative can become all-absorbing if you let it--don't let it! It will be more work than you expect, but make sure it doesn't take over your entire life. I hope this doesn't sound too negative--these experiences were also deeply, deeply rewarding.

Pay attention to the personal care that your MIL will want--by which I mean not the medical care, but the ways of looking after her that show she's a person, not just a collection of symptoms.  For my grandmother-in-law, that meant doing her nails regularly with pretty colours.  For another relative, it meant keeping her hair dyed and styled.

I highly recommend Atul Gawande's book Being Mortal. It has a lot of discussion of the ways in which caring for elderly people is more complicated than the standard medical "fix this problem" approach, and about the kind of conversations that are essential to discover what matters most to the patient.


Sun Hat

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #3 on: February 09, 2018, 07:05:37 AM »
My mother is coordinator-in-chief for my grandmother's care - also in Canada. GM has dementia + cancer and was also an over-saver, so fortunately my mother and uncle (who have joint PoA) are able to throw money at the situation to keep GM in her own home as long as possible, which has always been her priority. When GM started to need more around-the-clock care, she insisted that it be done by her 5 children alone, which soon exhausted the only 2 who were willing (GM is fiercely critical of her children).

A few months ago, my mother explained that even the Queen had paid help, and if it was good enough for Her Majesty, that GM can tolerate paid help too. Despite early objections, GM has quickly adapted to the home care aides. A note of caution though, my mother has applied for provincial funding to offset this cost, and has been told that it'll take up to 18 months to be approved, by which point GM will likely have passed, so it's fortunate that she can afford to pay for it out of pocket).

Similarly, when my mother inquired about a nursing home, she was told that if you apply, you have to take the position as soon as it becomes available, and that if you decide that your elder can stand to be at home a few more months and decline the position, you have to go to the back of the line and even then, get a lower priority than first-time applicants. This is in Manitoba, hopefully things are more straightforward where you are (it's also quite possible that my mom has put a negative spin on the process since she's the most resistant of her siblings to the idea of putting GM into a nursing home).

The good news is that since they're self-funding, my mother was able to hand-pick home care attendants, and both she and GM really like the help that they've found. The hired help arrive in the early evening, cook supper, chat, spend the night, and in the morning, they hand off to a family member for the day. My mom and uncle still spend a night or two there per week, but I suspect that as GM's condition worsens that they'll hire even more help.

I hope that things go well with your MIL. Having the money to buy options really helps make a difficult time easier.

Linea_Norway

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #4 on: February 09, 2018, 07:23:17 AM »
When  MIL got dementia, FIL started to look after her in their own house. Without receiving any aid from society. This went reasonably well, until she started to get up 10 times at night and started to do uncontrollable things. FIL did not get enough sleep. He also couldn't get done anything for himself. Then finally she got an emergency place in a care home, a stone throw from her own house and lives their permanently now. FIL finally has a life again.

I think it might be very overwhelming to take care of a person if you are the sole caretaker and the person in need requires day and night care. Normally day and night care would be divided by different shifts or people. Don't start doing it yourself.

goatmom

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #5 on: February 09, 2018, 04:49:17 PM »
I had some experience doing this with my mom who had the usual old people diseases including dementia and incontinence. She had no money other than about 800 in SS monthly.  We moved her into our home one year before she passed away in her sleep.

The Pros:

1.  I knew she was getting good care from loving people.  Having dementia can be scary - sometimes she needed one of us to hold her hand and just reassure.  I made sure she had clean clothes on and was kept clean.  She wore stylish clothes and had frequent manicures from willing grandkids and nieces.
2.  She always had her favorite foods served at the right temperature.
3.  She had plenty of company - my friends, kids friends, kids, neighbors, workmen, etc.
4.  It was easy to include her in things - if I was going somewhere - I took her along for the ride.  We took her to the mall, high school ball games, wedding receptions, anywhere noisy because she was hard of hearing and lacked a filter. 
5. She got appropriate medical care in a timely manner.



The Cons:

1.  I  hired aide to come in for 8 hours a day.  I was glad to hand off the difficult tasks of making sure she got clean during a shower, etc.  The aide was loving and firm and got her to do things she did not want to do. 
2.  Cost of the aide - twenty an hour.
3.  The aide need rides, etc.  They can become like members of the family.  One more person to include in planning your life.
4.  Lack of sleep - it was like having an infant again.


I will never regret doing this.  I can rest easy knowing I did the best I could within reason to make her last years the best they could be.  She really did have quality of life and it also enriched our lives as well.  We miss her every day.

Treb3

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #6 on: February 09, 2018, 08:32:34 PM »
I work in hospice.  If you have the money, outsourcing as much as you can will help you keep your sanity. Itíll also help you see your relative as family and not just as a patient. You can hire sitters who can sit with her, clean, etc. CNAs or sitters to help with bathing and personal care. Home health companies for nursing and physical therapy. There are even some nurse practitioners who make home visits and can prescribe medicines. An increasing number of pharmacies (in the US at least) will deliver.

Moustachienne

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #7 on: February 10, 2018, 10:32:36 AM »
Thanks very much for the insights, everyone.  Very helpful!

 I can already see that making sure that we keep up with activities/identity separate from "caregiver" is going to be important for us, as well as figuring out which care can be paid/outsourced and which will be best for us to do.  So easy to get completely sucked in to the caregiver role, then overwhelmed and cranky, which negates the whole positive intention of being hands on.

I've also found that I really need to let go of my thoughts of the "best" way to do things or the "best" outcomes.  As a former successful administrator, this is hard for me!  MIL has her own ideas, and even if some of them are objectively bad (e.g. underspending on herself for necessary things; under medicating her pain) there's no point at all in arguing directly with her.  Better to find a way to deal indirectly (e.g. POA, meds in bubble packs) or even let some things, e.g. regular baths, go entirely.  Whew!  That last will be hard once she's staying with us.  Febreze for the win.  :(

Despite the frustrations, though, we've already had good times with her and we know that our interventions have meant that she's been living better in her house in the last while than probably the last 10 years (daily visitors, de-hoarded spaces, regular meals, clean bed linen and clothes).  Not to mention all the co-ordination needed between doctors, hospital, home support services and more.  If we were out of town, we would absolutely need to pay someone for this role.  No way a stubborn, frail, and sometimes confused senior could deal with this.

Our province (BC) no longer has non-emergency waitlists for public care homes but as she can afford private care for some while, that is the route we'll take if/when necessary.  Her desire is to stay in her home and she has the means to do so BUT she will have to accept a lot of in-house care to make this happen once she's declined further.

For  now, we're going to take her in to deal with the immediate medical issue (daily radiation to manage the symptoms of a painful cancer) and then reassess.  We'll also take the opportunity to continue de-hoarding her house, which she has given permission to do.

I've helped a parent through a terminal illness in the past but we knew the finite time frame.  The long drawn out decline of old age is new territory.  And since I'm older now too, it shines a light on my own decline/mortality.  I have read the excellent Gawande book.  Much to reflect on!

Modified to comment on this - "A few months ago, my mother explained that even the Queen had paid help, and if it was good enough for Her Majesty, that GM can tolerate paid help too."   Hahaha!  We've tried this too but so far it hasn't worked because according to my MIL  the Queen is "used to help".  How many families in the UK/Commonwealth are trying this tactic?
« Last Edit: February 10, 2018, 12:19:36 PM by Moustachienne »

okits

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #8 on: February 10, 2018, 02:48:18 PM »
Modified to comment on this - "A few months ago, my mother explained that even the Queen had paid help, and if it was good enough for Her Majesty, that GM can tolerate paid help too."   Hahaha!  We've tried this too but so far it hasn't worked because according to my MIL  the Queen is "used to help".  How many families in the UK/Commonwealth are trying this tactic?

I super-loved this comment and will be using it, someday!  As for your MIL's response, I'd say, "yes, the Queen is used to that level of luxury/privilege, and you can get used to privilege/luxury, too".

Best wishes to you, Moustachienne.

AMandM

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Re: In-sourcing eldercare - the good, bad, ugly?
« Reply #9 on: February 10, 2018, 08:44:08 PM »
Modified to comment on this - "A few months ago, my mother explained that even the Queen had paid help, and if it was good enough for Her Majesty, that GM can tolerate paid help too."   Hahaha!  We've tried this too but so far it hasn't worked because according to my MIL  the Queen is "used to help".  How many families in the UK/Commonwealth are trying this tactic?

My grandmother would have sniffed and said, "But I am not supported at the taxpayers' expense!" (which was not true).