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Deciding how to care for an ill or incapacitated parent can be difficult. For the thousands of people who find themselves in the sandwich generation, caring for their own children and aging parents at the same time, knowing the options available can make a big difference in stress levels. In many cases, a nursing home is not the best, or least expensive, choice.

Home health care – where a trained aide or nurse visits the home and helps a patient with daily activities and medical care if required – has become a preferred option to placing a loved one in a nursing home. Although many nursing homes offer excellent care there is a stigma associated with being in an ‘institution.’ Also, studies show again and again that the elderly respond better when they are cared for in the comfort and privacy of their own homes.

Many families continue to care for dependent parents at home. According to the Family Caregiver Alliance, approximately 25 percent of all workers in the U.S. provide care to an elderly relative or friend. This, however, may become impractical when the caretaker works, has children of her own, or the parents suddenly require greater medical assistance than can be provided.

Home health services have greatly expanded over the years. Patients can get assistance in running errands such as food shopping and picking up prescriptions, preparing meals, cleaning the house and getting a ride to the physician. Home health care can be full-time or part-time. Whether someone needs round the clock attention or an aide to visit for a few hours a day, help is available.

Everyone’s situation is different and most home health agencies assign an experienced case manager, usually an R.N., to visit the home, evaluate and assess the person’s needs and work with the client, family and home care staff to draft and implement a plan of care.

All home health aides in New Jersey must complete the NJ State Board of Nursing approved course, which includes 77 hours training and both written and practical competency exams.

More than ten million elderly Americans need help today with such basics as bathing and dressing, preparing meals and other activities of daily living. Many more need nursing attention. And with the percentage of senior citizens expected to increase sharply by the year 2020 – by about 50 percent – from 35.5 million persons in 2000 to 52.6 million persons, the demand for home health services is sure to grow.

Those considering home health care, need to ask the following questions of any agency they are considering:

 

• How long have you been in business?
• Have you personally checked this person’s references and is he or she bonded?Is there a registered nurse who supervises on a regular basis?
• Is there a trained coordinator available by telephone 24-7? (a requirement for licensed facilities)
• Are your home health care workers certified or licensed by the state?
• How long have they worked in the agency’s employ?
• Is the agency accredited by a recognized accrediting body?
• Is the agency licensed by the state?

Aging begins the moment we are born. Aging is NOT a disease, although we do develop more aches and pains and undergo many changes as we grow older. Therefore, it is important to understand the aging process in order that it not be confused with a disease.  After about age 25 we tend to lose height as the disks in the vertebrae in the spine begin to shrink, causing the bones to move closer together. The back begins to bend forward after about 40. From age 20 to age 70 a woman may shrink about two inches, while a man about one inch. Some women lose as much as one-third of their skeletal structure by the time they reach 75, twice the rate of men.

Weight also changes with age. It is likely to go up until middle age, perhaps to age 50, and then start decreasing. The rate at which the resting body converts food into energy slows down about 3% every decade after age 20. When combined with a sedentary lifestyle and an undiminished appetite, middle-age spread can result. At the same time, we lose muscle tissue at the rate of about one-half of one percent per year. In the years between 20 and 70, a quarter of the original muscle mass can disappear, replaced by fat. In some people, the loss of muscle tissue is balanced by the gain of fat. In the elderly, however, the loss of muscle tissue is more conspicuous. Because muscle tissue weighs more than fat, overall weight usually declines.

Don’t be discouraged by the list of changes that accompany aging. They occur gradually, not instantly the day we turn 65!  Here’s a list of specific changes that occur as we age, with tips on how to manage them successfully:

APPETITE: Decreases occur in our sense of smell and taste. This can lead to a decrease in appetite and a loss of interest in eating. TIP: Add more seasonings to foods, eat meals with friends, prepare favorite meals, eat small but more frequent meals.

BLADDER: The size of the bladder decreases, by ½ or more, leading to increased frequency of urination. The brain’s inability to control the bladder’s muscles can result in incontinence. The structure of a female’s urethra changes and may lead to an increased incidence of urinary tract infections. The prostate enlarges in men often leading to difficulty with urination. TIP: Avoid drinking fluids before bedtime.

COMMUNICATION: Comprehension (understanding) of conversations remains good unless hearing is impaired. Some decrease in vocal volume may be noted as well as in vocal quality, producing roughness or hoarseness. An individual may demonstrate increased difficulty with remembering names, dates, and the like. TIP: It can help to think through the alphabet to recall a name, or to relax when trying to come up with a name or fact. To help a person with a hearing loss, remember to speak up.

TEETH: Atrophy (shrinking) of gums and bone tissue can occur. This can lead to loss of teeth and/or dentures which may, in turn, cause difficulty in chewing solid food. TIP: Visit the dentist twice a year. If without natural teeth, see a dentist yearly to check for any gum lesions, etc. Have dentures realigned every five years or more often if a decrease in weight has occurred.

GASTROINTESTINAL: General slowing of function of the intestines, stomach, liver, etc., may lead to decreased metabolism and clearance of medications. Delays in transit time in the colon due to this slowing may lead to constipation, hemorrhoids, and dehydration. TIP: Have adequate fluid intake (6-8 glasses of water daily) and good fiber intake (fresh vegetables, whole-grain breads, cereals, etc.)

HEARING: May experience high-frequency hearing loss due to decreased movement of the bones and muscles of the ear. May have difficulty hearing women’s voices, or hearing in a noisy environment. A high-frequency loss may affect the ability to hear certain speech sounds such as s,z,f,v, and th. TIP: Have your hearing checked and, if warranted, consider a hearing aid.

HEART: As the heart ages, it may become enlarged and function less efficiently. If the elasticity in the blood vessels decreases you may see an increase in blood pressure. Lightheadedness may occur if one changes position too quickly as the circulatory system is unable to adapt quickly. The heart may be unable to meet the demands of the activity. TIP: When using heart medication, be sure to follow physicians’ recommendations, including exercise.

IMMUNE SYSTEM: Decreased ability of the immune system to repair damage from disease or to resist disease may cause increased susceptibility to pneumonia or viruses such as the flu. TIP: Maintain a good diet, get adequate rest, manage stress, ask the doctor about taking vitamin supplements, and exercise regularly.

KIDNEY: Decreased circulation to the kidneys results in shrinkage in size. Function becomes less efficient but is generally adequate under normal conditions. However, certain medications that filter through the kidneys may remain longer in the system. TIP: Have adequate fluid intake, review all medications with your doctor periodically.

MUSCLES: Decline in the number and size of the muscle cells leads to decreased strength. This may get worse with inactivity and can improve with increased activity. TIP: Keep active, exercise daily.

LUNGS: Decreased elasticity of the lungs and chest wall and decreased strength in respiratory muscles often leads to decreased oxygen delivery. TIP: Have a regular exercise routine, avoid smoking and secondhand smoke. If experiencing shortness of breath see your physician.

MEMORY: Minimal changes in memory. One of the greatest fears people have about growing old is senility. Senility is not a normal part of the aging process. People don’t lose their power to think and to reason without a physical cause. TIP: Use lists, a day book, calendars, etc. to help remember appointments, important information, birthdays, etc.

REPRODUCTION: Men – Enlargement of the prostate, shrinkage of the testes, ejaculation is slower and volume decreases. Women – After menopause, decreased hormone levels can lead to dryness of the vagina. These changes can make intercourse uncomfortable. TIP: Sexuality can still be an enjoyable part of life. Check with the doctor about hormone medications, the use of lubricating gel, etc.

SKIN: Thinning of the outer layer and loss of circulation increases the chances of wounds from minor traumas (tear in skin from bumping against an object), or areas of pressure (bed sores). These changes make the skin less effective in retaining body heat. TIP: Practice good skin hygiene including the use of moisturizing lotions; drink 6-8 glasses of water a day. May require an extra layer of clothing or extra blankets on the bed.

SLEEP: Sleep patterns become altered: periods of deep sleep become shortened and may result in more frequent awakenings. Signs of inadequate sleep include anxiety, fatigue, and irritability. TIP: May need to include more time for naps during the day. Keep the drapes open during the day to provide plenty of daylight. Some form of exercise during the day may improve sleep patterns. Maintain a regular routine (always go to bed about the same time). If you can’t sleep, it is better to get up for awhile than to lay there and toss and turn.

VISION: More light is needed to see because the eyes adapt to changes in light more slowly. Eye lens gradually clouds causing vision to become less clear. Problems with depth perception may require bifocals to see things both near and far. Decreased tear production may lead to dryness, itching, and burning. TIP: Increase the lighting in the home, especially in the work and reading areas. Use a hand-held magnifying glass. Large print books and magazines may be available at your local library. Ask the doctor about artificial tears.

Excerpted from The Caregiver’s Guide, A Hands-on Book, 3rd Edition © by The Continuum, 1997

This Page provides a link to the National Council on Aging’s BenefitsCheckUp site. Just click on the box below to move to that service. If you need additional local information please call intake or your case manager at HomeCare Options at 973-523-1224.

Benefits Checkup BenefitsCheckUp is a free, online service from the National Council on the Aging that helps seniors identify state and federal assistance programs that can help improve their quality of life. This confidential service contains a simple, straightforward questionnaire that takes no longer than 15 minutes to complete within minutes you get a report detailing programs and services for which you qualify.

The BenefitsCheckUp report provides a carefully edited list of government programs older Americans most likely qualify for, including those that provide educational opportunities, employment programs, financial assistance and legal services, health care, prescription drug, home energy and housing assistance, in-home services, or volunteer opportunities.

Caring for Deaf Seniors

Commission on Accreditation for Home Care

National Association for Home Care

North Jersey Home Care Association

Passaic County Office on Aging

NJ Dept of Health & Senior Services

Medicare

United Way of Passaic County

Better Business Bureau

Rutgers Extension Service Health and Finance topics