Making Life Better for Older Adults

As we age, there comes a time when we may need assistance making it safely through the day. Perhaps you have a nagging suspicion that an older adult (a spouse, your parents…) needs that help right now. Of course, you want to avoid being forced to confront a crisis where an older adult has deteriorated, physically and/or mentally, to the point where they are a danger to themselves or others. What can you do to plan ahead?

The first step is to be aware of warning signs rather than waiting for a crisis to occur. The next, and often the most difficult, step is taking action and getting appropriate help.

Early signs that an older adult might need help

The National Association of Professional Geriatric Care Managers has compiled a list of some of the early warning signs that an older adult might need help, including:

  1. Personal hygiene Is he shaving? Does she shower less frequently, wear dirty clothes, or have neglected teeth? Are there any injuries that you can see? Is there a urine smell?
  2. Forgetfulness Are there stacks of unopened mail or newspapers, unpaid bills, unfilled prescriptions or missed appointment slips?
  3. Interaction/Behavior Does she constantly repeat questions? Can he carry on an extended conversation? Does he refuse any suggestion or does he agree with every suggestion? Does he retain what was said? Are there any apparent mood swings? Is he unusually loud or quiet? Is she angry? Does she make phone calls at all hours of the night?
  4. Relationships Do friends call? Do friends or neighbors express concerns? Has she quit socializing or participating in group activities?
  5. Mobility/Medication Can she get around? Can he take medications without supervision? What are the medications? Who goes to the doctor with him? Is she going to the doctor at all or does she refuse to go?
  6. Refrigerator/Eating Habits Does the refrigerator contain adequate food? Is there any spoiled food? Have his eating habits changed? Has she lost weight? Has she missed meals or is she generally not hungry?
  7. Shopping Does he have any problems making change or writing checks?
  8. Buying things he doesn’t need Is there evidence of excessive shopping, ordering. Is the mail full of charitable letters, a sign that he is giving out money to anyone who asks?
  9. House Does it look maintained or is it in disrepair? Is dust and/or trash accumulating in what was once an immaculate household?
  10. Driving Can he drive safely? Is her reaction time adequate on the road? Is there any evidence of automobile accidents?

Taking action at this stage to address problems can forestall a full blown crisis.

Obstacles to securing help

There are significant obstacles to securing help for older adults, however. Just because you have observed warning signs doesn’t mean that others will agree with your observations.

One of the biggest obstacles to securing help is denial that a problem even exists. Children are reluctant to acknowledge that their parents, the ones who have been the traditional family caregivers, now need care themselves. A spouse, even the person needing help, is likely to deny the need for additional assistance because of a combination of fear and anger about their declining health. Moreover, how do you arrange and monitor care for someone if they don’t live in close proximity to you? Move them into your home?

Taking action

A Geriatric Care Manager (GCM) is an excellent resource to help you avoid an elder care crisis or, in the unfortunate event one occurs, to help you deal with the crisis and, as the name implies, manage the care. A GCM can evaluate an older adult’s current living situation, their needs, including physical and mental health, and their resources, including family, community and financial resources and create a comprehensive care plan. As a trained, experienced and objective third-party, the GCM can help overcome the many psychological and family dynamics obstacles to care.

Once the care plan has been recommended, it is up to the older adult and the older adult’s family to determine next steps. GCMs can coordinate implementation of the plan, from the simple (having grab bars installed in the bathrooms and other safety measures) to the complex (screening, arranging and monitoring in-home help, identifying institutional care facilities...) Once services have been established, GCMs can monitor and coordinate them, or leave that up to the family. GCMs can be used on a one-time basis, or they can serve in an on-going role, depending on the situation. At the very least, plan to bring in the GCM periodically to reevaluate the older adult’s ongoing needs and revise the care plan as necessary, as continued deterioration is likely.

Unless the older adult suffers from a severe cognitive disability, he should play a significant part in the evaluation and follow-on care. Remember, the GCM works for the older adult and if the older adult does not accept the process and recommendations, nothing is going to change.

Aspiriant maintains a list of helpful resources, including Geriatric Care Managers. Please contact your client service team for a referral or you can go to the website for the National Association of Professional Geriatric Care Manager, Inc. www.caremanager.org.

In selecting a GCM, some important things to look for include:

  • Length of time as a Geriatric Care Manager
  • Degree in a field related to nursing, counseling, mental health, social work, psychology or gerontology
  • Previous occupation as an RN, social worker or geriatric nurse practitioner
  • Independent from any service providers (no conflict of interest)
  • Experience using community based resources
  • Available for emergencies
  • Member of the National Association of Professional Geriatric Care Managers (GCM)

Fees

GCMs bill by the hour for their services and their fees can range from $150 - $300 per hour depending on location and needs. The initial evaluation could take two to three hours and a written care plan a bit more, so the total initial cost is likely to be about $1,000. This is a very small price for our clients to pay for an objective, competent plan for dealing with such a critical issue, and for the access to an ongoing resource for the older adult and his or her family.

Even if estate tax reduction planning is not currently urgent, families of any wealth should review the effects of the new laws on their existing revocable living trusts. The increase in the exemption to $5,000,000 raises some of the same funding concerns raised in 2009 when the exemption was $3,500,000. Plus, the new portability rules provide additional planning opportunities.

Brett Gookin, CFP®
Director - Wealth Management, Principal