Over the last 20 years, through my agency, I have found necessary help for hundreds of families with homes and children. It is easy to decide when you need a nanny or housekeeper as you buy your first home and have your first child. The only question that comes up is how much help to get which often depends on whether the parents are both working and how much input they can provide themselves.
This is not the case when it comes to elderly people who have for the most part been independent all their lives and in many cases lived alone for many years. The idea of relinquishing the car keys or knowing that they can no longer shower alone is devastating. They actually know that this is a problem, but they really don't want to admit it to others, especially their children. Yet if someone does not step in to insist on the proper assistance, something even more disastrous can occur. Here are some tips on how and when to approach the subject with the elderly.
1) If the elderly person is close to you such as a parent or grandparent, and you have the opportunity to visit often, then you being there to observe how they are doing is the first step. It is necessary to assess the situation closely on a regular basis. The best way to do this is to drop in at all times of the day. Begin with the morning to see if the elderly person is eating, showering and getting themselves together. Calling to check on this is fine, but they may not tell you the truth. Check in during the day to see what is going on in terms of activities. Go out driving with them and see how well they can handle the road and how their reflexes are doing. Drop in for dinner and offer to assist so that you can watch them in the kitchen.
2) While this first stage of observance is going, take notes on the things that are of concern. Pick up the phone and call their doctor to discuss this matter. Offer to take the elderly person to the doctor's so that you can be there to talk to the doctor together. Once the message is a matter of concern from the doctor's point of view, then you are ready for the next step.
3) Call a family meeting to discuss the need for help and the options available. First discuss the options and attending costs with the appropriate family members alone so that you are prepared for a second meeting having the elderly present. If it involves financial assistance, you may want to get an accountant involved or even a mortgage broker who may assist with a reverse mortgage. Be well-prepared before talking to the elderly so that you can calm their fears with answers that make sense.
4) If they are reluctant to relinquish car keys, then call the DMV and check on the laws for license renewal. Most states are no longer allowing a "mail in" license renewal after a certain age. Take it out of your hands with a little help of the law and have them decide on whether this elderly person should be on the road driving or not.
5) Have the Doctor insist on the necessary help by calling the patient and explaining their observation as it relates to dimentia, walking, or any related-diseases that need 24 hour assistance. The decision as to how much help will also need to be defined by the Doctor depending on the patient's medical history.
6) If the option is to leave the patient at home and hire help. Begin with live/out help that comes daily for 4 hours and work your way to 8 hours. You may consider having the helper come early to serve breakfast and help with showering and then return later in the day to assist with dinner hour. It isn't easy getting someone to break up the day with hours but in this economy nothing is impossible. The imporant reason for easing into the "need for help" is so that the elderly person gets used to having someone around. Graduating from part time to full time and even 24 hour care is a major step for someone who has lived alone and does not want anyone there. You may need to be rather insistent. When it gets to the point where the person cannot be left a moment alone, then hire 5 day help and 2 day help on the weekends. You may get lucky enough to find a helper who wants a home to live in and is willing to be there 24/7 for wages and room and board.
The process of getting the elderly to admit to needing help is the first step. Showing them that you care about their welfare and that without the necessary help, they may cause damage to themselves and others is a key message. It will be necessary that you have continued compassion and patience throughout.