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When you can go home again — with some help

Sally and Bill moved out of a local assisted living facility, where they had lived for some months. Sally, in particular, was confident that she could manage Bill’s care on her own again. She missed making meals, especially for the holidays coming up. She had persuaded their adult children that all was well, and she could handle it. Bill, at 88, had been diagnosed with early-stage Parkinson’s disease. This is not easy for anyone to handle, let alone his 86-year-old wife, who also had the beginnings of cognitive impairment. But back they went into a rental apartment, sure that all would be fine. Then the adult children arrived from Portland, and saw the truth of the matter.

This week, Thanksgiving will bring many families together who may not have seen one another for some time. Talking to an older parent on the phone is not the same as being in the same house with them for several days. Things become more apparent that had been overlooked, and concerns arise. The number-one concern I often hear is that the parent does not agree with what the adult child is telling them they are noticing. The question is, what might the family notice in the home that seems not-quite-right? Here are some signs that might indicate a situation that needs some assistance:

• Unopened mail;

• Confusion or lack of interest about what bills have been paid;

• Disorganized personal paperwork, newspapers, or general clutter;

• A large number of magazine subscriptions;

• Spoiled food or minimal food in the fridge;

• Unclean bathrooms or kitchens; and

• Lack of interest or shortened attention span in get-togethers.

Sally and Bill’s family saw a huge pile of paperwork, including unpaid bills, on what used to be the dining room table. There was a general lack of cleanliness and orderliness, Sally’s former hallmark of good housekeeping. Now that they saw the reality, how were the going to get some help? A good place to start is with the family doctor. Hopefully, someone has already been appointed the health care representative or Power of Attorney for health care, and can access this important resource. Their doctor had known this family for years and was able to talk about their medical needs. It was also decided that caregiver support would be brought onboard from a local caregiving agency.

Next, they needed to get information about their resources, to be able to pay for all this help. Their financial planner was contacted, and a review of their assets and how long they would last, brought the picture into a clearer focus. This was all helpful with some immediate support. But what happens after everyone leaves town again? Who will monitor their ongoing needs and the potential changes yet to occur?

The family was provided with a list of local agencies that can help out in specific ways:

• Ashland Senior Center (www.ashlandseniorcenter.org, 541-488-5342);

• Ashland at Home (ashlandathome.org, 541-613-6985);

• Aging and Disability Resource Connection (www.adrcoforegon.org, 541-618-7572);

• Food and Friends (rvcog.org/mn.asp?pg=FF_Home, 541-734-9505); and the

• Aging Life Care Association (www.aginglifecare.org, 520-881-8008).

A professional was employed to oversee all these new services and monitor ongoing needs.

Let’s go back to the number-one concern mentioned above. What happens if the parent does not agree with what the adult child is telling them? In this case, their lack of understanding was the result of their cognitive impairment. The person cannot see areas where they are gapping, and they remain convinced they don’t need or want whatever is being proposed to them. In times like this, something actually called a “therapeutic fiblet” might be employed. Although most adults have the sincere wish to be truthful, it’s important to understand that the disease process is what is causing this refusal for help. It’s vital to find ways to get the help that is desperately needed. Here are two examples most often identified by professional care managers as situations when it can actually be therapeutic to tell a “fiblet”:

• The person is refusing needed care/assistance at home. Telling them the caregiver is there for their spouse’s benefit or for another concrete role can help them maintain self-esteem and reduce anxiety.

• Knowing that the cost of in-home care/help prevents them from accepting the needed service. Telling them their insurance covers this service often works.

If people have full capacity, certainly it’s their choice if they want help, if they think they need help, and if they want to pay for help. But if there is a lack of ability to see their needs due to a cognitive impairment, then it’s kinder to provide support behind the scenes. That’s what this family learned to do, too. The results are their parents get the help they need to support them staying at home, and the family can have peace of mind in Portland. Everyone feels good about this outcome.

Ellen Waldman is a certified Aging Life Care Professional. Submit questions about aging and Ashland-area aging resources and column suggestions to her through her website, www.SeniorOptionsAshland.com.