OK, the picture to the left is the ideal.  Mom needs help but she has two children who are cooperating perfectly for one big happy family.  Those of us who have done the job alone think of the big families with envy, oh how much easier it would be if only there were other adult children to share the load of  elder parent care.

And then there are cases that make me glad that I did it alone, or at least without a daily person to deal with.   I am going to share the story below not to get anyone depressed, or even feel relieved about their own situation, but rather to give ideas about how to manage difficult situation.

A client of mine just left a position as a nurses aid.  She was an ideal find for this family who is working on the elder care for their mother, a woman in her 80′s who had been beloved by all and currently totally debilitated by Parkinson’s disease.  She needed to be feed, bathed and put on the toilet.  But they had managed to keep her in her own home, with the employment of 3 home health aids and by having each sister stay with her one night.

My client was a teacher who got a CNA on her way to nursing degree.  She took a home health aid job because she wanted the experience and knew people who knew the patient and had respected her.  However, my client was soon in a mess of sibling rivalry and contradiction.  One example.  one sister criticized the home health aid for staying in the bathroom while the patient was on the toilet, and when she sat outside the room another sister came in and criticized her for that.  She eventually left, which was a great loss to the patient.

What could have been done?  For one thing, coordinating the care through organization.  To use this example, if you and your siblings disagree over things like whether a parent should be left alone on the toilet needs to be straightened out in private and ahead of time.  Fighting in front of the home health aid or worse criticizing the elderly parent care worker in front of your elderly parent is going to make strife at best and could result in losing a very good home health aid.

As I have said again and again, this is a problem that can be helped by lovingly organizing the parent care.

I just got this beautiful statement from a friend of mine on Squidoo. I wanted to share the whole thing with you. BTW, she has experience that leads her to agree with me that its better to try to hire your own Home Health Aids instead of going the agency route. Her reasoning is similar to mine!

Your free information “What to know before you hire a Home Health Aide” could have been written by me, albeit, not nearly as well.

My now 94 year old Mother came to live with me the day after Dad died in April 2007. My parents had always been with me in the summer and wintered in Arizona so, in a way, it was just like Mom coming home to stay. Little did I know what that meant.

The first part of the grieving process was very tough as Mom and Dad shared an unbelievable love and marriage for 65.5 year. With him gone, there was suddenly a huge void for both she and I. We got up, went through the motions, and went to bed every day. I worked back then and she was healthy enough to leave alone that first year (she was 90). In fact, she took care of my dogs during the day, made her bed, and still was able to get around and do some very light house chores.

As time went on, the inevitable aging process took its due and I wasn’t comfortable leaving her 8 hours any longer. So, I reached out to home care agencies in the area. I checked their business references, called the Better Business Bureau, went online and asked for and got opinions. I selected an agency and the fun began.

As you documented in your article, we paid $20 an hour and the aides got $7. Consequently, the aides were not as interested in doing anything more than the bare minimum. Some of them wouldn’t even cook my mom a scrambled egg. Another aide did crack an egg once to find a double yolk. She went screaming from the kitchen! Who knew that a double yolked egg is the sign of a devil in some cultures. Next….

There were aides who came in late, aides who left early, aides who yelled at my Mom (THAT didn’t last long). There were aides who complained she was awake too long during the day, aides who wouldn’t clean up the floor from dropped food, aides that would only use a straw broom. There were aides who didn’t drive, aides who wanted to use my car to go to their bank, aides that my dogs hated (those rarely made it in the door). To be honest, there were just two good aides; women who still have a special place in my heart. Women who would call me during the day to check in and let me know how it was going. Women who would jot down notes and questions to ask me later. Aides who were aware of my Mom’s feelings and went out of the way to assuage any issues.

But, in the end, when the last good aide went to nursing school, I decided the time had come to quit my job and take care of my Mom myself. If I thought I’d learned anything that first year, I was wrong! I was in the fire man, and it was HOT!

I immediately established routines which stand to this day. There’s 3 breakfasts, 2 lunches, and 2 dinners served along with snacks. Mom eats very small meals so a ‘breakfast’ might well be a piece of toast. When the doctor told me that she shouldn’t have caffeine any longer, I came home and stocked up on the very best coffee (caffinated!) I could find. I was not going to take away mama’s coffee! So, it’s been a learning trial for both of us.

And, I knew I’d need help. At first, I enlisted my best friends to spell me for a night here or two. But, as Mom aged, that has become more difficult. She’s sometimes confused and I’m the only one so far who can center her back to herself. In a way, we’re the same person. I do have a home care worker during the day though. I found her when she cleaned my house through an agency. I immediately liked her and, 2 years later, she’s in the living room talking to my mom right now. Carina, the worker, is a blessing. She does anything and everything Mom or I ask of her, including feeding and medicating 6 dogs! You are right on when you say that it takes a team (and, upon occasion, a village)….

My Mom is about the easiest woman in the world to care for. She’s loving to this day, she thanks me every night for her care, and she never wants to get in the way or cause trouble for me. I wouldn’t have traded this time in my life for anything.

While reading the new Oprah Magazine, I read something that is common wisdom, that men are more likely to leave wives with severe medical problems than women are to leave husbands. I have heard that many places and it makes sense. How does this translate into elder care or parent care?

Between my daughter and my niece there are 3 sets of grandparents and in all three cases the husbands nursed their elderly and very sick wives. For that matter my grandfather did the same thing. I could say that it is just a fluke in my family, but my in laws aren’t related to the rest in any way, nor are my brother’s.

Richard Jacob, my father-in-law was a very traditional man. I remember one Mother’s Day he thought he was doing a good deed to buy paper plates so Betty, his wife wouldn’t have to wash dishes. I couldn’t believe it so I suggested that perhaps he could just do the dishes and got a odd look as if I had just suggested he fly to the moon! But when his wife got Lou Gehrig’s disease, which eventually put her into a total paralysis before death, he became a most tender care taker. It was quite touching. Richard Jacob became an elder care giver.

My grandfather Orval Byrd was also a traditionalist, except in a generation before where the tradition was even more strict. But when Alberta had her stroke he quit the railroad to stay home and care for her. He learned to make noodles from scratch and spoiled her to the point where it probably made her worse. He had never so much as put a plate in the sink before.

My mother’s sister, Dorothy was cared for by her husband Ross and their son, Ross. She had Alzheimer’s disease and it took both of them to do the elder parent care in that home.

I don’t know much about my brother’s in-laws. Carrol Farris was a career military non-com and Billie gave birth to 8 children. But they may not have been as traditional. I don’t think she got as sick as the other women, but I do know that as her obesity and diabetes got worse, he took over until she died.

And then there was Dad. No one would have been surprised at all that he became Mom’s number one means of care. Fritz and Margo had always been a non traditional couple. When they went into the newspaper business together they worked all day, side by side and then went home to take care of the house and kids. Dad was a sweet heart and his devotion to her lasted until the very end.

So, no, there are men who don’t abandon sick wives, heck, where I come from its the norm! And I certainly know that men can do it, even the ones who never lifted a finger until the day their wives got sick. My cousin is an example of men who do elder parent care.

Are things changing or have these wonderful men, husbands caring for wives, just been ignored by a society who didn’t expect them to step up to the plate?

Ten years ago Mom was still alive and Dad got very sick. He needed the hospital and several weeks of rehab to learn to eat again after suffering from aspiration pneumonia, which lead to hallucinations from a high fever. I panicked and checked out an assisted living home. I was so caught off guard to think that my father might suddenly need help instead of helping Mom that I was ready for anything. But I also remember how over priced it all seemed. However, at the time I never thought it was possible to hire a home health care team to help while I was at work and even at night.

I know that many people think that s home health care team is out of reach. It seems like a waste of money, it seems unaffordable. They think that assisted living is the cheapest and easiest way to go. So today, in the name of research I made an appointment with one of the nicer homes I had looked into, to find out just what it would cost today. The whole thing only took 20 minutes and I was talking to the marketing manager, so I didn’t feel too guilty. But I went and gave the same exact details that we were dealing with 10 years ago. Here is what I found.

A room with a bath would be a minimum of $3,785 a month for 240 square feet with a bathroom. Some of them had walk in showers, but if it didn’t you had to pay to convert it. It was another $2000 for Dad to live in the same room, and Mom’s level of care would have been another $635 (at least) a month. That comes to $6420 each and every month. That included 3 meals a day for both of them and laundry once a week. There were trips and things, but those were extra.

I have to say that there are people who want to be in assisted living, although my parents would have hated it. But $6420 minimum a month for 240 square feet 3 meals a day and laundry? It was a lovely place, but I have to say that is awfully expensive.

So I thought about what else people could buy for that. Lets say it would cost $400 a month for food. That’s not bad, even today. That leaves $6000 a month, assuming that people live in a paid for home or with their children. Paying $15 an hour for home health aids (Most around here get $8.50) that would leave money for 400 hours a month of home health care! Anyone who needed more than that would probably need a nursing home. In fact, most people would need a whole lot less. It would be easy to find the money to pay $500-$600 a month for a really nice one bedroom apartment here. I known there are places where rent is much higher, but then the Assisted Living is probably higher there also. Oh, and the actual attention given is a fraction of 100 hours a week, more like a few hours a week.

Look, if you and your parents think that assisted living is the best elderly parent care and you can afford it for many years, by all means do it. BUT, if your parents are staying in their home or yours and it is looking like they will need some care, remember that they will get more care for a lot less money by staying home and getting a team.