By: Dr. Kerry Burnight
Former first lady, Rosalynn Carter, got it exactly right when she said that there are only four kinds of people in the world:
An estimated 41.8 million of us in the U.S. provide care for an older adult. Many of these caregivers are juggling jobs, children, and elder care responsibilities, which leads to becoming mentally and physically exhausted. Here’s what you need to know: It’s nearly impossible to do it alone. Without adequate support and training, you will struggle to provide care for your loved ones: not good for you, not good for them.
What options does a family member have when an older loved one needs care? Here's how I see it:
- Provide the care yourself with the help of other family members or friends
- Hire a professional caregiver
- Move your loved one to a care residence
- Do a combination of these options
By educating yourself about your loved ones needs and preferences you can increase your likelihood of creating a care solution that works for you and your family. Let's explore these options.
Option 1: Provide the care yourself
Caregiving requires both mental and physical stamina, and it’s not easy work. Caregivers, family and professional, are required to be attentive and compassionate to older adults’ needs while also understanding the complexities of caring for someone living with chronic conditions such as Parkinson’s disease or COPD. It is crucial that you recruit other family members or friends to help with the caregiving responsibilities. Going it alone is often a recipe for disaster. Look into adult day programs that provide engaging activities and meals, as well as senior centers and other community resources.
A key point to consider in this situation is if your older loved one is living by themselves. In this case you want to keep an eye out for isolation and loneliness, which has been shown to dramatically increase medical problems. Making sure that they are involved in social activities, staying in touch with friends and loved ones, and trying out new things is a good way to keep them socially connected, as well as reduce the likelihood of depression, anxiety and other negative mental and emotional changes.
Option 2: Hire a professional caregiver
Enlisting the support of professionals to help care for an older adult can improve the quality of life for families. In considering this option, the first step is listening. Far too many families dive in to hiring a caregiver before listening deeply to their older loved one. Unfortunately, this approach makes the older adult feel controlled and understandably resistant. Instead, a good starting place is have a casual conversation about how your loved one has been. Listen to what is important to the older adult and what the challenges are. Ask about his or her plans for the future if things grow more challenging.
After you’ve listening to your loved one’s assessment of how things are going, you might say something to this effect, “ Activities of daily living get harder in later life, if at some point it would be helpful to have assistance getting around, bathing, eating, getting dressed, preparing meals, would you prefer to move or age at home?” Most people respond that they would like to age at home. You can assure them that you are in this together and care deeply about doing right by them. After this conversation, do not come to any solutions. Do not push or rush.
With the seed gently planted, the next step is to ascertain how much care is needed. A helpful source of guidance is your loved one’s doctor. The doctor knows the physical, functional, and cognitive status of your loved one and can provide an objective opinion on the care needed.
When the older adult expresses any openness to some care at home, the next step is to find a reputable caregiving agency. The doctor may even know a caregiving agency to refer you to. If not, look up agency options at your local Area Agency on Aging or with a Google search. Not all professional caregivers or caregiving agencies are created equally. Four essential qualities you are looking for in are a caregiver are: compassion, knowledge, integrity, and reliability. When interviewing agencies, here are some questions to ask:
- What does your background checks process entail?
- What type of experience and training do your caregivers have?
- When are caregivers available?
- What is the price of services (hourly wages or shift payment)?
- How do you oversee the quality of care your caregivers provide?
- What is your hourly rate that I will pay to the caregiving agency?
- What is the hourly rate the caregiver receives?
The hourly cost of a professional caregiver varies depending upon: where you live; the level of care required; the responsibilities are included; and the caregiver’s level of experience. Nationally the average hourly rate is The average caregiver makes about $21 per hour. Some areas have pay rates as low as $11-13 per hour and in other areas they earn over $30 per hour. There are independent caregivers, small caregiving agencies, and large caregiving agencies. There are good actors and bad actors in all three options, so doing your homework in hiring is essential.
Option 3: Assist the older adult by moving to residence that provides care
Supporting someone with bathing, dressing, walking, cooking, eating, housekeeping, shopping, transportation to appointments may not sound like such a big deal, but with a frail or confused elderly person or someone with any number of chronic illnesses, any one of these tasks can be extremely difficult. If caring for a loved-one at home becomes untenable, how you approach the topic matters. Paternalistic approaches that charge in with, “this is what’s best for you” are not well-received.
Start care conversations with open-ended questions and do way more listening that talking. Repeat back what your loved one expresses so they know you hear them. Let them know they you respect their judgement. Be clear about your boundaries regarding care at home or paying for professional care.
Use what you learned from listening to prompt conversations about moving. For example if you father is losing weight and is not preparing food, set-up a lunch at an assisted living community known to have good food. Exploration is the first step. Before including your family member, visit the places yourself first so you can screen out any places you know they will not like or that are out of your price range. The average annual cost of assisted living is $4,500 per month. These rates vary dramatically by state, the average monthly cost of assisted living in Missouri is $3,000 per month, for instance, while the District of Columbia and Rhode Island are both close to $7,000 (Genworth Cost of Care Survey, 2021).
Option 4: Do a combination of these
This ends up being the most common option, a combination of family care, professional care, and if the situation necessitates it, residential care. It is critical to explore all support care options, a tribe of caring. The U.S. Department of Health and Human Services reports that someone turning 65 today has almost a 70 percent chance of needing some type of long-term care services and support in their remaining years.
The secret to caregiving success is that we simply cannot do it alone — no one can. By being thoughtful and proactive, we can navigate the challenges and opportunities that come with growing old - for those we love and in our own aging.