Paula Span - When the Time Comes
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Excerpt: Chapter One

Chapter 5

Staying Put: Home Care

In theory, almost everyone could stay at home.  Short of surgery, virtually any form of health care -- kidney dialysis, physical therapy, wound care, intravenous medication – can be delivered in a private home. Companies have sprung up to modify homes for safety and accessibility; they install grab bars and toilet risers, ramps and stair lifts.

Since capitalism abhors a vacuum, the growth of a more affluent group of seniors, and other disabled people determined to remain independent, has fostered a raft of new businesses.  Is your parent doing pretty well at home, except that she can’t handle the bill paying any longer?  Or drive to the supermarket?  Or manage small chores like changing light bulbs?  You can hire firms, or sometimes find social service agencies or volunteers, to do all those things.

Whether you should, whether a frail or ailing parent ought to stay at home, is another question.  Home is so favored over any other alternative that staying put has become an aim in itself, regarded as the highest good, and families turn themselves inside out to make it possible. 

“But there’s no question that it’s not the right answer for everybody,” points out Gail Hunt of the National Alliance for Caregiving.  Figuring out who will do well at home is a complicated equation.
Seniors who live alone, for example, can find themselves increasingly isolated. Nearly a third of the elderly, and half of women over 75, live alone.  That’s not always a problem.  For an older person who has maintained strong community ties -- the weekly bridge group, fellow parishioners who visit regularly, neighbors and friends of long standing – home probably still is where the heart is.

But a senior who has outlived friends, whose social relationships are disrupted by her confusion or immobility, can find home a bleak place.   Possibly the house has six or seven rooms, but the occupant’s world has shrunk to an armchair in front of the TV, a bed, and a bathroom, with occasional forays to the kitchen.   “Introverts are going to be fine being more isolated, home alone,” says Donna Schempp of the Family Caregiver Alliance.  “Extroverts are going to be depressed.”

Health also matters.  Many illnesses can be managed successfully at home, including the early to middle stages of Alzheimer’s disease and other forms of dementia.  But if dementia causes agitation, problem behaviors, a need for constant supervision, then keeping someone at home becomes markedly more difficult.  It will be hard to hold onto aides for a senior who hits or uses abusive language, or wanders the neighborhood, or doesn’t sleep well and therefore needs supervision both day and night.  It will similarly be hard to care at home for someone large enough to be a “two-person transfer,” meaning that a single caregiver, paid or unpaid, can’t physically move her from bed to wheelchair to toilet seat.

Safety concerns come into play.  In case of an emergency, is a parent at home capable of dialing 9-1-1 and giving her address? Will she remember to push the button on her emergency pendant? 

“We should not always be so quick to make that commitment, ‘I will never put you in a nursing home, Mom,’” says Gail Hunt.  “Sometimes, that’s going to be the best option.”

  When the Time Comes -Paula Span