FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

SUCCESSFUL HOME CARE FOR AGING PARENT REQUIRES TEAMWORK

Question: My mother is in failing health, and I'm afraid that soon she will no longer be able to continue to live alone. She will probably come and live with us. I know from the experiences of our friends that it can be difficult caring for a parent in one's home. Do you have any suggestions that could help us?

Answer: Caring for a loved one with a disability at home is an increasingly common situation. This trend stems primarily from two factors - the geriatric population is increasing, and older people have a disproportionate percentage of disabilities. Additionally, the changes in health-care delivery and insurance rules that put an emphasis on "cost containment" compel more families to care for disabled relatives in the home because it is less expensive than the hospital or nursing home. Less than four percent of the geriatric population is in a nursing home, but a significantly larger percentage of this group needs assistance with their health care and or activities of daily living.

The nature of your mother's "failing health" makes a significant difference in the type of problems you can experience. Conditions that produce intellectual deterioration are clearly the most difficult regardless of the individual's age. We expect our loved ones to be rational, although not necessarily reasonable. Emotionally it is extraordinarily difficult to live with a loved one who is losing his or her faculties. It can be very demanding physically as well. There are additional special stresses when the loved one is a parent, as is true in your situation.

Regardless of the nature of the disability, it is common for the caregiver to experience a sense of powerlessness. You can't stop the disability causing illness in your loved one, and you are physically and emotionally burdened by providing the care. Depression is very common. This is due, in part, to the emotional strain caused as caregiving demands restrict one's performance in other roles of spouse, parent, worker, etc. Feelings of guilt and grief typically are present, too.

The burden of caregiving can be eased by a diverse support network. Those whose support system is made up of a healthy mix of friends and family seem to do best. Caregivers, on the other hand, who depend almost exclusively on other family members often have more difficulty managing their complex responsibilities.

Remember that it takes a team effort to care for your mother. You will certainly need guidance and support from her physician. It may even be worthwhile to consider switching to a geriatric physician. (That's a physician who specializes in the care of the aged, not just an old doctor!)

Your mother may also need additional care from a home health-care nurse or aid, a geriatric nurse and a geriatric social worker. These specialists can then identify other community services that may be of benefit for your mother and for you as you care for her.

I suggest that you talk with your mother, other family members, appropriate friends, your mother's doctor and any agencies that may be needed to assist in her care before you move her to your home. Think of this as signing up the members of her health-care team. As part of the planning, be sure to establish realistic goals for the amount of time and the type of care you can provide. Be sure to schedule time for your other responsibilities, and don't forget to include time for frequent recreational activities and occasional vacations. This type of preliminary planning will help you determine if home care is a realistic option for you and your mother.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.