Judd Matsunaga
We just got word that my cousin from Chicago just passed away. Bruce Matsunaga died at 76 years of age. Interestingly to me, he was the first Sansei in the Matsunaga clan (approximately 12-15) to die. In some ways, he was one of the lucky ones, i.e., passing quickly of a heart attack while playing his favorite sport, golf, on a beautiful day.
Did you know that only a minority of people transition from being fully independent to deceased, with no intervening period of needing assistance? In other words, “Only the good die young.” The rest of us will eventually need some form of assistance and care, especially if we live into our 80s, 90s or beyond.
Sometimes, the care required is fairly simple, e.g., a little help with transportation or arranging for some assistance with shopping or household chores. But in other cases, more care is required, e.g., housecleaning, meal preparation, laundry, grocery shopping and personal care services (such as bowel and bladder care, bathing, grooming).
Helping an older parent is rewarding but can easily become a source of chronic stress. Quite often, family caregivers find themselves having to take on quite a lot. Because family caregivers are often busy, they can easily neglect their own needs and well-being, which can jeopardize their own health and also affect their ability to care for and connect with their older parent.
You, the caregiver, desperately need some help and regular breaks. However, many times the senior refuses. Your senior might see strangers coming into their home as a waste of money, an insult to their abilities or an invasion of privacy. Fortunately, there are ways to make this transition easier.
Family Caregiver Alliance gives some helpful tips on how to make in-home care more acceptable, even if your older adult initially said no. The following are highlights of key points from an article titled “Introducing In-Home Care When Your Loved One Says ‘No’”:
- Start gradually.
Begin by having the aide come only a couple of hours each week, then add hours as your loved one builds a relationship with the helper. If you feel comfortable with the attendant running errands or preparing meals that can be brought to the house, you can start with those services, which can be done outside the home.
- Listen to your loved one’s fears and reasons for not wanting in-home care.
Express your understanding of those feelings. If possible, get your loved one involved in choosing the aide. He or she will feel more invested and comfortable with the decision.
- This is for me. I know you don’t need help.”
Expressing the need as yours, rather than your loved ones, helps maintain his/her sense of dignity and independence. You can also add that having someone stay at home allows you not to worry while you are gone. Make it clear that you will be coming back.
- “This is prescribed by the doctor.”
Doctors are often seen as authority figures, and your loved one may be more willing to accept help if they feel that they are required to do so.
- “I need someone to help clean.”
Even if this is not the real reason, often people will allow someone in to clean when they “don’t need” care for themselves.
- “This is a free service.”
This strategy may work if other family members are paying for the home care or if it is, in fact, provided without charge. Your loved one may be more open to using the service since she does not feel that she is spending money for it.
- “This is my friend.”
By pretending that the attendant is a friend of yours you are relating the home care worker to the family. This can help with establishing trust and rapport. You can also say that your “friend” is the one who needs company and that by having him or her over your loved one is helping him out.
- “This is only temporary.”
This strategy depends on the condition of your loved one’s memory. If he/she often forgets what you say, then he/she may also forget that you said this. By presenting the situation as short-term, you will give some time for your loved one to form a relationship or become comfortable with home care as part of his/her daily routine and give you a chance for a well-deserved break.
Hopefully, one of the above tips works, and you are successful in getting your senior to agree to give an in-home caregiver a try. Great — but proceed cautiously! Here are some common mistakes that can cause families problems from board-certified geriatrician Dr. Leslie Kernisan, MD, MPH, on “Common Mistakes to Avoid When Hiring an In-Home Caregiver” (source: www.betterhealthwhileaging.net):
- Paying individual caregivers “under the table.”
It may be tempting to hire an independent caregiver or one that does not work for an agency because of the cost savings. But doing so can leave you in violation of IRS laws if the appropriate taxes are not filed and paid. Federal laws consider paid caregivers to be “household employees,” and generally you must pay taxes and follow other rules if you pay them more than $2,000 in a calendar year.
- Allowing the paid caregiver to have too much control or access.
It is important that family members stay involved in their loved one’s care, even when trusted caregivers are in place. When there isn’t much family oversight, an older person can be vulnerable to abuse, neglect and exploitation. So, it’s essential that family members stay informed and aware of what is happening in their loved one’s life.
- Naming a paid caregiver as a healthcare or financial agent.
It may seem unlikely, but this happens all too often! A trusted caregiver that has been with a family for years will be named as the healthcare or financial agent on powers of attorney out of a desire for efficiency and with a false sense of security. Older adults may feel like their trust will not be betrayed by their loyal companion, but this situation puts the older adult in a vulnerable situation.
In conclusion, today more seniors than ever are hiring in-home care. That’s because they want to “age in place,” but need help with Activities of Daily Living (ADLs) and Instrumental Activity of Daily Living (IADSs). And as many Pacific Citizen readers already know from personal experience — helping an older parent in late life can be a pretty complicated endeavor.
Get some help!!!
Judd Matsunaga is the founding attorney of Elder Law Services of California, a law firm that specializes in Medi-Cal Planning, Estate Planning and Probate. He can be contacted at (310) 348-2995 or judd@elderlawcalifornia.com. The opinions expressed in this article are the author’s own and do not necessarily reflect the view of the Pacific Citizen or constitute legal or tax advice and should not be treated as such.
