I purchased my first house a year after my parents moved in with me. Rather than take any chances on my own, I hired a designer who quickly read my mind and began helping me decorate the humble abode. Actually, appearance-wise it was very humble; price-wise it was ridiculous. The rugs were recently purchased from a rug dealer in NYC, some new, some old, all expensive. The couch was in a basic Pottery Barn style, but was re-upholstered in a contemporary fabric that would make even the best designer salute. The armoire was French, circa late 19th century, and looked indestructible.
I figured I would stop there, install some shutters, and put some thought into the color scheme before purchasing any more household furnishings. Good thing. It took my mother 2 days to permanently stain the couch and a rug, mark the newly painted doors with the heel of her custom-made orthopedic shoes, and with pure brute force, bust the armoire doors off their 100-plus-year-old hinges. That’s pretty good for a 130-pound, 80-year-old woman.
STARTING THE CONVERSATION WITH YOUR AGING PARENTS
For most of us, it is never easy to convince our parents to leave their independent lifestyle, despite the warning signs of impending doom. I could spend the rest of this post discussing stories from individuals whose parents refused their help, and as a result ended up much worse off than if they had chosen to move in with a willing family member. However, the goal of this article is to help you prepare yourself, your home, and your loved one for the life changes about to happen.
Open the doors to communication, but start slow. Offer options, not demands. Suggest–and for best results, pay for–a caregiver to visit their home once a week. You can choose the caregiver based on the need (e.g. handle chores like laundry, pay bills, run errands, play companion, etc.).
It was January, 2000. I was dining with friends in Houston, Texas when I got the call from my sister, Tami. She was shaken and on her way to Cumberland, Maryland to look in on my parents. During her usual daily phone call to check on Mom and Dad she had noticed that Dad was delirious. Unable to get a straight answer from Dad, she hung up the phone, gathered her stuff and headed off to Cumberland. Tami had been caring for Mom and Dad for years. At least twice monthly, she would trek to Cumberland to help with the grocery shopping and meal preparation.
If you can convince them to relocate, help them to choose the location carefully. Pick an area that encourages exercise and one that is close to their medical provider, whether that be a physician or a facility (i.e. dialysis center, emergency center).
Of course, Tami and I had discussed this possibility many times over. For years we had tried to get Mom and Dad to move closer to either one of us. In fact, as recently as the summer of 1999, Dad and I had spent several days looking for available real estate near my sister’s house. Unfortunately, after three days of house hunting, Dad got cold feet and decided to delay the decision for another year. That was the last summer that they would spend alone, and in Cumberland.
When dealing with the coherent elderly person, it is often difficult, if not impossible, to relocate them from their home, even if it is for their own good. Whenever possible, it should be a mutual decision, which is often easier said than done. If not, remember to offer options and not demands, slowly integrating small but helpful caregiver solutions such as laundry, paying bills, running errands, etc.
Now it was my turn to step up to the plate. I told her that after they were cleared medically, she could place them on a plane bound for Houston. Though I am sure that it was self-evident by my facial expression, I told my friends about the conversation. With blank faces we all knew that my life was about to change forever.
PREPARING YOUR HOME
But how does one prepare for the arrival of an elderly person? My first step in the process was to find a place for us all to live in harmony. For me, it was by trial and error. My first home contained everything that I had accumulated over the previous 16 years, most of which was not necessarily be conducive to elderly care-giving.
Let me put it this way: my friends really made out in the first few months following my parent’s arrival. While my friends and family’s homes became furnished, mine quickly began to resemble that of a barren wasteland. But it was injury free–for the most part. Here is something to consider:
In the elderly, there are some things that can be improved upon but not always remedied such as unsteady gate, vision disturbances, and dementia. Realizing that you can’t alter the progression of aging, it is essential that you improve upon the environment to ensure safe ambulation.
I only looked at property near to my job and close to the medical center. Fortunately, I worked in the medical center. It took only a few days for me to find what I believed to be the perfect apartment. It was the first floor of a duplex, with two bedrooms, one big bath, and two steps that included a hand rail. The two bedrooms were connected by the bathroom. This would make it easier for me to help with trips to the toilet, especially at night. The rooms were well lit and the walls were painted white to reflect the light.
The medical center was 1 block away, and as an added bonus, the apartment was directly across the street from a college campus which was encircled by a 3-mile walking trail. Historically, Mom and Dad had both been good walkers. Every morning for as long as I can remember, they would join a group of friends and walk the Cumberland Mall. However, things were quite different now and I had no idea what to expect.
Exercise is one of the five keys to ensuring a good quality of life (proper nutrition, social and financial independence, friends, and access to good medical care are the other four), especially with the elderly.
Many falls are the result of visual disturbances in the elderly, and most falls occur in the dark, making nightlights essential at bedtime. Bright lighting is essential and an easy remedy to a potentially dangerous situation. Just as one must speak louder to someone who is hearing disabled, the lights should shine brighter for someone with poor vision.
In my parents’ situation, their visual impairment improved dramatically with cataract surgery. But not all visual impairment is due to cataracts, and improving the lighting in a room is one more thing that may help to prevent a fall. Also consider that most falls occur in the dark, making nightlights essential at bedtime.
Injury is the leading cause of death in the elderly, and falls are the most common cause of injury.
Your priority should be injury prevention, specifically as it relates to falls.
Ideally, the living environment for the elderly person should be only one story with no steps.
If you do have steps, you must have a hand rail or a banister, which is easy to access (e.g. middle of the steps), with a hand grip no more than 2 inches in diameter and comfortable to grip, like the handle of a broom.
Remember that people have hand preferences. If an elderly parent is left-handed, they do not feel secure with a right-handed railing. In that situation, it is probably better to install two railings, one on each side of the steps.
Equally important is that the base be firmly planted into the ground.
Most elderly have difficulty ambulating as they age forcing a dependency on stationary objects in their path to be used as a means to support their balance.
As a pediatrician, I am well aware of the “leave no stone unturned” effort that must be put forth when preparing a house for a toddler. Preparing for the arrival of an elderly parent is similar to a grandparent preparing for the arrival of a toddler, with a slightly different focus.
To make your home Elderly Friendly (EF), Avoid steps, dim lighting, and TRIP TARGETS:
Satchels/briefcases/suitcases and Shoes
My mother, due to her dementia, would reach for anything to help steady her gait. That “anything” may be a lamp with a small base or a cardboard box. The next thing you know, she’s heading for the floor. We found it best to remove all unstable objects from her surroundings, unless they were lower than her reach. It was injury free–for the most part.
Unfortunately, “for the most part” doesn’t mean “completely.” There was the time mom tripped on her own two feet and fractured her hand. Ah, I remember it well. Upon arriving home one day I noticed that Mom’s hand was in a sling. The sitter explained that Mom had lost her balance and had fallen onto her outstretched hand. It was now swollen and tender, and likely broken. I made an appointment with an orthopedist to see her the next morning. (Being a physician does have its advantages.)
No matter what you do to your house you can never guarantee an injury-free environment, only elderly-friendly. In most cases, your parents are fortunate enough to be living with you. Changing your entire lifestyle to accommodate their arrival is recommended, considerate, but not essential. Realistically, if you secure your stairs with hand rails, minimize trip targets, and install bright lighting in all elderly traveled rooms, you will have prevented the cause of most falls incurred by the elderly.