Most people don't start as caregivers knowing the ropes. To the contrary, most caregivers tend to learn as they go along, with a fair amount of wrong turns and struggles. What helps: knowing where to find reliable help.
The following ten organizations and professionals can help you meet your responsibilities, make you feel less alone, and cut your stress if you're helping an elderly loved one who's receiving care at home.
1. Companion care services
What they are: Companion care providers do just what the name says: provide company for older adults, especially those who are shut-ins because of frailty or a dementing illness (such as mild- to moderate-stage Alzheimer's disease, or who live alone. Sometimes called "elder companions," these aides keep a watchful eye, dispense daily medications, drive to haircut appointments, safeguard someone unsteady on his or her feet, read aloud, play cards, prepare light meals and snacks, and otherwise function as an extra set of hands, eyes, and feet for your loved one. Companion care is a growing subset of home care options.
How they help: Companion care is ideal for someone who would otherwise have to spend part of the day alone and who requires some light assistance. Family members can work or handle other activities knowing their loved one isn't left alone. Companion care also provides a valuable social benefit, decreasing isolation and improving mood. Warm relationships are often formed when a consistent companion is on the job.
How to get started: You can find companions on your own in much the same way you'd find a babysitter: by talking to neighbors, friends, or family members.
2. Personal care assistants
What they are: In addition to providing companion care, personal care assistants offer assistance with all kinds of activities of daily living, from grocery shopping to such nonmedical personal care as toileting, dressing, grooming, and bathing. They can also provide temporary respite care for families.
How they help: Many families enlist personal care assistants -- hired independently or through in-home care agencies -- to solve problems in their home care situation, such as a small woman hiring a strong aide who can lift a spouse for bathing, or a son concerned about privacy hiring a woman to bathe his mother. Personal care assistants can arrange for meal preparation, escorts to doctor visits, and any other type of nonmedical assistance your loved one may need in order to live at home longer. If you need to get away for a few hours a week or overnight, in-home care can ease the worry, especially if the in-home caregiver is familiar to your loved one because he or she provides regular services.
3. Adult day services
What they are: Adult day services -- also called adult day health services, adult daycare, or respite care -- provide care and supervision outside the home for older adults with physical or mental limitations. Many provide limited health services, mind and body exercise, social activities, meals, transportation, and other support services. Most offer a safe, supervised environment -- even for those with dementia or who are so frail they'd otherwise have to be cared for in a skilled nursing facility. Adult day services often operate as stand-alone centers or in connection with senior centers, churches, hospitals, or residential care facilities.
How they help: Adult day services provide an important care option to families who can't afford full-time, in-home care and need some way to keep their loved busy and engaged in a safe, supportive, supervised place. Adult day services also provide caregivers with much-needed temporary relief, whether the services are used for a few hours a week or more extensively.
How to get started: It's a good idea to tour possible adult day services providers to get the best fit. Two good places to find leads:
4. Home health agencies
What they are: Home health agencies are the go-to source when your loved one needs a higher level of care, including minor medical care. Certified nursing assistants have more medical training than elder companions or personal care assistants and must pass exams to receive certification; they usually work under a supervising registered nurse.
How they help: If your loved one is going to be discharged from a hospital stay, having someone around the house who can change bandages or check vital signs can provide peace of mind. Home health agencies are sometimes recommended for certain kinds of in-home rehabilitation, such as physical therapy. You may also welcome these services if your loved one needs personal care or health care that the family is uncomfortable providing or is unable to provide, such as colostomy or wound care, incontinence care, insulin management, or other medical services.
5. Your local Area Agency on Aging
What it is: Your local Area Agency on Aging is a government-mandated clearinghouse for general information about nearby eldercare services. These agencies offer free referrals to local services that provide transportation, meals, adult day services, in-home caregivers, legal assistance, home-based training programs for caregivers, and other forms of help -- all the kinds of services that can help you keep a loved one at home longer. The names of these agencies often vary by community. But the services they refer to are usually free or low-cost, and calling the agency is free.
How it helps: Calls to area agencies on aging are among the best first actions a caregiver can make to learn the local lay of the land on eldercare: what kinds of programs, facilities, and expertise are available in the community. Staffers can answer common questions and refer you to resources that are most likely to match your family's specific needs -- speeding your research process and perhaps making you aware of resources you never knew existed.
6. Geriatric care managers
What they are: Geriatric care managers, or GCMs, assess needs and identify and coordinate resources for older adults. Geriatric care managers can take over nearly all aspects of eldercare in some cases. Some local government agencies and charities offer geriatric care consulting services free or on a sliding scale. If hired privately, expect to pay a GCM $75 to $250 an hour.
How they help: Geriatric care managers are best at helping you organize care needs when there's a change in situation, such as when your loved one is moving in or has had a health crisis. They can also manage complicated ongoing care, such as cases in which a number of doctors and therapists are involved. Working caregivers and long-distance caregivers find their support cost-effective.
How to get started: Use Caring.com's Senior Living Directory to search for geriatric care managers by city or zip code -- and to see ratings and reviews.
7. Senior move managers
What they are: Senior move managers help plan and manage a move of any distance, such as from a longtime home or to a communal living situation. They will hire and supervise movers, help sort and pack belongings, and unpack at the new home.
How they help: Senior move managers are an important resource for older folks who downsizing. They don't just handle the time-consuming (and often backbreaking) logistics; they're experts in navigating the tricky emotional terrain involved with someone who has accumulated a lifetime of possessions. Caregivers who work or whose older loved ones live far away find such services especially useful. You can also hire a senior move manager to help downsize possessions if a loved one is moving in with you, to accommodate multiple generations under one roof.
8. Elder law attorneys
What they are: Elder law attorneys are lawyers who specialize in legal and financial matters that are especially relevant to older adults -- and to their families --including estate planning, trusts, and documents to ensure that medical wishes and financial wishes will be honored.
How they help: Getting documents in order that ensure your ability to communicate with doctors and banks will streamline your ability to be an effective advocate and caregiver. Among the legal documents you need for your loved ones: an advance healthcare directive, a durable power of attorney for healthcare, a revocable living trust, and a will.
9. Family mediators
What they are: Family mediators are lawyers, social workers, or other professionals with special training in the fine art of negotiation and compromise. They work with families to solve problems that are often highly emotional and polarized. "Elder mediators" specialize in matters concerning aging parents or partners, including questions of guardianship, living situations, charges of favoritism, and stepfamily tangles.
How they help: Unfortunately, not all crises bring families together; sometimes issues crop up that pull them apart. A good family mediator can be an impartial third party who can cut through old grievances and childhood pigeonholes to resolve tough situations. Aging parents may welcome this service to bring a strained family back together. Mediators can also get siblings on the same page, help far-flung families see eye to eye, help formulate care plans -- and curb the stress levels of hands-on caregivers, who often feel smack in the middle of family disagreements.
How to get started: To find a family mediator, ask a local geriatric care manager or elder law attorney. Many mediators are themselves GCMs or attorneys, although the person you use should be an impartial third party to all involved. Try for someone with a lot of experience working with elder concerns; look for the moniker "elder mediator."
10. Senior home remodelers
What they are: Senior home remodelers are builders and home-repair services that specialize in retrofitting homes to make them safe and accessible; many also create new construction with eldercare needs in mind. As a fairly recent subset of the home building industry, they're experts at assessing danger spots and inconveniences in existing homes, making safe upgrades (such as installing grab bars, widening access for wheelchairs, building ramps), and designing new living spaces. They apply universal design principles to create a house you can live in forever.
How they help: Whether a loved one is moving in with you or aging in place in his or her own home, getting an assessment from a senior home remodeler is useful for identifying dated fixtures and designs that put the person at risk for falls and other mishaps. Given that an increasing number of families are becoming multigenerational households, senior home remodelers can also make suggestions for altering an existing structure to give everyone privacy.