Old, Alone, “Don’t Need Help”

Old, Alone, “Don’t Need Help” is a common response a Home Care Social Worker hears. It is hard to be ill or incapacitated. Living alone makes it that much harder. In fact, age, illness, and living alone are “risk factors” to be considered when putting together or thinking of a “Care Plan”.  Whether returning home following a surgery, illness, stay in Rehab or have a chronic, degenerative disease, at some point in time all of us will need help at home.

Research shows that having help during convalescence does cause faster healing. Help comes in many forms, especially for older adults. Medicare covers at 100% skilled home care services such as a visiting nurse, physical, occupational and speech therapists, a Social Worker, and some bath visits. Many seniors, and their adult sons and daughters, believe that Medicare covers an aide for multiple hours a shift. This is so rare, I have never seen it happen as Medicare home health is comprised of one-hour visits and is NOT considered “custodial”.  Most care falls to the spouse or other family members. Friends and neighbors may also pitch in but that does wear thin after a time.

Trained Help

It depends on individual needs and incapacitation. Mobility is very important. If you or a loved one cannot get out of bed, bear weight, pivot, and walk, then help is necessary. Most people can get, with assistance out of bed, to the bathroom, to the kitchen. It is crucial to be honest with oneself about safety and ability.  A fall often sends people back to their doctor or even the hospital. Post-surgery, it takes longer for the anesthesia to leave an older person’s system. They may also be on pain medications which can cause balance issues and clouded thinking. Because of these and other uncertainties, having a trained aide, at least for the first 72 hours can make a huge difference in recovery.

Family and friends are fine when available. They are well-meaning, but an untrained person helping with personal care (ADLs) such as bathing, dressing, transferring, and walking and in the bathroom are unsafe. It takes some training to know how to hold and maneuver another adult, especially with balance issues.  There are a lot of trained aides and caregivers in South Florida. People often hire someone they know or an aide that a neighbor used. Check credentials and references. Know that when you hire privately that you are the “employer” and taxes, workmen’s comp etc. become your responsibility.

Hiring a caregiver from a licensed home care company means that the screening and certification are complete and up to date. You also benefit from having back up and choice to change if need be.

Independence is in the Mind

Wish I had a dollar for every time I’ve been told that ” I don’t need help, I’m independent”. But, if you have a broken leg, you can’t walk by yourself. Independence doesn’t mean you do everything on your own.  It does mean you make your own decisions, plans, and choices. Denial however is a powerful defense mechanism. It is also a brittle one because it crumbles before reality. Sure, most people are independent and can manage even when ill or injured. Why add to your risk? Sure, it is unpleasant having a stranger in your home and helping you with personal care. It is also prudent. Old, alone, “don’t need help” is often a reflexive response. It is a cultural aspect of the rugged, individualist many of us see ourselves to be. We also tend to see ourselves as younger than we are and sometimes more capable though we are ill or hurt.

Should you need help, consider your options. When family is nearby and available, discuss (in advance) what each person can do for you. Consider what they can’t. If your son or daughter works full time and has children or other obligations, they likely are not as available as either of you would like. Does your family member want to help you in the bathroom or shower? Are they able to do so safely? An independent person would consider their needs, options, and then plan accordingly.

An Example

A woman in her sixties calls to inquire about home care. She is awaiting a kidney transplant and knows she will need some help upon returning home. As home care is expensive, she reconsiders and plans to have her sister and friends help her. Bear in mind, her sister is older and just getting over a virus. Her friends and neighbors are also in her age group, but happy to help with meals, shopping, and appointments. The woman doesn’t take into consideration that a transplant is a major surgery with a lot of aftercare protocols with medications and recuperation.  She is advised to speak to her transplant team and find out what they advise for her home care.

Although the woman is not wealthy, she can afford a few weeks of assistance. Often this type of plan falls apart due to realizing the complicated needs that do require a trained person to help out.  Is it fair to expect a family or friend to help out in the first week when there are so many variables to consider? Is having a continuum of care, caregivers, even for a week or two more sensible than fragmented help? Can you ask more of a hired aide than you do of a friend?  What happens when your informal schedule of help runs into a friend or family member not being available?

Remember, most home care companies do not charge anything until the aide is helping you. There is no downside to having your informal plan with a more formalized one. Being older often means having one or more health conditions. Living alone means you are largely on your own, especially at night. Not needing help, really, following a big surgery or lengthy rehab stay? Think safety first, put your pride aside, and take this time to spoil yourself a bit. Consider your best interest. The first two or three days are crucial for your recuperation. If you were in a rehab center or a hospital for more than a week, you are used to having a lot of staff care for you. It is not the case at home. Are you really able to cook, clean, shop, do the laundry, keep up with appointments, medications, possible in pain all by yourself.  Perhaps yes, is it the smart thing to do?

Recovering or managing a degenerative condition, physical or cognitive, is a good time to be kind to yourself instead of stubborn.