NEVADA VIEWS: Elderly care: Who’s taking care of grandma?

While you’re busy working and raising your own family, who’s taking care of your own aging parents? Eventually if your parents are still alive, many adults are thrust into a new role of caring for aging parents. Navigating the decisions to be made about home care, assisted living, memory care, meals, finances and even hospice care can be daunting.

Unless you’re working in elder care, people may not be familiar with options and resources. I wasn’t, and I’m a nurse practitioner.

When my aging father was unable to physically assist my petite mother out of bed and into a wheelchair, he declared her bedfast, which only accelerated her physical decline and worsened her Alzheimer’s. It took many weeks to coordinate in-home care, which was expensive and frustrating. Finally, the day I saw he was going to serve her uncooked bacon for breakfast I realized his own mental decline. It was time for full-time assisted living care.

Lessons learned: Social workers and case managers have wonderful lists of in-home service companies, but always check for recommendations yourself. Having a home camera and clearly written instructions for home care workers are essential.

It took many more weeks and spreadsheets to review group homes and assisted living and memory care facilities in Las Vegas. My only known resource was Google. Even for someone in health care, it was a slow process to identify the different options, tiered prices and quality of care. A fancy lobby didn’t make up for poorly trained caregivers. Regulations governing group homes and assisted living facilities are stringent. Those that do not follow them are not the best choice for your loved one or your peace of mind.

Lessons learned: Physically visiting each facility and doing a “taste and smell test” were key. You need to smell the facility, and if a whiff of urine permeates the air, leave. You can ask for a sample lunch/dinner meal to evaluate the food quality. Ask about the training of caregivers and the ratio of personal care attendants to residents. Ask about activities and look at the faces of the residents to evaluate their general physical condition and state.

A valuable resource I finally discovered is Spotlight, which is a book listing senior services and living options in Las Vegas and surrounding areas. It is also available online and through a phone app at spotlightseniorserviceslasvegas.com/.

Spotlight is sponsored by a marketing agency and does showcase companies by paid endorsement. But the outline of services is still a helpful place to start. You can also use a free broker service called “A Place for Mom” that will guide your search based on your preferences of location and services. The National Resource Directory is also helpful and lists community resources for veterans and the elderly.

Be a fierce advocate for your loved one because navigating the complicated and confusing health care system can be daunting. When the time for hospice care became a reality, there were more decisions, and I needed to hunt for reputable hospice care. Again, ask questions to clearly identify services, communication processes and details. Identifying the process of notification and transport when a loved one passes was a simple act that was missed. When my father passed away, nobody from the memory care facility called me. It was finally the hospice nurse who contacted me, and she didn’t know where his body had been taken. The memory care facility had arbitrarily chosen a mortuary from their default list, and I was not notified. The mortuary charged $300 to go and identify his body.

Lessons learned: Plan ahead of time in details for hospice and burial care. Make decisions early and in writing so they are not made arbitrarily for you.

Planning end-of-life care and decisions is an uncomfortable but necessary process. Preparing documents for a living will, medical power of attorney, mortuary preference and burial plans needs to be done before parents have poor memory and are confused. Working with a lawyer for estate planning is wise to avoid probate and additional avoidable fees.

The positive lessons I learned include that there are many resources to help you make decisions. The Harmony Hospice team of Las Vegas is fabulous, the Veterans Administration offers an incredibly touching service of burial privileges and military honors, life is precious and that my mother is now in a different memory care that makes her smile again. That makes me smile, too.

Tracey Long is a family nurse practitioner in Las Vegas. A version of this essay will appear in the April edition of RN Formation, a publication for the Nevada Nurses Association.