Family Home Care for Solitary Seniors

This report is a composite of observations of a Senior citizen in her normal life setting. It represents near optimal family coordination to assure:

1. Adequate personal security
2. Relative Senior independence
3. Medication compliance
4. While maintaining normal life function for the children.

Let’s call her Helen and she’s an 89 year old African American woman. A petite108 pounds and five feet tall, Helen is the Mother of three professional children who maintain her status as the family’s alpha female. She lives alone since being widowed some 20 years ago. Her dedicated home companion is an obedient 150 pound black Great Dane named Titan. Her home is a 3500 square foot, brick, and tri-level home on a wooded acre in suburban North Carolina. It still appears modern despite its 50 year age, and has lots of stairs.

As a retired college Math PhD, Helen maintains a current computer with internet access but uses it infrequently due to ease of use and security concerns. Luckily Tracy, her Granddaughter, is available for in-home IT consultation. The wall mounted kitchen TV constantly broadcasts CNN from early morning to her bedtime. It provides continuous background noise in the large home, despite the audio volume being too low for her to understand. When she wants to hear details, she stands and watches closely.

Helen’s memories of recent events and details are usually clouded, forgotten and repetitive. Cognitive function such as reasoning, calculating and remote memory is still above average. Managing her bills, real estate, checking account, taxes and investments is time intensive and laborious. It’s accomplished by her and Sharon, her daughter in weekly segments. Playing Bridge was her passion and favorite social pastime, until four years ago when she stopped playing.

Dr. Spruill, her Internist, reports that her overall health is appropriate for her age, as she is a Cancer survivor and has several chronic, yet well controlled illnesses. Medication management and compliance are monitored daily by her kids. Her activities of daily living are conducted without assistance. Though the noon meal is delivered, eating is usually inadequate and requires being reminded. The exception is the nightly cup of Breyer’s Butter Pecan ice cream before bed.

Adventures outside of the homestead occur about twice a week for her. She accepts invitations to college events, if not sports related. Though no longer maintaining driving privileges, at least once weekly she’s taken to a local restaurant and attends one of several local churches. Recently, as a speaker at a testimonial event for a friend, the audience was entranced as she recited twenty lines of poetry from memory. The poem was learned at 22 years old but practiced prior to performance.

As the sole survivor of her parents and siblings, most of Helen’s extended family live within75 miles. Children, Grandchildren and Great Grandchildren all frequently participate in her life with visits and group events. Twice daily phone calls monitor her wellbeing. The older kids visit at least once weekly, maintaining the homeland, keeping health appointments and doing the laundry. This is prime time for monitoring personal habits, medication compliance, and performing a physical assessment. These visits last from a few hours to several days at a time. The highlight of the week is the mandatory Sunday phone conference call with Helen and the three older kids. It doesn’t matter where the kids are in the country, attendance is expected. Music and reminiscing are usual themes with a weekly personal update followed by a current events challenge. Episodically business issues are discussed but seldom settled. Everybody enjoys these get-togethers, usually.

For security purposes, the kids maintain a substantial home monitoring system along with an emergency pendant, fire extinguishers and night lights. Fall detection and video surveillance systems are controversial, as Helen resists intrusive or invasive technologies. Personal independence is the principle upon which most decisions are measured.

Here’s some advice before planning any family based home care model. Top priority should be given to monitoring well-being and safety… primarily precautions with multiple back up plans and redundant resources. The overall goal should be to provide therapy that combats the onslaught of loneliness, memory loss, chronically diminishing technical skills and mobility compromise. The individual needs and behaviors of each Senior should be determined. This assessment should include a close evaluation of mental and physical capabilities and limitations. A third party analysis of the plan might enhance its value and efficiency while promoting family confidence.

Dr. David W. Trader, Geriatric Psychiatrist, describes socialization as an essential element for Seniors to attain a satisfactory quality of life. Our research reveals that in prehistoric times, human predecessors found group behavior to be requisite for survival, as it is in many insect and animal species. Socialization has multiple beneficial effects on isolation, memory loss, diminishing skills, and mobility. The caregivers’ mission is to identify and address these critical factors.

Despite Helen’s limited needs and exceptional mental status, the principles applied to this home care model produce an above average quality of care which is achieved by:

1. Establishing quality standards and goals
2. Modifying methods of care based on customized Senior needs and their environment
3. Importantly, sharing the duties and costs throughout the family which decreases early caregiver “burn-out”.

Our next article will discuss the strengths and weaknesses of this family based home care plan.