Navigating the Local Eldercare System: A First Person Account
As my father's mental and physical health began to decline, I found myself in the very confusing and complicated world of eldercare
Author Ann Cochran knew she had to find help for her elderly father, Gene Peters. Photo by April Witt.
I FIRST STARTED TO realize that my dad’s mind was in decline when he began having trouble with the concept of time. He was 88 years old and residing close to our home in Cabin John, at Victory Terrace, a lovely Potomac apartment building for seniors living independently. I’d ask him to come over at noon, and he’d come at 11, or 10. Since he was always early, I thought he was anxious about missing something.
His cognitive unraveling happened over the course of a year, starting about two years ago. When he showed up at our house at 4 a.m. one morning, he insisted that he was supposed to be there. Unfazed by our blaring security alarm, he said we asked him to come for breakfast. True, but at 9.
He hadn’t driven at night for a year. Neither the empty lobby of his apartment building, nor the deserted streets on the drive over, nor our dark house alerted him that something was off. Soon after that night, Dad agreed to sell his car.
Looking back, I realize now that I resisted adding up the signs, like the discovery that he hadn’t refilled his prescriptions in weeks, or seeing that he had rubbed toothpaste all over his face, or the deterioration in his cooking. My father, Gene Peters, always loved to cook. Dad was known for his Christmas beef bourguignonne as well as eggplant parmigiana. His homemade biscotti graced dessert tables at the weddings of both of my sons, and his recipe was featured in Relish, a Sunday newspaper magazine.
After a half-day outing together last summer, I walked Dad into his apartment and found a pot of cooled chicken soup on his stove. Despite my many warnings about food safety, he didn’t understand why this could pose a problem. Gradually, his dishes weren’t what they used to be. He could no longer make even the most familiar meatloaf.
My solution was to take each problem as it came and figure out a way to resolve it. In January 2013, worried about what he was eating when he wasn’t at my house or my brother’s, I called Meals on Wheels. Volunteers began delivering lunch and dinner Monday through Friday. For about $200 a month, we had peace of mind.
But even with the daily deliveries, he saved milk and food and let it go bad. I now regret my impatience in dealing with the situation. “Come on, Dad,” I’d say, “can’t you see this milk is expired? Here’s the date.” My intention was instructive encouragement: You can do it! Realistically, I’m afraid I only badgered him.
Reasoning that all he needed were better strategies, reminders and tools, I bought him new calendars, clocks, watches and a phone with oversize numbers. I also started to call him well in advance of when I planned to pick him up. I’d call again when I was leaving my house, 10 minutes away. Sometimes it worked. Other times, his concerned neighbors would notice him sitting for an hour in the lobby or outside on a bench.
In the fall of 2013, Dad had an accident at my house. I should have put him in the shower—instead, I cleaned him up while he sat on our powder room toilet. My husband, Chuck, and one of my sons were around, but this was my responsibility. I hoped Dad would continue to clean himself up while I ran to get sweatpants from Chuck’s closet, but when I returned, I saw that he didn’t have the dexterity or strength to do much. I held my breath and my tears and got to work.
Shortly after that, while I was putting away groceries at his apartment, I asked him to heat a frozen meal. Watching him struggle with the microwave was painful. I had put dots of red nail polish on the “start” and “2 minute” buttons, but I finally realized my strategies were futile.
We had to do something.
Cochran’s father, Gene, now resides at J’ Rose Assisted Living, a group home in Aspen Hill, where he shares a room with Victor, one of the home’s caregivers. Photo by April Witt.
MY RELATIONSHIP WITH MY father is complicated. My mother died suddenly of a brain aneurysm when she was 50, leaving all of us traumatized. Having worked as an accountant for RCA his whole career, my dad sought a transfer overseas after my mom died. Even from Israel, Dad stayed close to my brother and me, and to our children. We vacationed together in Israel, Italy and Spain. But when he remarried just after he retired, he got wrapped up in his new life and we didn’t see him very much.
When Dad moved to Maryland about eight years ago, it was in part to separate from his wife and in part because my brother, my husband and I had encouraged him to be near us as he aged. Although I was doing right by him, I resented his indifference over the previous two decades, and I felt burdened by his need for financial support. He admitted that he had lost money in several real estate transactions, and soon after we started to help pay his bills, we discovered that he had let his excellent health insurance lapse. Prayer and determination eventually helped me transition from serving him out of obligation to caring for him with love.
I’ve heard stories from friends and neighbors about their elderly parents fighting help. That was one area where we were lucky—Dad never questioned or resisted anything we did to help him. Due to a heart problem he had years earlier, my brother, Phil, and I already had the necessary legal documents in place: a power of attorney for financial matters, a power of attorney for health care decisions and an advanced medical directive.
Attorney William Fralin, president of The Estate Planning & Elder Law Firm, P.C., which has offices in Bethesda, says having those documents helps caregivers avoid the need to petition for guardianship. “That last resort process can cost $2,000 to $5,000,” he says. “No one wants to go there if they can avoid it.”
Our first step was to find a caregiver. Fortunately, we didn’t have to look far. A man who’d done similar work for a friend of ours was available. My dad knew both men well, and the instant comfort was worth $25 an hour. We began with four hours of help three days a week. A cheerful soul, Pong took Dad shopping and on all kinds of errands, including some medical appointments, always ending with lunch at Corner Bakery Cafe or some other favorite restaurant. For additional help with medication management and meals, we increased the weekly pay of the trusted woman who had been coming to clean and do Dad’s laundry ever since he moved to Potomac.
With those crucial documents in a folder and some caregiving in place, I started the search for a long-term plan. I discovered that we would have found support if we wanted Dad to remain in his apartment or move in with my brother or me. A nonprofit called The Senior Connection in Silver Spring matches seniors with volunteers who do food shopping and escort them to medical appointments free of charge. Volunteers also check on seniors by phone, make in-person visits and help pay bills. There are doctors and nurse practitioners who make house calls, and in Montgomery County there are 47 companies that offer home health care.
“The need is there and the demand is increasing,” says Shaun Toomey of Capital City Nurses, the oldest home care agency in Maryland. Susan Rodgers, a registered nurse who established Capital City Nurses 40 years ago, says, “Having cared for my dad in my home, I experienced firsthand the physical and emotional needs of caring for a family member. It’s not easy, no matter what your background is.”