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What Does It Take To Maintain Aging Parents’ Independence?

Aging takes its toll, even among the healthiest elders. We love our self-sufficiency. We don’t want to give it up. Nearly everyone asked says they want to stay at home for as long as possible. But staying at home without any help can be very dangerous.

Safety Issues

Here’s an example of an elder who is fiercely independent and wants to remain in her own home for life. But, she is taking serious safety risks every day. She has already had a few falls, luckily not sustaining any broken bones.

Retired Executive (RE), age 78, lives alone in her large home. Family is nearby but no one seems to quite get it yet that RE is unsafe in her present circumstances. She has no help coming in, though she needs it with numerous activities of daily living (ADLs), such as bathing, dressing, and incontinence problems. Years ago, she bought long term care insurance, a high quality policy the insurers no longer offer. Her policy is available and can provide the daily helper she needs. But the bureaucracy of the insurer makes it very difficult for her to access her well deserved benefits. She has tried and failed to get her benefits for two years, because she wasn’t clear about how to get a licensed healthcare professional to assess her needs and write up what the insurer calls a Plan of Care. Her M.D. won’t do it. The nurse at her managed care office won’t do it. She’s not totally homebound so Medicare won’t cover a home health assessment by an R.N. She had no idea how to solve the problem. She felt stuck.

Getting Insurance Benefits

When she contacted us at, an RN-Attorney, geriatric psychologist team, we addressed the insurance questions first. She needed that assessment, but who could do it? We asked questions. We spoke with her M.D. We learned that her granddaughter, who lives several hours away, is a newly licensed R.N. Meeting with her, RE and us was a first step. We developed a schedule and a time for her granddaughter to come to the home. (I will also attend). That assessment will take place and a Plan of Care will be written up soon. That will likely be enough to qualify her for benefits, according to our review of her policy.

In the meantime, she gets in and out of her tub every evening for a warm bath that helps her sleep. Every evening is a huge fall risk. There are no grab bars, nor other safety devices. Long term care insurance does not provide these, nor any other similar safety devices. Her MD and staff have been no help whatsoever in addressing this problem.

With our inquiry into available private pay local resources in the community, we located a licensed Occupational Therapist who can come to ER’s home and determine how to make bathing safer. Whether it is grab bars, an entirely new walk-in tub, tub mat, or other accessibility recommendations, ER can implement these recommendations. She has the resources to pay for them. That will help her maintain her independence and stay where she is determined to stay—in her own home.

The Coordination of Information

With the Occupational Therapy assessment and report, the granddaughter’s assessment and Plan of Care (verified by myself, a retired home health care RN), she will meet the insurer’s requirements for getting her benefits. Those will need to include a daily helper to assist with bathing, dressing, incontinence hygiene, cooking, and other activities. ER is fully intact cognitively. She has daily pain, difficulty with movement and will benefit greatly with a consistent caregiver. She will be able to remain in her home with the contemplated appropriate support. A fall with a hip fracture or other damage could destroy that plan but the safety measures afforded by both her own resources and her insurance will maximize her chances to remain independent.

The Takeaways

For those who are not homebound, getting help at home is a challenge, According to ER’s M.D., Medicare will not even allow a nursing assessment at home to determine what a person needs to be safe. If this sounds as ridiculous to you as it does to me, consider that Medicare will readily pay for hospitalization and a nursing home for post hospitalization care but will not pay for any measure to prevent hospitalization for ER in the first place!

  1. If your aging parent is getting frail or has difficulty with daily activities, get help for them before a crisis happens. When they resist, as many do, use every persuasive trick you can come up with to get them to accept help.
  2. During any crisis, such as a fall and fracture(s), the burden of decision-making often falls on family. It can be a very preventable stress no one needs. Using that tactic to help persuade a resistant elder to accept that assistance is needed can work: “Mom/Dad, please don’t put a burden on us if you fall and get hurt. It can happen and it’s not fair to us”.
  3. If obstacles get in the way of actually getting help, as in ER’s case, offer to be involved in problem solving. ER is quite willing to get assistance in the form of a caregiver. But she got stymied by the obstacles in her way. I suspect that if she had not reached out for someone to help her remove the barriers, i.e., the insurer’s stringent requirements to get her benefits, she might well have ended up in a hospital.
  4. No matter how independent your aging parents or other loved ones may be, don’t take it for granted that this will stay the same as time passes. Be on the alert for signs of decline. Ask specific questions, such as “Are you having any issues getting in and out of your tub?”
  5. Finally, accept that change is inevitable for all of us who love our independence. Aging can compromise this but with appropriate help, many of us will not be required to leave the home where we prefer to remain.

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