A very compassionate view of caregivers, emphasizing the humanity of all involved. Intro: We step up:-- even though we're not terrible well prepared for the job.-- though the work is harder. Families are taking on more technical aspects of health care, as hospitals and health plans cut back on what they will provide.-- despite the fact that most of us have jobs.-- despite the considerable expense.-- though we may have children at home.-- even if we qualify as elderly ourselves. Chapter 1 -- Home care. Hiring help for the home -- going through agencies, or on your own. Pros and cons. Is public funding through Medicaid, city & state programs, or local charities available? Is your parent sociable & communicative enough to form relationships with paid caregivers? Will she be able to reliably report how caregivers are working out, what problems have arisen, whether she's happy with the arrangement? Will you or other family members be able to drop in to monitor her care?A quality home care agency should screen its employees, check their education and employment histories, perform drug tests, and run criminal background checks. Good agencies supervise their people, including making unannounced visits to home where aides are working. An agency provides backup, or a substitute for absences.An agency handles the paperwork -- and the legal responsibilities for payroll, having an employee identification number, taking care of SS taxes, workman's comp, liability and theft insurance. Median hourly wage for a home health aide was $19 (2009 publication date) and $17 for a less skilled homemaker/companion. Preparing for hiring: come up with a list of needs and tasks. It's helpful to bring in a geriatric care manager or a social worker with a local senior health program for a professional assessment. An experienced outsider can be more dispassionate about the needs. Ask the home health care agency very specific questions:- Does it run background checks and require drug testing?- Do supervisors meet regularly with workers and drop in when they are on the job?- Will your parents get the same aide every day? - What sort of backup is available if an aide gets sick or quits? - Is the aide an agency employee, or a contract worker not covered by workman's comp or liability insurance? - Will aides be able to administer meds or drive your parents? - Can you call previous clients as references?- Whom do you talk to if you're unsatisfied; how are complaints addressed? If you are hiring on your own, long-term care experts advise starting with a written job description. You'll want references. You may want to run your own background check. Start with a month's trial. You will often go through 2 or 3 candidates before finding a match. You'll need a contract or written employment agreement, specifying hours, tasks, payment schedules. Drop in unannounced to see how things are going. Chapter 2 -- Moving In. I did not read this chapter.Chapter 3 -- Moving On. Assisted living. Is your parent able to live comfortably in her own room or small apartment? Can she feed herself? Use a toilet or manage her own incontinence garments? If not, your parent may need more help & supervision than most assisted living residences provide. Is she mobile enough with a cane, walker, or wheelchair, to go to and from the dining room and to participate in activities and outings? Does she require vigilant daily health monitoring (of blood glucose for instance) or regular skilled nursing care? Most assisted living facilities don't provide such services, even if there is a nurse on the staff. Can your parent or family afford steep monthly fees? In most cases, assisted living residents pay privately. But Medicaid will pay part of the tab in some states, and some facilities offer subsidized apts; have you looked into these arrangements? Can family members, trusted friends, or a geriatric case mgr visit your parent weekly or more often, not only to spend time with her, but to monitor her care? Can they come on varying days and at odd times?Is your parent social enough to form relationships with staffers and friendships with fellow residents? Is she adaptable enough for a group residence?Chapter 4 -- What else is there to fear? Nursing homes. The industry rule of thumb is that someone moving into a nursing hoe needs 3 to 6 months to adjust. "New residents are 'dealing with loss, with a capital L-O-S-S. Not just of their physical abilities, their senses, their independence, but their homes, their possessions.' Possibly they're mourning the person who cared for them until now. Perhaps, too, they're aware of oncoming dementia, their ability to make decisions for themselves.Their children have to adapt too, and that means maintaining reasonable expectations. There's definitely some compromise. It's not home. It's an institution."Finding the facility is the initial challenge. This is getting easier, but it's still not simple. Talk to others with relatives in a facility. Walk through the place. Are there cars in the parking lot? Are people visiting? You'll want to hear lively things, not just the sound of a TV. You want to see staff who generally have a good demeanor. There could be pets, or flowers. There's life there. Especially visit during the evening, where staff and activity levels are lower to get a sense.Continued involvement by family members can be crucial. Does your parent need help with almost all activities, including moving around his room & eating meals? Does he need 2 helpers in order to safely take a shower or use a toilet? A nursing home is the most likely facility to provide this much assistance. Does he need physical o occupational therapy, or help from a social worker? Nursing homes generally have such specialized care available onsite; other facilities may not. Has he exhausted his assets, or will he soon, so that he will be eligible for Medicaid? Skilled nursing facilities are the only long-term care option that Medicaid will pay for regardless of the state that your parent lives in; coverage for other alternatives, like home care of assisted living, varies from state to state. Can family, friends, or a geriatric case mgr check on your parent regularly, sometimes at odd hours, to be sure he is receiving the care he needs? Can you locate a nursing home with a family council, so that family members can support one another and communicate with administrators as a group? Chapter 5 -- A wedding & 2 funerals. Hospice care. Hospice patients need not reject all medical care, but the goals of care shift. Resources: www.aarp.org/caregiving. www.caregiver.org. www.caregiving.org. wwwnfcacares.org.