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The Rundown on In-Home Eldercare, with Wendy Adlerstein

What are the signs your aging parent needs in-home care? How do you have that conversation? How do you choose a caregiver? This week in the club, Wendy Adlerstein, a licensed social worker and executive director of FirstLight Home Care in Boston, shares tips for what to think about when considering in-home care — and how to include your parents when making decisions about their needs

July 20, 2021

MEET OUR GUEST:

WENDY ADLERSTEIN has more than 20 years of experience working with seniors. She is currently executive director of FirstLight Home Care of West Suburban Boston, and holds a B.A. in Psychology from Clark University, with a concentration in Sociology and Human Services. In addition to her Massachusetts License in Social Work, Wendy holds a Certificate in Gerontology from the Worcester Consortium Gerontology Program. She is a member of the Aging Life Care Association (ALCA), formerly the National Association of Professional Geriatric Care Managers. Finally, Wendy is a Certified Dementia Practitioner® in good standing from the National Council of Certified Dementia Practitioners. 

Jennifer Owens
Wendy, thank you so much for sharing your Sandwich expertise with us. You have 20 years' experience as a licensed social worker, you're a certified dementia practitioner, and you're Executive Director of FirstLight Home Care of West Suburban Boston, and Boston Back Bay. I'd love to dive right in and kind of learn about how you came into this field.

Wendy Adlerstein
I worked in the non-profit side for most of those years in-home care, dabbling in different pieces of state-funded home care and some Medicaid programs, and also overseeing volunteer services for many years. And then I was able to start up our FirstLight Home Care office in the west suburban Boston area. We provide private paid home care services, primarily to seniors, but also to anyone over the age of 18, who could use a little extra help in their home, to be able to stay there safely and comfortably.

Jennifer 
I'm someone who's just been through a cycle of having a parent go into having home care, then go into a nursing home, then go into hospice care. So the idea is to keep people in their home as long as possible?

Wendy
Exactly. With the growing population of aging individuals and really looking at what people want, most or a lot of people say they want to be able to age in place in their own homes. Sometimes in order to do that, when you get to a certain point, it may require a little extra support to be able to, to do it safely.

Jennifer
I'm Gen X and my parents are right before the moment the Boomers start — and it really does change in an instant. You visit one day and you're like, "Oh, geez, what's happening in the fridge this week?" And yet, no one size fits all. I love the idea you were saying to me previously about that — that our circumstances are always changing. I'd love to talk about the different living situations to consider when we come home, visit our mom and we're thinking, "Oh, mom needs a little help."

Wendy
Like you said, no one size fits all. This is a very individualized process. Sometimes it's a family decision or an individual's decision, depending on what they want. If somebody does want to live at home, it's great to know what the options are, in terms of anything to make it better. It could be simplifying some of the arrangements in the home — say, in terms of the bathroom, making it safer by adding safety things like grab bars — or modifying doors so that a walker or a wheelchair can easily get in or making kitchens more user-friendly.  Or it can mean having a person come in to assist with bathing, dressing, meal prep. You know, having somebody help with the shower can make all the difference in terms of safety; the bathroom is a slippery place, especially when you're already unstable. It's important to do the research and know what the options are that are out there to help somebody stay at home.

Jennifer
Can we talk a little bit about what in-home care looks like? I'm distant to my parents but for a while my dad and stepmom had in-home care. And my dad got mad, causing a whole drama. What is homecare really? 

Wendy
What we do is look at the situation because everyone's needs are different. We start with asking, what is the person's routine and where is it that they might need that support the most? A lot of times we hear that it's just about getting up in the morning and getting the day started. Having someone come in for maybe four or five hours, from maybe 8 a.m. to 12 p.m. and assist with that morning routine of getting up out of bed, having breakfast and getting cleaned up and dressed. Right there that can set the tone so that the person can go on with the day after that caregiver leaves.  That's one example of how it can work. But homecare can be 24/7. We have clients where it's a 12-hour shift during the day and then a 12-hour overnight for when people are getting up in the middle of the night and trying to get themselves to the bathroom safely. We're always providing lots of safety and supervision to prevent falls. For anyone who's a fall risk, having someone with them is key.

Jennifer 
Is there any way to know when it's time to start thinking about these options? You get that little ping in your heart that says, "Oh, I think we need to," but it's so fraught with the sensitivity of being the child and thinking, "I might need to help Mom out here."

Wendy 
There are certainly little signs that can let you know that maybe things aren't the way they used to be. Like the refrigerator: maybe the food isn't being thrown out or eaten. Maybe you notice different smells in the house. It could be food issues, it could be incontinence issues. You may just see that somebody is not as stable on their feet and you're worried that if they do fall, who would be who would be there with them? So it's sort of just these little clues that could kind of start, triggering the thought that maybe it would be good to explore having someone come in and be that sort of assistant in the home.

Jennifer
And then there's the talk. How do we say "Mom, I have concerns — and I also have ideas about what we might want to do." You can hear me already because it's not easy. How do we start the conversation? Because we love them and we respect them. You don't want to take over for them, they are your parents. This is a conversation that you want them to be part of as much as they can.

Wendy 
Exactly. It's understandable. If you flip the feeling if somebody comes up to you and says, "You know, I think you need some help..." I think it's really sort of just taking a look at where that person is at for themselves and how they see themselves. So starting a conversation maybe starts with asking questions: how do you think you've been doing with the day more? How do you feel taking a shower? Do you feel unsafe? It's really involving the person in the conversation and getting them to even just start to think about the questions, even if they might say, "I'm fine." You want to plant a seed that could potentially open up to the next step of what might be. A lot of times, it's the fear of the unknown that leads people to think, "I don't need someone in my house to take over." Then, as soon as they actually meet someone, it becomes a person that maybe they actually like, that they might look forward to having come in. It's important to help somebody understand that nothing is set in stone. Why don't you try having someone for a couple of days and let's see how you feel? It's taking baby steps.

Jennifer 
That makes a lot of sense: Finding where the gaps are and what do you think we can incorporate? Let's figure that out. Let's make a plan for that. In a perfect world, I don't want someone in my home, either. As much as I'm open to someone doing my house cleaning and cooking and cleaning and shopping, I'd love to have someone do it without actually entering my home because I just want to sit on the couch some days. So I get that. I felt with my grandmother that for her it was a loss of freedom. It was never going to be a thing, but then it eventually did become a thing. It started with landscaping and then helping with some cleaning. It was just as her needs increased we tried to add in stuff and she stayed in her home into her 90s. Nobody wants to take away your home. We just want you to be safe in it.

Wendy 
That's a great way you described it; it's finding out where the person feels the needs are for themselves. It gives them a feeling of control in making those decisions. Because you're right, it's all about the fear of losing their freedom and losing control over their own environment. And as they age, there are so many losses already, that you want to give someone as much control as possible.

Jennifer 
We're worried about the next chapter, when the needs increase — and we don't want to show it on our faces. It's a variation on a theme of the conversation we have with our kids, when we're trying to get them to do their college essays, right? They're putting it off, and you're thinking, "I'm trying not to show you that I know how the next chapter plays out if you do a good job."  It's just life in the middle. We know too much!

Wendy 
And some of the things that you're doing right when you're in the middle with your kids may apply to the older generation on the other side.

Jennifer 
It's all that emotional stuff that comes with pushing them but not trying to push — and then adding on the fact that you are doing this with a parent and that you remember your parent when they were, the boss of you and you're pushing against them. It's just fraught, and you want to come to it with love and respect.

Wendy 
It's very challenging — and it's really a little bit of just feeling it out and starting conversations as early as possible so that you don't you're not having these conversations in crisis. It's just getting a sense of what somebody's wishes are, what they want as they get older. That way, you can always refer back to the earlier conversations as in, "Remember when we talked about, what you thought you'd want?" Doing things in crisis is a lot harder.

Jennifer 
This is a very independent generation that is our parents. 

Wendy 
People are aging, they're living longer. And there is more activity and more travel and more exercise and more knowledge about diet and health — so it's a different kind of aging.

Jennifer 
So then secretly among us in the middle, can we talk a little bit on how you hire in-home help so that we can come prepared? When I was looking at child care, when this was all about babies and going back to work, I purposely picked center-based care because I didn't know how to hire someone into my home back then. And so now I believe I'm gonna need to learn this sort of stuff. What can you tell me about getting ready to like to choose someone? What should we be looking for?

Wendy 
It's a great question. I think one of the things to consider is the difference between hiring a private person on your own versus an agency. Oftentimes, hiring somebody privately can be a little cheaper, but what people don't realize is that when you do hire somebody privately like that, you are on the hook for a lot of liabilities.  What an agency brings is a whole umbrella of coverage of insurance. It also brings fill-ins if your aid calls out sick. At our agency, we have a great team of care coordinators that are constantly overseeing the caregivers and managing the schedule. The responsibility becomes more of the agency's, in terms of care, and the family can be the family. When you're a family just hiring a caregiver directly, now you're an employer and have all these other pieces to take into consideration. So that's one thing to keep in mind. With an agency, it's a lot safer in many ways: we do very careful screenings. The caregivers go through multi-state background checks and local background checks. There are interviews, reference checks, they take little quizzes that we give online, to measure their abilities to make decisions. It's just a lot more oversight and vetting. Those are the kinds of questions when you are searching for an agency that you want to ask, What is your vetting process for caregivers?

Jennifer 
And then when you're meeting the caregiver yourself, what are you looking for? In? I mean as the kid in the equation.

Wendy 
I always say this is a people business. We're matching people with people and we do our best, you know, to make a match, and sometimes it just takes off right away. It's great. And, you know, like any relationship sometimes it might take a second try, if you're meeting someone and that's just not the right personality fit. That's okay. A good agency should say, no problem. It's also a skill. Everyone has different needs; somebody need might be related to dementia. So we want to have somebody who understands that and how to navigate, helping someone with dementia versus maybe somebody in need of a lot of personal care assistance and not the dementia side. It's making sure that the big puzzle fits together.

Jennifer 
And then how about Mom and Dad? I could foresee the day where they don't like anyone because they don't want them in your house. These are professionals that know from this situation, I'm sure, but how do we navigate having your parents' voice in this choice?

Wendy 
Our philosophy at FirstLight, and that of the caregivers we hire, is that the goal is to encourage as much independence as possible. So we're not sending somebody in to take over or to take away things that the person can do. We want to make sure that mom and dad are able to still do what they can do. If that's folding and putting away laundry, maybe the caregiver goes down in the basement with the basket. But then once the basket is downstairs, they can help mom go down the steps, and she can put the laundry in, because that's her thing.

Jennifer 
My husband does the laundry. He can still do it and I'm just his assistance. I don't want to do the laundry. Right? Just putting that out there for the future.

Wendy 
Exactly. So you know, it's a way of finding how somebody can make the task better and safer, but not take the task away.

Jennifer 
I love that. Because it is really how you think about yourself, with these sorts of things. I have a fervent hope that the generation that's in the middle right now is learning lessons about how we want to leave things for our kids. I hope that we're looking at this and thinking that these things like doing the laundry or making scrambled eggs mean that I'm in control of my life. So if it's just that I can't carry the basket, but I can still fold up the socks and make pairs? That says, I still have that control. How great is that? I think that's wonderful.  Is there anything that before we kind of close out our conversation today that you want to make sure that people think about when they start thinking about the need for in-home care and having these conversations with their parents. 

Wendy 
Really, it's just about taking it in steps. Families should know the options that are out there. It's a relief as a family caregiver, as a daughter, or a son and niece, a friend. Having someone come in the home can be a way to take care of yourself too because it gives you the breaks that you might need if you're doing a lot of caregiving for your parents or loved one to have that support. That's important to keep in mind.

Jennifer 
Oh, I love that. Because we are talking about people who are caregiving, whether the generation behind us or the generation ahead of us. So yes, we need to take care of ourselves. Thank you so much for joining us on Club Sandwich.

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