ELDER CARE: Caring for California’s Aging Population : RESOURCE GUIDE: CARING FOR THE ELDERLY : Q & A: Commonly Asked Questions About Caring for Elderly

Question: What is the first step in caring for an elderly person?

Answer: The answer depends on the particular situation. In some cases, there is a dramatic event--a fall, a heart attack--requiring families to swing into action and change their life styles almost overnight.

In other cases, changes occur slowly; relationships and responsibilities evolve over months and years. Whatever the situation, experts urge care givers not to be afraid to admit that there are problems and to seek advice in solving them.

A word of caution: In dealing with an older person, family members should not assume that they know what they--or their elder relatives--actually need. In most cases, if not all, families could benefit from some kind of professional help or counseling to sort out the many complex issues associated with learning how to adjust to changing family relationships and how to care for an aging relative.

Q: Where can families go for help?

A: The list of places to check is almost endless: employers’ group benefit offices, churches and synagogues, hospitals, university medical centers, government social service agencies. Government agencies are usually referred to in the telephone directory as family services or elderly or senior citizens’ services and are listed under city, county or state headings.

Private consultants and private senior citizens programs are listed in the telephone book under family services, gerontology, elder care, aged or aging, senior citizens. (For resources, see special pull-out guide page 9.)

Experts also urge families not to be shy about asking friends and acquaintances for referrals.

Q: Under what circumstances should the elderly move out of their own homes?

A: The simple answer is whenever they want to. Until recently, moving out of the apartment or selling the house was the only thing most families knew to do for the elderly who had become so frail or disabled that they could no longer take care of themselves.

Today, however, most cities have enough government and private services available--both free and for a fee for those who can afford to pay--that families have options to nursing homes. Studies have shown that most people, whatever their age, would rather live in their own homes than go to a nursing home or move in with their children. Talk with the elderly person and then to try to use the resources of the community to meet that person’s needs.

Q: What is long-term care insurance? Is it a wise investment?

A: Long-term care insurance is a new form of insurance that pays many of the costs of growing old not covered by Medicare or by private health insurance policies. The new policies cover mainly the costs associated with entering a nursing home. According to Consumers’ Union, a long-term care policy is not advisable for people under 60 unless the policy offers a reliable way of keeping benefits current with inflation in nursing home costs.

For those over 60 who are more affluent and want to protect their estates, policies from top-rated companies may make sense, but consumers need to read the fine print about what is covered, for how long and at what cost. Those of modest means should not consider these policies because, if they require nursing care, they will quickly qualify for Medicaid.

Q: What if an elderly person has little or no income or savings?

Are there programs to help?

A: One of the reasons that life is better economically for today’s elderly has been a tremendous growth in Social Security, a program of retirement benefits for which virtually every American is eligible. Most senior citizens are also eligible for Medicare for health benefits, and elderly people who have few or no assets can collect Medicaid benefits. In addition, there are numerous social service programs--some supported by federal, state and local governments, others financed by private foundations--to which lower-income senior citizens may apply. Because funding levels and eligibility requirements change frequently, as do the needs of the elderly, it is important to check regularly with counselors at local senior citizens’ centers to learn what is available and who is eligible.

Q: Where should elderly people go for medical care? To a private doctor or an HMO?

A: Health maintenance organizations are prepaid medical plans that both insure people against the costs of medical care and provide that care. Services range from office visits and medications to surgery.

If there is an HMO nearby and it will admit an elderly person to the program--some refuse to take high-risk patients--and if the program has a good reputation, this may be an easy and economical way to obtain health care.

HMOs are not advisable for people who want to continue to see their private physicians or who want to be able to shop around for specialists or who have a preference in hospitals. A rule of thumb is that, although there is more choice and freedom with private doctors, there are more decisions to be made and usually higher prices to be paid.

Q: What kind of physician is best?

A: The vast majority of Americans have a specialist for every ailment--heart doctor, skin doctor, back doctor, “regular” doctor. Although these specialists are in many cases quite critical to maintaining good health, it is in many cases the regular doctor--usually an internist--who is most important because he or she keeps track of all problems, all medications, all treatments. Some elderly people elect to use geriatricians as their primary physicians.

Although there are as yet few doctors in this new sub-specialty of family and internal medicine, geriatricians are specially trained to deal with the multiple, overlapping and chronic problems that often plague the elderly. Typically, geriatricians can be found only at university hospitals, at day hospitals specially designed for the elderly or at clinics at senior citizens’ centers.

Q: When there has been a death in the family, is it advisable to seek psychological counseling or to join a bereavement group?

A: Counseling and support groups can be of tremendous help in the months and years after losing a friend or family member. So can friends. According to a number of studies, people who have experienced the death of a loved one benefit from the comfort and advice of people who have been through similar situations.

Some studies have suggested that families can be a hindrance in the grieving process: Because different family members have different ways of grieving, conflicts and misunderstandings can often arise. Women who have lost their husbands complain in particular about adult sons, who often express impatience at the length and magnitude of grief their mothers are feeling.

Q: Are there certain medical tests all elderly people should have?

A: Even if there are no symptoms, after the age of 50, certain tests are almost universally recommended by doctors.

These include a test for blood in the stool; a rectal exam for tumors and signs of prostate cancer in men; sigmoidoscopy for signs of cancer in the colon; a pelvic examination and Pap test for signs of cervical, uterine and other forms of cancer; a breast examination and mammography for signs of breast cancer in women. Other tests may be recommended as well. All senior citizens, healthy or not, should see a physician at least once a year.

Q: What is elder abuse? Is there anything that can been done when a family member or friend suspects that a loved one is being abused or neglected?

A: The first thing to do, experts say, is to acknowledge the feelings of frustration, rage, impotence and sadness that often affect both the care giver and the care receiver.

When those feelings are not acknowledged, when people don’t seek help in managing their situations, then neglect or even violence can occur.

For guidance and referrals, call an elder-abuse hot line, a clergyman or a senior citizens’ center.