We're not sure if our 81-year-old father can stay home alone any more. It's the hardest question we've ever asked ourselves, my brother and sisters and myself. He's 81, been widowed for 2 years now, and up until December 28 th , he was getting along pretty well. He was living in my family home in small-town Southeast Kansas (100 miles from any metropolitan airport or hospital) with his dog and enjoying spending time with his girlfriend of 6 months. He was arthritic, but walking and driving; had lung disease from 55 years of smoking, but was not dependent on oxygen; and he had just been diagnosed with a form of leukemia which did not need treatment, according to blood tests.

Then he had surgery.

Since repair of his aneurysms on December 28 th , he has not been healthy enough to live alone. He tried it for 2 weeks and ended up back in the hospital for dehydration. No medical authority has yet to give us a reason for his failing. To me, it's reminiscent of what they call "failure to thrive" in some babies. He just can't eat, which makes him weak, and when he does try to eat, he either has digestive problems from one end or the other (if you get my drift), and that makes him weak so he doesn't want to eat. It's a vicious cycle.

So what do we do?

Healthy Living News is featuring a different assisted living facility in each issue lately. This is helpful information for local families, but there are still questions the family needs to ask themselves. The wealth of choices that Northwest Ohio has is both a blessing and a curse. Which one is best? How do we make sure?

Nobody likes to move, and seniors least of all. Our most important concern is that seniors move only once in their later years, to minimize the trauma of the move itself, and to ensure comfort and continuity of care for the person.

One of the primary reasons a family comes to a private professional care manager for help is to determine what the best living situation is for their elderly or disabled loved ones. "Mom shouldn't be alone at home any more. What do we do now?" Déjà vu!

Don't you just hate it when your professional life creeps into your home life?! You're an attorney and your sister is getting sued. You're a realtor and your mother-in-law is selling her home. You're a physician and your wife needs surgery. You're an eldercare advocate and your dad needs an assessment. Suddenly you're the family expert. Watch out! You could easily become the family scapegoat, too.

I really don't want to try to assess my own dad. But. Since there are no professional geriatric care managers in my home town, here are just some of the questions and considerations I will put before my family:

•  Financial:

•  What are Dad's exact assets?

•  In what form are they? (liquidity)

•  What are the tax ramifications if they are accessed?

•  When will they run out?

•  Medical:

•  What is Dad's diagnosis and prognosis?

•  Is he going to continue to decline?

•  Will he have possible behavioral issues due to dementia or memory loss?

•  What care does he need now, and will he need in the future?

•  Legal: Questions for Dad:

•  Does he have the appropriate Powers of Attorney for finances and health care in place?

•  A state-appropriate Living Will?

•  A Do Not Resuscitate order, if he wants it?

•  Legal: Questions for any Potential facility:

•  What legal obligations do they have regarding staffing?

•  Does the administration have the authority to admit a resident to the nursing home if she of he becomes too confused or ill to care for himself or herself? What procedures are in place?

•  Do they have any governing board looking over their shoulder to meet specifications for care?

•  What is their record with this Board?

•  Social:

•  What social network can my dad rely on at home to help him with shopping, transportation, etc.?

•  What type of socialization would he want or need from a facility?

•  Will he have privacy when he wants it, but stimulation when he needs it?

•  Can he bring his dog???

•  Psychological:

•  How will my dad react to moving?

•  How is he coping with his illness?

•  Has he been assessed for depression?

•  Does he have capacity to continue making his own decisions? If not, we have more legal questions.

•  If he were to move, would he agree to a visit from a psychologist to assess his adjustment to the change?

•  How badly does he want to stay home, or want to move? (Yes, Virginia, some seniors actually WANT to move. They are tired of feeling inadequate at caring for themselves, and they want some help. This, however, is most likely NOT my dad.)

•  Environmental:

•  Given all of the above,
what IS the most appropriate environment for my dad?

•  What can he afford?

•  What kind of medical care will he need on a daily basis?

•  What does he want?

•  How could his current home be changed to meet his needs?

•  How much help could we hire from the community and how could we ensure the reliability of the help?

There are more questions like these on the Resources page of our company's website: www.professionalcareforyou.com . As well as many other articles of interest regarding elder care.

The honest answers to these questions help me to better advise my clients regarding their choices. With luck, love, and careful consideration, they will help my own family help my dad. Most of all, we want to maintain his dignity and independence, just as professional care managers do for their clients.

In Northwest Ohio, the choices are almost overwhelming. There are private-pay only assisted living facilities, some which even specialize in, or have special units for, memory-impaired. If your senior has any potential for problem behaviors, I would ask very serious questions of their specially trained staff such as, "Will he be asked to leave if his behaviors increase?"

There are some facilities which promise the full spectrum of care on campus. My question for you and your family is: Can your senior tolerate multiple moves; albeit on the same campus, a move is a move is a move.

There are some facilities which promise life-long care regardless if your family's funds run dry. Make sure that your loved one will not be asked to move to the nursing home unit prematurely so that Medicaid becomes the facility's payor source.

In Southeast Kansas, my dad's choices are pretty slim. Unless he wants to move in with my brother and sister-in-law (a situation that professionals usually advise against for many reasons), he pretty much needs to come to grips with the fact that it's time to cash in that nest egg and spend it. The rainy day is here, and he can afford an umbrella. For awhile.

Debra Sorensen, MSW, LISW, CMC, is a professional care manager and owner of Debra J. Sorensen & Associates Inc., a private geriatric care management company serving Northwest Ohio and Southeast Michigan. She can be reached at 419-367-8835 or e-mail Debra@professionalcareforyou.com.