Caring for Aging Parents Can Present Confusing Choices

By Robert L. Kane, M.D.
(December 5, 2006)

At some point in your life it’s likely you’ll be involved in caring for your parents or other elders. When this happens, you’ll be faced with a confusing spectrum of choices—home care, assisted living, nursing homes, and more. How does a person navigate this maze?

As holder of the Minnesota Chair in Long-Term Care and Aging and director of the University of Minnesota Center on Aging, I have spent years studying the options and conducting research to improve them. My wake-up moment came when I was faced with helping my own mother through the last years of her life. In a book I wrote with my sister (It Shouldn’t Be This Way: The Failure of Long-Term Care), I discuss problems we encountered with the current system and provide suggestions for navigating them. Following are tips for facing this challenging stage of life:

1) Secure a good source of information . This can come in two forms: a professional case manager who will be your advocate and informant or a good advice book.

2) Know your options. Most people think of nursing homes when they think about long-term care, but there are alternatives.  Because the need for long-term care often comes during a crisis, when you don’t have time or emotional energy to weigh choices, the more you understand the options ahead of time, the better the decisions you will make.

3) Identify and prioritize goals. The first question should not be: Which nursing home? but What is most important for Dad (or Mom)? Rehabilitation? Safety? Comfort? Autonomy? Often opinions will differ within the family, but if you don’t agree where you’re headed, it will be hard to plot a useful course. Once you know your goals, you can look for a situation that best addresses them.

4) Find good, objective advice. Don’t rely solely on a hospital discharge planner to find the best situation for your parent. Based on research, we developed (with the state of Minnesota) a computer-based tool for making decisions about long-term care (see http://longtermcarechoices.minnesotahelp.info). We also created a research-based report card for Minnesota nursing homes (http://www.health.state.mn.us/nhreportcard).  

5) Know what you’re getting, and get it in writing. Exactly what is the situation or service you’re considering? Are there references? What is included in the base cost? What are the extras? Negotiate so you pay for only the services your parent needs. Then make sure they are provided.

6) Stay involved. You cannot rely on the medical system to keep track of things. You will need to: find a primary care doctor who is good with older persons; coordinate care among specialists; keep track of medications; and advocate for your parent. Work hard to keep your parent out of emergency rooms; they are terrible places for frail old people. 

7) Work for better care. Advocacy counts. Older people do not have strong advocates. Our current system is by and large inadequate so, if you find a good situation, reward and promote it. Encourage elected officials to create a better situation for future generations—including your own.

Robert Kane, M.D., holds the endowed Chair in Long-Term Care and Aging and directs the University of Minnesota ’s Center on Aging. Health Talk & You is an educational service of the University of Minnesota. Advice presented here should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu/