Caring For The Elderly: Being Prepared For The Decisions To Be Made

All through my life, I had been accustomed to seeing my father as a strong and healthy individual – he rarely (if ever) even had a cold or a fever. It all changed when (in April 2012) he had a fall in the park and cracked his shoulder joint. It all happened in a few seconds and he was 89…While he was coping with the surgery and post-surgical complications, I was beginning to understand what caring for the elderly really meant. We all hear about how caring for elders is not very different from parenting since you need to care for their needs and assist with daily living tasks. While seeing our children grow-up, we see or hear from other parents a lot of common characteristics (more or less) across others of that age group. These patterns are useful for forming some broad approaches to parenting. On the other hand, as a person ages, there are a lot of differences (physical, mental and emotional) and rarely do two people of the same age enjoy the same degree of health and well-being. In my opinion, this is what makes it particularly tricky. There is always the unexpected that comes with ageing.

This sudden and unexpected period was marked with challenges – the first set of challenges were about how I dealt with my own emotions – and there was an array of them. Only if I could deal with myself correctly could I deal with the new-found responsibility of looking after my father?

It becomes about balancing responsibilities and needs of all the roles/relationships (including with self) that one is a part of. At any point in time, we would have our own plans and aspirations – a more challenging role at work or even a vacation to consider along with taking care of my father. Caregiving requires us to sit down and prioritize whether we can do some things later or take help and manage more than one situation. While it is important to take breaks and do something different, it is also important to realise that some things in life can be postponed and other things cannot.

One of the early challenging decisions I faced was: whether or not to be the “primary” caregiver in the long run! It was not too difficult to take a few days off from work during my father’s hospitalization. However, on his discharge, the home duties were not easy for me. It became evident that we would need an attendant. Not just because I had to get back to work, but as it was physically draining too. It is obvious that the family member as a caregiver can give a lot more support, especially emotional than any outsider. However, to make it sustainable for an indefinitely long period (months and years), it is worth looking at attendants who can be around when we have a day job or even just need to rest.

I tried various combinations of agencies, attendants etc and would like to summarise my learning here in brief. There is no particular order in this:

  • Agencies in Bangalore (and other metros) are aplenty which offer attendants, but many of them (in my experience) are there to make a fast buck and disappear without a trace. Stay with reputed ones, ideally, one which someone you know can vouch for as here, a penny saved is not one earned!
  • Like salaries for housemaids vary with the locality that you live in, so do salaries for attendants as does availability – even from agencies. It is a good idea to do some shopping around so that you are aware of the salaries and the options available to you
  • A 24×7 attendant is easier to find as the agencies get individuals from distant towns and they would rather have a place to stay than commute daily from some other location. It is expensive and tiring for them too and it is only fair to have a human touch with them. It is better too since they will become an integral part of the family
  • Although on the surface, an attendant at night sometimes appears to be a bigger inconvenience (preparing meals for an extra person, space to sleep etc). It may be unavoidable depending on the condition and limitations of the elderly person.
  • If you have hired an individual directly, be prepared to train him/her and it will take significant time and effort. However, on the positive side, the experience would allow customization to specific needs but on the flip side in some cases existing specific ‘hard’ skills and medical training is necessary. Critically, always have Plan-B ready (to hedge against when an individual suddenly chooses to disappear).
  • It is important to decide which tasks you would like to keep to yourself and which to give the attendant. The choice may be driven by any reason and that is not the important part but having that clarity helps you and your loved one get your own special moments and something to look forward to. For example, bathing my father was something that I always wanted to do myself.
  • If there has been a period of hospitalization, watch closely how attendants in hospitals do their tasks. There are many small tricks in changing clothes or diapers or bathing that are helpful and there is no harm in asking for advice from them. Many of the more compassionate ones will be happy to pass on their knowledge and skills
  • An attendant will be in the house and eat home food so do check on food preferences. It is of paramount importance to recruit an attendant for their skills and attitude like any other resource in your workplace. However, since these are longer periods of “service” and at home, it is best if any potential areas of conflict are discussed and adjusted for.

Another important aspect to plan for and balance is the medical care team.

  • Engage with a doctor who gives simple holistic advice on geriatric care – especially diet. When working with doctors it is important to look beyond their medical qualifications and see how they interact with their patient and family members. Do they instil confidence or desperation?
    • Small changes to the diet can help deal with issues like constipation, indigestion etc., none of which require a doctor but can be a regular inconvenience to the patient and the family.
    • I found that ragi (finger millet) porridge helped treat constipation while probiotic curd (Yakult) could quickly heal indigestion. Likewise barley water, tender coconut water, papaya etc. can serve as diuretics.
  • Ask the doctor whether you can really cut down on medications – very often this is possible and you can maintain a minimum required list.
    • Each specialist would prescribe medicines for specific symptoms however each would also account for other aspects like blood thinning etc. The combination of drugs for multiple symptoms can lead to a doubling of dosages and it is best to discuss the entire prescription list with each specialist.
    • The same applies to even diagnostics. Is it really needed? With age, even the prick of a needle can be un-bearable and too much frequency can be exhausting. A few months before my father passed away, he pleaded with me to stop the daily collection of blood samples as he found it very painful – and we stopped it.
  • Home & natural remedies may also work much better than their factory-made counterparts and a mature doctor would be aware of alternatives
    • For instance, I was using a certain brand of body lotion for my father and was advised to avoid it as it is mildly abrasive for the already thinning skin of the aged. Instead, I switched over to coconut oil.
  • It is helpful to build a planned set of routines and activities which are aligned to your loved one’s interests as well as their capabilities.
    • Simple routines like taking my father to a park to sit in the morning sun were therapeutic. He could see the flowers, trees, birds apart from talking to a few neighbours and this was something he loved.
    • Physiotherapy can be a great healer and achieve results which will surprise you.
  • Often there is a choice between a really aggressive medical treatment and something that is moderate. There is a need to think about it. Does the patient feel comfortable? Is it something that they would really want?

In mid-2012, the doctor at the hospital called me aside and said that my father was critical and perhaps we should put him on a ventilator. We refused. Later they informed us that his kidneys had failed and his heart was also showing problems. Even as the doctor said this, he went inside the ICU and as he came out he said to me “It is surprising, the kidneys have recovered!”. He recovered his health and was discharged. A week later, when we visited the same doctor (an experienced Army Doc in his 70s) he got up from his chair as he said (in Kannada) “God has placed his hands on your head – and that’s the only explanation I have for your recovery”. My father lived for 4 years more after this incident. So, don’t give up hope, miracles do happen and prayers are answered.

Above all, it is important to keep the conversation going with friends and family who can understand what you are going through. They may have a more objective viewpoint – very different from what we (as the family) feel since they are one step removed.

Finally, be prepared for the end to come. When my father passed away, (it was more than 4 years since his fall in the park) he was at home and had all the near and dear ones around him. He closed his eyes, his breathing slowed like a fan slowing down and he was gone – as we all chanted our prayers and bade him goodbye.

About The Author

Ravi Karnad

“A passionate engineer, I retired in 2014 and am now using my skills to provide engineering solutions to environmental problems. My other interests are in yoga and spirituality (how to blend philosophy into daily living). I also love listening to Hindustani Classical music.”

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