Wednesday, January 30, 2008

Adult children caregivers: how much help can they get with their own mobility?

Karma is a concept central to our moral thinking, something that takes the collective needs of families and communities and brings them down to figuring out the responsibilities of each individual person. An only child who does not have his own children may, given today’s demographics, find himself increasingly exposed to responsibility for parents. A childless adult in a family with siblings may be singled out for more such responsibility (more or less a premise of the 1998 film “One True Thing”). States, given financial pressures today, may start enforcing filial responsibility laws on adult children (although the remarks on LTC insurance in the last posting are relevant).

One particularly troubling problem will concern balancing work and family. Family leave laws in the United States provide only for unpaid leave of finite length in certain circumstances. Even conventional families with children have issues with this. People may feel that someone in my position should not live in another city from an aging parent(s), because of the likelihood of disruption or neglect, unless the parent is placed in assisted living (at least), entailing large financial risk that could eventually fall upon the adult child in many states. I don’t want to go into personal detail here, but I have looked again into a couple of measures to deal with this.

One is whether life alert systems really provide sufficient safety for elderly parents alone at home while adult children are away. I wrote about this on Nov. 15, 2007 on this blog. There are a number of companies offering varying levels of alert service, among which Life Alert is well known, somewhat expensive, and controversial. By the way, it’s true that this kind of service has been around a long time. In 1985, in fact, a home security system that I bought in Dallas had a medical alert feature, but the resident had to get to the security box to use it. It’s not hard to imagine technology that would make that part of a security system more portable. It’s only logical to expect the potential for this sort of home monitoring to expand with wireless technology. Life Alert says that its customers can typically delay the need for assisted living for about six years. But even Life Alert (or C. Everett Koop) does not claim that moving into assisted living or a nursing home is never necessary, or can be prevented forever.

The other issue is the usefulness of home health companies, which offer caregivers. What is typical is that caregiving can be purchased (typically $15 to $20 an hour, depending on expertise and duties) for a minimum number of days and hours per week (two days and four hours per day is typical), up to live-in arrangements. Since 9/11, caregiving companies have become much more conscientious about illegal immigration, which admittedly was becoming an issue before 9/11. Still, the availability of workers (legally) in many metropolitan areas could become an issue as people live ever longer and are frail for longer periods of time. Some companies are run by larger area churches and are faith-based, so Republican (and Bush administration) claims that government should work with faith-based organizations may be well founded with this issue.

Caregivers may simply be “home companions” or they may have training for hands-on custodial care. In 2002, I remember there were programs in Minneapolis to hire “senior home companions” for a small stipend with the companions having a minimum age of 60.

The website giving extensive links in all geographical areas is this.

Most agencies will interview the person and the caregiver. They may insist on a more frequent schedule of visits. Some clients may have short term memory problems that would hinder self-administration of medication according to schedule if no one checks every day.

Adult children used to a large measure of independence and ability to pursue their own goals in their own retirement can find themselves challenged, even on moral grounds. They can be pressured to stay in a particular area and pursue hucksterish “careers” that may not work for their value systems, because of the needs of other family members. One way to deal with this, beside the LTC concept already discussed, could be, well before retirement, to buy larger homes than they need (which places additional financial risk and strain) in order to take control of any such family responsibilities and bring them to the geographical areas in which they want to live.

It now seems remarkable how the eldercare debate, when cast in terms of individual morality they way the debate over AIDS was in the 80s, can focus attention on individual responsibility, when families used to conceive themselves as living in cohesive and loyal units.

Update: Jan. 31, 2008

CNN has a major story, by Elizabeth Cohen, "Caring for Mom and Dad from afar" this evening. It mentions the particular problems for only children living afar. The link is here.

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