If you are charged with the care of an elderly person, here are three wishes for you. And a warning.
Focus on these attributes: courage, patience, and grace. These three wishes will grant you self-preservation. With courage, patience, and grace, you can be the caregiver you want to be, with whatever resources you may have.
And the warning. You will never have enough time, experience, and money for this job. Caregiving grinds down resources on all levels. You can’t help anyone if you are tapped out. Find ways to replenish your reservoirs.
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(Update 3.14 -- this post on Caregiving was written before my Mom passed away. See this March 2024 post for Top Tips on Hospice and End-of-Life care: https://stuartngbooks.blogspot.com/2024/03/top-tips-hospice-and-end-of-life-care.html)
The 3 paragraphs above are an update to the opening of my first-ever “Top Tips” post back in Sept 2022. Writing that post was a chance to reflect on all I’d learned in my first year as a primary caregiver. My beloved Dad passed suddenly at the end of 2021. I quickly realized my wonderful Mom wasn’t safe living alone. Dad had been doing all the heavy lifting to keep them living independently in their condo. Now it was my turn. On the 1st year of our journey, I went from full-time sole caregiver, to being with her along with in-home caregivers. I lived with Mom for the first seven months while we sorted out many details. After that, she had overnight caregivers on 12-hour shifts. I was with her for the early morning and dinner-to-bedtime routines, with day shift caregivers in between. It was a steep learning curve.
With a lot of hard work from me, and pre-planning we did as a family, I was able to keep Mom in the condo for over a year. Looking ahead, I could see the situation wasn’t sustainable. Mom is in her late 90s. I'm lucky she is mobile, alert, cheerful and grateful. And I know she works at it. When I started caring for her, we decided as long as she could stay safe and stay healthy she could stay in the condo. By early 2023, I could see we were nearing the end of that phase.
We transitioned Mom to Assisted Living (AL). Again, we're lucky. Mom has the best of both worlds for now -- a community designed to meet her needs, and still one-on-one hands-on care. She has a private caregiver with her 12 hours a day, 7 days a week. Due to her advanced age and increasingly frail body, she is safer when someone is with her during the day. She enjoys the social interaction with residents and staff at AL, as well as the activities. I get to visit her daily as her daughter. It was time for me to pass the personal caregiving jobs -- one of the few roles I can delegate while I manages all of her affairs -- to more experienced hands. The move to AL was a big transition. It was well timed, as she had a brief but dramatic hospitalization about 2 months after she moved in. She recovered -- but I have no idea how I would have managed her recovery from that if she was still at the condo w/ shifts of caregivers, and not a AL which is a much safer situation.
I recently revised this post to add video links for 2 important Frontline documentaries on aging. The most recent post revisions are always in blue text.
My first big revision to this post was back in Nov 2022. When I went to add some more updates in April 2023 -- I accidentally deleted the post. All that work and all those resources. Gone in a blip. Thank goodness I had a backup of most of the text of the post and the links. April 2023 me owes a debt to Sept 2022 me for taking that precaution.
This Caregiving Top Tips 2.0 comes in three sections:
1) TLDR – here are the links for the recommended equipment. Independent living means having the right tools for the job. Preventing falls and safety risks is the top priority.
2) Three wishes and self-care reminders. This section covers caregiving options and the costs. There are emotional as well as financial burdens to caregiving. This section has tips to prepare for them, including links for some articles. I will also address some of the pros and cons of assisted living vs. in-home caregivers.
3) Recommended equipment. This section has links, photos and my feedback/reviews from using these products.
Section 1 -- TDLR (Too Long, Didn’t Read). Links for essential equipment:
UPDATE 8.10.23 -- The lessons in this 2006 Frontline documentary still apply:
Mobility is independence. Independent living requires the right equipment.
Mobility Aids –
Walkers
Combination walker-transport Chair
This is my number one recommended item. It’s essential mobility gear for the elderly person as well as the caregiver. Pros and cons of this model in section 3
https://goplusus.com/products/2-in-1-folding-rollator-walker-4-wheel-medical-rolling-walker
Here are links for the other mobility gear/walkers we got. Pros, cons, and photos in section 3
Traditional 4-wheeled walker (Nova Zoom)
https://novajoy.com/products?categoryId=368
3-wheeled walker (Nova Traveler)
https://novajoy.com/products?categoryId=187&productId=382
Standing walker (ViveHealth Upright Walker)
https://www.vivehealth.com/collections/mobility-aids/products/upright-walker
Footed quad cane
https://www.vivehealth.com/products/carbon-fiber-quad-cane
Room safety --
Landline phone for hearing impaired
Never disconnect your landline! I was shocked to learn after Dad died that Mom couldn't use a cell phone on her own. Dad had disconnected their landline years before. So for the first few weeks after he passed away, there was NO WAY to reach mom on the phone when I wasn't at the condo. She couldn't even make a 911 call if I wasn't there. I was scrambling to get a landline phone installed. Even with the landline, Mom needed help to make or receive calls. If there’s no landline at the elderly persons residence, get one installed. A 911 call from a landline is the fastest way to get help to the right location. Check with local agencies about qualifying for a free or discounted landline phone for the hearing impaired.
Call Button (CallToU transmitter and receiver)
This is different than those "I've fallen and I can't get up" medical alert call buttons that connect seniors to a service that can summon help for them outside the home as well as inside. I don't have any experience with those since my Mom couldn't be left alone. My recommendations here are for in-home call buttons.
Being able to use a caregiver-pager-type call button to summon help is an essential safety skill for in-home care and assisted living. Get one early. Get your loved one in the habit of using it to let someone else in the home know they are moving from room-to-room. It may seem silly at first, but this helps prevent falls. Using a call button consistently will help the transition to assisted living or in-home help from caregivers. Knowing to use a call button can help you and your loved ones get the most out of those additional caregiving expenses. Knowing to use a call button will also assist your loved one if they end up in the hospital. For the hours you can't be with them.. it will be up to them to know how to call for help!
https://www.amazon.com/CallToU-Caregiver-Transmitters-Receivers-Attention/dp/B077SYPD5K
A “Grabber” helps reach items on tall shelves or on the floor.
Grabber (The one I like best I got from Diaso – this link has photos and a review)
https://www.thestuffsreview.com/2022/07/daiso-all-purpose-grabber.html
Nighttime trips to the bathroom are a high risk for falls. Nightlights in hallways and rooms can prevent this. Battery operated “tap lights” can also be handy.
Foot Care --
donate all the shoes w/ laces, they are a tripping hazard. Keep feet clean and moisturized. Cracks in dry skin on feet are a vulnerable area for infections.
Velcro shoes
Top pick for fit and sturdy enough for walking
Yibobay Diabetic Velcro closed-toe shoes
https://www.amazon.com/Yibobay-Diabetic-Adjustable-Breathable-Lightweight/dp/B096KVHJLT/ref=
Silverts Sandals – open toed with Velcro. These are a sturdy option for times when toe pain may require an open-toed shoe option.
https://www.silverts.com/womens-easy-closure-sandal-for-indoors-outdoors
Collections Etc catalog Memory Foam Sandals
These are inexpensive, but lack support and are good as house slippers only
Stretchy socks
Ankle length – available in black or white
“Hugh Ugoli Diabetic ankle socks, seamless, stretchy” socks from Amazon
https://www.amazon.com/gp/product/B084Q61X8K/ref=ppx_yo_dt_b_search_asin_title?ie=UTF8&psc=1
Viasox Diabetic Socks – these are super stretchy socks that are easy to get on and off. Available in knee length, ankle and compression sock options. There are lots of fun prints as well as solids. https://viasox.com/
Electric Foot Warmer Pad (cold feet are a common problem)
Mom’s favorite is the “Accelery Double-Sided Heated Foot Warmer” with a tag that reads: “OnKey Electric Technology Heating Pad Model # FT-1616,” now listed as “unavailable”
Here’s a similar one, but this lacks the zipper and timer on the control:
Bathroom Safety ---
Do these upgrades early. Bathrooms are a high-risk area for falls etc.
Handles for the sides of the toilet
Shower Chair https://www.vivehealth.com/products/shower-chair
Toilet Seat Cushion (women need versions like this – more on that in section 3)
https://www.vivehealth.com/products/toilet-seat-cushion
Waterproof Mattress Protection No one likes to think about overnight accidents… but these can save a lot of grief. https://www.target.com/p/ultimate-mattress-protector-allerease/-/A-17273320
Gifts for caregivers --- "Let me know if you need anything" shows you want to support, but try to be specific. Check in on your way to the store to see if the caregiver needs anything. Offer to get take-out food. Meals and grocery store/drug store runs are always helpful, especially the first few weeks. Before you bring by flowers, plants etc .. please ASK first. While flowers are lovely.. they are also possible allergy issues... and one more thing to take care of in a caregiving situation that's already overwhelming.
Section 2 -- Three wishes and self-care reminders
(art by Kate Allan, aka The Latest Kate https://www.thelatestkate.art/)
Remember the three wishes for you. And the warning.
With courage, patience, and grace, you can be the caregiver you want to be, with whatever resources you may have.
This job grinds resources to exhaustion on all levels. You can’t help anyone if you are tapped out. Find ways to replenish your reservoirs.
Caregiving in guidebooks covers generalities. Caregiving in action is deeply emotional and utterly unique. You may find great support from resources (websites; support groups) and from friends/family members who have been on a similar path. However, becoming a caregiver is a learning curve for a skill set you will be improvising as you go. The responsibilities are relentless (even if you can delegate some of them). You will want this job to end, and it will, but the exit options are all awful.
Be prepared. Years before you need to, have the difficult conversations about end of life wishes, use of extreme measures (or avoidance of them), finances and obligations, intentions for the dispersal of personal effects, and of the person.
UPDATE 8.11.23. This 2010 Frontline documentary shows families and loved ones facing tough end of life choices. There are vital cautionary tales here. Watch and discuss with your family. BEFORE you find yourselves facing these decisions unprepared at a hospital. Keep documents like Advanced Healthcare Directives; Healthcare Proxy/POA; DRN instructions updated in a portable file or binder or saved as photos on a phone.
Caregiving plan choices fall into three categories –
Co-residence with Family
Aging at home with private caregiver help
Assisted Living communities
UPDATE 8.20.23 -- This 2006 Frontline Documentary is an excellent recap of these caregiving options.. and the challenges they bring
Don’t want to have cancer surgery at an advanced age after dementia has set in? Don’t want to have the surgery confirm your cancer is spreading, and accelerate your dementia to the point that you forget to eat, so they have to put a feeding tube in you?
Make. Alternative. Plans (ie legal documents/healthcare directives). Now!!
Just one statistic from this documentary: at air date (2006) “over the next 30 years, the number of people over the age of 65 will double. To the point that they are about 20% of our population. That’s 70 million people.”
The documentary shows how medicine has made great advances in curing infectious diseases like pneumonia and flu that used to claim elderly people. But that often leaves people to perhaps a harsher fate: lingering with chronic conditions that often have devastating complications over time. Sometimes the only escape from the cycle of treating and curing is dying from a "medical catastrophe" -- a non-healing bedsore or rampant UTI -- likely induced by a prolonged hospitalization.
The documentary also explores how we’re keeping people alive longer with fewer doctors to care for them. As many people are too frail to leave their homes, doctors are returning to house calls. Life is prolonged, but with loss of function. Chronic diseases take a toll on the body. Leading to enfeebled frailty. All at staggering costs to family resources at every level.
It’s always been the assumption in the US that the elderly are cared for by members of their own family. But this situation is becoming untenable as families are smaller, less stable, and more geographically isolated. Plus the amount of time devoted to caregiving has moved from months to years, and even sometimes decades. We are facing a future where people are living longer, with conditions that are deeply needy, while there are fewer family caregiver options than ever.
If family care is your plan — the documentary cites a study that shows only people with 3 or more daughters or daughters in law have a better than 50% chance of not finishing their life in a nursing home or an institution.
Co-residence with Family
Many families have no choice. Parents or elders move in with family members to save money. There are emotional costs to this option that need to be considered as well. It is a huge ask of your caregiver for them to run your life and a second household, or leave their life and home to move in with you for an unknown period of time. I did this for 7 months. I adore my mom and was always very close to my parents.. but this arrangement was still hard. It gets even more complicated if family relations are strained. I have friends who did it for years – at the eventual cost of their previously close relationships with family members. Proceed with caution.
Find and join support groups. Check with educational and medical institutions nearby. In Southern California, we are lucky to have the USC Family Caregiver Support Center. An excellent resource that will connect you with an individual "navigator." Your Navigator will guide you to help for your specific needs. They also have excellent listening skills and are a compassionate advocate for your care as the caregiver as well: https://www.fcsc.usc.edu/ The Los Angeles Caregiver Resource Center is also part of this organization: https://www.fcsc.usc.edu/
Here are some articles about the crushing costs – on all levels – for senior care:
https://www.washingtonpost.com/business/2023/04/06/seniors-assisted-living-medicaid-eviction/
https://www.washingtonpost.com/parenting/2023/03/22/caregivers-sandwich-generation/
https://www.nytimes.com/2023/03/28/magazine/elder-child-care-millennials.html
photo below "Randi and her father Keith..." by Haruka Sakaguchi from NY Times 3.23
This March 23 post on the blog contains the entire 3.18.23 Post article about the costs of care: http://stuartngbooks.blogspot.com/2023/03/caregiving-crushing-costs-and-limited.html
Aging at home with private caregiver help
Everyone wants to age at home, independently, for as long as possible. This is a wonderful dream, but not always a safe or practical reality. Aging at home when the home is not appropriate (stairs etc) can be dangerous. Accidents like falls in bathrooms or on stairways. Injuries in kitchens or yards. These can be life changers that lead to hospitalization and loss of mobility.
Aging at home with private caregivers is the most financially expensive choice. I highly recommend using a free service like “A Place for Mom” to get referrals for licensed caregiver agencies. They can match you with options that fit your budget. Another plus for using “A Place for Mom” is that you will get enrolled in a free email newsletter with lots of tips from others who are caring for family members.
A caregiver agency will handle insurance, employment, and liability issues with having workers in your home. Agencies also screen the caregivers for you and provide professional training for them. It takes time to pick an agency, go through the evaluation process to assess your loved ones needs, and get matched with and “try-out” some candidates. Once you have the right caregivers on a schedule (that you are in charge of creating), there are pros and cons to this situation. If a caregiver can’t make their shift, or needs a scheduled day off, the agency will usually be able to send a replacement. But you will need to spend time orienting the replacement with your loved-one’s needs. Many caregivers like a client that offers long shifts on a steady schedule. The overtime hours help with their income, but this also adds to your expenses. Aging at home with private caregivers can become socially isolating for your loved one. Having your loved one with caregivers means you are their social director, appointment coordinator and always the back-up. This can be back-up for problems with your loved one, or their residence. That can get exhausting. It wasn’t until we transitioned Mom to assisted living that I realized the impact of this. For over a year, my radar was up every night for a possible call from Mom’s overnight caregiver. I rarely got a nightshift call. But once Mom was in assisted living, I started sleeping much better. At assisted living, there is always an experienced team around her to help her… or deal with any problems with her room. If I got a call from assisted living, it was just to inform me and let me lend support. It wasn’t a call to rush over and solve a problem.
Assisted Living Communities
Tour assisted living communities with your loved one. Get acquainted with options and staff prior to need of these services. Assisted living provides medication management, social enrichment, help with ADLs (activities of daily living) and room and board in a home-like setting. "Assisted living" implies some independence on the part of the resident. This includes being able to use a call button. (This safety tool is good to get early and use at home so it becomes a healthy habit.) The assisted living admissions process will include an assessment of your loved one's care level needs.
Assisted living will meet your loved ones needs, but maybe on a slightly different schedule than you're used to. Be flexible. Learn the routines at the community and help your family member adapt. Good communication between you and the staff helps everyone. Your loved one will be issued a call button to summon care team help when they need assistance. Residents who are more independent and don't need call button help will still be checked-in on periodically. The goal is to strike a safe balance between independence and support. Do not expect assisted living to replicate the one-on-one care of your loved one at home with you… or them at their house with an in-home caregiver. Some assisted living establishments will allow you to bring in a licensed private caregiver to give your loved one more one-on-one support -- but that expense will be on you.
Assisted living gives loved ones a safe, supportive environment. The 24/7 care from a staff of professionals gives family caregivers peace of mind. But it doesn't relieve the responsibilty of checking in frequently. In-person visits can rekindle family connections, which may be strained after being in caregiving roles. Visit as often as you can. Being there in person is the best way to assess how your loved one is adapting, and how the facility and staff are performing. Common struggles for assisted living communities include chronic understaffing and delays in response time for call button assistance. You can best assess how these issues are handled when you visit frequently. Once your loved one is a resident, you will still need advocate for them. This includes monitoring basics in your loved one's room, such as making sure the plumbing, heating and AC are in good working order.
Find a community with a vibe that resonates with you as well as your loved one. Caregiving is a calling. Cherish the good people who take care of others as a career. Benefits for your loved one at assisted living include more social contact with peers and younger adults, activities options, and hands-on personal care that can advance as needs change. Some assisted living establishments can provide two week or 30 day stays as “respite care” to give family caregivers a break. (However, many assisted living rooms come unfurnished, so factor in that added expense). Memory care units are part of many assisted living communities. This makes that transition easier for residents if that need arises. Most assisted living places do not offer skilled nursing care like a nursing home setting. Tour a range of elder care establishments to learn about these care levels and options.
Care homes, with only a handful of residents and a small team of caregivers in a private residence setting, can be a good option. Especially if the situation involves long-term care along with limited mobility. Many families turn to churches and community senior centers to get in touch with resources, activities, and volunteer or part time caregivers/companions. Unlicensed care may seem cost effective, but be mindful of the associated risks.
Long-term care insurance is a common way many families afford the prohibitive expenses of in-home caregivers and/or assisted living. However, there is always a big risk. You may pay the high premiums for years only to find out when you need the policy coverage it may not be accepted at the facility/agency you want.
Caring for a senior with dementia... or disabilities... or a chronic or terminal condition (including Alzheimer’s) are categories I won’t be covering here.
Finding elder care that fits, and is affordable, is hard. It can mean making tough decisions. The options are all costly. They can bankrupt families.
Caregiving for an elderly parent as an only child has benefits and disadvantages. If you are the only person who knows all the details for caring for your family member, you must make sure there is either a back-up person, or you and your family member must consider their need to enter assisted living earlier. You are not immune to having an accident or illness that could put your loved ones care in jeopardy. Having your elderly friend/family member in a facility can be a safer option for them and you if you are their only advocate. Even in sibling situations, it’s usually one person tasked with being the “burden bearer” – a role that leads to burnout, resentment, and other complications for any caregiver. ("Burden bearer" is a term from a 1966 study of families struggling with elder care. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1545-5300.1966.00076.x. I first read about it in this 3.23 NY Times article https://www.nytimes.com/2023/03/28/magazine/elder-child-care-millennials.html)
Caregiving for anyone when you have a chronic condition yourself adds more unstable variables to the equation. My Dad and I planned for various scenarios of how I would care for my parents in their final years – but when the reality happened, I was quickly humbled by the one variable we never factored in – my own limitations. When family caregivers themselves are seniors 60+ and caring for elders in their 80s and 90s, the entire situation can seem like a sitcom premise. Because as Mom likes do say: "You have to laugh or else you'd cry and who wants to cry?" Or as iconic actress Bette Davis put it:
Before you agree to become a full-time caregiver….
Everyone must have their final documents in place -- a will or trust, an Advanced Healthcare Directive. No exceptions. Never agree to become a caregiver for someone who hasn’t gotten their affairs in order. Even with all the paperwork ducks in a row, all the re-organization of accounts, bills, legal documents, and even mundane things like newspaper/magazine subscriptions, will devour your time. And drain cash reserves.
My two mottos learned the hard way from experience:
Get the right tool for the job.Whoever dies first, wins.
Encourage all family members to have most household bills set on auto pay via a regular checking account. Get signed up to have access to those accounts. If your family has the resources to have 2-3 mos of cash to cover monthly expenses on hand, that will relieve you of a lot of stress if the “financial manager” parent passes suddenly and you are left to juggle bills, taxes etc for a parent who hasn’t dealt with these for decades. When someone passes, a lot of important information can be lost suddenly too. They don’t have to deal with the fallout of that. But their survivors will. Plan now to avoid pain later.
Know your parent/family member’s medical history, medications they are on, and try to go to a routine doctor appointment with them. Going on a routine appointment will give you a chance to meet their regular doctor, and familiarize you with location of the clinic etc. Elderly people go to the doctor a lot. There are age-related issues that come up even for those without pre-existing conditions. You will also need to be proactive about getting these routine health issues addressed for your senior: Foot care. Skin care. Hydration. Vision issues. Hearing issues/aids. Physical Therapy to keep major muscle groups strong for maintain balance and mobility.
Assess your elderly parent/family members mobility. Plan ahead for special equipment that will be needed – for their safety, and for yours. Evaluate the home for fall hazards. Avoid preventable accidents. Remove safety risks.
Adapt or replace furnishings. Older people need sturdy chairs with arms. Bathrooms need many safety upgrades.
Shop early and often for items that will protect your senior’s independence. They will need these items eventually. Better to try them out with plenty of time to find what works BEFORE the urgent need arises. Practice using them “for if we need this” scenarios. It will make everyone more comfortable, confident, and safe.
Section 3 -- Recommended Products:
Mobility Aids –
Mobility is independence. Loss of mobility means more hands-on caregiving. Fight hard to maintain and protect mobility. Embrace simple changes, like mobility aids, appropriate shoes, physical therapy exercises to keep muscles strong.
UPDATE 9.17.23 -- Here are two You Tube videos with excellent tips on how to safely use a walker! How to walk with a walker the right way...
How to safely use a rollator (4-wheeled) walker
Walkers
Combo/convertible walker-transport chair.
I got this GoPlus model.
https://goplusus.com/products/2-in-1-folding-rollator-walker-4-wheel-medical-rolling-walker
https://www.amazon.com/dp/B09LRYSVKR?psc=1&ref=ppx_yo2ov_dt_b_product_details
A transport chair is not a wheelchair. A transport chair has smaller wheels. It can’t be self-propelled. But a transport chair is essential safety equipment if you’re caregiving for someone who is elderly/and or has mobility issues. If you need to move them quickly and safely – you must have a transport chair available.
Get a combo/convertible walker-transport chair. This is best for trips to appointments and longer walks. The person can use as a walker, but if they get tired, it converts easily to a transport chair.
Top tip for transport chairs/wheelchairs: Back the person into elevators and over bumps and obstacles in pathways. Pushing the person forward into these hazards can “catch” the chair wheels and tip the elderly person forward and out of the chair! These chairs do NOT have seatbelts.
I looked at several brands and styles of combo walker-transport chairs.. Here’s why I picked the GoPlus one and how it delivers in these areas:
Pros --
It has the greatest range of adjustable height options for the handle bars used in both the walker and transport chair modes. Trying to match the right height for these bars has been a struggle on other walkers. This feature has been a game changer. It saves the back of the caregiver pushing when its in transport chair mode. It improves the posture and balance of person using it in walker mode, helping reduce that classic “hunched over the walker” posture.
The foot rests are pedal-shaped foot rests and that the foot rests can be folded away.
There is a foot lever in the back to help whoever is pushing it in transport chair mode get the wheels over small bumps/floor surface transitions. It takes some practice.
If you’re trying to get someone with limited mobility to appointment, or across parking lots/uneven terrain, or an emergency exit -- a mobility chair is a must.
Having one tool that does 2 jobs saves storage space.
This unit collapses down for easy storage and is pretty lightweight.
Cons –
The seat is an odd shape and there is NO padding. There’s no storage under the seat and storage/pouch situation with this unit is limited and awkward.
There is built-in padding for the arm rests, and that helps, but we did mail order some wrap around/Velcro arm rest pads and they are a big help
It’s larger and more awkward to use as a walker inside the home. But the fact that the handle heights are adjustable more than compensates.
The foot rests fold back fine, but flop around. I ended up buying some Velcro strips which we use to secure the foot rests. It’s an extra step.. and an extra item to make sure we have when we use this in transport chair mode. It’s an area I would check out well if I got to see some of these in person vs. buying online.
Wheelchair seat cushion https://www.amazon.com/Essential-Medical-Supply-Covered-Wheelchair/dp/B007X2EXIS/ref=
Wheelchair Armrest pads (this link has assorted colors) https://www.vivehealth.com/products/wheelchair-armrests
Traditional 4-wheeled walker (Nova Zoom)
https://novajoy.com/products?categoryId=368
Pros -- These are nimble, smaller, and come with a padded seat and generous storage. Wheeled walkers excel at turning and pivoting, and they also have brakes for stability. They are better than the old-school 2 wheeled walkers.
This walker gives the most support for when Mom has knee pain.
We went to a local home healthcare aids store to get Mom a 4-wheeled walker. They fit her for this model. (However, it’s turned out to be just a bit too short for her, even at the highest handle height setting.)
Cons – Only 3 settings for handle height. Not having the handles at the appropriate height contributes to that “hunched over the walker” posture you often see.
Shop around and find a walker that has an appropriate handle height. Walkers work best in walker mode. You can use it to push someone in a pinch, but they will be facing backwards and they must be able to suspend their feet to keep out of your way and not be dragging their feet on the ground. Of course, a walker is not designed to be a transport chair. And this limitation is obvious if you ever try to use it as one.
Standing/Upright Walker –https://www.vivehealth.com/products/upright-walker
I got Mom one of these when we realized her 4-wheeled walker was too short for her. The upright walker has a seat (not padded), encourages better posture, and provides better eye contact with other pedestrians. It may be a good option for more active, taller seniors. I wouldn’t recommend one for most elderly people.
It’s cumbersome to move and store. It can collapse and be put in a car, but would take up a lot of space and be hard to get in and out.
It’s hard to find padding for the arm rests that fit properly. The arm rests and hard plastic and do need extra padding that’s not provided or built in.
Because Mom was in a condo, and got most of her exercise walking the hallway of the condo building, this worked out okay for us for several months. But we never used it on sidewalks or parking lots… where I’m not sure how safe/stable it would be on those sorts of surfaces.
3-wheeled walker (Nova Traveler) https://novajoy.com/products?categoryId=187&productId=382
Once Mom transitioned into assisted living, this walker became her favorite. I bought this one specifically because the handles can be set higher than her 4 wheel walker. She likes that this one is easy to maneuver around her large bathroom and studio room, as well as the common areas. She is close to any seating options in these situations, so the lack of a seat on the walker isn’t a problem.
Pros --Nimble to use and maneuver. Has a generous storage pouch built it. There is also a detachable wire basket and tray. Adjustable handle height.
Cons – Not as much stability as the 4 wheeled walker. No seat built in.
Footed “quad” Cane https://www.vivehealth.com/products/carbon-fiber-quad-cane
A cane with four feet is always ready to be used and not falling to the ground etc. This one is lightweight, but also very strong.
Foot safety and care --
Velcro shoes & open toed sandals
Shoes with laces are a tripping hazard. Round those up and donate them. Poorly fitting shoes can contribute to foot pain, infections, etc. That leads to mobility loss. Look for shoes that protect feet and prevent slipping. Old bones are fragile. I learned from Mom's podiatrist that many elderly folks fracture their toes by bumping them while wearing footwear that lacks support and protection. Foot or toe pain should be checked out by a doctor ASAP.
Replace old shoes with Velcro closure footwear. Mom preferred a style with a single flap vs multiple tabs. Look for shoes with a sturdy sole that supports the foot.
Yibobay Diabetic Shoes https://www.amazon.com/Yibobay-Diabetic-Adjustable-Breathable-Lightweight/dp/B096KVHJLT/ref=
I had to mail order these in several sizes to find the right fit, but it was worth it. Mom loves them.
Since Mom had a toe injury (ingrown nail) that took months to correct, she needed shoes indoors that gave her stability but also were open toed.
Silverts Sandals – open toed with Velcro. These are a sturdy option for times when toe pain may need an open-toed shoe. https://www.silverts.com/womens-easy-closure-sandal-for-indoors-outdoors
These Memory Foam Sandals from the “Collections Etc” catalog are inexpensive, but lack support. They are suitable as slippers, but not for long walks. https://www.collectionsetc.com/products/ultra-lightweight-adjustable-memory-foam-sandals/?color=BLCK&size=XSA&utm_source=google&utm
Keep feet clean and dry. Make sure they are moisturized to prevent cracks in skin and nails that can invite infections. Be sure a doctor looks at the elderly persons feet at least once a year. Medicare covers routine podiatrist visits. It’s worth getting your elderly family members to a podiatrist on a regular schedule to handle things like toe nail trims. This basic personal care can become a breeding ground for infections if neglected or relegated to self-care or non-medical services (ie salons). Both of my parents had foot issues that needed attention but their primary care doctor never had them take off their socks – even at annual physical exams! Unacceptable.
Ears need attention too. Age-related hearing issues are common. Be sure your senior has a hearing evaluation by an audiologist. And make sure their primary care doctor examines inside their ears at least once a year. Your loved one may need routine ear irrigation. Regular dental cleanings are also essential. Many older people don't have all their own teeth. You need to know if your loved one has any dentures or partials. Be sure they fit well and are cleaned properly. Check with their dentist. Your senior may need new eyeglasses too. Get a vision exam scheduled as soon as you take over their care. Finding problems in any of these areas early can make all the difference.
Because of my diabetes, I’m very pro-active about foot care. I will always suspect my dad could have lived longer if his non-healing foot wound got earlier attention. Instead, he slapped a band aid on it -- for nearly 2 years! Dad was so healthy otherwise, and he presented so well clinically, his doctor never looked at his bare feet. By the time he showed his non-healing wound to the doctor, it had progressed to skin cancer. That required surgery. And oncologists. I learned about all this too late. Please take these lessons to heart.
Change socks daily. Be sure they are not binding. Mom loved these “Hugh Ugoli Diabetic ankle socks, seamless, stretchy” socks from Amazon
Try out different compression socks. There are better ones available now that aren’t the vice grip socks of years ago. Most older people have legs and ankles that swell. Compression socks… and/or elevating their legs so they are higher than their heart for a period of time during the day or at night.. can help reduce swelling.
Viasox Diabetic Socks –these are super stretchy socks that are easy to get on and off. Available in knee length, ankle and compression sock options. There are lots of fun prints as well as solids. https://viasox.com/
Electric foot warmer pad –
Cold extremities are a common problem with the elderly. Mom often has cold feet at the end of the day, even on warm days. The right tool for this job turned out to be a double-sided electric foot warmer. (Any electric heating pad/blanket needs to be used with supervision as elderly people have thin skin that can be damaged.) Mom’s favorite foot warmer pad worked better than traditional heating pad as it has a zipper. You can make it into a pouch to slip both feet into. You can also unzip it and use it to heat a larger area like backs, or shoulders. It took some trial and error to find this item on Amazon “Accelery Double-Sided Heated Foot Warmer” with a tag that reads: “OnKey Electric Technology Heating Pad Model # FT-1616,” now listed as “unavailable”
Here’s a similar one, but this lacks the zipper and timer on the control:
Room Safety
Landline phone for hearing impaired
A 911 call from a landline is the fastest way to get help to the right location. Check with local agencies about qualifying for a free or discounted landline phone for the hearing impaired. Hearing/vision loss and other age-related challenges like arthritis can make it a struggle to use even the most basic cell phones. Be confident your loved ones can make and receive phone calls.
Call Button (CallToU transmitter and receiver) https://www.amazon.com/CallToU-Caregiver-Transmitters-Receivers-Attention/dp/B077SYPD5K
One of the best “tips from the trenches” we got from one of mom’s caregivers was to get her a call button. Getting a senior accustomed to using a call button keeps everyone safe. It’s an essential skill for assisted living. Knowing how to use a call button will also help your loved one get help if they end up in the hospital. For the hours you can't be with them, it will be up to them to use a call button to get help from a nurse.
Grabber (The one I like best I got from Diaso – this link has photos and a review) https://www.thestuffsreview.com/2022/07/daiso-all-purpose-grabber.html.
Back injuries or hip/knee pain can prohibit bending over. A “grabber” is a safer way to retrieve objects that fall to the floor.
Motion detector Night Lights
Light in hallways can prevent trip and fall hazards. Especially for nighttime trips to the bathroom. Battery operated “tap lights” can also be handy. Many options of both are online or at hardware and home improvement stores.
Bathroom safety
Shower chair https://www.vivehealth.com/products/shower-chair
Baths and showers are the #1 place where life-changing falls happen. Take shower/bathing safety seriously.
I mailed order this one for the handles, height adjustment choices, and drainage holes in the seat. It’s good, but we still ended up adding a padded shower floor pad for her to sit on while she uses this as the seat is a tiny bit slippery.
Talk with your elder’s doctor/dermatologist about ways to keep fragile older skin well moisturized. Slathering lotion on damp skin right after showering is a good practice for anyone to prevent dry skin issues. Use gentle body wash (Aveeno unscented etc). Bar soap, even Dove, can be drying.
Grab bars
These are essential and need to be installed/attached to studs in the walls. I didn’t have to buy any of these are they were already at Mom’s condo.
Toilet seat support
Handles on the sides of the toilet are safer than a single grab bar on the wall. Finding the right handles was another trial and error discovery. We found this worked best because it used the toilet seat itself (not the floor) as the base for the handles. This product was more stable than other seat-based options we tried. She didn’t like options that raised her higher on the toilet seat as it made her feet dangle. This option lets her use the toilet seat at the traditional height, but gives her support with sturdy handles.
If there is back or knee pain involved that can make it difficult to lower down to the traditional toilet seat. There are a range of risers and cushions available. But here’s a twist – I think most of them are designed by and for men. Women wipe in front. The lack of a front opening on many risers and cushions makes this basic self-care hygiene challenging for women. Find options with a front opening when shopping for a woman.
Toilet seat Cushion https://www.vivehealth.com/products/toilet-seat-cushion
Toilet Seat Riser with handles https://www.homedepot.com/p/Glacier-Bay-E-Z-Lock-Raised-Toilet-Seat-With-Adjustable-Armrests-5-in-FGB303GB-THD/312272463?source=
Toileting issues/Home as a healthcare setting
No one wants to think about needing help with personal hygiene care.
Caregivers have to think about it. They may be that help.
If you can’t imagine taking on these tasks – plan ahead now.
Do you know how to find in-home help for these hands-on jobs?
Can you afford this?? – the cost of caregivers that come to your home is mind-blowingly expensive.
Will you and your loved one feel that needing help with toileting is a deciding factor for transitioning to assisted living care? Helping another adult in the shower or at the toilet can put you at risk for injuries.
If underwear “accidents” are mild/infrequent, your life will be easier if you have already stocked some essential supplies. See a great coupon for Depends or similar products? Use it. Get your elder to try out some different brands and sizes. They will see these products are comfortable, effective, and discreet. It can be good "practice" to wear them overnight in bed, or out for an errand. Sometimes medical tests or health issues will prompt the need for these items on a short-term basis. Use that opportunity.
Wearing disposable underwear and changing them frequently helps prevent UTIs. Fragile skin in personal areas is a high-risk zone for infections. These can be hard to detect until they become severe.
Be sure you have lots of disposable gloves in a range of sizes (a Medium in one brand may need a Large in others). Baby wipes are essential! They serve multiple purposes. Carry them in a ziplock bag to appointments with your elder. The Costco Kirkland ones are always in my car and purse. Disinfecting wipes and/or a spray bottle with 70% isopropyl alcohol are essential supplies for every room when there is healthcare involved.
Buy waterproof liner covers for mattresses –online or at Target –and start using them now. Do yourself a favor. Spending $20 now may save you from dealing with disposing of a soiled mattress later. I like these “Allerease Ultimate Mattress Protectors” because they block everything: https://www.target.com/p/ultimate-mattress-protector-allerease/-/A-17273320
The Allerese “Perfect Protection” line is also good, and more widely available
Your family member may struggle with the reality home is now a healthcare setting. Even if it’s friends and family helping out… it’s more people using restrooms, common areas, and the kitchen. Everyone needs to be practicing good healthcare setting habits -- washing hands, disinfecting surfaces regularly etc. Older people have compromised immune systems. Protect them from common colds/flu and infections. Diligent heathcare setting practices by caregivers help avoid costly and health-compromising hosptial stays for seniors.
Another struggle your loved ones may have is accepting they need help with caring for their physical body, in spite of how indelicate and embarrassing that may be. Be compassionate. Let them know you understand. They are forever 30 in heart and spirit. But now they have a "vintage" body that needs specialized support and maintenance. You are here to help. Just like they helped with your body when it was very young and needed special care. When adult children are caring for elderly parents, we are all past our "best by" dates. But here we are...making the best of it.
UPDATE 12.6.23 -- For female elderly that have lost mobility and/or suffer from needing to be moved out of bed to urinate overnight -- consider getting a "PureWick" system. Once mobility is lost, getting lifted on and off a chair commode becomes a burden for everyone. This system is the home version of what's used in hospitals. It isn't cheap -- but the wear and tear they save on caregivers -- and on moving fragile patients around, especially when their skin gets so thin with age and is easily torn or bruised -- makes this system worth the investment:
https://www.purewickathome.com/caregivers.html
General safety and comfort
Transfer belts & harness
Avoid injury to elderly person and to caregivers. Try out some transfer belt/harness options before you need them. If you have an emergency and need to move someone who is suddenly not able to move all or part of their body – you will be glad you were prepared. UPDATE 12.6.23: Try these out early -- especially for size! Most of these items are designed by and for men. You may need to do some tailoring for a secure fit for smaller framed/female seniors. Here are links for these items I found most helpful--
Transfer blanket https://www.vivehealth.com/collections/transfer-belts-aids/products/patient-transfer-sheet-handles
Transfer belt with handles https://www.vivehealth.com/collections/transfer-belts-aids/products/gait-transfer-belt
Here are more options: https://www.vivehealth.com/blogs/resources/patient-transfer-device-aids
Adaptive Clothing
As mobility becomes more limited, simple tasks like dressing can get complicated. Standing on one leg can become impossible due weak knees or hips. Being able to dress yourself safely helps maintain independence without risking balance/falls etc.
These websites feature clothing designed for ease of dressing and undressing with limited mobility.
Dry Erase Boards, Care Guide Binder, Log books
These items became lifesavers. When mom was aging at home with in-home caregivers, that made me her one-person-assisted-living-coordinator: in charge of communication between her caregivers as well as scheduling that care with the caregiver agency. Having systems and standards in place helped everyone.
Dry Erase board message centers
A dry erase board with magnets on the back is easy to attach to the fridge. This becomes a great place to update meal lists, as well as a central place to list items that need re-supply from the drug or grocery store.
I also made a “housekeeping” dry erase board with list of housekeeping chores. Caregivers who did some of those chores on their shift could write it on the housekeeping board. It was also a place to write down disinfecting jobs that needed to be done with each shift.
Care Guide binder
A large 3-ring binder marked “Care Guide”. This is where I keep detailed instructions on all the care needed for Day Shift, Night Shift, 12-hour shifts for 24 hour care days, PT exercises done at home, Foot care, Meal prep routines; Housekeeping supplement; “bullet points” of FAQ, a photocopy of current Covid vaccination card, and copy of the Advanced Healthcare Directive. You’ll also need a complete list of all medications (with doses and times for delivery); any background medical information (chronic conditions; allergies; past surgeries or hospitalizations); as well as a list of doctors and the pharmacy used.
The Care Guide Binder is a complete and portable record of everything that visiting caregivers… or EMT.. would need in case the primary family contact wasn’t available. Dates on each of the entries there helped everyone know how current the info is, and if there is a newer date on any entry since they last reviewed it.
Log books –
I kept two log books. One had water intake, OTC and Rx doses. This also is where the caregivers listed any activities like walking or social visits.
The other log book had appointments during the day, when home PT was done, when Foot care happened, and notes from the overnight caregivers.
(art by Kate Allan, aka The Latest Kate https://www.thelatestkate.art/ )
Caregiving is an endurance test. Take care of yourself. Be prepared. Replenish your reserves of courage, patience and grace.
UPDATE 4.20.23
Bonus item to thank you for reading this far! Here's a book I discovered years before I needed it. I re-read it recently, and it's even funnier, and more poignant. This book was put in my hands by one of my favorite indie booksellers. Yes, Chast's take on the process is a bit dark, but humor always helps. On re-reading it from the perspective of someone who has now been on a journey like this... Chast's was a lot tougher. But she shares insights that are helpful.. and talks about the costs involved across the board.
https://en.wikipedia.org/wiki/Can%27t_We_Talk_About_Something_More_Pleasant%3F
Artist Roz Chast is well known for her New Yorker cartoons like these panels...
This link previews some pages from the book...
https://projects.newyorker.com/story/chast-parents/
I also wrote about the book in this post from 2019.
Here are some of my favorite pages from the book...
