Planning Ahead to Ensure Care for Aging Parents
You’ve always admired your mom’s ability to manage her diabetes. But recently you’ve noticed she’s more forgetful and her medication is no longer organized. It makes you wonder if managing her condition—checking blood glucose throughout the day, taking multiple meds—has become too much for her to handle without some added assistance. It might be time for you to take action. Here’s how to navigate.
Broaching the topic of assistance with diabetes care is so sensitive that many families don’t have the conversation until they’re forced to—after Dad stops eating regularly, for example, or Mom is hospitalized for a fall that happened because of low blood glucose (hypoglycemia). “When you’re not staying with somebody, they can really hide [diabetes issues] well,” says Medha Munshi, MD, director of Joslin Diabetes Center’s Geriatric Diabetes Program.
Ideally, you’ll discuss the issue in advance so you’ll know what to do when the time comes. “When we talk to family members, sometimes it’s harder than they think to ask these questions,” says Valari Fauntleroy, MS, RD, RDN, a clinical dietitian in geriatric nutrition for the senior-care company InnovAge. That’s because you and your loved one may not want to think about the end of independence. But doing so is important.
Diabetes caregiving can be addressed in a larger discussion about estate planning, specifically when making plans for a power of attorney and an advance directive, a written statement that relays people’s wishes for medical treatment if they’re unable to speak for themselves. As you write down these plans, you can also talk about whether caregiving needs to begin now or in the future.
A certified diabetes educator can help you decide when the time is right for you to step in, but these conversations should be led by your parent. What does he or she want? Some people prefer lots of hands-on help, while others are concerned they’ll be a burden. So approach them from a place of love and bonding. Fauntleroy suggests using gentle but specific language. Try saying, “Would you like my help with bolus dose calculations?” Or even: “I see that you are having difficulty with medication injections. Can I help?” Phrases that are vague—such as “Is there anything you need help with?”—are less likely to be effective.
Ask to tag along to a doctor’s appointment and, once there, find out from the provider what you can do to join the care team. If Dad doesn’t want you at the appointment, ask if you can access his medical records. Without your parent’s signed consent or your presence in the exam room, a provider can’t share health information.
Even if a health provider can’t give you the particulars about Dad’s care, you can supply the provider with valuable info. A doctor might see your father for years without spotting a problem because your father says all is well. By calling or e-mailing with concerns, you may help the provider better talk to your father about health issues.
Spring Into Action
Look for clues that it’s time to put your plan to use. When your already slim father’s clothes are suddenly too big, it may be a sign that he isn’t able to feed himself anymore. If Mom can explain how to give herself injections but the amount of insulin in the vial doesn’t go down, she may be forgetting her doses.
The most important aspect of diabetes management as your parent ages is simplicity. Look for ways to make things less difficult:
- Switch your parent to insulin pens, which are easier to handle than a vial and syringe.
- Label pill bottles with different-color stickers for night and day.
- Opt for a non-childproof cap, which can take the struggle out of bottle opening for people with arthritis or neuropathy.
- Periodically check with the pharmacy to be sure your parent is keeping up with drug refills. It’s a sign he or she is taking medication as directed.
- Sort oral meds into clearly labeled pill containers. This will help you notice if your parent is missing doses.
- Set an alarm on Dad’s phone or clock to remind him to take a morning or evening dose.
- Use an app to view Mom’s continuous glucose monitor (CGM) and/or meter glucose data on your smartphone. If you notice high readings, she may have forgotten to take medication. Spot a low? Give a call to remind her to take fast-acting carbs.
- Grocery shop with your parent. If he or she is homebound and unable to cook, Meals on Wheels can deliver hot, healthy food at least once a day. If your parent is still able to get out, the local senior center can provide a meal.
- Encourage peer interaction. A senior center is a good source of company. A 2012 consensus report from Diabetes Care notes that older adults with diabetes are at risk for dementia and depression, both of which can be alleviated by social interaction.
Your parent’s diabetes care team can help you simplify diabetes-care goals. For people older than 80, very strict blood glucose management may not be ideal. With older age, complications may not have time to develop, so the risks that come with too-tight diabetes management—lows that can do serious harm or even cause death—aren’t warranted. Research published in 2016 in JAMA Internal Medicine showed that health providers sometimes recommend that people who take multiple daily injections switch to basal insulin only, which makes their diabetes management easier and reduces the risk for hypoglycemia while only modestly increasing their risk of complications. And depending on age, those potential complications may not occur.
Create a Community
Caregiving is a team effort. Enlist a neighbor or relative to make sure Mom takes her medication. Local charitable organizations or a faith community might have volunteers who visit older adults and can give medication reminders or share a meal for free.
Or you may want to pay for some help. A diabetes educator or a local office on aging should have a list of senior service providers, such as home health aides or visiting nurses. Medicare won’t pay for those services. “It can cost quite a bit,” says Yvonne Kuo, MSG, CMC, a family care navigator at the University of Southern California’s Family Caregiver Support Center. “Twenty dollars and up for one visit, and sometimes it can be [needed] twice or three times a day.” Another option: Pay to train a friend, neighbor, or family member to handle things such as insulin shots.
Make sure everyone who helps is communicating regularly. “Everyone needs to be on the same page and hear the same thing,” Fauntleroy says. So use technology, such as a meter with cloud technology or a shared spreadsheet for logging food, or place a notebook in a designated spot of your parent’s home to keep records in one place.
Navigating the transition to caregiving for Mom and Dad can take time, patience, and communication. So keep talking! Let them know you’re there for them and that you’ll make sure they’re happy, healthy, and safe for years to come.
Here are three signs your parent may be ready to leave home for an assisted living facility:
- He or she isn’t bathing or changing clothes.
- The house is unusually messy or dirty.
- He or she is unable to perform basic tasks, such as cooking on the stove without burning food or using a microwave without confusion.