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Paul and Lori Hogan co-founded Home Instead Senior Care in 1994. The Home Instead Senior Care franchise network has grown from one franchise in Omaha to more than 800 worldwide. The company is the global leader in non-medical, in-home care for seniors. The Hogans have won awards for their franchise business model.

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STAGES of SENIOR CARE

The McGraw-Hill Companies, Inc.

Contents

Chapter One

The realization comes unexpectedly and suddenly; or it's a gradual awakening that can no longer be ignored. Yesterday you were your mother's daughter, or your father's daughter, as you have been all your life, through all of life's passages—but the passages were always yours. You were the one who was a disruptive three-year-old, compliant ten-year-old, rebellious adolescent, overconfident college student, confused novice in the workplace, cocky associate director, nervous newlywed, and then a sometimes-overwhelmed parent of your own three-year-old.

Through it all, your mother never changed. She was the rock, home base. Your tumultuous spinning from stage to stage may have exasperated her from time to time, but she rarely showed it. She was the fixed point in your small universe, the one you could always rely on to get you out of that impossible jam, that catastrophic situation, or so it seemed at the time.

That Was Yesterday

Today is very different. This morning you drove to your mother's house for a routine visit and found her sitting in her car in the driveway, making no effort to move the car or get out. When you asked her to roll down the window, she did, and she recognized you. But she had no idea where she was or where she was going.

The episode confirms a truth you had been trying to hide from—your mother's growing detachment from the world around her. On your last several visits, her home has been in disarray, extraordinary neglect on the part of a woman who had been a diligent housekeeper to the point of obsession all your life.

Or perhaps the realization that your parents are no longer your protectors but now your dependents comes with your father's spinal injury. He was always Mr. Fix-It—electrician, carpenter, plumber, roofer all in one. Not only did he take care of your parents' home, he was the one you called when your furnace collapsed in midwinter, your own husband far less adept with tools. Now your father is likely to be a semi-invalid for the rest of his life, confined to a wheelchair much of the time.

Who Takes Responsibility?

The world is now turned upside down. You have suddenly become your parents' parent. And you realize that the coming years are going to be extremely challenging. How do you talk to your parents about their changed lives and bring them in on the decision about what kind of care they need? How do you engage your siblings in sharing the responsibilities? Which sibling should be the health care proxy, and should he have absolute authority?

Who should manage the finances and protect your parents' assets? How do you distinguish between a good assisted living center and a bad one before your parent is already in residence? How do you know which option of the senior care continuum best suits you parents' needs now? What information do you need to make the best decisions about care options? We will address these and many other important issues throughout this book to help you make wise and responsible senior care decisions.

You are understandably devastated by the realization that your mother or father is failing. The fear had crossed your mind from time to time in recent years after they reached the age of seventy, but you pushed your concern aside in favor of more immediate worries, like college tuitions for your children. You are likely feeling guilty because you hadn't been more insistent that your parents buy long-term care insurance and create advance directives. You are afraid that the decisions you make in the coming months are going to shorten your mother's life, or worse, make her final years miserable.

You Are Not Alone

Also, you may feel angry—angry, in large part, because you feel that you are alone, that you must manage your mother's or your father's care by yourself, perhaps with only grudging assistance from your siblings.

Fortunately, that is not true. You are not alone. The enterprise of caring for the elderly has grown prodigiously in the past few years. Which isn't surprising. The senior population in the United States is increasing at an astonishing rate. Some 38.7 million Americans are now sixty-five or older. That population is expected to more than double in the first half of this century, from 35 million in 2000 to 88.5 million in 2050. (See Figure 1.1.) The fastest growing part of the U.S. population is the very old, that is, those over eighty-five. That group is projected to double from 4.6 million in 2002 to 9.6 million in 2030—and double again to 20.9 million in 2050. (See Figure 1.2.)

Moreover, it is not just the United States that is experiencing this huge growth in its elderly population. Aging is truly a global phenomenon. The population of the United Kingdom over eighty years old has increased by more than 1.1 million between 1981 and 2007. People seventy-five and older now constitute 10 percent of the population of Japan. In 2007, people sixty-five and older made up 13 percent of Australia's population; by 2056 those over sixty-five are expected to constitute 23 percent or more of the population. In many developing countries, especially those of Asia and Latin America, the elderly population is expected to grow by as much as 300 percent by 2025.

An Expanding World of Care Choices

Fortunately, however, a flourishing senior care industry is prepared to help take care of them. In the United States alone, the size of the home care market in 2007 was more than $57.6 billion. There are currently about 16,000 certified nursing homes with some 1.4 million residents. Also, according to the National Center for Assisted Living, an additional 1 million seniors live in up to 38,000 assisted living residences, which provide some help with daily living but not around-the-clock nursing care. An even larger group of Americans with long-term health problems, about 7.6 million of them, remain at home suffering from acute illness, most of it related to aging. They are supported by a cadre of 83,000 caregivers, who visit them in their homes, cook meals, do light housework, and provide companionship.

Among the many others who can be called upon to help the elderly are 7,600 geriatricians (physicians specializing in the care of seniors) and about 4,400 elder law attorneys. Hundreds of churches and synagogues across the country now sponsor adult care centers and other programs to help the elderly.

So, you are not alone. Indeed, you have entered a heavily populated and complex new world that is changing rapidly. Professionals ranging from research scientists in their laboratories to hands-on caregivers at the bedside learn more and more about the care of the elderly and how to apply those lessons. What you must do is learn how to find your way through the maze of services that are available and how to determine which are best for you and your parent. And you need to be armed with information to avoid the misunderstandings, deceptions, conflicts of interest, and misleading information that develop in any industry—the senior care industry sadly being no exception.

The Evolution of Senior Care

Throughout history, families, both immediate and extended, have borne the primary responsibility for taking care of their elderly, just as...