Knowing When an Aging Parent Needs Help

Peter Ciuffa and his mother Carolina make gnocchi together.

Thanksgiving is a happy time for many. We cook, eat, and travel to spend time together, often with our elderly parents, grandparents and other aging relatives. While the holidays are a joyful time, they can also prompt us to realize that our elders are not as able to care for themselves as much as before. If we don’t see them often, this could be an opportunity to compare how they are able to get along and whether it is still appropriate for them to continue to live independently.

Start By Assessing Activities of Daily Living

In this post, we provide a simple way to assess the amount of care that an elderly loved one might require through later life. We share this to encourage families to start a process of long term care planning. We focus on how to evaluate the non-medical care needs of an aging, elderly person. These non-medical needs are not typically covered by health insurance policies, like Medicare. Families are left to figure them out on their own, often paying out-of-packet for home modifications, home care, adult day care, or assisted living.

Elder care financial assistance programs and insurance companies frequently refer to the Activities of Daily Living as a way to assess care needs. Families can also use it as a checklist to identify needs and to estimate the amount of time required to provide care. This list of common activities covers the spectrum of tasks and actions that a person needs to do in a typical day.

Evaluate Both Senior and Living Situation

We recommend an improved and standardized version of the Activities of Daily Living Checklist from AARP and PBS.org. To use the checklist, try to imagine whether the elderly person would be able to do the activity on their own. If they require assistance, the checklist will prompt you to consider how many hours it would take on a weekly basis.

Because the holidays sometimes bring us to see our elder relatives in their home, this presents an opportunity to assess whether the house or apartment could be made safer and easier for them to continue living independently or, at least, with as little outside help as possible.

Be aware that some seniors might try to hide their care needs from family and loved ones. It is best to observe their behavior rather than just asking them.

How to Assess Care Needs

To do this activity, we recommend that you download a rewritable version of the Activities of Daily Living Checklist and save it locally to your computer. You can get one here.

Once you have done so, refer to each activity and decide whether your loved one requires assistance performing the task and if so, how many hours per week. Next, we recommend that you consider whether there are any tools, technologies, or modifications to the home that would help to reduce the need for outside care and help the elder feel more independent and less of a burden on the family.

Of course, these same tools, elder care technologies or modifications might also help reduce the number of hours of care needed. Consider whether and how many hours of care could be reduced by the aging assistance tools, technologies, or modifications. Estimate the net need for care by subtracting the labor savings from the original estimate of care hours for each of the activities.

Next Steps

There are some financial assistance programs to help with the cost of home modifications and improvements to safely age in place. However, if their need is great or the living situation is too challenging, this might also be a time to consider whether a senior living community might be the right move.

We recommend that families not delay on the important conversations about how to care for aging parents. A proactive approach will reduce stress, likely help you save money, and will improve the quality of care for your loved one.

Calculating the Cost Savings of Walk In Tubs

Our organization is contacted regularly by individuals inquiring about walk-in tubs and which government programs, if any, provide financial assistance for them. We've written in depth on that subject here so we won't go into those details in this post. However, for families struggling with the purchase decision and for program administrators and legislators, we want to examine the economic question of if and when there are care cost savings associated with the installation and usage of walk-in bathtubs instead of showers.

There are two ways to look at this question. The most obvious way is to look at the reduced need for personal care assistance. If one is able to safely bath themselves, then a family need not hire a home care professional to provide assistance. The second, somewhat roundabout way of calculating cost savings, is to look at the medical costs associated with bath related falls.

When caring for a loved one at home for a period of one year or more, the purchase of a walk in tub is a sound economic decision.

For families in the situation where they must hire outside assistance to help an elderly love one bath, the calculation is fairly straightforward. Let's assume an individual needs to bath 5 times per week. Family members can provide assistance on both days of the weekend which means on 3 weekdays outside assistance is required for approximately 1 hour / day (although realistically, one cannot hire home care assistance for just one hour.) 3 hours / week times the national average hourly rate for personal care ($20 / hour) equals $60 / week or $3,120 / year. Basic walk-in tubs costs $2,000 - $3,000 and wheelchair accessible tubs cost $3,000 - $4,000. Using this math, we can see that should one be caring for a loved one at home for a period of one year or longer, the installation of a walk in tub makes economic sense.

The more complicated calculation for determining the cost savings of walk-in tubs is by looking at the reduced injury rate. This question is of greater interest to program administrators when considering if and whether to include walk in tub installations as a covered benefit of their program. Our methodology is clearly unscientific. However, our 'napkin numbers' make a case that on the whole including walk-in tubs as a benefit of assistance or insurance programs is also a good economic decision.

The hospitalization costs of one fall can pay for 10 walk in tubs.

By combining the statistics from a variety of different studies, we estimate the following. Each month there are approximately 12,000 falls experienced by American seniors in their bathrooms. One third of which are serious enough to warrant a hospital visit. The CDC finds the average hospitalization cost for a fall injury is almost $35,000. Doing the math, we find that over $1.5B is spent annually on medical costs from bath related falls. Since most seniors are insured by Medicare or Medicaid, both of which are government programs, it seems a 'no brainer' that walk-in tubs should be a covered benefit for the frail elderly at risk who cannot bath themselves otherwise.

It is worth mentioning that this post strictly examines the walk-in tub decision from an economic perspective and that there are other factors that can and should be considered. Most important of which is the increased sense of self-reliance and dignity afforded by being able to manage one's own personal hygiene.