The signs can hit you quickly or sneak up on you gradually. But what do you do if Mom or Dad isn't safe living alone anymore?
"The worst thing you can do is ignore it," said Bob Mecca, principal of Robert A. Mecca & Associates, an independent, fee-only financial planning firm in Hoffman Estates, Ill.
If an elderly relative starts to need help to get through the day, families who want to avoid institutions often face two choices: hire a home-care aide or become one yourself. Both these options allow the older person to remain at home where he or she may be most comfortable, experts say, but each has its own pitfalls.
Families who choose outside help must decide what level of care their loved one requires and whether they want to go through an agency or hire a caregiver privately. And people who join the ranks of the 65 million unpaid family caregivers in the U.S. can face health-draining burnout if they don't budget for respite care for themselves.
There are two main kinds of in-home care. Personal or home-care aides provide companionship and support a person's activities of daily living such as dressing, bathing, preparing meals and doing laundry. Home health aides may do all those things plus tasks such as administering medication or recording changes in a client's condition. They also may work under a nurse's supervision.
Here are five questions to consider when thinking of hiring or becoming a caregiver.
1. What kind of care do you need and can you afford?
If you don't know what kind of care is needed, a specially trained geriatric care manager can help you assess the situation by doing a site visit. Assessments cost $500 to $800 depending where you live, said Stan Samples, communications director for the National Association of Professional Geriatric Care Managers. Its website, Caremanager.org, can match you with local geriatric care managers.
The Alzheimer's Association offers an always-open phone line at 800-272-3900 and an online CareFinder tool at www.Alz.org/carefinder. And Medicare's website has a Home Health Compare tool at www.Medicare.gov/HHCompare.
Before looking for a home-care worker, families need to make sure they can afford to hire one, Mecca said.
Families typically pay for these services out of their pockets unless the older person meets Medicare's coverage conditions or has a private long-term-care insurance policy that covers such needs.
Agencies' hourly rates often are toward the top of the scale while caregivers who work independently are typically less expensive.
Rates vary widely but are often $14 to $22 an hour for nonmedical in-home care, said Jim McCabe, president of Eldercare Resources, a geriatric care-management company in Scottsdale, Ariz. Still, home care is often less pricey than assisted-living facilities, which can run $2,800 to $4,400 a month, he said.
2. Should you hire an independent worker directly or go with an agency?
The advantage of using a home-care agency is it takes responsibility for screening and supplying aides and paying their wages, taxes and insurance in the event they get hurt on the job, said Ethan Kassel, a geriatric care manager and co-owner of Garden State Eldercare, a home-health agency in South Orange, N.J.
Agencies also run criminal background and driving-record checks, and they provide backup aides should your main caregiver get sick or go on vacation.
Families who decide to hire someone on their own should make sure they follow all state and federal employment laws, including any provisions for overtime pay, Kassel said.
"The last thing you want is somebody going after your estate or the family member's estate because something wasn't handled correctly," he said.
3. Can you manage the process with other family members?
If an elder's adult children live close by, they may decide to divide at least some home-care duties among themselves. But tension often develops if one feels he's contributing more hands-on work or money than the others.
Siblings who can't get along may require arbitration sessions so they can get past the conflict to organize care for their parent, said McCabe, who calls family arbitration a fast-growing part of his business.
One ground rule he establishes: "If they want to weigh in on what the solution should be, they have to participate in the process that leads up to that."
4. How do you find the right home-care aide for your needs?
Once families hammer out a plan, the next step is choosing the right person for the job, said Mecca, who has worked with professional caregivers for his own family members. He recommends interviewing at least six candidates, comparing their strengths and checking the references of those who interest you.
Families should interview applicants in the home so the aides know what kind of environment they would be working in, Kassel said. If the home has a smoker or pets, that could affect the relationship. And don't forget to include the elder's input. "All these things are important in making a good fit," he said.
Finally, don't pinch pennies if someone stands out but is a little more expensive, Mecca said. "If you give a few more bucks to someone you really like, it will be well worth it and pay you back."
5. Do you have a plan to take care of yourself?
If you're caring for a loved one yourself, you need to plan time away so you can tend to your own physical, social and emotional needs. McCabe sees what happens when family caregivers put themselves last. "They're so consumed with making sure Mom's needs are met that they break down in the process, and with respite care they could have avoided that," he said.
Churches, synagogues and volunteer groups may offer short-term relief. Adult day-care centers may be another option. The Alzheimer's Association and your local Area Agency on Aging also provide respite-care resources. For more frequent and overnight breaks, check with assisted-living facilities, some of which offer furnished rooms, meals and nursing staff on a temporary basis, Kassel said.
Family caregivers can find more resources at www.familycaregiving101.org, a website run by two nonprofit organizations.