Home care best care

My mother turned 98 at the end of March, which made her disproportionately pleased because she couldn't relate to 97 at all at all: "It's a prime number, dear, and it's too far to say 'almost 100', it's a nothing age".  I was over for a few days in February and heard this story a couple of times. I also absorbed a fair amount of anxiety about nursing homes, which consisted of a litany of anecdotes about unfortunate events which had happened to her friends-and-relations in such places.

• Being subjected to a management take-over which neglected to pay the staff who therefore didn't turn up for work and left a number of demented elders shuffling about like a zombie apocalypse.
• Being cited for racism.
• Having no undemented people to talk to.
• Having little autonomy about when to have lunch.
• Being charged an outrageous fee for a compulsory change of the carpet after final departure.

One of the reasons I went when I did is because m'sister, the primary carer, was abroad for three weeks and my visit plugged a gap in the schedule. It was interesting: a visit with her is often a visit to the 1930s or 1940s. And we also took in a couple of the local pubs for lunch. On one such expedition we set off for West Bay on the coast of Dorset because there was a nice place where you can get fish-and-chips. That was a bit of a bust because we couldn't find the little café but we did climb to the top of the shingle dune from the car park and got a whip of salty breeze and a terrific view [R] along the Jurassic Coast to Golden Cap. It turned out that the last time my mother had been in West Bay was before I was born, and she'd eaten her chips with a charming, funny and absurdly erudite young naval officer whom she eventually married. We got a very good lunch later at The Greyhound in Sydling St Nicholas.

On the other side of the Irish Sea family we have Pat the Salt, my aged father-in-law who is determined to hang around on Planet Earth until he clocks up the ton (makes 100 years) in 2025 and gets a card and a cheque from the President. The family have made a pact that Pat will be living at home at least until he doesn't know where he is. He currently has one very good friend, a bit younger that him who is in a nursing home because her own place is absurdly inconvenient to support a frail, partial sighted, mobility impaired person on her own. Pat has been to visit - once - and won't go again. We suspect it's because he thinks one of his children will "take him to visit" and not take him back home again.

In the light of these elder care issues, I am a bit primed for such matter as How to keep your elderly parents safe and in their home longer | Roger Wong | TEDxStanleyPark. [20 minutes of Youtube advice from a consultant geriatrician].  His advice:

• Keep your parents in the social loop; loneliness kills
• Teach them smart phone and social media, including skype, before they lose all their marbles
• Skype and Friendface don't replace face-time and a real hug but they can bridge the gaps.
• Tech can also promote safety and peace of mind.
• The Internet of Things can manage door locks and cameras from remote; and switch off appliances at night.
• If they are attached to their smart phone [because of your prior planning] then you can GPS track them down if they do a runner. 
• I had a friend who grew up in Dublin but was living and working in Cork. His father had Alzheimer's when his parents came down on the train to visit for the weekend. They were really concerned when they woke up on Saturday morning to find the back door open and the father missing. He turned up in Dublin several hours later and was taken in my the next-door neighbours. Nobody could work out how he'd negotiated the journey home.
• A trip and fall will be the most likely thing to precipitate a one way visit to hospital/rehab/care-home or indeed a quicker visit to the funeral home.
• Remove all loose rugs
• We had a rug in the kitchen 25 years ago which my mother fell over and broke her wrist  - then aged 73 - it was painful but not a death sentence because she was 'only' 73 and it wasn't a broke hip. I learned from the event that, after 6 weeks practice, you can write well with your non-dominant hand with noticeably the same 'hand' as you write normally.
• Probably good to take up the carpets (under-floor heating if you have the choice) because they are a bit draggy on a walker. The evidence say that walker benefit trumps the fact that carpets soften the impact of a fall.
• Get rid of the knee-height coffee tables too
• Sort out the plumbing sooner rather than too late.
• Drive-in shower room on the same floor as the bedroom
• Change the height of toilet to make it easier to get on and off the throne
• Suitable handles near that toilet: check out the nearest disabled toilet for ideas
• Even if you, or the parents, never need these aids they will add to the value of the house when/if you have to sell it. There are 7.4 billion of us now and many of those people will need those facilities before the house itself falls down. 
• Most important is to make the shift to the final home while you and/or your parents are with it enough to learn where the light-switches are. If you wait for the precipitating crisis, you'll add needlessly to the subsequent confusion.

Think before you shift your parent to be nearer to your home, even if you are the primary carer. Thus wrenching them from familiar surroundings and familiar community will be bad for them . . . and bad for you because all their care-and-attention will fall to you. It is waaaay cheaper to maintain someone in their own home than in a residential care facility, even if you pay for infrastructural support.