St Louis In Home Care Tips

St. Louis Home Care Tips: Five Signs of Low Vitamin D

Seniors need Vitamin D5 Signs of Vitamin D Deficiency

Jefferey Morgan at

Vitamin D deficiency is a pretty common condition. Sadly, very few people realize that their health is at risk, so they choose to ignore the side effects. Even though milk products have substantial quantities of vitamin D, that's still not enough to maintain bone strength and stay healthy.

In fact, the main source of this vitamin is not food, but the sun. Only natural sunlight provides enough vitamin D for your body to look and feel good. Unfortunately, older adults don't get out much, and because they spend a lot of time indoors, it's easy for them to become vitamin D deficient.

Here are five clear signs of vitamin D deficiency to watch out for:

  1. Weak muscles: In aging adults, vitamin D deficiency is strongly linked to weak muscles. Older people are susceptible to developing a vitamin D deficit due to several factors such as diminished exposure to direct sunlight, insufficient dietary intake, less-than-optimal intestinal absorption, and reduced skin thickness. Weakening of the muscles because of vitamin D deficiency can manifest in different ways. In general, older adults feel a heaviness in their legs and difficulty with standing up and climbing stairs. The good news is that supplementation can help older adults compensate for these insufficiencies, and thus get back on their feet.
  2. Mood changes: Vitamin D is not your average vitamin. In fact, it is a hormone. After vitamin D has been absorbed by the skin, it relocates to the kidneys and liver, where it is then transformed into an active hormone. This hormone helps assimilate calcium, and keeps the bones, muscles and teeth in excellent condition. Studies have shown that vitamin D is also responsible for activating genes that control the release of neurotransmitters (serotonin, dopamine); thereby affecting the functions of the brain. Seniors who feel depressed and tired all the time may actually suffer from a vitamin D deficiency.
  3. Weight gain: Research claims that, together with a hormone called leptin, vitamin D helps regulate body weight. Leptin is manufactured inside the body's fat cells and works by delivering signals to the human brain, basically letting a person know that they're full and they can stop eating. Vitamin D controls leptin levels inside the body, making sure that the right signals are sent to the brain. When someone is deficient in vitamin D, these signals get disrupted and the body doesn't know when to stop eating. This can make people overeat and gain weight.
  4. Fatigue: Many older adults who feel tired don't realize that they might have a vitamin D deficiency, so they choose to ignore their symptoms. Someone who has stiff joints and is constantly feeling fatigued might want to boost their intake of vitamin D (especially if they don't go outside much or don't eat many milk products). Apart from fatigue, vitamin D deficiency may also trigger pain in the legs and difficulty moving around the house.
  5. Stomach problems: Vitamin D deficiency may lead to inflammatory bowel disease, which is a chronic illness that causes swelling and irritation in the digestive tract. This condition is split into two main types: ulcerative colitis and Crohn's disease. Older adults are more predisposed to developing inflammatory bowel disease because they're susceptible to vitamin D deficiency. Gut problems are unpleasant and they can also tamper with the fat absorption process. Since vitamin D falls into the category of fat-soluble vitamins, insufficiencies may trigger severe gastrointestinal problems.

Vitamin D is an extremely important nutrient that the body needs to function properly, and insufficiencies may trigger severe health problems. Older adults who don't go outside much should make a lifestyle change if they want to preserve their health, maintain strong bones and have a healthy digestive tract.

Expose yourself to more natural sunlight, especially in the morning. Take relaxing walks to the park and enjoy the beautiful weather. This will boost your mood and keep your bones strong and healthy. Vitamin D supplements may be advised if your deficiency is extremely severe, but it's a decision you'll have to consult with your physician before staring a treatment.

Need Help Caring for an Aging Parent or Getting Them Out for a Little Sunshine in the St. Louis area?

Let our  by Text-Enhance" href="">St. Louis in home care team help! If you are in need of assistance at home care for your loved one in the St Louis area or just have questions, contact our Director of Client Care at Assistance Home Care. We are a St. Louis Home Care Agency providing quality and affordable caregivers in St Charles, St Louis, Lincoln and Warren County, Mo. We would welcome the opportunity to answer your home care questions and more.
Call today: St. Louis County 314-631-1989 or St. Charles County 636-724-4357 or visit us online at Assistance Home Care in St. Louis.

Tags: St Louis Home Care, Caring for Aging Parents, Vitamin Deficiencies in Older Adults

St. Louis Home Care - Alzheimer's Loving Bond Lasts Forever

You won't believe what this man does for his wife every single day.

Alzheimer's Caring for an aging loved one with Alzheimer's
Great video that truly demonstrates how true love and a lot of patience can make even the worst disease just a bit easier for everyone involved.
What a great example for all of those caring for a loved one with Alzheimer's.

Need Help Caring for an Aging Parent or Loved one with Alzheimer's in the St. Louis area?

Let our St. Louis in home care team help! If you are in need of assistance at home care for your loved one in the St Louis area or just have questions, contact our Director of Client Care at Assistance Home Care. We are a St. Louis Home Care Agency providing quality and affordable caregivers in St Charles, St Louis, Lincoln and Warren County, Mo. We would welcome the opportunity to answer your home care questions and more.
Call today: St. Louis County 314-631-1989 or St. Charles County 636-724-4357 or visit us online at Assistance Home Care in St. Louis.

Tags: Caring for an aging parent, Alzheimer's Care, Dementia Care, Alzheimer's Communication Tips, Alzheimer's Disease, Caring for Aging Parents

Home Care in St Louis: What is it like to be old?

An important component for

Caring for an Aging Parent in St.

Louis is EMPATHY.

Caring for an aging parent with Empathy

As they say a picture is worth a thousand words, then this video speaks volumes and truly helps to demonstrate what it is like to grow older and understand all of the limitations and difficulties an aging parent faces in regular day to day activites.

Please take a moment and watch this video from PBS on the Empathy Suit.  Knowledge is power and can help one to understand that your parent really isn't just trying to be "difficult" when they seem to take forever to do even some of the most basic daily tasks.

If you know someone who is caring for a loved one, please share this post and help them to have empathy for those that they care so deeply about.

Need Help Caring for an Aging Parent in St. Louis?

Let our St. Louis in home care team help! If you are in need of assistance at home care for your loved one in the St Louis area or just have questions, contact our Director of Client Care at Assistance Home Care. We are a St. Louis Home Care Agency providing quality and affordable caregivers in St Charles, St Louis, Lincoln and Warren County, Mo. We would welcome the opportunity to answer your questions and more.
Call today: St. Louis County 314-631-1989 or St. Charles County 636-724-4357 or visit us online at Assistance Home Care in St. Louis.

Tags: St Louis Home Care, Caring for Aging Parents, Aging in Place

St. Louis Home Care: Caring for your Aging Parents

Caring for Your Parents: How to Reclaim the Good Old Times

Who knew that I would be touting Oprah's O?  Here's an insightful article that I can relate to having helped so many wonderful families who are in the "emotional grinder'.  Please share with others as you see fit!
By Martha Beck   |   From the May 2009 issue of O, The Oprah Magazine
A winding road
Shepherding fragile elders can leave a person lost and overwhelmed. Martha Beck offers a path back toward sanity.

I once attended a Navajo blessing ceremony, held in a tepee on the red sand of the Sonoran desert. The tepee was set up with great reverence, since to the Navajo, it symbolized the womb from which we all emerge, and the tent poles were "the bones of our grandmother." The word grandparents was spoken often and lovingly throughout the ceremony. The group's silver-haired matriarch quietly reigned over the gathering, with everyone else poised to supply her needs. It was a graceful dance of mutual care, with the elderly at the center.

By contrast, our First World way of caring for the elderly is a clumsy, exhausting tarantella. It force-partners isolated caregivers (usually middle-aged women) with decline, disease, dementia, and death. As one woman told me, "Having aging parents simultaneously orphaned me, saddled me with two insane strangers, and shoved every nightmare about my own future right into my face." I heard many such stories as I researched this subject: Polly nearly bankrupted herself caring for her father, who has Alzheimer's. Brooke has barely slept since her ailing mother-in-law moved in. Jennifer had to testify against her parents in court so they'd be declared "incompetent to drive" before accidentally killing themselves or someone else.

This is what happens when a society forgets something people like the Navajo teach explicitly—that caring for the elderly is a "blessing path" in which the whole community should participate. Although our culture shows no signs of collectively adopting this perspective, there are ways to regain it on a case-by-case basis. If you're one of the 34 million or so Americans who are caring for an older relative, I offer my deep respect, and the following suggestions.

Practical Coping Strategies

As I interviewed people who are known in demographics as "unpaid caregivers," I thought I'd hear a few logistical hints. But that turned out to be like seeking just a few general rules on "how to heal sickness" or "controlling bad emotions." Every aging-parent scenario is unique, and there are precious few generalities that apply. One thing I can say is that you'll have fun with the responsibilities of eldercare if you enjoy running the high hurdles while juggling angry badgers. If not, you might try these techniques.

Trust your intuition about how much care is needed.

"There are hundreds of lines between being a little daffy and needing constant supervision," says Polly, describing her father's Alzheimer's. "At first my dad wasn't totally out to lunch; he was just...snacking. Then he definitely went out to lunch, then breakfast, then dinner. I've had to trust my instincts to increase care as he crossed each new line."

Denial is potent and seductive when it comes to dealing with aging. No one wants to acknowledge that a family member is in permanent decline. But when your parent gets really sick, or begins, um, lunching out, you'll feel an uneasy warning from your gut. Pay attention. The sooner you acknowledge the truth—"I must intercede"—the sooner you can begin exploring care options. And there's a mess of exploring to do.

Prepare for a logistical wilderness.

There's no rule book to guide you through the morass of eldercare tasks and demands. Your best source of information is the Internet, where you can e-mail friends and family and research everything from buying walkers to curing constipation. If you're a caregiver and you don't like computers, get over it. Buy a laptop—it will cost far less than the mistakes it will help you avoid—and make some 8-year-old teach you to cruise the Web. Everyone I interviewed, even the technophobes, told me that the Internet was a lifeline in negotiating eldercare obligations.

Online information can prepare you—sort of—for the pragmatic tasks you may encounter: filling out medical paperwork, hiring a care nurse, wrestling the car keys out of a beloved parent's desperate clutches. Many of these duties will be indescribably difficult. But if instincts and information tell you to take a step, take it firmly, without second-guessing, the way you'd lead a frightened horse out of a burning barn. And don't try to manage everything alone.

Create your own village.

The Navajo and other traditional cultures understand that there's nothing more soulful than supporting people at the margins of life, those who can't walk fast or talk sense or remember how to use a toilet. They also know that this takes a village.

It really does.

Most eldercare providers in our village-less society end up jury-rigging systems of helpers. The common refrain I heard from people in the trenches? Take notes. Write down every bit of advice you get, from every person who interacts with your family member: doctors, pharmacists, neighbors, hairstylists. Write down these people's contact information. For good or evil, they're your village.

Jennifer has 45 people on her call list should her elderly parents encounter a crisis. Polly rallied support from her parents' church congregation. Not everyone in the village will help care for an elderly person, but a long list gives you multiple possibilities for support.

"No one can tell you what to expect," Anne said to me. "You have to live like a firefighter, ready to call other firefighters to solve whatever problem arises."

Psychological Coping Strategies

Once you've adopted this firefighting mentality about your parent's needs, you'll need a whole new set of strategies like the ones below to deal with the emotional wreckage that piles up along the way.

Surrender to the emotional grinder.

"The thing that galls me most about caring for my mother," one woman told me, "is that she's the only one who gets a morphine drip." The emotional pain suffered by caregivers is intense—and unlike the elderly, caregivers are expected to live through it. With every new issue your elderly relative develops, you'll head into the emotional grinder called the grief process: bargaining, anger, sadness, acceptance, repeat.

Grieving, like physical caretaking, differs from case to case. If you had a troubled relationship with an aging parent, expect to spend lots of time in the anger stage. Use this time to clean your emotional closet. Explore the anger with a therapist. Journal it. Process it with friends. Clean the wounds.

On the other hand, if your declining parent was your main source of emotional support, you'll find yourself spending lots of time in sadness. You'll feel as though it's killing you. It won't. As Naomi Shihab Nye wrote, "Before you know kindness / as the deepest thing inside, / you must know sorrow / as the other deepest thing.... / Then it is only kindness / that makes sense anymore...."

As the grieving process scrapes along, you'll learn to offer kindness to everyone: your aging relative, the people of your village, yourself. When you snap under stress and begin to rail at Nana, God, yourself, and the cat, you'll learn to be kind to yourself anyway. At that point, you'll find relief and an unexpected gift: laughter.

Nourish a sick sense of humor.

A morbid sense of humor isn't listed in any official guides to eldercare, but to the caregivers I interviewed, it is like oxygen. Take, for example, Meg Federico's memoir Welcome to the Departure Lounge. Federico's wry portrayal of her mother's senescence is both sad and hilarious. Without belittling her mother or her stepfather, Walter, both of whom suffered dementia, Federico recounts conversations like this one:

"I can't seem to find my keys," Walter told Mom. "Say, do you have them?"

"Oh, don't worry about keys, dearest. We don't need them. We can jump out the window and fly home."

"What?" said Walter. "You can fly? I never knew."

"So can you, but you have to take your shoes off."

To Walter's credit, he was not convinced.

Just acknowledging that this is funny makes it tolerable. Cracking up can keep caregivers from, well, cracking up.

"Bill and I are training his dad to 'go toward the light,'" said my friend Anne, whose father-in-law no longer recognizes his family. "Any light we see—lamps, flashlights, the TV—we steer him over there. We figure he can use the practice."

Of course, Anne isn't serious. Not being serious is how she and Bill are surviving. If you can't train your elder to go toward the light, you can make light of the situation. And sometimes, that light becomes splendiferous.

Ponder the nature of existence.

There's nothing like caring for the elderly to help you face your own mortality. Many caregivers told me that their experience was dissolving, through simple drudgery, their fear of death. Pulitzer Prize–winning psychologist Ernest Becker wrote that the denial of death underlies all evils, and that we must drop this denial to live fully. The caregivers I interviewed would agree.

"Fear of death was my biggest obstacle in life," said Polly. "To help my dad, I have to get past it. He's showing me how to die, which is really helping me live."

Other caregivers went further. They said that as they watched the door close on their loved one's physical identity, a door to the metaphysical slowly opened.

"I don't believe in an afterlife, but as my mother died, I truly understood that being dead is no more frightening than being asleep, which I love."

"As my husband's body was failing, he became almost translucent. I went right through my own pain and felt the most intense peace. I can still find that."

"Just before my grandmother died in surgery, I heard her voice saying, 'I'm leaving now, but you'll be fine.' I've been less anxious about everything ever since."

This is why traditional cultures value even the most fragile, disoriented elder, why the Navajo carry "Grandmother's bones" with such reverent attention. Even as you grapple with the logistical and psychological stress of eldercare, there will be moments when you find yourself on the "blessing path." Rather than a long day's journey into night, you'll feel yourself making a long night's journey into day: through fear and confusion to courage and wisdom. Receive this gift, the final one your parents can offer before they take off their shoes, jump out the window, and fly home.

Need help caring for an Aging Parent at home?

Let our in home care team help! If you are in need of assistance at home care for your loved one in the St Louis area or just have questions, contact our Director of Client Care at Assistance Home Care. We are a St. Louis Home Care Agency providing quality and affordable caregivers in St Charles, St Louis, Lincoln and Warren County, Mo. We would welcome the opportunity to answer your questions and more.
Call today: St. Louis County 314-631-1989 or St. Charles County 636-724-4357 or visit us online at Assistance Home Care in St. Louis.


Tags: St Louis Home Care, Caring for Aging Parents, Home Care Tips, Caregiver Tips

St. Louis Home Care: What's Involved in providing hands-on care?

What's Involved in Hands-On Care

A few years ago, Ethelinn brought her 78-year-old Caring for your Parents resized 600father, then in the early stages of Alzheimer’s, to live with her and her teenage son. “At first I was upset, because this should have been a time in my life to spend with my son,” says Ethelinn. “But there are so many positives in having my father with us. He is safe and comfortable. He is surrounded by his books and portraits of my mother. He whistles, he laughs, he feels loved and respected. Every night he says, ‘Thank you,’ and I know this is the least I can do for him. My father was always there for me, and he is always there for my son, who is learning patience, compassion, and acceptance. Is there any other way this could be?”

Adapted from Caring for Your Parents

Caring for a parent at home may mean providing only minimal help or it may require 24-hour-a-day assistance.

In these situations families must make choices. Where will your parents receive the care they need? Who will be the caregiver? One answer many adult children choose is to provide hands-on care for a parent at home, either moving in with the parent or having the parent move in with them.

What It Involves:

Caring for a parent at home may mean providing only minimal help or it may require 24-hour-a-day assistance. Your parent may need help only with some everyday activities, such as eating, bathing, or using the toilet. Or your parent may need help with most activities as well as professional nursing or medical care.

Today, older people are living longer with chronic illnesses and disabilities. Only a very committed caregiver can manage at home without help when a parent’s needs are as extensive as those of nursing home residents. Even when caregivers take advantage of all the outside help available, the job remains intense. Some parents may need care only for a few days or weeks. For others, the need will last longer. Caregivers must be able to handle both the practical and emotional aspects of caring. Here are some factors to consider in reviewing the situation for you and your parents:

Practical AspectsFactors to consider:

    • Home. Does the house have enough room for your parent and a wheelchair, walker, hospital bed, or bedside toilet? Is medical care nearby? Would assistive devices, such as grab bars, be helpful? Is there enough money to pay for outside help, the home care products and equipment your parent needs, and physical changes to the home such as wheelchair ramps and bath safety aids? What will insurance cover? Is your parent eligible for any financial aid, subsidized services, or benefits?
    • Tasks Involved. Can you make sure the house is kept clean to minimize the risk of infection? Can you help your parents with walking, bathing, or turning in bed? How about working with medical and home health professionals as a member of your parent’s health care team? Are you comfortable administering medication or monitoring an illness? Will you be able to help your parent manage pain? How are you at dealing with medical emergencies? Do you know where to find and how to manage home-care providers? Where will you get any training you need, such as how to use medical equipment or change dressings? Are you comfortable dealing with all the agencies and organizations involved in your parents’ care?
    • Time. Do you have the time for caregiving tasks along with your other responsibilities? Can you get leave or set your own hours at work? Could you afford to stop working, if necessary?
    • Support. Will you get financial or hands-on help from other family members? What sources of community assistance are available? What other options are available if you do not provide care?

Emotional AspectsFactors to consider:

  • Your Parents’ Needs. How much companionship does your parent want? Is your parent sad about the loss of his or her home? Any problems with depression, homesickness, or grief? Can you meet your parent’s need for privacy? How well do you, your parent, and your family get along? Will you be able to help your parent feel useful and appreciated?
  • Your Family’s Needs. How do other members of the family feel about having your parent move in? Will you be able to spend enough time with your family? Are they ready to adjust their habits and behavior? Children may need to be quieter. Family members may be awakened in the night. How do they feel about helping out?
  • Your Needs. Have you considered the potential downside of caregiving, such as loss of freedom, less time for other activities, lack of control, and stress? Are you prepared to deal with your parent if he or she appears uncooperative or unpleasant? How will you handle it if he or she doesn’t recognize you because of dementia? Is it easy for you to talk with your parent? Do you know what care he or she wants? Are you able to deal with personal and health care tasks? Can you face caring for a parent who is dying? Will you be able to ask for help when you need it, including emotional support and breaks for yourself? Are you the best person to become the primary caregiver?

Many caregivers report getting much satisfaction from helping their parents, even when the job is hard. However, it is important to reassess your situation periodically to see if home care still makes sense. If at any stage you decide you can no longer provide hands-on care, you should not feel guilty or think that you have failed. There are other options that will be best for everyone should home care become impractical.

Some of this material appears in slightly different form in Caring For Your Parents: The Complete AARP Guide.

Need help caring for an Aging Parent?

Let our in  by Text-Enhance" href="">home care team help! If you are in need of assistance at home care for your loved one in the St Louis area or just have questions, contact our Director of Client Care at Assistance Home Care. We are a St. Louis Home Care Agency providing quality and affordable caregivers in St Charles, St Louis, Lincoln and Warren County, Mo. We would welcome the opportunity to answer your questions and more.
Call today: St. Louis County 314-631-1989 or St. Charles County 636-724-4357 or visit us online at Home Care in St. Louis.

Tags: St Louis Home Care, Caring for Aging Parents, Assistance Home Care

St. Louis Home Care: Taking Care of Mom and Dad

Families are often confronted with significant changes in their aging parent's abilities to remain independent and safe at home while visiting during the Holiday Season.  If you find yourself in this situation, here's a great article that can help map out a good course of direction to help ensure the best outcome for everyone involved.

Caring for Aging Parents at Christmas

Taking Care of Mom and Dad

Ten key questions for every future caregiver

It can be overwhelming, seeing someone you love debilitated—either gradually or dramatically—by aging and illness. They need help, they need care, and if statistics prove anything, that job could fall to you. Caregivers are found in one in five households in the United States, according to a 2004 report by the AARP. Eighty-five percent are family members, friends, and neighbors unpaid for the job. And as the healthcare system advances along with life expectancy, the Centers for Disease Control expect an 85 percent rise in family caregivers between 2000 and 2050. Though many who undertake caregiving are unsure at first what they’re getting into, those who have been there are often eager to share stories of its challenges and rewards. We’ve gathered some of their essential tips on how to face what comes next. “There’s no way that anyone’s ever prepared,” says Debby Halpern, communications director for the National Family Caregivers Association (NFCA). But you can start laying some groundwork and finding resources for the journey ahead.

1. How, and when, should we talk about this? 
In a word: now. While not an easy subject to approach, talking with your loved ones about caregiving is better than waiting until something actually happens. One thing that needs to take place is assessing a person’s health through a geriatric exam, says Lisa Little, director of senior care and physician relations at Des Peres Hospital. Try a physician who specializes in gerontology, recommends John Riley, of John Riley Elder Care & Cost Consultants, Inc., or the Memory and Aging Project at Washington University in St. Louis. Even if your family member’s health is strong, you’ll have a baseline for moving forward. And if his or her health has been altered by a specific illness, says Mark Esker of the St. Louis chapter of the Alzheimer’s Association, it’s important to understand exactly what’s happening and what you need to do to keep that family member safe and well. 

2. What are some of the ways you can prepare? 
The NFCA and the National Alliance for Caregiving offer an easy-to-navigate source called “Family Caregiving 101” at This website provides tools for everything from assessing where you are on the caregiving journey to understanding how to navigate the healthcare system. The NFCA recommends checking the phone book for local resources. Those include the Department of Health, the Social Security Administration, the Department of Mental Health, social-service departments at area hospitals, and local chapters of disease groups. Althea West, a local geriatric-care manager, says people in her profession can help clients make sense of the legal, medical, financial, and emotional landscape of caregiving. In the St. Louis region, costs vary from $75 to $105 an hour, West says. For help finding a care manager, visit the National Association of Professional Geriatric Care Managers’ website at

3. When, or at what level of care, should you step in?
The answer, according to many experts: when safety becomes an issue. If the family member is living alone, what effect will their illness have on their safety? Is there a danger of leaving the stove on or eating spoiled food? Are they in danger of falling down stairs or tripping over rugs and furniture? Are they still capable of driving? In Missouri, family members, doctors, and police concerned about that last example can complete a driver condition report confidentially (, and the individual may be reevaluated and could have his or her license revoked. But safety’s not the only factor, says Halpern. Examine the family member’s quality of life, too, to help determine what’s needed next, from more frequent visits to in-home care or beyond.

4. What will the living situation be?
“It’s not as simple as ‘Come live with me, and we’ll be a happy family,’” says Little. That’s why Riley recommends a trial run before houses are sold and moves are made permanent. Does the caregiver work? What will happen to the family member during the day? Have you considered how the move will affect not just the family member’s life, but also yours and that of your family? If bringing the family member into the home is the best solution for your family, the same safety concerns need to be addressed, as they would in that person’s own home. Apart from hosting an ailing family member at home, many other opportunities exist, including assisted living, retirement communities, and nursing homes (see sidebar). One recently launched resource is the NAELA Senior Housing Locator, a collaboration between SNAPforSeniors ( and the National Academy of Elder Law Attorneys (NAELA).

5. How will you pay for long-term care?
Medicare and private health insurance don’t usually pay for long-term care. And really, no single plan will fit all situations. Riley often recommends long-term care insurance to people in their fifties and sixties, as long as they have enough time to research the subject. “People need to be informed before they purchase,” he says. Often he sees people who’ve purchased too little or too much coverage—so it’s not as easy as picking car insurance. Also, of those who consider long-term care insurance, Riley says only about half his clients follow through, because many find the monthly premiums of $150 to $200 too high. But the advantages, he says, are freedom of choice when the time comes to look at long-term care facilities and—because the insurance allows you to pay privately longer—the opportunity to secure a placement in a higher-quality establishment. Long-term care insurance can also help pay for in-home care, but for that, there are a number of other options as well, including reverse mortgages, Medicaid, and Medicare. You can compare their benefits and limitations at Last, geriatric care managers often work with elder-law attorneys and can help steer you through the sometimes intersecting pathways between Medicare, Medicaid, and veterans’ benefits. 

6. Do you have the right legal measures in place? 
Power of attorney and medical power of attorney, two separate issues, both share one aspect, says Esker: They speak of trust. They tell institutions that the person being cared for has confidence in the caregiver. Establishing these two powers needs to happen early, when the loved one can help with the decision. “Most people wait entirely too long,” Esker says. To establish power of attorney, the family member needs to meet with a lawyer and have a private interview, says Julie Berkowitz, a local certified elder-law attorney. Once the lawyer understands the person’s wishes to give power of attorney, he or she will draft a document, meet again, and have that person sign it. That’s it, Berkowitz says: “Basically, these things are legal permission slips.” Establishing power of attorney now means you can avoid guardianship, says Maggie Cody-Reckert, director of Medicaid planning at The Next Step/ElderAssist in West County. Guardianship is determined when a person is no longer deemed competent. It’s decided by petitioning through a court. Downsides include attorney fees, annual court reports, and court-monitored expenses.

7. Who makes up the community surrounding you and the person you’re caring for?
Most people assume they can do everything by themselves. That’s because they don’t understand the full extent of what they’re about to undertake. Many organizations, such as the Alzheimer’s Association, offer care consultations both in the office and at home for $50 to $100; such meetings educate family members about caregiving and their loved one’s condition and provide a forum for discussing care options and legal and financial issues. The Alzheimer’s Association also offers a free online private group calendar you can set up to coordinate transportation, medical appointments, and legal information with family members at Many caregiving communities exist both online and in the physical world, including churches and groups specific to medical conditions. And caregiving is no excuse for giving up a social life, Little adds. In fact, it’s critical to have social outlets outside the home, for the sake of both the caregiver and the person receiving the care.

8. Do you know how to be an advocate?
Unless you happen to have an advanced degree in whatever illness plagues your family member, it’s likely you don’t know much about it. But you’ll need to—and you’ll need to learn how to become an advocate for your loved one. For many illnesses and for aging issues in general, there are many resources that provide support and help you learn more, including the St. Louis Area Agency on Aging and the Mid-East Area Agency on Aging. Also, maintaining open and regular communication with your family member’s doctor is essential, as is establishing a comfort level that enables you to challenge their care if something doesn’t seem right. Learn about all the medications your family member is on, and keep the doctor aware of what’s happening. You also may need to speak to insurance companies and staff on your loved one’s behalf at various points. On its website, the NFCA offers tip sheets to help keep track of medications and communicate symptoms during a crisis.

9. Are you prepared to take care of yourself while caring for others?
“It’s your responsibility as a family caregiver,” says Halpern. The stress felt by caregivers can lead to depression. The Alzheimer’s Association recommends getting outside help, taking care of yourself, planning ahead, being realistic about what’s happening, and, rather than feeling guilty, giving yourself credit for becoming a caregiver. The NFCA stresses four points: believe, protect, reach out, and speak up. “Family caregivers have to be prepared to do all four of these things to be successful,” Halpern says. They need to believe in their abilities as caregivers, protect their own health, reach out to professionals in the medical and legal worlds, and speak up when they need help or have issues with other family members, their community, or the person receiving care. Many agencies offer respite-care services, which give caregivers a break. For a list of one in your neighborhood, visit

10. What do you need to know about elder law?
More than you can Google, most likely. Like insurance and medical care, elder law is a maze, and good planning with professionals can keep you from getting lost. “The biggest misconception that people have is that an estate-planning attorney is the same thing as an elder-law attorney,” West says. But elder law is a specialized niche, and attorneys and care specialists stay up-to-date on issues and advocacy for people who need acute and chronic care. As with any kind of attorney, costs vary, but NAELA has a checklist of what to ask when seeking the right attorney, plus resources for finding one in your area. Just visit Also, Berkowitz adds, don’t discount the value of a referral. Lists and certifications are helpful, but knowing someone who had a good experience with an elder-law attorney can be a major help in making your own decision.
One final point: No two people’s caregiving experiences are the same, but if you are caring for someone you love, you are a caregiver, not just a dutiful spouse or child. That means you need to prepare and learn as much as you can, take breaks, and find rewards and resources. “It’s an additional job,” says Halpern. “And you need to treat it that way.” 

Where Will Your Loved One Stay?

A family member’s home, with in-home care

Pros: Comfort and familiarity for your family member; trained professional care.

Cons: Cost. “If you need 24-hour care, it’s more expensive to stay home,” says Diane Smith, geriatric-care manager with The Next Step/ElderAssist. Unless you have long-term health insurance, you’ll pay for this out of pocket. Medicare doesn’t cover in-home care (just in-home visits, when needed), and Medicaid won’t cover nonmedical in-home care. Also, people often benefit from outside social interactions and can find themselves isolated at home.

Average cost:
 $19 per hour for a home health aide.

A family member’s home, with a family caregiver

Pros: Even more comfort and familiarity for your family member.

Cons: Lost time, as well as wages and benefits, if the family member needs to stop working.

Average cost: $5,500 per year and up, according to a 2007 caregiver study from Evercare and the National Alliance for Caregiving. Those out-of-pocket costs include food, transportation, and medical costs. They do not include wages and benefits lost when a caregiver quits or reduces work.

Retirement community

Pros: The opportunity to live independently with amenities and little home maintenance, often with meals and social activities provided. Some offer the option of staying on the same campus but moving into assisted living, then a nursing home, when needed.

Cons: An initial and substantial investment is required, plus monthly maintenance fees.

Average cost: $2,672 per month.

Assisted living

Pros: A step between the retirement community and the nursing home, this option usually offers meals, medication management, and an on-site or on-call nurse.

Cons: As with retirement communities and nursing homes, prices can be high and quality can vary. There can also be some loss of independence, as some responsibilities are taken over.

Average cost: $2,968 per month.

Nursing home

Pros: Nursing homes offer their residents full medical care, meals, and medication management.

Cons: Significant costs, varying quality of care, and your loved one’s loss of independence. 

Average cost: 
$5,566 per month for a semiprivate room (Note: Medicaid beds are available once someone has “spent down” all their assets).

Note: Average prices for in-home care, retirement communities, assisted living, and nursing homes come from AARP. Prices for living with a family member come from the Evercare Study of Family Caregivers.

Need help caring for an Aging Parent?

Let our in  by Text-Enhance">home care team help! If you are in need of assistance at home care for your loved one in the St Louis area or just have questions, contact our Director of Client Care at Assistance Home Care. We are a St. Louis Home Care Agency providing quality and affordable caregivers in St Charles, St Louis, Lincoln and Warren County, Mo. We would welcome the opportunity to answer your questions and more.
Call today: St. Louis County 314-631-1989 or St. Charles County 636-724-4357 or visit us online at Home Care in St. Louis.

Tags: St Louis Home Care, Caring for Aging Parents, Elder Care, Senior Home Care