How Do You Start Caring for Aging Parents?

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October 3, 2024

Dwayna Covey (r) with her mother, Margaret.

Helping an aging parent starts with communication, advocacy, and support.

Watching your parents grow old is tough.

You might start to see your mom or dad mixing up medications, experiencing falls, or forgetting to open mail or pay bills.

"You'll also notice self-neglect," says Gina GS Fernandez, MD, a Dartmouth College assistant professor of medicine and former geriatric primary care provider at Dartmouth Health. "It could be that your parent can't maintain proper hygiene or they're losing weight."

When you notice signs of physical or cognitive impairment that are affecting your parent's daily life, it's a clear indication that they need help and support.

But where do you begin?

Go to doctor's appointments

"A good way to get involved is to start going to doctor visits with your parent," says Jennifer McCalley, LICSW, ACHP-SW, a palliative care and oncology social worker at Cheshire Medical Center. "You can get permission from your parent to do that."

Being at a doctor's appointment allows your parent to focus on the visit while you take notes and keep track of details, such as new prescriptions, instructions and follow-up appointments.

"It helps to have someone to bounce ideas off of and make sure that, between the two of you, you have everything you need," McCalley says. "Being there also makes you a better advocate for your parent."

Getting your parent on board

If a parent is resisting your involvement with their care, help them feel supported.

"That role reversal is a really big leap for a lot of people, understandably so. But I think the important thing is to normalize it."
Jennifer McCalley, LICSW, ACHP-SW

McCalley suggests using phrases I wish, I worry and I wonder can help you talk about issues without putting your parent on the defensive.

"It might sound something like, 'Mom, I wish we weren't at this place, but from what I understand, it's normal at your age to suddenly find yourself with a giant list of medications. But I'm worried that it's an awful lot to manage, and I wonder if you would consider me coming with you to the next doctor's visit,'" McCalley says.

Get your documents in a row

Accompanying your parent to a doctor's appointment allows you to meet their provider and get up to speed. But it doesn't grant you access to medical information or give you authority to make healthcare decisions for your parent.

That's why you need an advance directive, also called a durable power of attorney for healthcare, healthcare proxy or healthcare agent. The legal document, which should be completed by your parent when they have decision-making capacity, clarifies your parent's values and wishes for care and guides you in making decisions.

It goes into effect after a healthcare provider has determined and documented a loss of healthcare decision-making capacity. (Learn more about advance directives).

Suppose you need more time to set up an advance directive. In that case, McCalley says you should complete a designation of personal representative form (PDF) in the meantime.

The HIPAA-compliant form allows a patient to identify a person they trust to communicate with providers and have access to their medical records as a proxy. The form goes into effect once your parent signs it, but it does not allow you to make healthcare decisions for your parent.

Financial power of attorney is another legal document that allows your parent to give a person the authority to handle their financial decisions, pay bills or access bank accounts. The person selected for power of attorney has no authority to make healthcare decisions. (Learn more about power of attorney)

Finding solutions, support, and resources

Falls are the number one reason older adults end up in the emergency department.

Kristie Foster, MSN, RN, GERO-BC, with a patient — "When patients get discharged, we can't expect them to navigate the system on their own," says Kristie Foster, MSN, RN, GERO-BC, and Alice Peck Day Memorial Hospital's (APD) Emergency Department manager.

"All it does is lead to repeat emergency department or inpatient admissions," she adds. "That's not good for the patients, and our systems can't handle it."

That's why Foster is committed to examining the root of a patient's ailment, identifying gaps in their care and finding potential solutions.

"For an older adult, taking 10 or more medications is not that uncommon anymore, but we need to ask questions like, 'How are these medications affecting them? And is that why they're always falling?" she says.

Foster also helps patients and families find resources by identifying services for meals, transportation, caregiver support groups and more.

That approach helped APD recently receive Level 1 Geriatric Emergency Department accreditation from the American College of Emergency Physicians. It recognizes emergency departments that uphold the highest standards of care for older adults.

"Our geriatric patients want to be heard about what matters most to them. Our job is to let families know that help is available," Foster says. "And if you're a caregiver, you not only need resources, but validation that what you're doing is extremely difficult."