As principal of LaFrancis Hardiman Elementary School in Wyandanch, Delores Jenkins has her hands full, overseeing the operation of the school and its nearly 600 prekindergarten through grade two students.
But after school, Jenkins goes to the nearby two-story home of her parents, Jamie-Mae Maxwell, 85, and Herman Maxwell, 87. "I stop by after I leave work to see how they're doing; if they're eating and taking their medication, and to see how my father is breathing" in case he's having difficulty, said Jenkins, who lives five miles away in Wheatley Heights.
Her parents, generally, are independent and can take care of themselves, Jenkins said. "My mother cooks and cleans. They get dressed every day. They go to the store and to doctors' appointments." But given their ages, Jenkins, a widow and grandmother of five, worries about them, especially if she's not around. Last month, she asked her parents' next door neighbor to look in on them when she took a long-postponed, seven-day Caribbean cruise.
Jenkins is fortunate that she lives and works nearby and can check on her parents every day. But that's not always the case for the more than 40 million Americans who are, in some way, caring for a loved one older than 50. Some adult children are able to keep in touch with their parents who have computers by using Skype or FaceTime. But if technology isn't available, Long Island experts who serve the elderly offer a raft of tips for adult children who are unable to frequently visit aging parents who live alone.
"There are several things that are very important," said Dr. Gisele Wolf-Klein, director of geriatrics education for the North Shore Long Island Jewish School of Medicine. "If you have a parent who likes to go to church or play cards with friends or go shopping at the mall, if that routine changes that may be a sign of depression or some underlying illness."
Nutrition is also critical. "Good nutrition is very complex," she said. "It entails being able to get to a food source, bring items back to the house, which can mean carrying, climbing stairs, then cooking, and last but not least, eating. These are very complex tasks."
And there are physical signs adult children should look for, especially if visits are infrequent. "Look at the belt of your father. If the clothes are sagging, there's loss of weight," Wolf-Klein said. If possible, "At least once a week open the refrigerator and look to see if there's fresh milk. Look at the date. Look in the freezer and see if what you brought six months ago is still sitting there. If it needs to be thrown out, that tells you the person is not taking care of themselves."
Wolf-Klein also recommends checking to see that parents are taking their medications. Look at the date on the containers. If they were filled, say, in 2009, that's a problem. Also, inspect your parents' car for damages, which could indicate they shouldn't be driving.
Adult children also need to be aware of whether their parents' bills have been paid. "If you see bills accumulated on the floor, the table or the desk, and these bills were supposed to be paid three months ago and haven't been paid, that's an issue," Wolf-Klein said.
LIPA's "Friendly Follow-up" program allows elderly homeowners to designate a relative, friend, or social service agency to receive a duplicate of the parents' bill, and payments can be deducted automatically from a bank account.
Dr. Robert S. Helman, an emergency medicine specialist and director of the Premier Care walk-in medical center in Great Neck, advises that the family caregiver make a list of the parents' medical history, medication and surgical history. "The only way to keep that current is by keeping up with the parents," Helman said. "The longer it takes for us to get that information, the more danger the person is in."
Helman also emphasized the need for the elderly person to wear a medical alert bracelet that warns emergency responders and doctors of allergies to medications or special conditions, in case the senior is unconscious.
Some of the more obvious signs that elderly parents may not be as able to care for themselves, Helman said, include overgrown grass, a house in disarray, garbage piling up and kitty litter attracting flies. Grown children should also assess their elderly parents' overall mental status. Check "if they are more confused than normal, if they don't know who you are; things that are out of the norm," he suggested.
Since falls are a major cause of hospitalization and disability among the elderly, Dr. James Wyss, an assistant attending physician at the Hospital for Special Surgery in Uniondale, emphasizes prevention by inspection. "Are there clear spaces for them to walk at home? Is there a lot of clutter, such as throw rugs, changes in the level of the surface?" Wyss, a specialist in mobility issues, said visual problems, weakness and poor balance should be addressed. Equilibrium can be impaired by new medications, and falls can also result from orthopedic or neurological problems, he said. "Sometimes, there's a medical cause that's treatable."
Nassau County's Office for the Aging recommends checking for changes in vision, hearing, touch, smell and taste, which may indicate a doctor's visit is needed. Has the parent stopped reading? Does she give answers to a different question than one that was asked? Does it take longer for her to answer the door because she doesn't hear the bell?
The agency also suggests that a folder with important documents be kept where it's easily found. It should include updated information about the loved one's assets in case funds are needed for health care, Social Security number and insurance coverage.
Elder care attorney Ronald Fatoullah of Great Neck recommends home assessments -- also touted by AARP -- to determine the parents' mental, physical and financial condition. The assessment can help to establish if they can live alone successfully.
Susan Cohen, 59, a former social worker, and her sister, Ellen Bronheim, 57, both of Great Neck, made sure their widowed mother, who is 82 and lives alone near Cohen, obtained a power of attorney and health care proxy, which gives another person the authority to make health care decisions if the senior becomes incapacitated. "It's important to contact an elder care attorney," said Cohen, who is director of community relations at Brandywine Senior Living, an assisted- living facility in Little Neck. "It can be a dilemma if families have different feelings about what the right thing is for mom. It's so much less stressful for everybody."
Her mother also has a medical alert device in case of a fall or other emergency. "That's been a wonderful sense of security for her and for us," Cohen said. She and her sister see their mother several times a week. "She absolutely needs more help as time is going on," Cohen said.
Her mother finds that lists are helpful. "Lists are an important thing for folks as they get overwhelmed by things important to them," Cohen said. Even though she sees her mother often, "We notice changes," Cohen said. "Her gait is not as steady; she doesn't have the same stamina she had not only for walking but for participating in activities she loves. Her hearing is becoming more problematic." But she is adapting to her physical changes. Instead of going to the store, her mother now orders from a market that delivers. "She continues to function," Cohen observed, "but we still have to monitor."
Elder care experts say neighbors can be the best friends when it comes to keeping an eye out for elderly parents who live alone, and Cohen agrees. "People are becoming more aware of the people around them and are really stepping up to the plate," Cohen said. "There's no easy way, but if families band together and the individual feels . . . surrounded by loving care, that makes it so much easier."
Of course, there may come a time when parents reach a point when they can't live by themselves because of failing health or physical disabilities, and the adult children may have to consider having them share their home, or relocate the parents to an assisted-living facility or nursing home.
If that happens, agingcare.com recommends, "Seek support of all relatives, friends, clergy, and health care professionals to encourage and support the relocation."