I was looking thru some material I had taken off AOL and found an article
that was printed in the San Jose Mercury.  Without their permission, I will
put it on the list server.
 
ELDER CARE: THEY'RE AGING, AND YOU'RE WORRYING  8/26/94
 
When children grow up, and parents grow old
 
Published: Aug. 22, 1994
By KATHLEEN DONNELLY
Mercury News Staff Writer
 
The worrying started last Christmas, when Lynn Anderson s mother picked her
up at the airport. The car, Anderson noticed immediately, pulled violently to
the right. It hadn t been driven in so long that the tires had decomposed in
the Florida humidity.
 
Anderson, whose 70-year-old mother usually comes to San Jose for their
visits, was stunned.
 
  My mom, being a Navy nurse, is absolutely meticulous. You could bounce quart
ers on the beds,   she says.   But I went home, and the priorities had
completely changed.
 
Worry edges into her voice.   She s got books piled all around her. My
brother s room has not been changed since he moved out in the  70s. She was a
stickler about meals . . . and now she s using frozen hamburgers.   There was
dust on a lampshade. A curtain hung cockeyed. Plants withered in a
once-thriving garden.
 
Anderson, 36, pauses, as if still startled by her December discovery.   I
went home,   she says,   and I said to my brother,  We ve got to start visitin
g Mom. This is not safe.
 
Stories like Anderson s have become routine for those who work with the elderl
y. At some point, they say, nearly every family struggles to decide what kind
of care its oldest members need, and where to find it.
 
  My consultation appointment book just skyrockets in January,   says Mimi
Goodrich, manager of social work services for the Senior Coordinating Council
of the Palo Alto Area.   After they all come home from Christmas.
 
It s a matter of numbers. By 2020, projections put the number of Americans
over 65 at one in five, up from one in nine today. In San Jose, the city s
office on aging estimates the number of people over 60 will more than double
in the next 20 years, and the number over 85, the   old old,   is growing
even faster.
 
Agencies, both public and private, have sprung up to serve them. But the
array of choices is at once comforting and bewildering, especially for family
members trying to judge the situation from far away.
 
  I don t know what I m going to do,   says Anderson.   I just don t know.
 We re going to have to move closer to Florida.    She sighs.   What am I
going to find next time I go out there?
 
Staff members at Senior Information & Referral Services in San Jose answer
13,000 to 15,000 telephone calls each year. About a third of them, says
executive director Harryette Shuell, are from sons and daughters worried
about their parents. About 25 percent of those callers, she says, are trying
to deal with the situation long-distance.
 
The most common question?
 
  Where do we start?   Shuell answers.
 
Sorting through the services, and the terminology, is daunting. Do you need
telephone monitoring, adult day care, part-time or full-time home care? Meals
on Wheels, residential care or a case manager? A friendly visitor, a peer
counselor or a geriatric assessment?
 
Throw in the question of who pays for which service some may be funded by
government programs such as Medicare, some base their charges on sliding
scales, some are   private pay,   meaning the client pays for it all and the
process becomes overwhelming.
 
A good place to start looking for help is at groups like Shuell s the local
information and referral service.
 
Looking for answers
 
Eldercare Locator (800-677-1116), a national, toll-free telephone service
administered by the National Association of Area Agencies on Aging, provides
telephone numbers of information and referral services.
 
  We ask you some snoopy questions about the things you think may be the
problem,   says Shuell, whose group provides information and referral for
Santa Clara County.   Where does your grandmother live? Do you know about
services she has already? What s her financial status? What can she afford?
 What can t she afford?
 
Staff members comb through 17 thick binders filled with information on senior
services in Santa Clara County and pass out phone numbers. The non-profit
agency also annually publishes The Senior Handbook, filled with telephone
numbers of local services.
 
Family members take it from there. While the information and referral
services can be very helpful, some who plan care for the elderly warn they
vary in quality, depending on the amount of training given the person answerin
g the phone.
 
It helps to think about the kind of services you need before calling, and to
know a few key   elder care   phrases, such as   case management.
 
Case, or care, managers assess the needs of older people and put together a
plan for their long-term care. Federally funded case managers make home
visits and assessments of people who are over 60 and   in danger of being
institutionalized.
 
  Mainly, we step in when the person is homebound, frail and doesn t have any
support system in the area,   says Telma Cramer, coordinator for older adult
programs at Family Service of Santa Clara Valley. Case managers handle cases
in South San Jose, Campbell, Los Gatos and Saratoga.
 
Building a support system
 
The Family Service case managers try to see clients within 10 days of hearing
of them. They stay with cases   until the person is stable,   Cramer says, a
time period that varies greatly.
 
In the 14 years Cramer has been involved in case management in both
California and New Jersey, she has seen startling changes.
 
  I am seeing that people are living longer, and I m seeing the support
system is not there,   she says.   Families are all over the place and they
are not able to be in the same place as their aging parents.
 
  My father,   Steve Cain says with obvious pride,   is Stanley A. Cain. He
is 92 years old, and he was one of the original scientific ecologists in the
country.
 
Now, Stanley Cain has late stage Alzheimer s disease and lives in a Santa
Cruz nursing home. Steve Cain is 52, a journalist with seven children living
near Ann Arbor, Mich. It s the town he grew up in, the son of a University of
Michigan professor who took a job at the University of California, Santa Cruz
in 1969.
 
Stanley Cain began to show symptoms of Alzheimer s around 1980, his son says.
 
Meanwhile, Steve Cain s mother, Louise, was also having health problems.
 Steve Cain suggested one or both of them move back to Ann Arbor. His mother
declined.
 
By 1988, Louise Cain s ailments had become so severe that she could no longer
care for her husband. Stanley Cain moved into the nursing home that year. Not
long afterward, Louise Cain was diagnosed with bone and lung cancer, a
condition her son calls   immediately terminal.
 
The diagnosis forced both of them to think again about Stanley Cain s future.
 
  We were talking about it right along,   Steve Cain says.   What do we do
with my dad? My father has not spoken two words of understandable language in
three or four years, and it s been at least that long since he recognized me,
his only child.
 
He takes a long breath.   If you rub his hand, he ll smile. That s really the
extent of it.
 
Louise Cain died Oct. 22, 1993. For a number of reasons, Steve Cain has
decided to keep his father in Santa Cruz.
 
He visits a couple of times a year and believes his father is getting good
care. But he still wants someone to be his eyes and ears at the nursing home.
 
So he hired a private care manager. For $60 a month, registered nurse Becky
Peters, co-founder of Capitola-based Lifespan Care Management Agency, gives
Stanley Cain a physical check, talks with the nursing home staff, and mails a
report to Ann Arbor.
 
Lifespan, which Peters started 12 years ago with another nurse, Pam Goodman,
is one of a growing number of private geriatric care management companies
that arrange for everything from 24-hour home care to daily telephone
monitoring.
 
  We realized if people had a problem, there was nowhere to turn for advice
or consultation on that problem,   says Peters, who, along with Goodman,
worked with elderly clients in the public sector first.
 
The company has now grown to 140 employees, about 120 of them providing
in-home care. A good proportion of the firm s clients are grown children like
Steve Cain, who live thousands of miles away from their parents.
 
Lifespan charges $50 for an initial consultation (the fee is waived if the
client signs up for home care services) and $75 per hour for an assessment of
a client s health and financial situation. There is a 2-hour minimum for that
assessment, which leads to recommendations for care.
 
Fees vary depending on the kind of care needed. Care management which
includes telephone consultations, home or institutional visits, assistance in
placing clients in institutions and after-hours management, is $60 an hour. A
live-in care provider is $150 per 24-hour shift.
 
  Getting old is expensive. There s no doubt about it,   Peters acknowledges.
 
Some employers, recognizing that caring for elderly relatives is becoming a
topic almost as hot with employees as child care, have begun to help out.
 Those companies offer elder-care consultation as a corporate benefit.
 
  It s really having someone to brainstorm with and help you identify what
services you might need,   says Robbie Smith, elder care program coordinator
at Senior Information & Referral Services, which has a contract with several
local companies to provide consultation.
 
If company benefits aren t available, family members can meet to discuss
options with someone like the Senior Coordinating Council s Goodrich, a
licensed clinical social worker. A 50-minute consultation with Goodrich is
$40.
 
It s worth it, says Meredith Loring.
 
Loring, 49, is a technical writer in Las Cruces, New Mexico. Her 86-year-old
mother lives in Palo Alto. For the last few years, Loring says she s watched
a slow decline in her mother s ability to care for herself.
 
Gradually, Loring and her mother have sought help a roommate who gets room
and board in exchange for shopping, fixing dinner, checking the mail and
making sure Loring s mother takes her medication; a bookkeeping service to
take care of monthly bills.
 
But before coming to visit this month, Loring felt her mother needed to move.
 
  When I came out here, I was all stoked to start pressuring her to move out
of the house and move to New Mexico,   Loring says.   But after talking to
the social workers and to the people who know (my mother), I started to
change my mind.
 
Instead, Loring has arranged for her mother to spend the day twice a week at
the Senior Day Health Program in Palo Alto, where she ll get some medical
supervision as well as social and recreational programs. She plans to start
visiting every few months, instead of a couple times a year.
 
  As long as she can keep these familiar surroundings, I think it s much
better for her,   Loring says.   I m just afraid it might precipitate a total
decline if we move her.
 
Rebuilding a home
 
Ten years ago, Sara Goldstein and her husband Ernie tried moving to Palo Alto
to be closer to their two sons one in Palo Alto and one in Berkeley. Nine
months later, they moved back to their native New York.
 
  It wasn t absolutely great,   Goldstein, now 76, says of moving to the West
Coast.   I had retired from a job that I just loved. And my unhappiness, I
realized after awhile, was grieving. I was actually grieving.
 
After the Goldsteins moved back to New York, Ernie Goldstein s health began
to decline. He was diagnosed with Parkinson s disease, and Sara Goldstein
became his caretaker. Then, in 1990, arthritis forced her to have a hip
replacement.
 
The Goldsteins Sara walking with a cane and Ernie hooked up to oxygen  moved
back to Palo Alto, this time for good.
 
  I think it was easier, because the situation was more than I could
handle,   she says.   Even though my friends were (in New York), there is
something about family support. I can t explain it, but it s very profound.
 
The Goldsteins have lived in Palo Alto four years now, and bought a
condominium two years ago. They have a mortgage for the first time in their
lives, Sara Goldstein says, laughing. It s for 30 years.
 
Sometimes, she admits, they still miss New York and old friends. But Sara
Goldstein, who volunteers as a peer counselor at the Senior Center of Palo
Alto, is adamant that moving closer to their sons was the right thing.
 
Now, she advises people to think about their options before they re forced
to.
 
  I guess, in a way, you live in a dream world,   she muses.   You always
think life is going to be this way. You re always going to be well. You re
never going to get old.
 
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