When the importance of care at home . . . hits home

This week, I was interested to see long-term care and independence at home get injected into national politics. Vermont Senator Bernie Sanders shared a Washington Post piece on Twitter about the challenges facing Maine’s long-term care system (lots of older people, fewer young people) and naming Vermont as a state facing similar challenges. The news couldn’t have hit closer to home for me.
 
I’m 51. My husband is 56. Most of our friends are somewhere between 50 and 60. Twenty years ago, our social gatherings with friends often included keeping one eye on our young kids who were running around. We talked a lot about parenting. These days, it’s not unusual for our social gatherings to include someone’s octogenarian parent - or one of our own.
 
I’m nearing my third anniversary as the Executive Director of the VNAs of Vermont. This new role came at a time in my life when home health, hospice and long-term care were about to become central to my personal life, not just my professional one.
 
This summer has been a case-in-point. My mother-in-law and my mother each had a fall that resulted in a broken bone and the need for in-home services so they could maintain their independence.
 
My mother-in-law fell while walking back to our car after the July 3rd fireworks in Montpelier, fracturing her pelvis. My husband and I both felt awful that we hadn’t been right next to her to prevent it, but she’s not the kind of older person who inspires hovering from adult children. She’s a spry and active 88-year-old whose visit to us marked the last destination in a months-long solo road trip across country from her home in Arizona to see friends, attend a family wedding and see her granddaughter graduate from college. After the fall, she spent a couple weeks at our house recovering and receiving physical therapy from Central Vermont Home Health and Hospice. In-home care was by far the best option for our family. My husband always works from home, and I sometimes do. Between us, it was convenient for one of us to be present for every therapy visit to listen to the conversation and ask questions, without taking much time away from work. We knew that she was supposed to get up and walk every few hours—as much as she didn’t want to—and our nudges to move around were backed by the credibility of having heard it straight from her therapist in our living room. I’m pleased to report that after a few weeks with us, she was anxious to be home and felt well enough for a road trip—as a passenger, only! My husband drove her back to Tucson in her car and sorted out other logistics that were essential to her continued independence, like how to get her trash and recycling out.
 
My husband had barely been home for a week when my sister texted me to say that our mother had taken a fall in a parking garage. She fractured her right arm AND her left elbow. Luckily, she doesn’t need any surgery or casts. Like my mother-in-law, my mom lives alone in a city. Unlike my mother-in-law, she also runs an independent real estate business. My mother’s in home “care” included a house call from an IT expert to deal with an ill-timed computer crash and to set up a new laptop so she could keep working. She didn’t qualify for Medicare services (hard to make the case that someone is “homebound” when they’re still making appointments to show apartments to prospective buyers!), but she needed help. She can take a shower and get dressed (thanks to my sister, who installed a hand-held shower head) but she can’t put away her groceries. And the trash problem came up again. We’re lucky that she has the means to hire a little bit of help every day from the woman who cleans her apartment – someone she trusts and who knows how my mom “likes things done.”
 
I can’t help but wonder what kind of care these loved ones—and all of us—will have access to in the future. Protecting the viability and sustainability of skilled home care and long-term care should be a very real priority for all of us, especially those of us who are newly becoming caregivers for aging parents.