There are questions you ask as a polite formality, like "How are you?" There are questions that ask for a definitive yes or no, such as "Will you marry me?" And then there are questions you ask to find out more information.
When you visit a parent in a long-term care facility, there is an emotional back story. It might contain the death of a spouse, the pain of a long illness, the guilt of not being able to take care of someone anymore. But while you know the back story and how it might influence the present, the missing piece is what's going on when you're not around.
So to ease your mind and make sure that mom or dad is being taken care of properly, we've put together 10 questions you should ask them to help you get a better picture of their day-to-day life.
"Who comes in to take care of you?"
It's the thing we worry about most when finding caretakers for our loved ones, whether they're our children or our parents: Who will take care of them with as much love as we do?
While the same kind of love might not be there, a level of caring and compassion must be. And in the case of ailing seniors, someone who is trained and certified in certain kinds of medical care will take better care of them than you can.
Ask what nurses and nursing assistants your mom or dad sees on a daily basis. Is there a favorite, one that makes mom perk up? Or one that dad seems uncomfortable talking about? Residents don't report caretaker abuse because they fear retribution, so pay attention to any evasiveness on your parent's part.
"What did you have for breakfast today?"
Our taste buds and tastes change as we age, as anyone who referred to mushrooms as "disgusting" at age 7 and fell in love with chanterelles at age 27 can attest. After the age of 50, our taste buds decrease. This, combined with the fact that taste and smell disorders affect about a third of Americans between the ages of 70 and 80, means that an enticing meal for a senior takes a certain kind of talent to prepare [source: NIDCD].
Medications affect appetite, dental problems can make it difficult to eat and restricted diets have all the appeal of a Dickensian orphanage. The long-term care cooking challenge should definitely make it onto "Top Chef," if it hasn't already.
If eating is no longer pleasurable, you can imagine that someone may skip a meal or two. But the danger of that is malnutrition, and with it goes the body's ability to fight off illness.
Do you notice a change in mom or dad's weight? If she or he isn't eating, find out why. Drop by during mealtimes. And, of course, bring snacks that tempt the palate (as long as the doctor doesn't mind).
"What medicines are you taking? How do they make you feel?"
This question asks for two answers. The first speaks to your parent's relationship to caregivers and whether he or she is being treated like an equal party in his or her own care management.
The second is a way to ferret out possible mismanagement or medication abuse.
Not all elder abuse is done out of malice. It may be that caretakers are not coordinating and sharing information with each other, or that a caregiver is ignorant or neglectful. This is especially true when it comes to medications.
Older people are often on several medications, and they all have possible adverse side effects and interactions. You can act as an advocate for your parent. Does your father seem sleepy and out of it whenever you visit? Is your mother complaining of pain?
If you have power of attorney for your parent, you can request to see medical charts and records. Look for changed dosages or new medications and speak to the prescribing doctor.
"Mom, where's the Kindle we got you?"
Once someone is in a nursing home, his or her finances are likely not much of an issue anymore. Possessions, however, are.
Do an inventory of everything your parent takes to the facility, from clothing to hearing aids. Take photos of all valuables, and mark the valuables that you can -- you can engrave dentures and tag prosthetic devices.
Be observant when you come to visit. Is mom not wearing her wedding band? Where are dad's glasses? Note explanations like, "Someone took it to get it cleaned." Jewelry can be switched out with fakes, and expensive frames with a drugstore pair.
Report missing items to the facility and consider a police report, as well, if you suspect theft. In some cases, facilities can replace the items, or your homeowner's insurance might cover it.
"It was beautiful out yesterday -- did you get to spend some time outside?"
The person directing your facility tour before your parent moved in may have spoken glowingly of residents gardening, but now it's time to check if that matches up with the real deal.
Find out how often mom or dad gets to take a stroll outside. (For people with very limited mobility, that might not even happen without you.) A gorgeous garden that people only see from a window isn't quite filling its purpose, and we could all use some sunshiny vitamin D.
Many facilities offer chances to get off the grounds -- field trips or even a bus to the mall to do a little shopping.
Once you've checked the "outside time" box, ask about exercise. How often do mom and dad get up and get around? If they're wheelchair-bound or bedfast, is there a program of directed exercise they do in the chair or in bed?
There is a big and visible difference between older adults who exercise and older adults who don't. The longer you want a healthy mom or dad around, the more important it is to make daily physical activity a priority for them -- even if dad complains during the whole walk.
"Who are your friends here?"
Some adult children don't ask questions because they're afraid of the answers -- they feel guilty for choosing an assisted living facility instead of their own home to care for their parents. This kind of avoidance can lead to missing opportunities to improve quality of life.
It's not impossible to make friends in a nursing home. If your parent has none, that could be a sign of depression, or it may just be that he or she hasn't joined any activities. Most facilities have an activities director who arranges things like sing-alongs, birthday parties, bridge games and chair exercises. They also put out feelers in the community for volunteer events, like charity performances from a local dance troupe or choir, and opportunities for worships, such as visiting ministers.
If your parent is lonely, look for a solution. If your mom misses her creative outlet, see if there's a newsletter she can contribute to. If not, help start one. If dad misses teaching, help him organize a seminar at the facility on his topic of expertise for fellow residents.
"How often does your nurse check on you? Does it take a long time to get help?"
There's one good way to answer this one, and that's to press the call button and see.
For residents with certain conditions, this question is especially important. How often does a nursing assistant check on an incontinent person? How often is he or she changed? For a person who is bedfast, how often is he or she turned to prevent bedsores?
Does dad ever have to wait so long to get help to the bathroom that he soils himself? Does mom have to ask for help bathing repeatedly?
A patient might be too ashamed to tell you about losing continence or not being able to maintain hygiene, so you will have to ask. Another big clue? The smell of urine is pretty unmistakable, and despite stereotypes, a long-term care facility shouldn't smell like it.
"Ouch, where did that bruise come from?"
Mom has a bruise; dad's hand seems a little stiffer -- you might notice something before it turns into a bigger problem.
It's hard for some people to admit when their bodies are failing them in little ways, so you might need to press a little bit for information. When did they notice the symptoms? Has this happened before? How often?
If dad is sore from falling down and it seems like he's been falling down a lot, an investigation is needed. It could be an ear infection, a medication side effect or just plain clumsiness. Mom's bruises could be explained by anticoagulants, or it could be a sign of something else going wrong. You won't know until you ask, and you can't assume that someone else is cataloging these symptoms as lovingly as you are.
"Where is the phone you can use to make a call?"
Another thing that's missing from most facilities: enough privacy. Along with independence, that's a tough thing to lose.
It would also make it difficult for a parent in trouble to call you. Do residents have access to a phone and privacy? In other words, if something was wrong and your father needed to tell you, could anyone keep him from doing so?
From a less frightening perspective, is it easy for a resident to communicate with their loved ones? Is it convenient to get stamps and envelopes? Is there a computer with Internet? And is there an opportunity simply to close the door and have an hour of uninterrupted peace?
It's tough to find the right balance between giving someone time and space to herself and checking up on her for sound medical reasons. If that balance doesn't seem to have been achieved, talk to the staff and see what can be changed and what can't.
"What can I do for you?"
This question is the easiest or the hardest, depending on the temperament of your loved one.
Some things you can do without being asked, like manicuring mom's nails and finding dad a robe that doesn't make him feel old. Locate their favorite movies, frame old photos and decorate their room to look lived-in. Candles may not be allowed, but few people will argue against mom's favorite scented soap in the shape of a seashell.
It might be enough just for you to be there, talking to the staff, checking up on things and making conversation.
Those are the easy things. Harder are wishes for more frequent visits, or simply to go home. You may not be able to say yes. But you did what you could -- you asked.
What happens when the child becomes the parent? Being a caregiver to your parent can be a hard job. Get tips and information on when a child becomes the parent.
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- Schaffer, Amanda. "Fighting Bedsores with a Team Approach." New York Times. Feb. 19, 2008. (June 20, 2011) http://www.nytimes.com/2008/02/19/health/19sore.html