Andrea Brassard Answers Your Caregiving Questions

AARP's expert offers advice on caring for a loved one

Are you confused about how to find the best care for a loved one? This transcript of a live online chat with Andrea Brassard, senior strategic policy adviser for the Center to Champion Nursing in America — an initiative of AARP, AARP Foundation and the Robert Wood Johnson Foundation — may be able to help.

See also: My mother doesn't like her nursing home.

I don't feel that my dad's doctor is taking him seriously. Is there anything I can do?

In my experience, sometimes patients minimize their complaints or don't speak up. First suggestion: If possible, go with your dad to the doctor.

Second suggestion: Use the phrase "I'm concerned" when talking about your dad's symptoms. You might need to keep saying "I'm concerned" until you are heard.

How do I know if I should keep Mom at home or move her to an assisted living facility?

It really depends on your mom and on you. What are your mom's needs and how can she best get the help she needs? AARP has a helpful resource on assessing your loved ones. And here's an AARP resource specific to assisted living if that seems to be the right path.

I have a friend whose elderly father is in a SNF [skilled nursing facility]. After repeated episodes of dehydration/kidney failure, he is once again in acute care and cannot get answers. Seems the staff are not communicating with one another, the care is uncoordinated and the M.D.s don't seem to know what is going on. The daughter refuses to make her father DNR [Do Not Resuscitate] as she is afraid he will be further neglected. Who is ultimately responsible as care goes on?

Your friend should start by talking with the nurse who is taking care of her father. If your friend feels that she is not being heard, know that the head nurse or unit manager is responsible for all the care on his or her unit. Use "I'm concerned" language. Please tell your friend to consider palliative care — comfort care. The palliative care team will make sure that her father will not be neglected.

My husband just had surgery and the hospital discharged him quickly. I'm expected to give antibiotics intravenously. I can't believe I'm expected to do this myself! I'm terrified of doing it wrong — especially keeping a sterile environment.

The AARP Public Policy Institute and the United Hospital Fund just released a report, "Home Alone: Family Caregivers Providing Complex Care." We learned that many family caregivers manage their loved ones' medications, including intravenous medications. But it's not easy. You should get some help with this. Talk to the hospital discharge planner. Ask for your husband to be referred to a visiting nurse association or a home health agency. When patients receive IV medications at home, there is a high-tech pharmacy involved. Assertively communicate with the pharmacy that you need training and guidance. In my experience as a home health nurse, I trained many families and was impressed with their devotion and care. This isn't easy, but you can do it.

My mom needs more help these days but I'm not local and can't help her much. She wants to stay in her own home. Do you know if Medicare or Medicaid will cover any home care? She lives in New York.

Medicare covers very limited home health care — primarily following a hospital stay. Medicaid covers more long-term home care. Benefits vary by state, but New York has more generous Medicaid home health coverage than most states. Contact your local Area Agency on Aging. Be persistent. I know from personal experience that it's not easy being a long-distance caregiver.

Next: What's the difference between hospice and palliative care?

My mom has been forgetting things recently (such as paying her bills). Is this simply absentmindedness or could it be serious?

Has this been a problem for your mom in her younger years? Some people just forget to pay bills. But if you've noticed this change and other concerns, you do need to evaluate whether this is a more serious problem. The Alzheimer's Association has a helpful resource online. And ask your mom if you can help her with getting her bills paid on time. Good luck!

My mom is getting released from the hospital soon. How do I prepare best to care for her? She will be with me for a while.

You need to talk to the discharge planner today! Your mom may be eligible for Medicare home health services. You also can talk to the nurses who are taking care of your mom and ask them how to best prepare to care for her. It's wonderful that you're getting prepared and being so proactive.

Both my 87-year-old father and his wife have been assessed and advised that they need to move to an assisted-care facility. Dad is willing and understands the need. His alcoholic wife adamantly refuses to even consider it. She falls down frequently and neither one can prepare meals, so nutrition is suffering. Dad will not move without her, as he feels she will die. What can be done when one half of the couple will simply not cooperate and the other is effectively held hostage by that refusal? Finances are not the issue here.

This is very difficult. Who else in your family can you go to for help? Does your father's wife have any adult children who can get involved? Sometimes people need to hear the same message — "Mom, we're concerned about your safety" — from many different people. You could also talk to your doctor about an adult protective services referral. Be sure to use the phrase, "I'm concerned."

Can the system be changed so that seniors don't have the burden of having to reevaluate their drug insurance policies each year?

I'm sorry, but this isn't my area of expertise. Hopefully my colleagues at AARP's Public Policy Institute can advise. Go to

I am in Georgia. I am curious if there are any special licenses one needs to start a nonmedical home care business.

Although I'm not specifically familiar with Georgia, in every state there are regulations for home care businesses in order to protect the public. Start with your state's Department of Health website. Here at AARP, we think it's important that all home care workers have criminal background checks. It's not an easy business to get into. Good luck.

Am concerned that not all my dad's doctors know all the meds he is on. Seems a recent change is not going well. Where do I start?

Start with your pharmacy. Ask the pharmacist to give your dad a list of all the medications he is taking. Also tell the pharmacist your concern and ask the pharmacist to check for drug interactions. Your question reminds us why it's so important to have all your medications filled at the same pharmacy. Pharmacists are an underutilized resource. When you pick up a new medication, don't automatically check the box and decline counseling. Get your questions answered.

What's the difference between hospice and palliative care?

Good question. Hospice ususally refers to a Medicare program that pays for services for persons with terminal illness. Palliative care is more expansive. It is a philosophy of comfort care, not a payment mechanism.  As our loved ones become more frail and sicker, with repeated hospitalizations, please talk to your doctor or nurse about palliative care.

What's a nurse practitioner?

Thanks for asking. A nurse practitioner, or NP, is a registered nurse with advanced education and training. Nurse practitioners provide primary care or chronic care in doctors' offices or their own house-calls practices.  Go to for more information. Go to to find out more. Look for the picture of the NP on her bicycle making house calls.

I'm a nurse and work in a large hospital. I deal with a lot of older patients. Do you have any tips for working with seniors?

We applaud you! By any chance is your hospital a NICHE hospital? This organization's website has many resources for working with older adults and their family caregivers.

AARP: We want to thank all of you for tuning in and contributing to a great discussion. We also want to thank Andrea for being here!

Andrea Brassard: My pleasure. I hope to join you again soon. For further information and resources, please check out AARP's Caregiving Resource Center.

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