How do I determine how much care they need?

I agree an area on aging, the nurse of the home health agency you use can do a needs assessment on them.

Good luck on your continuing journey. Blessings to you and your family.

Sounds like you are doing a fine management job here, with 4 under your care. Wow!

You can google the Lawson-Brody Instrumental Activities of Daily Living - it may be useful to you - or use the Area of Aging or each Home Help Agency's own checklists.

All I'd add is if all this management suits you, keep it up. If not, look into finding Geriatric Case Managers instead to hand over to. I haven't personally used a service like that but I am going to look into it. After the slippery slope journey I went on (& since climbed out of) I made the decision to do temporary care (eg post surgery) only. To stay in their homes, occupants need to be either independent, able to manage their own affairs, or possibly use a GCM, or find some other solution - their solution won't be ME. I work full-time so won't be taking on that role in the forseeable future. But that's me.

I have respect for you juggling so much.

Can you speak to nurse from a home health agency? They can do an assessment and give you an idea. Many do free assessments.

Observation is going to be your best judge of how much more is needed each day.

Observation is going to be your best judge of how much more is needed each day.

SeniorStruggles: Geaton777 has provided the link for the Illinois Department of Aging. Thank you, Geaton! SeniorStruggles, your profile indicates that you're caring for your 81 year old father and that you've got FIVE elders on your hands.

Would they be willing to enter a facility? If so, it’s 24/7 care for them and is often more practical as far as finances go.

You have spent a lot on them because you care but you do need to consider your own future as well.

You could start with someone to help with cleaning. That could be once a week or once every 2 weeks. Maybe get a second home care aide who will shop and cook on one other day a week. I also see many people are using DoorDash or some similar app that helps with shopping, when I'm in the grocery store these days. You can build it up gradually, as needed. Do they need someone to take them places, and escort them so that they are getting around safely? If they are capable of escorting themselves, but no longer driving, then an account with a car service might be helpful.

Needs and capabilities can fluctuate during the day. Some days are better, some are worse, some are a mix.

When I was hiring aides, to get mom used to having them, the agency sent a nurse first, with a "test." It is a better "test" than the ones used in a doc office (those are primarily to get a baseline and monitor changes over time - it isn't sufficient to get a full picture of what goes on at home.) It also allowed her to assess mom's needs. Hers at the time were not that bad. She couldn't do finances (I'd already taken that over), couldn't really monitor her own medication (nurse suggested a timed/locked dispenser, which the aides can check but not dispense - they can point out missed doses that day and watch to see it is taken) and was no longer cooking (found this out after taking the car away, requiring me to go periodically to take her shopping or bring supplies.) We started with 1hr/day, to get her used to them. The plan was to increase time and duties as needed, to allow her to remain in her condo longer. Sadly dementia lies to the person, and this didn't last even 2 months.

The "test" she did was done in the condo, mom sitting at her "comfy" spot at the kitchen table. Two of us were there as well, making this "test" less threatening to her and she participated. The nurse then made her recommendations. She told me Medicare would have covered some in-home assistance, IF mom had agreed to some personal care, such as help with bathing. Of course, in her mind she was just fine, thank you, and didn't need any help!

If the aide you've hired is through an agency, ask about this test (I wish she'd told me what it was called.) If they don't do this, ask the PCP about it. I'm sure there must be a way to have this ordered.

BE THERE when the test/assessment is given/done. You are observant and know their daily routines better than a newcomer and even more than aides who are only there 6 hr/week. If you exclude 8hr sleep, there are 112 hours in a week, only 6 of which is observed by aides.

Home health care agencies have wonderful assessment tools. Talk to a few local agencies. Some will come to do evaluations in the home and others will ask you to self-report needs.

Most home health care workers work "shifts" 6-12 hour blocks of time. Care will be based on a worker coming in for those blocks of time.

Insurance will only pay if the need is "new" and expected only until the person recuperates (as in somebody having a cast on their arm or leg and needing help). Insurance generally will not pay for long term needs. Long term care insurance will pay for long term care help but it is expensive.

Home care can do an assessment. Their medical foc there is help everywhere just need to know where toblo hhere jh

The fact that you "all all of their management stuff" speaks volumes.

Start making a typed list of everything that you do and the home care aide does for them and how often it needs to be done.

It is clear to me that they really can no longer "live independently" - since there is nothing independent about how they are currently living.

I am at this point with my dad. He actually has someone in for about 5 hours a day. He can get himself up and dressed but doesn’t do anything else for himself. I say “doesn’t” because in many way he likely could, but my mom did everything for him, so after she died, he was pretty helpless. My husband and I looked in to assisted living for him at one point because we were getting burned out and my dad was declining. He was diagnosed with bladder cancer last year, has dementia and heart issues (pacemaker). My brother and sister, who live 4 time zones away, then decided we were being cruel to even think of such a thing. My main point here: you have to factor YOURSELF in as much as you parents. My siblings just don’t get the toll it takes to be the closest child to an aging parent. My dad is a wonderful guy, thankfully not an angry senior with dementia. But it is HARD, always knowing that whatever happens, I am the decision maker. My sibs are challenging me right now; want to add themselves to all the POA documents. Thankfully my dad and his lawyer will tell them that this would be ridiculous, given where we live. This has been tough as is, but my sibs are making it into a nightmare.

The Best thing is to have a couple Cameras installed where you can watch them 24 7 and see how they get along.

You should also talk to them yourself and ask .

You should make sure their bathroom has bars to assist at the toilet and shower/tub area as most accidents happen in the bathroom.

Also, you should make sure they have easy meals to fix in microwave.

If you think they could fall, you could have one or both if them wear First Alert bracelet or necklace

Here's the website to request an assessment:
https://www2.illinois.gov/aging/Pages/default.aspx

This is something that their local Area Agency on Aging should be abke to do. It's called a "needs assessment". Or their doctor can probably order one.

https://www.aafp.org/afp/2018/0615/p776.html