Buncombe County is expecting a large increase in its elderly population in the coming decades. The need for more caregivers will increase with the rise of the aging population.
According to a report by the N.C. Department of Health and Human Services Division on Aging and Adult Services, the county will experience a 23.1% increase, from 270,224 people to 332,660 people, from 2020-40. The county’s most drastic increases will be in the aging population. Residents age 65 and older are expected to increase 49.3% from 2020-40, while the population of residents 85 and older is expected to increase by 121%.
“We are actively seeking ideas and feedback from our community as to how we can best nurture this population and their caregivers,” says Jennifer Teague, program manager for aging and adult services. She adds that Buncombe County does not have a current estimate of caregivers for people age 65 and older.
Caregiving — especially for those in what’s called the sandwich generation, caring for elders as well as children — is stressful. “I often see a lot of isolation, a lot of loneliness” among caregivers, says Audrey Morris, clinical director of Healing Solutions Counseling at Jewish Family Services of WNC, a nonprofit serving the needs of older adults. “Depression is very common with caregivers [from] coping with grief and the stress of losing someone that they love.”
Caregivers must not tackle every problem on their own. “No single person can be everything to everyone all the time,” says Carrie McGuire, case manager at Jewish Family Services of WNC. “It’s really important for caregivers to assess what their limitations are and communicate that openly.”
Xpress spoke with several local experts in caregiving for their best advice and tips.
A family affair
Experts emphasized setting boundaries with the person needing care and with other family members or loved ones who are giving care.
McGuire recommends putting schedules on a calendar to which everyone has access. Family or friends may want to share a digital calendar, like CaringBridge Care Calendar or Lotsa Helping Hands. But if accessing the internet is difficult for the person needing care or a rotation of in-home medical staff need to see it, all information should also be updated on an analog calendar.
Asking for help is not always easy; people may believe they should be willing and able to do everything for their loved ones. But experts emphasize that life cannot stop completely. Caregivers need to care for their own health and finances, and continue as much as possible with their own careers or education.
Edward Jones, family caregiver specialist at the Land of Sky Regional Council Area Agency on Aging, recommends being specific when asking for assistance from others, such as asking for help doing the grocery shopping or driving someone to a doctor’s appointment.
There should also be a centrally-located list or folder with health care and pharmacy contacts for caregivers, family and loved ones to easily access. “Know who your support system is and know who the providers are that are working with your elder, and then you’re not scrambling in a crisis,” says McGuire.
Have conversations early
If one is a caregiver to an aging person or someone else who may experience cognitive decline, McGuire emphasizes the need to discuss finances and health decisions early. Loved ones should find out the wishes of the person needing care before he or she is unable to communicate those wishes.
In North Carolina, a person can designate a health care agent, which provides power of attorney for medical decisions. If a person needing care can’t communicate their wishes about health care, including mental health, and life-prolonging decisions, the power of attorney can do so.
Pat Hilgendorf, a caregiver program associate at the Land of Sky Regional Council Area Agency on Aging, recommends reviewing the elder law division of Pisgah Legal Services. It can help with end-of-life planning, as well as assist with cases of financial exploitation, consumer fraud or elder abuse.
Caregiving for a loved one requires everyone to be transparent about finances, says Morris, the clinical director. She says money talk can be “really sensitive but it’s really, really important.” She underscores the need to have sensitive conversations about finances before cognitive decline starts. Caregivers should know details about income and insurance, including Medicaid. Wills and trusts should reflect up-to-date wishes.
Wrapped into the discussion of finances is the cost of future health care. Caregivers should know whether the person needing care would like in-home health care or a residential facility that can provide health care and should understand how to pay for that care.
Support comes in many forms. McGuire notes that some loved ones may contribute hands-on care, while others may contribute financially. McGuire notes that she lives closer to her parents while her sibling lives abroad. That means the majority of in-person assistance is done by her, while her sibling contributes financially. “It can be a little uncomfortable [to talk about support] but it only benefits to do it ahead of time,” she says.
Transportation and home needs
A caregiver should also anticipate how their loved one’s transportation and home needs might change.
Jones recommends a medication organizer, which comes either with manually opened lids or electronic lids with locks. Some pharmacies will also package medications by the dosage, such as for morning, afternoon and evening, he says.
If the person needing care has mobility issues, he or she may need ramps to replace stairs indoors, outdoors or both. (Thirty-one percent of people age 65 and older in Buncombe County have a disability, according to NCDHHS data.)
Mountain Mobility is a service for Buncombe County residents age 65 and older who meet eligibility requirements. Rides must be scheduled in advance online, which can be done by a caregiver, and require the day and date of the trip and the destination, among other information. (More information is available at avl.mx/by8.)
In addition to family and loved ones, there are other supports for caregivers. The Buncombe Aging Services website lists numerous resources from Meals on Wheels of Asheville Buncombe County for home-delivered meals, Mountain Housing Opportunities for home improvements and OnTrack Financial Education and Counseling for credit counseling.
Jones says a great resource is the NCDHHS North Carolina Caregiver Portal, a free service that provides in-depth video lessons about caring for someone who is aging or has dementia, Alzheimer’s disease or cognitive decline. He recommends videos by Teepa Snow, who is renowned in the field of early dementia care.
Another resource Jones recommends is the Duke Caregiver Support Program, which does not require one to be a Duke Health patient to access. The program can offer guidance to caregivers about their options caring for a loved one and staff followss up with the caregiver for 90 days.
Jones also says the U.S. Department of Veterans Affairs has plenty of resources for caregivers of veterans. The Charles George VA Medical Center in Asheville provides caregiver support services, and caregiver support coordinators can help with accessing services. The program can also assist with arranging respite care, which enables the caregiver to take a break while someone else cares for their loved one.
NCDHHS’ Project Caregiver Alternatives to Running on Empty can also connect caregivers to funds for respite care, depending on eligibility.