Preserving dignity
No one wants to be told they're slacking on their personal care. And do they really want their adult children to know about it? Or to be involved with it, hands-on? Tread lightly here, in all aspects. You might not need to tell your parents that there is a problem; you might be able to jump to pointing out an opportunity. Share a story about a great new product, service, or provider. Or, talk about a story you heard of someone who's facing a challenge and talk through how it may be solved. Your parents may shut down if you talk to them directly about their incontinence, so look for all of the gentle conversation tools when you're starting this conversation.
Personal care affects self-image, and you know how your parents have presented themselves to the world in the past, plus how the world has reacted. This can be a really valuable context for you to have. If incontinence is an issue, consider terms like "disposable underwear" rather than "diapers," and "seat cushion" rather than "waterproof mat I'm putting in the chair." You might also highlight specific medical causes of their changes in personal care, like "that medicine you're taking that makes your poop runny." It may be easier for them to think of themselves as having a temporary side effect rather than a body change that they see as a bad sign of aging.
What is your role?
You may be the first or last person your parents want to see them naked. Rarely is it in between. Your parents may prefer a stranger to know their information rather than their adult child. This is a preference they can have, but it's likely that finances and your availability will make the decision. They can ask for things to be done a particular way (e.g., they want you to be the one doing the intimate tasks), but you don't have to agree. And if you find someone wonderful to support them but they don't accept that person, you do not have to do more. Remember that there are older adults who do not have adult children to help them. If you give your parents just one choice, that is still more than some other folks have.
Less might be fine
Older adults are probably not sweating as much as they did when they were younger, and their hair is growing slower. You may want them to be eating three balanced meals each day, wearing lace-up shoes, and trimming their nose hairs, but they may be getting by just fine without those things. On the other hand, changes in continence, skin, or hair could need medical attention. Encourage your parent to bring up these topics with their medical providers.
Practical supports
There may be changes your parents can make to help them preserve their home activities without bringing in another person to help them. Bathroom remodels are expensive (and discussed in the bathroom safety section), but some additions are much cheaper and can win back the cost quickly in savings on home health labor.
- Equipment like grab bars, a shower chair, a handheld showerhead, non-skid bath mats, and a raised toilet seat can make preferred bathroom routines safer and easier. All are available for under $100, though the bars must be installed securely and that could increase the cost substantially if you bring in paid labor.
- Setup changes — laid-out clothing, easy fasteners, good lighting reduce the need for hands-on help. If your parents start showing up in mismatched clothes - and they care - they can reduce the odds of that happening by eliminating the clashes. No more black or gray, just brown and blue!
- A regular routine at the person's best time of day makes tasks smoother. This may be accompanied by visual aids and a left-right flow to keep things moving.
- Salon services are similar to having a home health aide, but they have a very different vibe to them. Hair salons will often offer wash, dry, and styling and elderly customers frequently go in for weekly visits. Nail salons may also offer toenail trimming as a service that is especially useful for older folks who have trouble bending, seeing, and controlling the nail clippers. Dental care is not really a salon service, but I had a loved one who went in for a cleaning four times a year rather than twice a year because they wanted to supplement their at-home care. Insurance didn't cover these extra visits, but they were under $100 each because they didn't include x-rays.
After trying these options, you may find that a trained aide is the right answer. Prices vary by geography, of course, but a CNA can be as low as $20 per hour if you book them on a recurring basis. They will cost more if booked through an umbrella company than if you hire them directly.
Trusted resources
Next step
Plan a respectful care conversation.