The greatest challenge to many caregivers is finding time forthemselves. Working women juggle child care with parent care and job responsibilities. Older spouses often cannot leave their partners alone for trips to the barbershop, medical appointments or even naps. Over time, unrelieved demands of caregiving can erode physical, mental and emotional health of care providers.

So families often turn to other relatives, friends or neighbors to stay with their older parents or hire paid companions when they need time off. Adult day programs that offer activities, meals and supervised care can be lifesavers for working caregivers. Another option is residential respite care for short-term breaks from caregiving.

Many nursing homes and assisted-living residences are opening their doors to older adults for temporary stays ranging from a single day to several weeks. Respite residents enjoy all the amenities the facility has to offer - meals, activities, excursions, assistance with personal care and the company of the full-time residents. Access to medical care is readily available; and many provide rehabilitation and therapy services for those recovering from illness or surgery.

Family members can enjoy much-needed free time knowing that their older relative is in a safe environment. Respite stays offer new faces and experiences for older adults with few opportunities for social activities outside their homes. Occasional breaks from caregiving can make it possible for families to care for their relatives longer.

And the need is great. A national survey of caregivers done in 1996 for the AARP found that 21 million had to provide help with two instrumental activities of daily living, such as dressing, eating and using the bathroom, triple the number in 1988.

The typical caregiver for an older adult is a 46-year-old woman who spends about 18 hours a week caring for her elderly mother while holding a full- or part-time job, according to a 1997 survey of 1,500 caregivers conducted by the National Alliance for Caregiving and AARP. Forty-one percent of these women are raising children under 18 as well.

The study also showed that 36 percent of caregivers surveyed are 50 and older. In addition to coping with needs of their spouses, these older caregivers may have their own health problems, which are often neglected.

Mutual benefits

Respite-care options can be mutually beneficial for the family and the provider. For long-term care facilities, accepting respite care increases occupancy rates. Short-term stays also introduce potential full-time residents and their families to the facility and its staff. Moving to an environment that is familiar eases the transition from home to nursing home or assisted living when a move become necessary.

Robert Conrad's mother, Geneva, 93, lived in her own apartment until this summer, when she moved to Somerset Point, a Shaker Heights retirement community offering assisted living and skilled nursing care. When she was living by herself, Conrad, president of WCLV-FM, visited her several times a week. Because he and his wife spend part of the winter in Florida, Conrad worried about his mother being alone for long periods.

After back surgery two years ago, his mother needed a place to stay while she recuperated. She and her son chose Somerset Point because it was easy for him to stop there on his way home from the station. "We also remembered it when it was the Somerset Inn and restaurant," Robert Conrad said. "My parents used to stay there when they visited us from Illinois."

Although Geneva Conrad returned to her apartment after her rehabilitation, she revisited Somerset Point several times to stay while her son was in Florida. During her last stay, she fell and broke her hip. She and her son decided it was time for her to move there permanently. "Who knows what would have happened to her if she'd fallen at home?" Conrad said.

Sharon Stahler's mother, Carol, came to live with her shortly after she was diagnosed with Alzheimer's disease. Stahler's job requires frequent out-of-town travel and her mother could not stay home alone.

At first, Stahler tried to find companions to stay with her mother while she was away but had difficulty finding reliable people. She then found out about short-term respite care offered at the Eliza Jennings Home, an assisted-living facility close to her home in Lakewood.

Carol Stahler stays at Eliza Jennings once a month from three days to a week. Her daughter thinks she has a good time there although her mother doesn't talk about it much. "I don't think she remembers a whole lot about it," Stahler said. Although her mother has Alzheimer's disease, she does not yet need permanent nursing home care, Stahler said.

Barriers to use of care

Despite the respite care's advantages, only 14 percent of thecaregivers in the 1997 survey used respite services. Many family members do not want to turn over care of an elderly parent or spouse to an outsider, said Sharen Eckert, executive director of the Alzheimer's Association's Cleveland chapter. "They say: 'No one can provide the kind of care to my parent that I can.'

The association encourages the use of respite services by families caring for relatives with Alzheimer's disease or similar disorders. It offers a list of area facilities that provide in-home and residential respite care along with booklets about its benefits and services.

Another barrier to use of respite care is its cost. Residential respite care is expensive and is not covered by Medicare and private insurance, although Medicaid will pay for nursing home respite services for those who qualify. Assisted-living respite fees are entirely the responsibility of the individual or family. Daily costs at nursing homes and assisted-living facilities range from $130 to $190 and include meals, activities, personal care and other services.

Planning is essential for families considering a respite stay. Almost all nursing homes and many assisted-living residences provide respite care on a space-available basis although a few assisted-living facilities set aside rooms just for respite.

Consider the kind of care your relative requires when investigating residential respite. If he or she can manage most personal care tasks - getting dressed, eating, bathing, using the bathroom - assisted living may be most appropriate.

If your relative has difficulty with personal care, is confused or incontinent, nursing-home-based respite will be required. Be aware that those who wander or cannot eat without assistance may not be accepted for short-term stays at some facilities. Others can accommodate people who need wound care, cannot walk or who have feeding tubes.

Visit facilities

Visiting several facilities beforehand is wise - either by yourself or with your family member if such visits will not be upsetting or confusing.

While you're there, look at rooms and find out about activities offered to see if they will suit his or her interests. Ask about staff qualifications and specific services offered, as well as costs. If you are planning a vacation, find out if space is likely to be available for that time. Because of the uncertainty of room availability, nursing home admissions directors suggest getting on waiting lists at several facilities.

Before your family member's stay, you'll have to provide a variety of health and insurance documents. Assisted-living residences require completion of a general application with a full medical history supplied by your relative's doctor so a plan of care can be prepared.

Nursing homes will ask for a more detailed assessment of your relative's health from the physician along with a standard admission form. If he or she is covered by Medicaid, a level of care assessment must also be provided. This form includes information about medications, disabilities and finances.

Although the availability of space at most nursing homes and assisted-living facilities is uncertain, many can accommodate emergency stays. Even if you have no immediate plans for time off, identifying a couple of facilities and having up-to-date medical information readily available will ensure that your relative is cared for properly in case you become ill or an unexpected situation arises.

Your relative might enjoy a stay away from home as much as you do. He or she will feel better knowing that you are enjoying yourself and not worrying about his well-being while you're away.

If your relative has Alzheimer's disease, it may be difficult toexplain respite care without upsetting him or her. Stahler's mother found it hard to understand why she couldn't stay at home by herself, Stahler recalled. "I told her I found a nice hotel where she could stay so she wouldn't have to be alone," Stahler said. "It didn't sit well with her at first but I was firm and said 'this is the way it has to be.'

Even a short respite period can give families the strength to continue their caregiving responsibilities. "Family members often slide into heavy caregiving without realizing it," Eckert said. "Caregivers often put themselves second. They need to understand that by helping themselves, they are also helping the person they care for."

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