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Taking Care of Your Loved One
About This Web Page
Taking care of a loved one is a tremendous responsibility. If you have assumed this responsibility, you are a primary caregiver and this information is especially for you. When someone you love is discharged from the hospital or has a sudden need for increased medical care, you will be faced with many important decisions. There are so many options that the decision can be daunting.
You may ask:
This web page will attempt to answer these questions. We hope that this information assists you in making informed decisions during this important time.
The Aging Process
Before we discuss how to determine what type of care your loved one may need, let’s first explore the nature of aging and the basic functions of independent living.
A. What is aging?
Aging is not a disease. It is a normal process that begins at birth and continues throughout life. Most older adults have the same personalities, emotions, pride and beliefs that they have had throughout their lives. The body merely changes as each person grows older.
Like living itself, the aging process can be best managed through regular physical, emotional and social activity. However, because the body changes with age, some normal activities become more difficult to manage as a person grows older.
B. What physical changes occur with aging?
One circumstance of the normal aging process is the loss of height due to the disks in the spinal column, or vertebrae, slowly shrinking, causing the bones to move closer together. This shrinking process actually begins around the age of 25. After age 40, the back may even begin to lean forward. From age 20 to 70, women tend to lose about two inches in height, while men tend to lose about one inch. Another physical change people experience with age is weight variation. Generally, your weight increases until about age 50, and then begins to decrease. However, some older adults may experience weight gain because of increased food intake coupled with decreased activity.
In addition to the physical challenges presented by aging, the following medical conditions are likely to occur as a person ages:
Because no two people manage the aging process in exactly the same way, the effects of these medical conditions can vary in each person. Consult your loved one’s physician to find out more specific information about these conditions.
C. What mental changes occur with aging?
Along with physical changes, cognitive changes are often associated with aging. The causes of senility are generally neurological and are not the result of normal aging. In reality, only minimal changes to memory occur with the aging process.
Many people mistakenly believe that aging causes depression. Depression is usually due to the changes in a person’s ability, or inability, to manage the aging process. An estimated 18 to 20 percent of seniors seek treatment for depression. Although depression is not part of the aging process, deficiencies in hormones in women and testosterone in men can affect moods and cause a diminished sense of well-being. However, researchers say that if you were carefree when you were young, you should stay that way as you grow older. A few common signs of depression are:
Depression is much more than a bad mood. Left untreated, it can cause lack of motivation and ultimately lead to inactivity that can dramatically affect the body, mind and social well-being. Consult your loved one’s physician to find out more about depression. One thought bears repeating. The key to managing the aging process is maintaining regular physical, emotional and social activity.
How to Determine the Appropriate Level of Care for Your Loved One
A. Measuring abilities for independent living
When determining the appropriate amount of care for your loved one after a hospital stay or due to a sudden change in health, you first need to assess his or her level of independent living. Health care professionals utilize specific measurements to perform these assessments. The first widely used scale that measures ability to perform physical tasks is Activities of Daily Living.
These tasks include:
The second measurement of physical abilities is Instrumental Activities of Daily Living. It assesses more complex tasks such as:
When considering these two measurements, it is important to determine if an inability to perform Instrumental Activities of Daily Living or Activities of Daily Living is temporary. Individuals who are unable to perform these tasks temporarily usually receive support from family or friends. Those who have greater limitations in Activities of Daily Living over an extended period should usually seek professional support from skilled nursing or home care services. Moreover, if there are major medical needs, such as rehabilitation or recovery from surgery, professional support is usually the only option.
B. Working together toward independent living
As the primary caregiver, you may find yourself required to assist a loved one to regain the ability to perform Activities of Daily Living. Often, in order to facilitate independence in the home environment, it is advisable to utilize a special device, such as a walker or holding bar. These aids can provide a sense of safety and security, and allow your loved one to maintain self-reliance while performing daily tasks and activities. Consult with a physician or a physical therapist to determine what types of modifications you can make in the home environment to better foster your loved one’s independence.
It is important to note that regardless of the degree of support you give loved ones, you should encourage and challenge them toward independence in their care. This may be difficult because sometimes it is easier to do some of the tasks yourself. Unfortunately, this could cause your loved one to depend on you or others more than is necessary. Your loved one might then develop an attitude of "learned helplessness," which could lead to frustration for you and demanding behavior from your loved one. Remember, losing some control over one’s own care can lead to depression. Think through ways you can encourage your loved one to participate in his or her care, and you may find an improvement in attitude and progress toward increasing independence.
C. Maintaining effective communication
Throughout the care process, communication between you and your loved one is key to cooperation, harmony and real accomplishment. Be sure to exchange thoughts and feelings with each other.
Some disabilities, specifically stroke, may impact your loved one’s ability to communicate. Although they may speak more slowly or grasp for words, they are still the same person you knew before — just frustrated in their communication process. A physician or speech therapist can give you practical suggestions on how to improve the communication process.
D. Taking care of yourself
Once you commit to being a caregiver, there are many demands on your time as well as on your mental and emotional state. Remember to take care of you. If your inner resources become depleted, you will not be able to care for yourself or anyone else. Suggestions for taking care of yourself include:
There is relief. When you need a vacation or a break, many skilled nursing facilities offer "respite care," which provides temporary 24-hour-a-day medical supervision for your loved one.
Senior Housing/Activity Options
Once you are familiar with your loved one’s capabilities for independent living, it is time to determine what course to take. Many caregivers seek assistance from home care specialists who provide medical supervision and rehabilitation in the home environment. However, sometimes these services are not comprehensive enough or may prove to be very expensive. At some point, you may determine that you simply cannot take care of your loved one alone in the home environment.
The inability to take care of your loved one at home is not a failure on your part as a caregiver. Different medical conditions and situations call for different solutions. Sometimes care at home is appropriate. Sometimes an environment with 24-hour skilled nursing services is necessary. Part of being a responsible caregiver is understanding that difference and making the right choice. The following listing provides a brief overview and description of a number of senior housing options. They are presented in order of increasing services available, from the least medical assistance (low acuity) to the most (high acuity):
Senior Communities - provide a variety of on-site activities for older adults, including social programs, group meals, recreation, exercise and some health services.
Adult Day Care Communities - provide socialization, supervision, recreation, health services and meals in a community setting specifically for older adults with moderate physical or cognitive disabilities. Typically offered weekdays during business hours.
Independent Living Facilities - rental units in which the residents can purchase medical or professional services for an additional fee.
Home Sharing/Shared Housing - unrelated individuals share a home, chores and expenses that relate to operating that home. Those living in shared housing share all common areas, but each has a private bedroom.
Retirement Housing Communities - individuals rent separate units or apartments, but receive some services such as daily meals and social activities with other tenants. These facilities often have some common areas including dining rooms and lounges. They are also equipped with safety measures such as emergency call buttons and security systems.
Continuing Care Retirement Communities (CCRCs) - offer multiple levels of care, from independent living to assisted living to skilled nursing care. Residents needing various levels of care are housed in different areas on the same campus. CCRCs offer residential services, such as meals and housekeeping, social and recreational services, health care services, personal care and nursing care. CCRCs typically require a monthly charge with an advanced entrance fee.
Assisted Living Communities - provide a private apartment dwelling with 24-hour medical support when necessary. Recreational activities and community events are usually offered. Dining can be in a communal or private setting.
Home Health Care - includes a wide range of health-related services provided in the home. Some of the services offered include assistance with medications, wound care, intravenous (IV) therapy and help with basic needs such as bathing, dressing and mobility.
Skilled Nursing Facilities - provide intensive nursing care around the clock. Services include nursing care, personal care, room and board, supervision, medication, therapies and rehabilitation. Skilled nursing facilities specialize in "sub-acute" or post-hospital stay treatment. Sections of the skilled nursing facility may be dedicated to individuals needing special medical programs such as stroke rehabilitation or to individuals with Alzheimer’s disease. Private and semi-private rooms are usually available. Meals are served in a dining room or in the resident’s room.
Respite Care - temporary care offered by skilled nursing and home care services, primarily for the benefit of the caregiver. Through this type of program, medical professionals care for loved ones so caregivers may take a vacation or a needed break.
Acute Care - in-hospital care.
Hospice Care - provided for the terminally ill in the home, in hospitals, or in skilled nursing facilities. Services can include home health services, volunteer support, grief counseling and pain management.
Evaluating a Housing Alternative
If you have decided that your loved one will best be cared for in some type of senior housing, your next task is to evaluate your options. The American Association of Retired Persons (AARP) offers the following guidelines to help you make an informed evaluation:
Although the task may seem a bit overwhelming if you are visiting several facilities, the more information you have about potential senior housing alternatives, the more confident you will be with the decision you make.
Other Services Available to Help You and Your Loved One
If your decision involves having your loved one stay in the home while you arrange for some level of care, consider the following additional services that may be available in your community: Care/Case Management - offers the resources of a care/case manager to assess your loved one’s needs and create service plans; then coordinate and monitor those services.
Chore Services - assist older adults with projects such as home repairs, yard work and heavy housecleaning.
Friendly Visitor/Senior Companions - volunteers who regularly visit homebound people to provide socialization, run errands, or just check in on them.
Homemaker Services - assist with meal preparation, shopping, light housekeeping and laundry.
Mental Health Services - a variety of services provided to senior citizens including counseling, therapy, psychiatric evaluation, crisis intervention and support groups.
Nutrition Services - include “Meals-on-Wheels” home-delivered meals and congregate meals served at area churches and other gathering spots. Both are provided for a nominal fee.
Personal Emergency Response System (PERS)/Lifeline - a call button, usually worn around the senior citizen’s neck, which can be pushed to get help from family, friends and local emergency personnel.
Transportation Services - provide transportation to services and appointments with a variety of vehicles, most of which will accommodate wheelchairs.
More Support Services
As a caregiver, you have several avenues open to you where you can gain further information, insight and advice. The following organizations are good places to start:
Eldercare Locator - can give you phone numbers for ombudsman programs, Medicaid offices and Offices on Aging in the state and county where you are looking for senior housing. Call 1-800-677-1116.
Centers for Medicare and Medicaid Services (CMS) - formerly the Health Care Financing Administration (HCFA), this is the Federal agency that oversees the Medicare and Medicaid programs. The CMS web site provides useful information for finding and choosing a nursing facility. The web site address is http://www.medicare.gov.
Alzheimer’s Association - provides a guide for caregivers who are looking for residential care for loved ones with Alzheimer’s disease. Call 1-800-272-3900.
Conclusion
As you assume the responsibility of caring for your loved one, remember that there are many resources available to help you in the process.
We at The Laurels hope this web page has assisted you. If you need further information or help with a medical assessment or advice, you can click here to contact us.
With a solid understanding of your loved one’s living capabilities and desires, along with the various options available, you are well on your way to choosing the best solution for both you and your loved one.
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