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Planning Care

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Planning Care

When it comes to Planning Care, generally, you may fall into one of three categories.
You are providing care for an individual already You are anticipating the possibility of future caregiving responsibilities. You are a senior who is exploring your own aging, and looking for resources, to assist you in this process.

Commonalities: Tools and Resources are needed to make sound choices.
In an AARP survey of senior concerns, it was found that 46% feared declining health, 38% feared not having enough money, 13% feared losing their mental capacity, while 12% feared becoming dependent on others.
It is important to take a pro-active approach to map out a clear and effective “Plan for Your Care”. This process will help in-an-effort to avoid unnecessary stress and financial concerns down the road. You would rather make choices when not under undue stress. Your loved one would rather be able to have input in the decisions. Open discussions will be necessary with everyone that will be involved in your care.
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Care Planning: Advanced

Most seniors are healthy and function at high level. It is inevitable that as they grow older, issues will surface related to their independence. Eldercare can involve many aspects of life such as healthcare, activities of daily living, transportation, finances, social, and emotional well-being.To ensure the highest quality of life for the longest time possible, it is crucial that elders and their loved ones begin before you are in a crisis. Where do you begin?

What is the care need you are concerned about?

Basic activities of daily living (ADLs) – focus on the daily self-care activities (e.g. eating, dressing, bathing, using the toilet).
Instrumental activities of daily living (IADLs) – focus on activities that enable a person to live independently in their home (e.g. shopping, cooking, taking medication, managing finances, using a telephone). Advanced activities of daily living – focus on more independent activities (e.g. driving, travel, gardening)

Some Steps to Follow while developing a Plan for Care for you or a loved one:

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STEP 1 — Identify the Wishes and Desires
The first step in this process is to talk with those involved in the process.
The one needing care
The Immediate Caregiver
Supportive Community (family and friends)
Other Support Systems
This will enable everyone to identify their feelings related to aging, as well as their wishes and desires, as they move forward. For open discussions that are likely to be emotionally charged, if needed, there are Geriatric Care Managers, Social Workers that may assist. Resources available are online. Hospital Case Managers/Social Workers are also available to assist you when you are in the hospital.
It is important to recognize an individual’s right to make their own choices related to their care; even if you don’t agree.
Opening a dialogue may progress smoothly or pose a challenge depending on:
your relationship with the senior (open and trusting vs. distant and strained).
the seniors present mental status (ability to communicate and process information vs. the presence of a disability such as depression or dementia).
the seniors present functional status (independent and active vs. struggling to
provide self-care).
the manner, in which, the discussion is initiated (genuine concern vs. intrusiveness).
STEP 2 — Gathering Important Information
The second step is to gather important information, that will be necessary in case medical treatment is needed, a crisis occurs, or upon the one’s death. A sampling of the information that you will want to collect includes:
Social Security #
Medicare #
Medicaid #
Veterans Administration Claim #
List of Insurance Plans (e.g. medical, car, life)
List of Doctors and their Telephone Numbers
Medical History
Medications and their Dosages
Financial Information
Legal Papers (e.g. Will)
List of Medical Devices (e.g. pacemakers, hearing aids, or bifocals)
Driver’s License Number
Passport Number
Name of Mortuary, Location of Burial Plot, and Deed
Birth Certificate
Step 3 — Determining what you will need
Before you can begin to develop an appropriate plan for anyone, you must determine the ability to remain safely independent. When you consider strengths, weaknesses, and areas of concern, you may need the assistance of trained professionals for a Comprehensive Assessment A Comprehensive Assessment is a multidimensional diagnostic process designed to evaluate the person’s medical, mental, physical, social, environmental, and financial status. This process is used to determine the capabilities, and will be used as a baseline, for moving forward in the development of an individual care plan.

STEP 4 — Components of Assessment

The functional ability is evaluated on the basis of:

  • Physical Status
  • Medical History
  • Physical Examination
  • Vision
  • Hearing
  • Continence
  • Gait
  • Balance
  • Chronic Pain
  • Sexual Dysfunction
  • Substance Abuse
  • Cognitive and Mental Health
  • Cognitive Dysfunction
  • Anxiety
  • Depression
  • Specific psychiatric symptoms (e.g. paranoia, delusions, behavior  bnormalities)
  • Social
  • Social Interaction (e.g. Senior Center)
  • Social Support Resources (e.g. friends)
  • Identify present and potential caregivers

Environmental

  • Evaluate the physical environment (e.g. determine safety, physical barriers, bathroom access)
  • Special Needs (e.g. transportation to doctors, shopping)
  • Legal
  • Financial Evaluation (e.g. financial resources, ability to manage own finances, advance medical directives)
  • Nutrition
  • Sleep

STEP 5 — Developing a Care Plan

The development of a care plan is based on the needs, wishes and desires, and financial situation, as well as their access to available resources.
Based on the individual, it may be possible for the individual to remain in their own home with family or paid caregivers, or they may need to look at alternative housing, such as an assisted living facility or nursing home. It is important to remember, as needs change, the plan will need to be modified to address their evolving needs. The spectrum of care may include:

Home Care

includes a variety of supportive services that enables the senior to remain in their own home. Services may include:

  • Companionship and reassurance
  • Assistance with medication
  • Meal preparation
  • Assistance with bathing, dressing, and toileting
    nursing care (e.g. wound care, injections)
  • Housekeeping chores
  • Rehabilitation services (e.g. physical, occupational, speech therapy)

Adult Day Care

is a supervised day program that addresses the cognitive and functional needs of impaired adults. Services may include:

  • meals
  • recreational activities
  • transportation to doctor’s appointments
  • professional services (e.g. nursing, physical therapy)
  • Respite Care – offers temporary and short-term care for elders with special needs (e.g. Alzheimer’s Disease)
  • These programs, are designed to provide short term care for elders, in order to allow their caregivers to receive a much needed break.

Residential Care

Assisted Living Facilities – offer comprehensive programs designed for those who are unable to live on their own. These facilities offer elders an independent apartment, 24-hour staff coverage, and assistance in the areas of meals, activities of daily living activities (e.g. bathing), medication, housekeeping, laundry, and transportation.
Continuing Care Retirement Community – provides a continuum of care ranging from independent living, to assisted living, to skilled nursing care. As the needs change, services may be implemented to address their evolving needs.
Skilled Nursing – are designed for those who need 24-hour care. These facilities provide room and board, personal care, supervision, recreational activities, activities of daily living, and various types of therapy (e.g. physical therapy).

Hospice Care versus Transitional Care

– is designed to offer services for those patients with incurable diseases that need symptoms managed or for those with a terminal illness. You can receive transition of care services before you qualify for full hospice. The cost of Transition Care is based on sliding scale; you may receive this for up to 2 yrs. before you qualify for full hospice benefits. This is available for persons of all ages. When an individual is terminally ill, they may remain in their own home, or enter a facility that is designed with a home like setting referred to as a hospice house. The primary focus of hospice is to provide palliative care to control pain and preserve the highest quality of life for as long as life remains.

Step 6 — Gathering Information on Various

Topics: Here are a few resources to help you get started:

  1. Alzheimer’s Association (800) 272-3900
  2. Medicare (800) 633-4227
  3. Social Security Administration (800) 772-1213
  4. Cornerstone Hospice (866) 742-6655
  5. American Parkinson’s Disease Association (800) 223-2732
  6. Clearinghouse on Elder Abuse and Neglect (302) 831-3525
  7. Eldercare Locator Hotline (800-677-1116)
  8. Meals on Wheels Association of America (703) 548-5558
  9. National Academy of Elder Law Attorneys (520) 881-4005 
  10. National Adult Day Services Association (202) 479-6682
  11. National Association for Home Care (202) 547-7424
  12. National Center on Elder Abuse (202) 682-2470
  13. National Senior Citizens Law Center (202) 289-6976
  14. National Health Information Center (800) 336-4797
  15. National Institute of Mental Health (301) 443-4513 
  16. National Stroke Association (800) 787-6537

STEP 7 — Arranging for Important Legal Documents

Have you ever wondered what would happen if you became incapacitated, and is unable to communicate your wishes, related to their medical care or financial affairs?
All too often when someone becomes incapacitated, their family scrambles to locate important financial and legal documents in an effort to ensure that they receive necessary care.
Your loved ones may not even be sure if you ever put wishes in writing. What now! Unfortunately, if you did not take a pro-active approach prior to this point, your loved ones are bound to face a very stressful and overwhelming task.
It doesn’t take much to ensure that personal affairs are in place. By having an attorney, prepare a set of documents in advance, you can ensure that your wishes will be followed. There are at least four key documents that you may wish to discuss with their attorney. The information presented here is meant to only serve as a basic overview.

Last Will and Testament

When a person has a Will drawn-up, they are outlining how they want their personal property and assets to be dispersed upon their death. It is important that an attorney draft the Will, to ensure that it meets all applicable laws, and will hold up in court.

Durable Power of Attorney

When a senior has their attorney create a durable power of attorney, they are designating another person to act on their behalf, in reference to their legal or financial decisions. This document is important, in-the-event that the senior becomes incapacitated, and is unable to make decisions on their own behalf. A durable power of attorney is especially important when planning asset transfers or attempting to qualify for Medicaid (Title 19).
When it comes to Planning Care, generally, you may fall into one of three categories.
You are providing care for an individual already
You are anticipating the possibility of future caregiving responsibilities.
You are a senior who is exploring your own aging, and looking for resources, to assist you
in this process.

Commonalities: Tools and Resources are needed to make sound choices.
In an AARP survey of senior concerns, it was found that 46% feared declining health, 38% feared not having enough money, 13% feared losing their mental capacity, while 12% feared becoming dependent on others.
It is important to take a pro-active approach to map out a clear and effective “Plan for Your Care”. This process will help in an effort to avoid unnecessary stress and financial concerns down the road. You would rather make choices when not under undue stress. Your loved one would rather be able to have input in the decisions. Open discussions will be necessary with everyone that will be involved
in your care.

Care Planning- Advanced

Most seniors are healthy and function at high level. It is inevitable that as they grow older, issues will surface related to their independence. Eldercare can involve many aspects of life such as healthcare, activities of daily living, transportation, finances, social, and emotional well-being.
To ensure the highest quality of life for the longest time possible, it is crucial that elders and their loved ones begin before you are in a crisis.

Where do you begin?

If you are in need of medical treatment, a Living Will clarifies issues related to the use of life support systems. When you completes a Living Will, it is important to share this information with their healthcare provider and loved ones, because often times the wishes are not the same as their spouse, partner, or children. It is important to note, that laws regarding Living Wills vary from State to State, and therefore it is suggested that you consult your attorney in drafting this document.

Health Care Proxy (or Medical Power of Attorney)

The value of having a health care proxy is that it assigns an individual to make health care decisions, in the event that you are unable to make decisions. This document includes all types of medical decisions, including surgical procedures, medication, selecting healthcare providers, the selection of healthcare facilities, as well as issues related to artificial nutrition or hydration. Prior to creating this document, it is important that you select a person, whom they know will honor their expressed wishes.

STEP 8—Utilizing Additional Tools

1. The person lives alone and may be at risk

There are a number of volunteer and fee for service programs that may be available within the elder’s community to help offer support.
Telephone Reassurance
These programs offer regular, pre-scheduled calls to homebound elders to help reduce isolation, and provide a routine safety check.
– Friendly Visiting

Services are available, that offer periodic neighborly visits to homebound elders, to provide social contact and reassurance.

2. The person may fall and be unable to reach the telephone

There are a number of services available that provide a pendant to wear, connecting them to a Central Monitoring Station. In the event that someone falls and is unable to reach a telephone, the person can push a button on the pendent, immediately connecting them with the Monitoring Station. The person will then receive support and reassurance, while emergency help is dispatched to their location.

3. The person may not be taking their medication which puts them at risk

Medication noncompliance in the United States accounts for over 125,000 deaths per year. Noncompliance includes forgetting to take a dose, not filling or refilling a prescription, not taking all the medicine as prescribed, and double dosing (taking two pills to make up for a skipped dose).

The Problem May be Financial

The first step may be to determine if someone is forgetting their medication, or feels financially unable to pay the cost of the medication. If the issue is a matter of finances, there are a number of State, Federal, and Pharmaceutical Company programs designed to assist elders in paying for medication.

The Problem May be Side Effects

Often times, someone is taking one or more medications, that may be causing uncomfortable side effects. Instead of discussing the side effects, with the person’s doctor or pharmacist, the person just decides to stop taking the medication. Initiating a conversation with the loved one, about their medication and possible side effects, may uncover a correctable problem.

The Problem May be Remembering

There are a number of options available to assist an senior in remembering to take their medication:
– Friendly telephone reminders from family or friends
– New technology – watches that vibrate or chirp, e-mail reminders, or pagers
– Automatic Medication Dispenser and Reminder System – that monitor the dispensing of medication during the day; and for an additional fee, a monitoring company can provide telephone calls to a designated family member, if medications are not properly dispensed

4. There may be a medical emergency, but when medical personnel arrive, the senior is unable to speak Vial of Life

The Vial of Life, allows elders to record important medical information, for easy access by Emergency Medical personnel during the first minutes of critical illness or accident in the elder’s home. The information is rolled up and inserted into a vial that is placed under the top shelf of their refrigerator. Once the vial is in the refrigerator, the person displays a Vial of Life magnet on their refrigerator door, where emergency medical personnel are trained to look.

Contact the local Senior Center, Fire Department, or Police Department to inquire about the Vial of Life.

5. The senior may have trouble using the phone, and not be able to call for help in an emergency

A telephone is a key tool in helping anyone stay in touch with family and friends, while ensuring access to assistance in case of an emergency. Unfortunately, as a person ages something as simple as using a telephone, can become a difficult and frustrating task. There are some steps that you can take to make phone usage easier for the elder.

  • Large number telephones
  • Photo phone
  • Speed dial with important numbers
  • Printed list of important numbers by the phone
  • Caller ID
  • Text telephone (TTY)
  • Telephone amplification aids
  • Extra loud telephone ringer
  • Emergency Telephone Dialer

For more information about special devices, you may want to contact your local telephone company.

STEP 9 — Accessing Caregiver Support

Caregiving can be a challenging and draining experience, regardless of the type of relationship that you have with a person. Often times, the caregiver is so consumed with doing all that they can that they forget to take care of themselves. Unfortunately the emotional and physical strain of caregiving, day in and day out, can lead to stress, burnout and even physical illness.
Common Signs of Caregiver Stress
Physical headache, muscle aches, sleeping and eating problems, frequent illness
Emotional guilt, anger, loneliness, depression, and anxiety
Mental forgetfulness, difficulty making decisions, attention wandering
Interpersonal withdrawal, blaming, irritability, impatience, and sensitivity to criticism
Spiritual feelings of alienation, and loss of hope, purpose, or meaning
Some Steps to Self-Care
Identify when you are under stress (e.g. headache)
Set realistic goals and expectations – what you can and cannot change
Practice stress reduction techniques (e.g. exercise, visualization, yoga)
Request assistance from family, friends, and neighbors
Identify community resources and support
Join a caregiver support group
Speak with a counselor about your feelings, stressors, and other caregiving issues
Utilize respite care services that provide temporary care for an elder
Retain the services of a professional who specializes in eldercare planning services