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

12%

Feared becoming dependent on others

It is important to take a pro-active approach to map out a clear and effective “Plan for 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.

Most seniors are healthy and function at a 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 daily self-care activities(i.e. 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(i.e. shopping, cooking, taking medication, managing finances, using a telephone).
  • Advanced activities of daily living – focus on more independent activities(i.e. driving, travel, gardening)

01

IDENTIFY THE WISHES AND DESIRES

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, or Social Workers that may assist. Resources are available on-line as well. Hospital Case Managers/Social Workers are also available to assist you when you are in the hospital.
It is important to recognize and 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:
  1. Your relationship with the senior (open and trusting vs. distant and strained)
  2. The senior’s present mental status (independent and active vs. struggling to provide self-care).
  3. The manner in which the discussion is initiated (genuine concern vs. intrusiveness).

Here are a few suggested areas that will need to be explored:

  • Has anyone already made any future long-term plans? If yes, what are these plans?
  • Would the person needing care like to remain in their home with assistance? If yes, would they prefer family or paid caregivers?
  • Does the person needing care want to explore alternative housing?(i.e. live with a relative, senior housing, and assisted living)
  • Has the person needing care taken any steps in the area of healthcare and financial planning?(i.e. long term healthcare insurance, living will, power of attorney)

02

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 one’s death. A sampling of the information that you will want to collect includes:

  • Social Security Number
  • Medicare Number
  • Medicaid Number
  • Veterans Administration Claim Number
  • Medical History
  • Medications and their Dosages
  • Financial Information
  • Legal Papers (i.e. will)
  • List of Medical Devices  (i.e. pacemakers, hearing aids, bifocals)
  • Drivers License Number
  • Passport Number
  • Name of Mortuary, Location of Burial Plot, Deed
  • Birth Certificate

03

DETERMINING WHAT YOU WILL NEED

Before you 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 multi-dimensional 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.:

COMPONENTS OF ASSESSMENT

  • Physical Status
  • Medical History
  • Physical Examination
  • Vision
  • Hearing
  • Continence
  • Gait
  • Balance
  • Chronic Pain
  • Sexual Dysfunction
  • Substance Abuse
  • ognitive and Mental Health
  • Anxiety
  • Depression
  • Specific Psychiatric Symptoms (i.e. paranoia, delusions, behavior abnormalities)
  • Social Interaction (i.e. Senior Center)
  • Social Support Resources (i.e. friends)
  • Identify Present and Potential Caregivers

Environmental

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

04

RESEARCHING
COMMUNITY RESOURCES

Researching Community Resources

Explore family and community resources to meet those needs. It may be helpful at this point to arrange a “family” meeting in order to inform all persons of the steps taken thus far, explain the current status, and their desired plan for moving forward. Explore “volunteers” who are willing to share in various care-giving tasks depending on the specific circumstances. If the wish is to remain in the home, assistance may be needed with meal preparation or housekeeping chores. If a person moves into an assisted living facility, assistance may be needed with transportation to doctors appointments or seeing that services are being provided as contracted.

Home Health Agency

  • Is the agency licensed by the state?
  • What type of credentials does the staff have?
  • Is the staff trained, bonded, etc?
  • Does the agency provide the level of assistance you require, given current status?
  • Does the agency provide an explanation of your rights and responsibilities as a client?
  • Does the agency ensure patient confidentiality?
  • Does the agency staff administer medications?
  • Does the agency staff provide dressing care?
  • Does the agency staff provide physical, occupational, or speech therapy?
  • Who will pay for this service? What are the costs?

Assisted Living Facility

  • Is the facility licensed by the state?
  • What services does the facility provide?
  • Does the facility provide the level of assistance you require, given the current status?
  • Are there medical conditions that the facility will not accept? If yes, what are these conditions?
  • Does the facility provide skilled nursing services, if needed?
  • Does the facility allow you to contract for outside services that are not provided by the facility?

Day Care Program

  • What are the hours of operation?
  • What days are the program open?
  • What are the eligibility requirements regarding age, diagnosis, and functional status? (i.e. incontinence, memory problems)
  • What is the staff to participant ratio?
  • What kind of activities do they offer?
  • What type of credentials does the staff possess?

Whatever services you are looking to obtain, it is a good idea to check with your local and State Health Department, and the Better Business Bureau to ensure that the business has a good reputation, and that they have not received health or safety violations. Other things to consider before moving forward are reference checks, site visits, and written contracts that outline the specific services to be provided, the fee for services, and the organization’s procedure for handing complaints.

05

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 home. Services may include:

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

RESPITE CARE

Offers temporary and short-term care for elders with special needs  (i.e. 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.

Skilled Nursing

– is designed for those who need 24-hour care. These facilities provide room and board, personal care, supervision, recreational, activities of daily living, and various types of therapy (i.e.physical therapy)

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.

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 and daily living activities (i.e. bathing, medication, housekeeping, laundry and transportation).

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 a sliding scale;

06

GATHERING INFORMATION
ON VARIOUS TOPICS

Here are a few resources to help you get started:

Alzheimer’s Association

(800) 272-3900

Medicare

(800) 772-1213

Social Security Administration

(800) 272-3900

Cornerstone Hospice

(866) 742-6655

American Parkinson’s Disease Association

(800) 223-2732

Clearinghouse on Elder Abuse & Neglect

(302) 831-3525

Eldercare Locator Hot-line

(800) 677-1116

Meals on Wheels Association of America

(703) 548-5558

National Academy of Elder Law Attorneys

(520) 881-4005

National Adult Day Services Association

(202) 479-6682

National Association for Home Care

(202) 547-7424

National Center on Elder Abuse

(202) 682-2470

National Senior Citizens Law Center

((202) 289-6976

National Health Information Center

(800) 289-6976

National Institute of Mental Health

(301) 443-4513

National Stroke Association

(800) 787-6537

07

ARRANGING FOR IMPORTANT LEGAL DOCUMENTS

Have you ever wondered what would happen if you became incapacitated, and unable to communicate your wishes related to your 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 your 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, inthe-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).

HEALTH CARE PROXY

The value of having a health care proxy is that it assigns an individual to make healthcare decisions. This document includes all types of medical decisions , including surgical procedures, medication, selecting physicians, 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.

08

UTILIZING ADDITIONAL TOOLS

One concern that is often expressed by loved ones is, what if my loved
one becomes ill, has an accident, or is a victim of crime. This can be a
recurring concern, especially if you live or work in another community
and can’t check on your loved ones on a regular basis. There are a number
of tools that may be appropriate for your situation.

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.

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

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

Medication non-compliance in the United States accounts for over 125,000 deaths per year. Non-compliance 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 remembering.

There are a number of options available to assist a 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 & 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.

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.

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 simples 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

09

ACCESSING CAREGIVER SUPPORT

Care-giving 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 care-giving, day in and day out, can lead to stress, burnout and even physical illness.

 

Common Signs of Caregiver Stress

  • Ο 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
  • Sensitivity to criticism
  • Spiritual feelings of alienation

Some steps of self-care

  • Ο Identify when you are under stress (i.e. headache)
  • Set realistic goals and expectations (what you can and cannot change)
  • Practice stress reduction techniques (i.e. 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 care-giving issues
  • Utilize respite care services that provide temporary care for an elder
  • Retain the services of a professional who specializes in eldercare planning services