C) What Sort of Care Is Necessary?
Though families may feel immediately motivated to provide eldercare services themselves, it is not always in the best interests of elders or families for them to take on such responsibility. For instance, it is of little use to elders if family members insist upon providing care that they are not qualified to provide (such as medical care), or not staffed to provide (such as 24-hour care). It is not helpful to an elder if he or she is brought to live with a family member who is already so stressed out caring for her own family that the elder becomes a burden. Also, it is likely to be counterproductive for family members to attempt to provide care based on guilt feelings, rather than a true desire to help. Providing care is stressful business; it will not do for the caregiver to resent the person being cared for!
Care decisions should be based on a solid and an objective-as-possible assessment of each elder's actual care needs, rather than on emotionally driven desires to be helpful or by guilt feelings. It is necessary to independently and comprehensively identify the elder's functional abilities in order to arrive at a realistic understanding of the types of care they will require. Any of the elder's abilities that have been compromised may require care depending on how vital each ability is to their ability to perform activities of daily living, and to maintain their own safety. The amount of danger the elder will be exposed to if care needs are not met must be determined, as well as the types of care that could restore the elder's safety. Additionally, any abilities that are likely to become compromised in the foreseeable future as a result of an elder's progressive condition will also need to be identified as well, and incorporated into a care plan.
Elders can be said to be unsafe if left unsupervised if they:
- Can no longer manage vital tasks of daily living (e.g., going to the bathroom, preparing meals, getting themselves from place to place, etc.) in an independent manner for whatever reason.
- Require medical care that they cannot self-administer (such as dialysis care), or if memory or physical impairments make it impossible for them to reliable self-administer medical care they might otherwise be able to self-administer (such as daily shots or pills).
- Have physical impairments that impair tasks of daily living (e.g., they are wheelchair bound and cannot get groceries or visit the doctor without assistance)
- Have moderate memory impairments or other cognitive impairments which make it difficult for them to remember whether they have left the stove on or have locked their doors properly or had taken medications.
- Have severe memory or other cognitive impairments that result in their being unable to maintain personal safety (e.g., the elder wanders into other people's homes or down the street, the elder becomes confused or paranoid)
The nature of elders' impairments are not always clear or obvious. It is a good idea that elders be evaluated by a medical doctor and by a social worker experienced with coordinating elder care needs. It may also be a good idea to have the elder tested by a neuropsychologist, particularly if elders' conditions have effected their mental abilities. Professional assessments like these are the best way to gain certainty regarding elders' capabilities and impairments and therefore, their true care needs. The information provided by these professionals is invaluable for formulating an appropriate care plan.
The determination of what types of care and how much care are are required in order to restore elders' safety is critical for families trying to determine whether they can manage care tasks on their own or whether professional help will be needed. Most families are simply not capable of providing constant "24/7" care for their elders without assistance, no matter how motivated they may be to do so. Also, elders requiring specialized medical care, or supervision will require some degree of professional care. Of course, if family members are not motivated to provide care themselves, then professional care will be necessary by default.
Armed with knowledge of the type and amount of care an elder will require, family members can begin to evaluate options and alternatives for getting care arrangements put into place. Family provided or in-home care will likely be appropriate for less impaired elders, while more seriously impaired elders will likely require more extensive professional care. Families of elders with progressive conditions should plan for their elder's decline over time, setting up arrangements for additional care in advance when possible so as to spare all family members the crisis of scrambling for appropriate care should care needs suddenly escalate.