Elder/Adult Dependent Care

Setting Up a Care Plan

For any care plan to work, your elder should be included in every possible aspect of the planning process. This will not only assure that his or her dignity is respected, but also that the plan will be followed. Whether your elder needs short- or long-term care, allow for flexibility as new challenges arise.

Depending on your relationship with your elder and with other family members, and on the elder's willingness to admit there's a problem, it may be hard to broach the subject of needing help. It's important to remember that our parents' generation came through the Depression and a World War; they are proud and independent, often unwilling to admit to " weakness " or any need for services.

Sometimes you can get around a stubborn or non-communicative elder by getting a trusted friend, physician or clergy member to bring up the subject. You can also raise the topic by suggesting, for example, that you need their help with your own financial or estate planning.

One of the first orders of business is to determine who will be the "primary caregiver," the one who will have the main responsibility either for the actual care, or for putting all the pieces of the plan together and monitoring them through their inevitable progression. If possible, involve as many family members, significant friends or neighbors as possible in building a network of caring people who ensure that your elder is being monitored at all times no matter how small or how large the needs. Make sure each person knows what is expected and encourage feedback and suggestions for improvements or alterations as the situation changes.

Be aware that in many families, old sibling rivalries and unresolved emotions toward elders can arise. You may resent that your brother doesn't do enough, that your parents aren't getting the love they need from relatives, or that you weren't "mothered" the way you needed. Be realistic, and don't expect 100 percent agreement on everything. Recognize roles that family members have played in the past and try not to exclude anyone.

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One of the hardest aspects of caregiving is the emotional toll that can arise from unexpectedly having to assist your elder. For many of America's care providers, duties range from helping with grocery shopping and doctor's appointments, to having to diaper and bathe an elder. Sometimes these tasks are challenging.

Care providers commonly have a range of emotions that can make them feel embarrassed and isolated. The reasons include guilt over feeling that you are not doing enough or that you can't protect your loved one from further harm, denial of the problem, and anger and frustration over not being able to get your loved one to do what you think is best.

Establishing a well thought-out but flexible care plan will help relieve stress for everyone involved. In addition to learning what resources are available, you especially need information about your loved one's mental and medical status. You need to collect data on health care, and legal and financial affairs. You need to gather names, addresses and phone numbers of all physicians and specialists, attorneys and financial planners; lists of medications and health history; locations and numbers of health insurance policies and legal papers; assets and debts, expenses and income sources. Many financial decisions need to be made at the planning stage, so they can be implemented when needed. For example, purchasing long-term care insurance or meeting Medicare eligibility requirements are steps that can affect plans both at home and in a nursing home.

You need to ask the following questions:

How much of my elder's dependency is due to illness or infirmity, and how much is attributable to personality, habits and coping styles?
Am I or my family reinforcing dependent behavior while my elder is anxious and able to remain independent?
Have I presumed that certain frailties exist or have they been confirmed medically?
What problems are a result of natural-aging processes? What problems can be corrected by making changes in my elder's living environment, medications, etc.?

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