We've outlined 6 steps to determine an older adult's care needs. Here we go:
1. Get a checkup, find out what's wrong and why:
Our mantra is: diagnosis, diagnosis, diagnosis. It is very important that you know the cause of an older person's health problems. If a physician tells you, "It's just old age," find another physician -- "old age" is not a diagnosis! The reason you want a diagnosis is that it gives you a prognosis--an educated sense of what the future holds--of how much care might someday be involved, and what the timeframe might be
2. Determine if the person suffers from cognitive impairment (memory loss) and why:
Serious memory loss is not a normal part of aging. If someone you care about shows severe gaps in short-term memory, have a physician who's knowledgeable about older adults find out why. There are temporary causes, such as depression, malnutrition, not drinking enough water every day, and medication interactions, which, if diagnosed, can be reversed. There are also untreatable causes that are the symptoms of a disease of the brain, such as Alzheimer's, small strokes, some forms of Parkinson's and Multiple Sclerosis, and alcoholism. These are progressive and permanent and have no cure.
To choose the best care for an older person with short-term memory problems, learn the cause -- why it's happening (just as you would a physical problem). Three reasons why:
- If it's treatable, you can help them start to get better
- If it's not treatable, there are medications available today that may be able to slow down their disease's progress, and
- If it's not treatable, you know you need to develop long-term plans -- the condition will only get worse over time
3. Think about the person's hobbies, values, and personality
Many different caregivers and care settings are available today, so the greater the extent to which you can choose options based on an older person's personality, values and lifestyle, the better. For example, someone who's never been a talker will probably not like a caregiver in his home who chats nonstop. Many older people who've lived downtown for years often want to live in a residential community downtown (the same for rural areas). A lifelong social butterfly will probably prefer an assisted living facility where she can meet lots of people, versus a smaller residential care home with just a few residents. Someone who likes things that are refined will prefer to live where her tastes are reflected.
4. Understand the person's needs at night
Getting help at night is expensive! If an older person needs human assistance at night (e.g. to go to the bathroom or to keep from wandering outside at 2 AM), the caregiver can't sleep -- he or she must stay awake and be available. This means the caregiver is paid by the hour, even if they're just sitting and watching TV, because they're ready and able to provide help instantly. (Something to think about if you or another family member is offering to care for someone who's unsafe at night alone.)
The most common reason most of us get up at night is to go to the bathroom. If only we could eliminate nighttime peeing, life would be simpler, safer, and less expensive as we get older! However, we can't, so families are encouraged to be inventive. Examples: place a commode next to the person's bed (assuming she can get up on her own to use it); make sure the hall and bathroom are set up for safety, such as installing a raised toilet seat and grab bars and night lights. Have the older person wear an emergency call system "necklace" to call for help if she falls.
5. Assess the person's mobility needs
Mobility can be another budget-buster because, if an older person can't walk or transfer in or out of a bed or chair without human assistance, then he probably needs to hire someone to help throughout the day - and he might need someone to lift him, which can take one or two strong people trained in lifting. This often adds to the cost.
The next time you get out of a deep sofa, notice all the muscles you use. Walking and getting in and out of a bed or chair require strong muscles. If you don't have them, you have to hire help. Exercise is the #1 way to avoid disability in old age. Too many older people don't exercise; they then lose their muscle tone and the ability to get around independently. It's called, "sarcopenia" -- severe withering of muscles during long periods of inactivity. It can impair us prematurely and permanently.
6. Determine the people who are significant in the older person's life to be caregivers, overseers, occasional helpers, and visitors
It's vital as we age to have people in our lives who we trust, are trustworthy, we like and who like us. These are our "significant others", "our care team," or "friends for the journey." They're usually family, but not always. Some people don't live near their family, their family has died, their family isn't trustworthy, or their family members have their own problems. There are many reasons we may need to count on our friends or hire someone (such as a guardian or geriatric care manager) to serve in this way.
As we get more frail, we not only need someone to help us with the everyday things -- like taking us to the bank, grocery store or Christmas shopping -- but we need help with the more unpleasant tasks: like helping us move, putting our house on the market, paying our bills, doing our taxes, or dealing with our doctors. Even more importantly, we need someone we trust to be there to help make decisions when our eyesight, our hearing or our brain gets fuzzy. That's when we become most vulnerable and unsafe by ourselves.
And, because of our diminished senses, we're not likely to even know how vulnerable we've become.
So here is where you should create a list of the people who can serve as an older person's "Significant Other." A spouse may be listed, but having someone younger is highly recommended. Many people list their children. People who have no children or their children live far away may list friends, grandchildren, a trusted neighbor or someone they pay to oversee their needs, such as a guardian or a geriatric care manager. In general, you want your "Significant Others" to live nearby, so they can keep close to what's happening and be able to take action quickly in an emergency, but people who live farther away can be listed as back-ups.
Written by eldercare expert Liz Taylor