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ADVANCED CARE PLANNING
"An Act of Love"

 
Advanced Care Planning

Components of A Comprehensive Geriatric Assessment

 

About Our Company

Contact Us

    

DID YOU KNOW

In 2002, about 30% (10.5 million) of all non-institutionalized older persons lived alone (7.9 million women, 2.6 million men). They represent 41% of older women and 18% of older men.

 

 

"Our mom was in medical crisis, and was unable to make any decisions for herself. I was so glad that our mom had worked so closely with The Caregiver Resource Center last year to put a care plan in place in the event of an emergency."

H. & T. Hindebrand

Forest Queens, NY

"The only limit to our realization of tomorrow will be our doubts of today.
Let us move forward with strong and active faith."

Franklin Delano Roosevelt

It is likely that if you are reading this article you fall into one of three categories.

1. You are an adult who is currently providing caregiving services to an elder.
2. You are an adult who is exploring the topic of aging, in an effort to prepare yourself, for the possibility of future caregiving responsibilities.
3. You are an elder who is exploring your own aging, and looking for resources, to assist you in this process.

Regardless of the category in which you fall, you all have one thing in common. You are actively looking for tools and resources, to ensure that you are prepared, to make educated and effective choices.

Thoughts of a loved one aging, can be frightening, possibly surfacing as fears of the person developing Alzheimer's Disease, becoming wheelchair bound, or ending up in a nursing home. It's important to note that elders are also concerned about what they may encounter as they grow older. In an AARP survey of elder concerns, it was found that 46% feared declining health, 38% feared not having enough money, 13% feared losing their mental facilities, while 12% feared becoming dependent on others.

As advances in medicine and technology allow Americans to live longer, it is likely that we will each be faced with the need to address issues, related to our own as well as a loved one's long term care. It is important to take a pro-active approach to map out a clear and effective "Advance Care Plan". This process will help in an effort to avoid unnecessary stress and financial concerns down the road. If an elder does not act now to develop a plan, future events will most likely require a loved one to step in to make decisions, usually without the benefit of the elder's input.

    
Advanced Care Planning

While studies show that most seniors are healthy and function at high levels, it is inevitable that as they grow older, issues will surface related to their independence. Eldercare often requires a multi-disciplinary approach that encompasses 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 a dialogue to discuss the topic of aging. This process needs to focus on the elder's hopes and desires, short and long term goals, and their abilities and needs; while at the same time establishing a spectrum of resources that will address the elder's evolving needs.

To follow is a series of 9 steps that may be taken in implementing Advanced Eldercare Planning:

STEP 1      The Elder's Wishes and Desires

The first step in this process is to talk with the elder to learn their feelings related to aging, as well as their wishes and desires, as they move forward. It is important to recognize the elder'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 elder (open and trusting vs. distant and strained).
  - the elder's present mental status (ability to communicate and process information vs. the presence of a disability such as depression or dementia).
  - the elder's present functional status (independent and active vs. struggling to provide self care).
  - the manner in which the discussion is initiated (genuine concern vs. intrusiveness).

To the extent possible, it is important to initiate this dialogue as soon as possible, and hopefully while the elder is able to openly voice their current and future wishes and desires. Of course this won't always be possible, so if you encounter resistance or difficulties, you may want to seek assistance from a professional to help facilitate the process.

Here are a few areas to explore:

1. Has the elder already made any future long term plans? If yes, what are these plans?
2. Would the elder like to remain in their home with assistance? If yes, would they prefer family or paid caregivers?
3. Does the elder want to explore alternative housing (e.g. live with a relative, senior housing, assisted living)?
4. Which family members would the elder like to assist with long term care issues?
5. Has the elder taken any steps in the area of healthcare and financial planning (e.g. long term healthcare insurance, Living Will, power of attorney)?

STEP 2      Gathering Important Information About the Elder

The second step, is to help the elder gather important information, that will be necessary in case medical treatment is needed, a crisis occurs, or upon the elder'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      Obtaining an Assessment

Before you can begin to develop an appropriate care plan for the elder, it is first necessary to determine the elder's ability to remain safely independent, along with their strengths, weaknesses, and areas of concern. The best way to determine the needs of an elder, is by means of a Comprehensive Geriatric Assessment, that can be provided by a number of trained professionals.

A Comprehensive Geriatric 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 elder's capabilities, and will be used as a baseline, for moving forward in the development of an individual care plan.

    
Components of A Comprehensive Geriatric Assessment

Functional

The elder's functional ability is evaluated on the basis of :

Basic activities of daily living (ADLs) - focus on the elder's 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)

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 abnormalities)

Social

  - Social Interaction (e.g. Senior Center)
  - Social Support Resources (e.g. friends)
  - Identify present and potential caregivers

Environmental

  - Evaluate the elder's 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

Medications and Medication Compliance

STEP 4      Researching Community Resources

Once the assessment is complete and it is clear what the elder's current needs are, it will be necessary to research possible 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 elder's current status, and their desired plan for moving forward.

During this meeting it may be possible to solicit "volunteers" who are willing to share in various caregiving tasks depending on the specific circumstances of the care plan. If the elder will remain in the home, assistance may be needed with meal preparation or house keeping chores, whereas if a person moves into an assisted living facility, assistance may be needed with transportation to doctors appointments or overseeing that services are being provided as contracted.

After family members have had an opportunity to volunteer their services, it will be necessary to locate and research community resources, in order to address the remaining areas of the care plan. Prior to contracting for any services, it is important to make sure that you do your homework. Here are a few examples of questions that you may want to ask:

Home Health Agency

Is the Agency licensed by the State?
What type of credentials do the staff have?
Are the staff trained, bonded, etc.?
Does the agency provide the level of assistance you require, given the elder's 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 wound and dressing care?
Does the agency staff provide physical, occupational, or speech therapy?

Assisted Living Facility

Is the facility licensed by the State?
What services goes the facility provide?
Does the facility provide the level of assistance you require, given the elder's 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 is the program open?
What are the eligibility requirements regarding age, diagnosis, and functional status (e.g. incontinence, memory problems.)?
What is the staff to participant ratio?
What kind of activities do they offer?
What type of credentials do their 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 outlining the specific services to be provided, the fee for services, and the organization's procedure for handling complaints.

STEP 5      Developing a Care Plan

The development of a care plan is based on the elder's needs, wishes and desires, their financial situation, as well as their access to available resources. Once the elder has undergone a Comprehensive Geriatric Assessment, the information will be used to outline an action plan that focuses on the individual's current needs, required treatment (e.g. medical, psychiatric, physical therapy), housing requirements, and optimal utilization of community resources.

Based on the individual elder, 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 continually monitor the elder, and as their needs change, the care 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 elder 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 elders 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 elder's needs change, services may be implemented to address their evolving needs.

Skilled Nursing - are designed for elders 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 - is designed to offer services for terminally ill 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. 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
     
  "Knowledge is Power"
 

Francis Bacon

Depending on the status and individual needs of the elder, it will be important to obtain as much information as possible about relevant topics such as aging, caregiving, dementia, depression, alternative housing options, Alzheimer's Disease, Parkinson's Disease, Hospice, etc. Here are a few resources to help you get started:

Alzheimer's Association (203) 845-0010
Medicare (800) 633-4227
Social Security Administration (800) 772-1213
Hospice Association of America (202) 546-4759
American Parkinson's Disease Association (800) 223-2732
Clearinghouse on Elder Abuse and Neglect      (302) 831-3525
Eldercare Locator Hotline (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) 336-4797
National Institute of Mental Health (301) 443-4513
National Stroke Association (303) 649-9299

STEP 7 Arranging for Important Legal Documents

Have you ever wondered what would happen if an elder became incapacitated, and is unable to communicate their wishes, related to their medical care or financial affairs?

All too often an elder becomes incapacitated, and their family scrambles to locate important financial and legal documents, in an effort to ensure that they receive necessary care. You may not even be sure if the elder ever put their wishes in writing. What now! Unfortunately, if the elder has not taken a pro-active approach prior to this point, their loved ones are bound to face a very stressful and overwhelming task.

It doesn't take much, for an elder and their loved ones, to ensure that all their personal affairs are in place. By having an attorney, prepare a set of documents in advance, the elder can ensure that their wishes will be followed. There are at least four key documents that the elder 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 an elder 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 elder 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).

Living Will

If an elder is in need of medical treatment, a Living Will clarifies issues, related to the use of life support systems. When an elder completes a Living Will, it is important to share this information with their physician and loved ones, because often times the elder's 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 an elder having a health care proxy, is that it assigns an individual to make health care decisions, in the event that the elder is unable to make decisions for themselves. 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 an elder select a person, whom they know will honor their expressed wishes.

STEP 8 Utilizing Additional Tools

One concern that is often expressed by loved ones, is what if the elder 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 not check on the elder on a regular basis. There are a number of tools that may be appropriate for your situation.

1. The elder 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 elder may fall and be unable to reach the telephone
     
  There are a number of services available, that provide the elder with a pendant to wear, connecting them to a Central Monitoring Station. In the event that the elder falls and is unable to reach a telephone, the elder can push a button on the pendent, immediately connecting them with the Monitoring Station. The elder will then receive support and reassurance, while emergency help is dispatched to their location.
     
3. The elder 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 the elder 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, an elder 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 elder just decides to stop taking the medication. Initiating a conversation with the elder, 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 elder 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 elder 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 elder 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 an elder 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 the elder. Often times, the caregiver is so consumed with doing all that they can for the elder, 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 can not 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

For more information on Caregiving click on The Caregiver

 

To obtain more information or to request a consultation click on Contact Us

     

About Our Company

Employee Assistance Professionals, Inc. has over twenty five years of experience providing services for individuals, couples, families, and organizations.  Our mission is to provide a broad range of high quality counseling, outreach, and consultation services to help clients assess their needs, evaluate their relationships, define their goals, and design action plans that includes specific and practical steps to achieve those goals.

Our organizational goals are to:

  - provide services regardless of race, color, ethnicity, sexual orientation, or religion
  - respect our clients' beliefs
  - support our clients' individuality, diversity, and unique needs
  - preserve our clients' independence, dignity, and confidentiality
  - offer services to individuals, couples, and families
  - consult with professionals, businesses, and other organizations
  - design and run effective Employee Assistance Programs (EAPs)
  - conduct quality educational programs

 

The Caregiver Resource Center is a division of Employee Assistance Professionals, Inc.  Our mission is to assist seniors, people with special needs and their families; in understanding the aging process, facilitating open communication; and providing information, support and guidance through the caregiving process.

Our goals are to:

  - offer services that will help preserve an elder's health, safety and quality of life; while at the same time allowing them to maintain their independence and dignity.
  - provide support, understanding, and guidance to all person's who are directly or indirectly responsible for the well-being of an elder; in an effort to improve the quality of their lives.

 

In addition to working with seniors, people with special needs and their families; The Caregiver Resource Center also provides a spectrum of services for businesses and their employees.

Our services help maximize employee productivity, sustain supervisors' focus on operations, and equips senior management with an effective cost management tool.

We are available to provide services on a case-by-case basis, or as a full service company program.

 

The Caregiver Resource Center
a division of
Employee Assistance Professionals, Inc.
PO Box 122
Cos Cob (Greenwich), CT 06807-0122

For more information or to request a consultation, please contact:
Linda A. Ziac,
LPC, LADC, BCPC, CCM, CEAP, CDP
President

 

  

(203) 861-9833
Contact Us

 

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Any reproduction of the content of this website site is strictly prohibited, without prior written permission from Employee Assistance Professionals, Inc. and The Caregiver Resource Center.

Updated 12/1/14

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