ADVANCED CARE PLANNING
Advanced Care Planning
It is likely that if you are reading this article you fall into one of three categories.
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.
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:
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:
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:
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.
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)
Cognitive and Mental Health
Legal - Financial Evaluation (e.g. financial resources, ability to manage own finances, advance medical directives)
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
Assisted Living Facility
Is the facility licensed by
Day Care Program
What are the hours of
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:
Adult Day Care - is a supervised day program that addresses the cognitive and functional needs of impaired adults. Services may include:
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.
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.
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:
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).
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.
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
Some Steps to Self Care
For more information on Caregiving click on The Caregiver
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