Elder Care

Elder Care

What is elder care?

Eldercare is the fulfillment of the special needs and requirements that are unique to older adults. This can include services such as assisted living, adult day care, long term care, nursing homes (or residential care), hospice care, and home care.

The stages of aging

The stages of aging based on physical abilities looks like this;

1. Independence
2. interdependence
3. Dependency
4. Crisis management
5. End of life

Transitioning from stage 1 to stage 2 is not quite as dramatic for older adults as from stage 2 to stage 3. This is the stage where you may want to start discussing long-term care plans and preferences with your parents. The earlier the better! Short, causal conversations may be a good way to start. For example, "Have you ever thought about....?" or "How do you feel about having help in the house?". What is important is to keep the lines of communication open and transparent.

Stage 1 to 2 includes transitioning from total independence to some assistance in housecleaning, meals and shopping. Stage 2 to 3 usually means having to have full time caregivers at home, or transfer into a continuing care home facility. This is a total loss of independence. this can be very hard for older adults to accept.

Challenges facing the elderly Part 2 of 3

As we age, new challenges are faced. These include biological, emotional, intellectual, social, and spiritual changes. Sometimes these changes can be more frightening than the thought of dying. Loss of independence for example may leave an older adult frightened and vulnerable, and thus resistant to care. Understanding these changes from the older adult perspective can lead to smoother communication about the need for care. More details on what to expect when aging can be found here https://www.mayoclinic.org/healthy-life-style/healthy-aging/in-depth/aging/art-20046070

When to Step in

Ideally, conversations about care start long before any issues arise. There are some things to look out for that should raise a red flag and indicate a more urgent need to assess the family member and place of residence. These include:

• Falls - falls are a leading cause of seniors' injury anywhere. One in three elderly people in Canada will have a fall in any given year.
• signs of neglect (poor personal hygiene, difficulty shaving, soiled clothing, weight loss)
• Difficulty walking; or climbing stairs
• Difficulties with medications (taking them too often, or not at all)
• Changes in eating habits
• Unpaid bills
• Irritability or sudden mood changes
• Concerns about driving
• Recovery from surgery, or the parent has a sudden, temporary illness and wants to stay at home
• More serious illness has been diagnosed - for example, Alzheimer's, Parkinson's
• Difficulty recovering from a hospitalization, especially if they experienced delirium
• Sudden disability after a fall, stroke, or other health emergency
• Increasing forgetfulness
• They may live in a neighborhood where they are vulnerable to crime, or have been scammed online
• Indications of loneliness and/or social isolation
• Financial vulnerability (or exploitation) - you feel a loved ones' "friend" or neighbor seems to have unprecedented access to your parents' bank account
• Legal or other financial issues

What can you do? Part 3 of 3

Early signs of dementia versus typical age-related change is important (https://www.alz.org/alzheimers-dementia/10_signs).

Here are ten common symptoms:

These 10 signs are listed on a worksheet at: https://www.alz.org/media/Documents/10-signs-worksheet.pdf Take action is you are concerned that you, or someone you know is displaying any of these signs.

More resources can be found at: Alzheimers Society

A doctors' appointment checklist (that includes questions to ask) is available to download: Docotrs Checlist

Another helpful tool offers suggestions on what to do when you notice changes in others: 10 Step to Approach Memory Concerns

" Fall Prevention" - an excellent source for information on fall prevention is at this link: Fall Prevention - Province of BC A number of strategies are listed as effective for reducing the number and frequency of falls. In Alberta: Preventing Falls in Older Adults

The strategies to reduce falls include:

Excercise programs, environmental modifications (rails, grab bars, removing rugs, clutter); education (informing older adults about risks); medication modification; the correct use of walkers/canes scooters and other devices, and the use of hip protectors to cushion the hip from the impact of a fall.

Signs of Neglect:

Signs of neglect could be an early sign of dementia (see above), or of depression. Ask your loved one for permission to speak with their doctor, and raise your concerns with them. If your loved one already has some level of homecare and signs of neglect persist, other resources include: Protection from Elder Abuse and Neglect and Elder Abuse - Get help

Difficulty walking or climbing stairs:

Assistive devices for walking can range from walkers (with wheels) to motorized wheelchairs or scooters. For climbing stairs, options range from "stair elevators" (such as Acorn Stairlifts) to installing a residential elevator in the home( such as Stiltz home lifts). When looking at any of these options, ask the supplier if any of the items are covered by provincial plans. Other options might be March of Dsimes (www.marchofdimes.ca) or Veterans' Affairs (www.vac-acc.gc.ca). Short term loans of equipment can be secured through The Canadian Red Cross (www.redcross.ca). Finally, check if your loved one has any private health insurance policies regarding coverage subsidies.

Difficulties with medications:

Pharmacists can help with medication control. Blister packs are now fairly common through most pharmacies. These control the day, time and amount of medication as well as having the option for different medications on a timed schedule throughout the day. This makes it easier to keep track of which medication is to be taken and when, as well as knowing if a dose has been taken, not been taken yet or skipped.

Changes in eating habits:

People tend to eat less as they age and this is normal. However, sometimes , as with the loss of a loved one, it becomes very difficult to cook for one person rather than two. Programs such as Meals-On-Wheels can help provide nutritious meals one to three times daily as required. Or, if you are cooking for the family and your loved one lives nearby, freeze extra for them so they just need to pull it out and reheat.

Unpaid bills:

Today it is easy to set up online banking and automatic bill payments. If you notice your loved one has overdue bills, then this option is a good one to keep bills paid on time. Ask your family member how they feel about either setting up online bill payments, or having you check their bills to make sure they are paid.

Legal and financial issues:

These issues are best discussed before any illness or mental deterioration. A way to introduce the topic is to say something like "hey mom, if you become ill suddenly and we are not able to talk or communicate, who would you want making healthcare decisions for you?" An excellent resource to understand the difference between Representation Agreements and Power of Attorney can be found at - Representative Agreement

Representation agreements can be drawn up for personal care only, for personal care and property, or for property only. Generally, a Section 7 Agreement is enough to cover routine, day-to-day care needs. Make sure they understand these are being drwan up only for use in an emergency or sudden deterioration in mental health. Advanced directive resources can be found at: BC Government - Advanced Care planning

Sudden illness or recovery from surgery:

hiring a private caregiver is a great option for these circumstances. Look for reviews, ask exactly what their care will be, speak with people and find the right fit for your loved one.

Concerns about driving:

This is probably the most sensitive issue to raise in a discussion. Many older adults cling to the independence that driving affords. It does not matter that taking a cab everywhere is often cheaper than maintaining a vehicle - the sense of independence that owning and driving a car brings, is priceless. In most provinces, once you reach 80 years you are required to take your test every two years and pass a test of cognitive abilities. But what if you have concerns before then? The best strategy is to discuss this with your parent first, if it can be done calmly. The next step is to discuss your concerns with their doctor. The doctor (if they agree problems are serious) can notify the Provincial licensing authority that your loved one is no longer safe to drive, and have their license revoked.  This is obviously a last resort as it is likely to cause great anger and resentment. However, better this than a tradegy with your loved on behind the wheel.

Other excellent resources can be found in both British Columbia and Albert through these links:

The British Columbia Seniors Guide

Service and Information: Alberta Government (includes financial assistance, seniors events and support for seniors)

Aging in British Columbia (includes healthy aging, financial and legal matters, caring for seniors, housing, home and community, health and safety, transportation)

Supporting Caregivers

Family Caregivers of British Columbia has an excellent Caregiver Self-Assessment tool that is also Downloadable (Caregiver Self-Assessment). Completing this tool gives the caregiver a guide to creating a self-care plan. It can start with just learning about the resources available to caregivers. For caregivers who are struggling, the Employee Assistance Plan (EAP) can help them sort out the mixed feelings often associated with looking after a senior parent or partner.

Family caregivers can use a variety of self-care strategies to keep their caregiving strain manageable.

These include:

• joining a support group
• asking for help
• setting boundaries
• allotting time to tend to ones' own health and other needs

Dealing with resistance

How do you help a loved one who does not want help? It can help the caregiver by understanding the reasons for resistance. If someone is in need of care it is usually because they have lost something - a physical loss, loss of a spouse, or loss of independence. To admit to needing help means having to let go of at least some of your privacy, and accept new routines. This can make someone feel frightened and vulnerable, angry that he or she needs help, or guilty about the idea of becoming a burden to the family and friends.

Some common reasons for resistance include:

• pride
• guilt about being a burden to the family
• anger at their situation - perhaps because they cannot do things the same way as before
• fear of losing independence
• denial that they actually need help
• depression form loss of a spouse
• fear that their lives will not be the same
• dementia

In all cases, remember - you are dealing with an adult who is used to independence and making their own decisions. Treat them as such and involve them as much as possible in the decision making. And if possible, at least the conversation early.

Jocelyn C. Herrett, DSW, RSW

Walmsley, EFAP