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The Caregiver's  Home Companion

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Posted: February 23, 2005

Professional Caregiving

Major Eldercare Decisions -- Where to Begin?

Who are your customers? Are they caregivers or are they care receivers? Does part of your work entail providing support as they move along the care continuum? Are you helping them process some of the resistance or denial they exhibit while simultaneously espousing their need to act? Exploring the source of this push/pull dilemma can go a long way in empowering your customer to take necessary actions, whether it is self care issues, collecting resources and evaluating them or taking steps in a new direction.

Raising the prospect of long term care understandably can be felt by the older adult as a statement about their aging, their losing independence or the need to give up control. It may also bring up painful self-images of becoming a burden. For this reason, many older adults worry about their future care needs, but avoid the discussion due to the discomfort it produces.

Likewise, bringing up the topic, if you believe someone else may need long term care, can cause the concerned caregiver to feel this is an insult or worse, a challenge to their older family member. Further complicating this scenario is that a mix of feelings may exist or develop among a number of the family members involved in the long term plan of a loved one. These feelings can include anger, guilt and anxiety, plus a varying assessment of the person?s future care needs.

The prospect of these situations can prevent the general conversation from taking place before care is actually needed. Many families find themselves forced into emergency-triggered decision making, which is the worst type to make. When there has not been an initial discussion about the older person?s preferences, the options they would consider in a variety of situations, the family only has conjecture on which to base decisions which are often life altering.

Some families need to get the conversation off the ground through the use of an outside party. Any of a range of professionals can and should be considered. The person?s medical doctor is a good place to start. The physician can make a general assessment of the person?s physical condition and identify the appropriate care management professionals they deem of value. At the other end of the spectrum are the friends and family who may have heard of good resources, services and professionals. These are good to consider as they have already proven to pass the muster of their reliable contacts.

Many people find confiding in their pastor, clergy or rabbi is a comforting first step. They can trust the confidentiality and the experience the religious leader has had with previous members of their community. Some clergy do this type of counseling themselves, and others can recommend knowledgeable resources to the family for further investigation.

While some folks seek a professional who has been involved with their loved one to begin the process, community agencies are valuable resources to contact as well. Area agencies on aging, departments of aging, the United Way agencies, and many others can be a good first step in reaching a professional who can provide a listing of resources. Early preparation of a file of these resources can be invaluable to families as they begin developing a plan of action later.

Geriatric care managers, as a profession, are the embodiment of the information, referral counseling and oversight needed when an older family member begins to need care. If there are geriatric care managers in the community, they are an excellent place to start exploring options available.

All of these resources will provide information based on the assessment you describe, which should be medically based. If there is any question in your or your family member?s mind that the medical needs identified by the family physician do not match the person?s care needs, finding a geriatrician or geriatric assessment program will give either a supportive or more detailed report on the physical, mental and emotional needs of the older adult. When we had our kids, we used a pediatrician. When our parents age, their medical conditions deserve the attention of a specially trained physician for geriatric conditions. This might be the best first step to getting the total picture of a family member?s condition and care needs.

However one chooses to start the process, a solid medical evaluation and the development of a file with information and resources gathered will strengthen the capability of the family group?s discussion of the care of an older loved one.

Coaches, family mediators and geriatric care managers, among others discussed above, can assist families through the difficult maze of care coordination. Arming oneself with the best information, however, is the most critical part of the process.


Sylvia Nissenboim is a licensed clinical social worker and who has been working in the field of adult day services in the St. Louis area. She is the director of four adult care and enrichment centers for the American Red Cross and also operates a personal and professional coaching firm, LifeWork Transitions, specializing in caregiving concerns, adult day care management and other aging services, such as virtual coaching and family care giving support groups. She co-authored The Positive Interactions Program, is a national speaker, and has served as president of the Missouri Adult Day Care Association and as a member of the Missouri Governor's Advisory Council on Aging..

© 2005 Pederson Publishing, Inc. All Rights Reserved.
Commercial use, redistribution or other forms of reuse of this information is strictly prohibited without the prior written permission of Pederson Publishing.

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