One of the crucial things in caring for a senior is to have a care plan. It may be informal or formal. Informally through verbal agreements and discussions among family members, including the elderly person. Formally through a geriatric care manager (GMS) or other health care professionals or administrators. Most care plans involve both family members and various health care professionals. No matter how a care plan is formulated, it is important that every senior have one. The care plan should be reviewed regularly as the elderly person's care needs evolve.
The first step in formulating a care plan involves assessment, which can also be done informally by family members and caregivers based on observation and understanding. In addition, the elderly person's recommendations are vital to preserve the dignity and autonomy of the person even if the elderly person's self-assessment is inaccurate in some areas. The elderly person's decision-making and wishes should be respected as much as possible.
In conducting an informal assessment, the family members to should take into account the categories professionals might use. For example, the Center for Social Sciences Research at UC Berkeley notes that a care plan should take into account an elderly person's mental and emotional states, as well as the person's level of social isolation.
The CSSR recommends that assessment of the person's physical needs range from a medications checklist to evaluation of the person's emergency support system. The safety of his or her dwelling should be checked as well. It is important to differentiate, too, between which compromised physical skills can be regained through therapy and which ones cannot. Of course, any care plan must assess the person's cognitive status as well.
For family members formulating a care plan, the Activities of Daily Living (ADLs) and the Instrumental Activities of Daily Living (IADLs) provide a simple framework for assessment. ADLs include the ability to dress, feed, toilet, and clean one's self. They also include mobility and the ability to raise and lower the body into chairs and onto beds and sofas. IADLs are more complex than ADLs. They usually are considered to include, in addition to meal preparation, doing one's own grocery shopping, housekeeping, and laundry. They also include the ability to use the telephone, use transportation, and to manage one's own medications and finances.
An important ADL that crosses into the IADLs is the ability to prepare one's food. Even if an elderly person is able to eat on his or her own (an ADL), if he or she cannot swipe mayonnaise on a slice of bread or use a microwave or stovetop, his or her needs are quite different from someone who can still do these things. The absence of this important skill set does not necessarily mean an elderly person can no longer live alone. It may simply require the assistance of a program like Meals on Wheels or a home health aide to come in specifically for meal preparation.
An elderly person is likely to lose IADLs and ADLs gradually. Therefore, frequent reassessment and revision of the care plan for a senior are needed. For example, someone who had done well with a caregiver who comes in several times a week may need a caregiver every day. Management of the person's medications or finances may be needed over time. In general, the IADLs will be gone before the ADLs are. There are cases, though, where a person is able to handle most of the IADLs and yet is unable to handle a basic ADL.
The assessment necessarily must include a constellation of the person's sources of available support, especially family members. The CSSR suggests that there be an assessment of factors such as the caregivers' proximity, time, ability, and the kind of support can be provided. The Center recommends that the willingness to provide the necessary care be gauged, too.
An elderly loved one's decline can be overwhelmingly depressive for family members. A care plan is essential. Everyone will be able to breathe more easily if they know that a plan is in place. Starting with a sound assessment of the person's full situation, families can construct useful, humane, and workable care plans in collaboration with their elderly loved ones.
University of California at Berkeley (n.d.). Care Plan Development. Center for Social Science Research. Available at http://cssr.berkeley.edu/pdfs/QALTC_CarePlanDev.pdf Accessed December 15, 2016.
Rosin, A.J. and van Dijk, Y. (2005). Subtle ethical dilemmas in geriatric management and clinical research. Journal of Medical Ethics, 31: 355-359. Doi: 10.1136/jme.2004.008532. Available online at http://jme.bmj.com/content/31/6/355.full.html.Accessed December 15, 2016.