When a company leader retires or dies, a succession plan is activated to keep operations running smoothly and uninterrupted. And just like countries and corporations, older adults are also in a vulnerable position: Their lives depend on continued care, which is why it only makes sense to plan for a successor in caregiving.
Family caregivers, however, are often so caught up juggling daily caregiving duties with other responsibilities, they don’t think of it.
In her 20+ years of assisting older adults and their families, social worker Daxa Sanghvi, MSW, has seen it happen countless times: A caregiving spouse dies, and their adult children are left unaware of their surviving parent’s needs and how to meet them.
“Planning for succession is an important component of planning for the future that is mostly neglected,” she said.
If you don’t have a succession plan in place, don’t worry. It doesn’t have to be formal. You can write one in a notebook today. All that matters is you do it.
First, appoint a backup caregiver
Have a family meeting and choose someone to be the secondary caregiver, advises Attorney Jory Chelin of Chelin Law Group in Des Plaines, Illinois. It doesn’t require filing legal documents; it just needs to be understood that this person will take over if the caregiver dies.
“If they don’t appoint a person [and the caregiver passes away], then a judge in a probate court appoints a person to take over their care and their estate,” he said. “It’s a headache and it costs money and time.”
While an estate plan has to do with finances and is included in end-of-life planning, a caregiver succession plan is focused on continuing care of the person.
Make a list of daily caregiving duties
Sometimes caregivers don’t realize all the things they do for the person, Sanghvi explained. Even though the family knows about their health condition, they may not be aware of the level of care they require. Maybe they’re unable to cook for themselves, manage their medications, go to the bathroom unassisted, hold a meaningful conversation or lock up the house at night. It’s the details of day-to-day living that a caregiver needs to outline.
“You might want to review your day and think about daily activities—what tasks your care receiver can accomplish and what he/she needs help with, what their impairments and limitations are,” she said.
Break it down into three categories: safety, basic necessities and personal hygiene. Include elaborate answers to the following questions:
- Do they have the ability to bathe and clean up after using the toilet or issues with incontinence? If not, they can be susceptible to urinary tract infections (UTI) that can also result in delirium.
- Do they follow a strict diet? List the foods they can and cannot eat.
- Do they have a medical diagnosis? Write it down, along with their symptoms.
- Do they take prescription medications? Keep an updated inventory of drugs and dosages.
- Do they suffer from chronic depression or sundowner’s syndrome (irritability and confusion at nighttime)? Describe their emotional health.
- What is their activity level?
Make it known if they need 24/7 care
State other special needs they may have, such as requiring assistance with activities of daily living: eating, dressing, bathing, toileting and walking. Don’t forget cooking, cleaning, doing dishes and laundry, and paying bills. Do they need someone to handle chores?
Keep an updated list of their medical conditions
If the caregiver happens to be the agent in charge of making medical decisions for their care recipient – power of attorney for health care – you’ll need to name a backup person for that role as well.
“If a care recipient has Alzheimer’s or dementia, it can come with a set of issues because of memory impairment and consequently behavioral changes,” Sanghvi explained. “A person’s language, personal hygiene, ability to socialize and communicate can be affected and gradually become worse as the disease progresses. Since each person could be affected differently, it is critical to describe which ability is lost, what the person needs help with, what is their emotional state of mind and what is the most challenging behavior you must deal with.”
Are they able to call for help in emergencies? A person with Alzheimer’s can forget they’re wearing a medical alert device or not remember how to use it.
Caregivers will also need to specify changes in behavior and note the risk factors, like eating too much: People with Alzheimer’s can eat all day long if nobody is there to stop them or they can forget to eat altogether. Include safety concerns about cooking, driving, wandering outside of the home, and medication compliance. For example, do they need someone to manage the ordering and administering of their medication to prevent them from running out or forgetting they already took it—or even repeating the dose and becoming overmedicated? Another significant issue might be financial, Sanghvi said. They might spend irresponsibly or give money away inappropriately due to their confusion.
“People who are having UTIs, vertigo or frequent falls require monitoring for safety as well,” she explained.
It’s also important to summarize caregiving do’s and don’ts for that person. For instance, identify any triggers that might provoke an intense reaction from them and warn the caregiver to avoid those types of situations.
Be sure to also include in the list any sensory losses, such as vision, hearing, smell and taste. Note any skin conditions, such as sores or wounds, and cover any issues with internal organs, including the heart, lungs, kidneys and digestive tract. Mention aches, pains and joint problems, trouble with UTIs, vertigo or sinuses.
“I can’t emphasize enough the need for having a plan of succession, to keep everyone abreast of the current state of the person’s health,” Sanghvi said.