What is Elder Care?
Elder Care describes the issues and care concerns for the frail elderly who make up 5% of the over 65 population. This means that of the approximate 45 million seniors currently in the U.S. 16% of the 2003 general population), 2.25 million are frail. Frailty is defined as chronic functional impairment in one or more of 6 activities of daily living (ADL's) requiring the help of another person. These ADL's include:
- bathing
- dressing
- grooming
- eating
- transferring
- toileting
While small in percentage terms, this group is also the cohort that utilizes the most healthcare resources including inpatient medical hospitalization, home care, and long-term care in nursing homes and other residential care facilities. It is important to recognize and keep in mind that 80% of the care provided to frail elderly in this country is provided by family members. Read more...
Services available to elders
Elder Care can be thought of as an umbrella of care and services for the frail elderly. These include a broad range of services including:
- Meals (in-home or in congregate settings)
- Socialization
- Personal care
- Light housekeeping in the home
- Residential facilities (retirement homes, Board and Care facilities, and nursing facilities)
- Adult day care
- Transportation
- Telephone reassurance
- Friendly visiting
- Caregiver support
- Respite care
- Emergency response systems such as Lifeline
Care options most useful for elders
Navigating the complex and often convoluted and disconnected maze of community-based services can be a daunting challenge. It can be difficult to determine what kinds of help or services could prove most useful to a particular situation such as home care vs. senior center-based socialization vs. placement in an assisted living facility. It can be reassuring to know that there exists a set of well-trained well-versed professionals in the aging services community who can help consumers through the care option and access process. Some of these professionals include agency-based and medical social workers and discharge planners in hospitals, and professional care managers.
Getting financial help
Financing of services, both in the home and in facilities, is a major concern for older people and their families. Consumers are often startled when learning how limited and specifically medical are the provisions for Medicare-covered services. For instance, just because the Medicare handbook states that 100 days of nursing home care is covered does not mean that the particular circumstances of a loved one's current illness is eligible for this level of coverage. While most of long-term nursing home care is paid for by Medicaid (Medi-Cal in California), the State program for frail, low-income/ low-asset elderly, the bulk of in-home care is paid for out-of-pocket, and is generally not covered by any insurance program.
Medical conditions that affect the elderly
The array of medical conditions that may result in frailty are numerous, and several stand out as most directly impacting upon the individual's day-to-day functioning. The most glaring of these is dementia in it's many forms (i.e., Alzheimer's Disease, vascular dementia, etc.). Other serious conditions affecting function include strokes, Parkinson's Disease, chronic obstructive pulmonary disease (COPD) and emphysema, near or total blindness, diabetes and advanced heart disease.
End-of-life options available for elders
Life planning specifically around end-of-life issues is a critical consideration in dealing with progressive chronic illness. Decision-making, whether on the part of the individual frail elder when capable or by a designated spokesperson via proxy, is a vital area to address in caregiving. This leads to a bigger discussion around mental capacity and the ability to make sound judgments and decisions on one's own behalf. There are a number of sociologic issues in aging such as conservatorship that need consideration, especially as up to 50% of persons 85 years of age or older develops dementia. And within this end-of-life area there needs to be discussion of Hospice and Palliative care options.
Support for caregivers
Caregiver concerns stand as a large area of consideration in Elder Care. Remembering that 80% of the care provided to the frail is given by families, it is key that these caregivers are supported over time. This support may take the form of:
- respite services
- support groups
- accurate, in-depth information about specific medical conditions
Sometimes such information can be garnered through condition-specific associations such as the Alzheimer's Association or the MS Society, to name just two.
Effects of depression on the elderly
Moderate to severe depression often accompanies physical decline and frailty. As many as 70% of institutionalized elderly experience significant depression, and the incidence in community settings is approximately 18% in the over 65 population (as opposed to 8% in the general population). Some estimates of frail elderly living in independent settings have found a 30% or higher incidence. Depression is a medical condition that affects not only quality of life, but also the way in which people take care of themselves. It is a condition that is usually easily resolved with new treatments, but untreated in the elderly, it can have dire consequences.