No one plans to become a family caregiver. It happens. Sometimes we become caregivers gradually. Our aging spouse or parent needs help with a few activities, such as grocery shopping, household chores, doctor appointments. As time goes on the need for assistance increases until one day we realize that we are spending many hours a week ‘helping out’. Other times a medical crisis is the precipitating event.
There are strategies that you can employ to help you become the best care giver you can be. Professional care managers always begin with an assessment, and there are good reasons why they do this. The assessment helps identify the care giving needs. Although you may not have the skills of a professional social worker or care manager you have one big advantage—you know the person.
Where do you start? A good assessment looks at a number of factors: a person’s physical, mental, cognitive and functional status, their living environment, social network, and their spiritual needs. So let’s begin to break these down.
In order to provide good care you first have to make sure you have permission from the person and the authority to do whatever has to be done. Your care giving may require health care and financial decisions as well as assistance with care and activities. It is for this reason I talked about advance care directives in my previous post. In this post I am going to assume that you have permissions required to undertake the care that is needed.
For obvious reasons it is important to understand the person’s physical status. This includes getting a health history in addition to learning about their current medical situation. Past health issues, even those not directly related to a current health event, often effect care needs. Then, of course, you need to become informed about the current health care issues. Educate yourself about your care receiver’s diseases, injuries and conditions from reliable sources, the doctors involved with their care, the National Institute for Health, Mayo Clinic, and other reputable websites.
Gather a list of all current medications and dosages along with instructions on how they should be taken. Older adults are particularly affected by polypharmacy—that is the prescribing of multiple medications. This happens easily when a variety of specialists treat a patient. Problems arise when these medications interact with one another in negative ways. You may want to request a medication review from a pharmacologist. Sometimes what looks like a medical, mental or cognitive problem is caused by medication.
Here again, it is important to find out if there have been any mental health problems in the past. While you may not be qualified to conduct a mental health assessment you will probably have a good sense of the person’s mental status since you know them. If you think they are anxious or depressed you should talk to their doctor about your concerns. These symptoms can be the result of illness or medications.
Much the same applies to an evaluation of cognitive status as to mental status. Sometimes people become temporarily confused due to illness, fever, or anesthesia. However, a stroke, for example, could impact cognition in permanent ways. And, of course, you want to know if there has been evidence of dementia in the past.
How much help does/will the person need in order to perform activities and tasks of daily living? This can range in duration from temporary assistance during a recovery to a permanent need for care. For example, a person might need someone present while they bathe or dress in the early stage of recovery just to steady them. Alternatively, they may need ongoing assistance if they fail to regain function following a stroke. It can also range in intensity from light assistance, such as help with chores, to total care for someone who is bedridden.
It is important to look at the person’s living environment with a critical eye. Is the home set up to accommodate whatever limitations the person has? Are there stairs? Handrails on stairs? Grab bars in bath tubs and showers? Good lighting? Trip hazards, such as area rugs? Many of these can be corrected with minor changes. However, depending on the level of impairment the person might not be able to return to their prior home without extensive remodeling.
It is very helpful to identify the person’s family and friends. Family and friends can be an important source of help and comfort for both you and the person you care for. A visit from a close friend often does more improve a mood than medication. And having someone come in to give you a break is critical.
Attending to spiritual needs may be extremely important to the person, both at the time of a crisis and afterwards. If you know that the person has a religious or spiritual affiliation, a visit from a pastor, priest, rabbi or healer may be just as important as the visit from the doctor.
These form the basic categories of the assessment. The assessment is a necessary first step that allows you to develop a care plan. It may not be possible to gather all the information you want or need. You may be able to fill in missing pieces as time goes by. However, whatever information you collect will help you as you put together a plan of care.
In my next post I will talk about how to develop a care plan based on your assessment.