List of Needs
The first step in organizing a
rational care plan is making a list of needs. As family members or
friends care for an impaired elderly person, several questions
In answering these questions you are
developing an important List of Needs of the impaired elderly
person, and bringing into perspective the caregiver's needs as well.
The questions do not have easy answers and the solution may vary in
every situation. The care of an impaired older person can create
stress that affects the ability of the caregiver to continue giving
necessary levels of care. The stress experienced may be physical,
financial, environmental and/or emotional in nature.
- What are his/her needs?
- What kinds of care are needed to
allow the elderly/impaired person to remain in the community?
- Who is going to provide the
care? When? How?
- Should the care-receiver remain
in his/her own home, live with the children or other relatives
or move to other surroundings (retirement apartments,
residential care, intermediate care, skilled nursing facility or
- How can living arrangements be
changed to help the person stay in the home or become more
- If outside services are needed,
does the impaired person have the resources to pay for them? How
can they be obtained?
- How can care be given to the
person in need without denying attention to others (spouse or
children) for whom the caregiver also has responsibility?
- Do you as the care giver feel
tired or frustrated from caring for an older person?
Physical Stress: Providing
physical care to an impaired older person can cause physical stress.
General homemaking and housekeeping activities such as cleaning,
laundry, shopping, and meal preparation require energy and can be
tiring, particularly when added to existing responsibilities in
one's own home.
Personal care required for the
supervision of medications and the maintenance of hygiene can also
be stressful, particularly in situations of acting-out behaviors,
incontinence (loss of bladder or bowel control), colostomies, or
assistance with bathing.
Lifting and transferring individuals with
limited mobility is not only tiring, but also can result in injury
to the caregiver or the impaired person. In some instances there is
the additional responsibility of maintenance of equipment such as
wheelchairs or hospital beds.
Financial Stress: The care
of an impaired elderly person has many financial dimensions. For
those services that cannot be provided by family members (medical,
pharmaceutical, therapeutic, etc.), decisions will have to be made
as to where service will be secured and how they will be paid. When
money is limited, many families assist with the cost of care,
causing financial burdens on all family members.
Environmental Stress: The
proper home setting has to be chosen. If the care-receiver elects to
remain in his/her own home, modifications such as railings and ramps
may have to be installed.
If the person cannot remain in his/her own
home, alternative arrangements must be sought, such as moving in
with a friend or relative or specialized housing (retirement hotels,
senior apartments, residential care homes, intermediate care
facilities, or nursing homes).
If the care-receiver is to remain in
the home, some major adjustments in the living arrangements and
patterns of daily living will be necessary.
Social Stress: Providing
personal care up to 24 hours a day can cause social stress by
isolating oneself from friends, family and a social life. The
caregiver may find him/herself becoming too tired or unable to have an
evening out even once a week, or once a month. What can result
is a build-up of anger and resentment toward the very person
receiving the care, as the care-receiver is the cause of the lost
Emotional Stress: All
of these factors often result in tremendous emotional stress.
Compounding these sources of stress are the difficulties in managing
one's time, juggling multiple responsibilities, and feeling the
pressure of the increased dependency.
For family members providing care,
the various forms of stress can result in different feelings. Anger,
resentment and bitterness about the constant responsibilities,
deprivation and isolation can result.
This is also a time when many
of the unresolved conflicts from parent-child relationships
resurface and can intensify, causing anxiety and frustration. There
might even be the unspoken desire, at times, to be relieved of the
burden through institutionalization or even death of the
This desire is frequently and
swiftly followed by feelings of guilt. All of these can be felt,
then denied because they seem unacceptable. The person giving care
needs to be assured that, in fact, these feelings are common even
though they may not be expressed.
There are resources that can help
caregivers. The remainder of this book will address those resources,
such as joining a caregiver support group, using community resources
and above all, caring for yourself the caregiver.