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More on Elder Care
What is elder care?
Americans are living longer and living well for longer periods of time. This has created a relatively new and growing area of health care and provider services, known as elder care. Elder care encompasses a wide variety of issues, including choosing an appropriate physician to care for an aging patient, and making decisions about moving an elderly person from the home environment to a residential care setting. Persons age 65 and older are the fastest growing segment of America's population. Many elderly people are living healthy, active, and independent lives. However, as more people reach their 80s and 90s, the number of elderly needing assistance with daily living increases, along with the responsibilities of those who provide care for them.
Elder care statistics:
According to the US Department of Health and Human Services' Administration on Aging:
- The older population (persons 65 years or older) numbered more than 37 million Americans in recent reports.
- The number of older Americans, age 65 and over, is projected to increase from 35 million in 2000 to 40 million in 2010 and then to 55 million in 2020.
- Today, persons who reach age 65 have an average life expectancy of an additional 18.6 years (20 years for women and 17.2 years for men) than what was estimated in 1900.
- In 1900, the average life expectancy was 49.2 years. Today, it is 77.9 years.
What is involved in choosing a physician for the elderly patient?
Different stages in life can require different health care providers. For the elderly, it is important to have a personal physician, or primary care physician, who understands the special needs of older patients.
Many types of physicians, including family practitioners, internists, and geriatricians, care for elderly patients. A family practitioner provides health care to all family members, regardless of age. An internist specializes in internal medicine generally for adults. A geriatrician is specially trained in elder care.
Choosing the right primary care physician is an important decision. Generally, you want a physician who is competent and well trained, and cares for and about the patient. Other considerations include:
- Will my insurance pay for office visits and physician services?
- Is the physician a solo practitioner, or is he/she part of a practice group?
- Does the physician accept Medicare patients? What are the practice's Medicare policies and procedures?
- What are the physician's managed care affiliations?
- Is the physician's office in a convenient and safe location?
- At which hospital does the physician treat patients?
- Am I comfortable with the age and gender of the physician?
- Are there any language barriers?
- Is the physician a good listener and communicator, explaining things clearly, fully and patiently?
- What is the physician's policy about continuing to follow patients who move to residential care centers?
What is involved in interviewing the physician?
Once you have selected two or three possible physicians, it is a good idea to visit their offices and ask them questions about office policies and their approach to elder care. For example:
- How far in advance do I have to make an appointment for a non-emergency visit?
- How are emergency visits handled?
- Do you treat many elderly patients?
- How do you feel about having family involved in health care decisions?
- Do you continue to follow patients if they move to a local residential care facility?
What is involved in getting ready for the appointment?
To make the most of each visit to the physician's office, it is best to plan ahead. The following guidelines may help you to prepare for the appointment:
- Know all the basic information that is likely to be asked of you (see Basic Information Form).
- Bring medical records or have them sent ahead.
- Know what medications the patient is taking, including prescription drugs, over-the-counter medicines, and vitamin and herbal supplements.
- Know all diagnosed medical conditions.
- Bring along a family member to act as a "second set of eyes and ears" for the elderly patient.
- Write down questions beforehand, including any concerns you would like to discuss with the physician.
- Bring a notepad and pencil or a tape recorder with you to record instructions, take notes, etc.
When visiting your physician, it is best to have the following basic information available to help your visit be as productive as possible. You may use this Basic Information Form to help you prepare for your next medical appointment.
Basic Information Form
|Date of birth||
|Social Security No.||
|Additional insurance provider||
|Primary physician's name||
|List diagnosed medical conditions:|
|List past surgeries and year performed:|
|List all medications:|
|(Name of drug)||Prescription or other?||Dosage|
Selecting an elder care facility:
Knowing if and when the time is right for an elderly person to move from the home to a residential care setting can be one of the most difficult decisions a family must make. Many persons continue to care for the elderly at home even though it becomes physically and emotionally exhausting for them to do so. Sometimes, moving to a residential care setting may become the most realistic decision to ensure the best care for the elderly person.
Moving from home and into residential care facility should be considered when one or more of the following situations applies:
- The elderly person requires round-the-clock care.
- The elderly person cannot manage activities of daily living (eating, toileting, bathing, etc.) without assistance.
- The elderly person is prone to violent outbursts (physical and/or verbal) or is a danger to himself or to others.
- The elderly person has "wandered" away from the safe surroundings of home or neighborhood.
- The caregiver's health and well-being is adversely affected by continuing to render care at home.
Types of out-of-home options for the elderly:
There are many types of out-of-home care options for the elderly, depending on the level of care required. These may include:
- Assisted living facility (ALF)
ALFs provide maximum independence for elderly persons who remain relatively active and healthy. Typically, a healthy spouse and an impaired spouse can live together in an ALF. Most ALFs feature apartment-style living, including individual kitchens, and many services for the elderly, such as 24-hour security, transportation, and recreational and social programs.
- Residential care facility (RCF)
RCFs are for those who are no longer able to live alone and independently, but do not require skilled nursing care. At an RCF, the elderly person can receive assistance with personal hygiene, grooming, and/or other activities of daily living, as well as bedside care for minor and temporary illnesses. Typically, RCFs offer rooms, not apartments, and provide some recreational and social services for the elderly.
- Skilled nursing facility (SNF)
SNFs are also known as nursing homes, convalescent centers, and rest homes. At SNFs, elderly patients receive continuous nursing services under the care of a registered nurse or licensed vocational nurse. SNFs can provide more extensive care services than assisted living or residential care facilities. Such services include intravenous feedings, blood pressure monitoring, medication injections, and care for patients on ventilators. SNFs often provide recreational, rehabilitative, and social programs for residents.
Special care centers are available for persons with particular medical conditions, such as Alzheimer's disease or dementia. For patients displaying violent or disruptive behaviors or presenting a danger to themselves or others, special psychiatric facilities may be an option.
What to consider when selecting an elder care facility:
- Is the facility staff amenable to your taking a tour and stopping in at mealtime to visit with residents?
- What care services are provided and do these services match your own individual needs?
- How much input does the individual and family have in daily life and care?
- What choices of accommodations are available?
- Are there graduated levels of care available? For example, can residents move from an assisted living environment to a higher level of care should the need arise?
- What personal items can be brought from home? What items are not allowed?
- Can residents have their own car on the premises?
- What is the visitation policy?
- Does the facility have a particular religious affiliation, and, if so, is the individual satisfied with this affiliation?
- How would an emergency situation, such as fire or severe winter storm, be handled by the facility? Does the facility have an emergency or crisis management plan in place?
- Is the facility clean and tidy throughout? Are sanitary standards strictly enforced?
- Are appropriate safety measures taken (clearly marked fire exits, well-lighted hallways, bathroom grip bars, in-room emergency call system, etc.)?
- Is the facility located in a safe and convenient location?
- Is 24-hour security provided?
- Are individual rooms bright, cheery, and roomy?
- Do room arrangements allow for privacy?
- Do individual rooms have windows, allowing for natural light and a pleasant view?
- Are the common areas (activity rooms, lobby, gathering rooms) large, bright, and well kept?
- Is the dining room welcoming, spacious and not too crowded, and easy to move around in?
- Is the kitchen area clean and organized?
Respect for the elderly individual:
- Does the facility have a written policy about patients' rights and responsibilities? Is it made readily available?
- Is the staff trained to treat residents with dignity and respect?
- Are patients and families involved in developing the patient's care plan?
- What is the number of staff members available per shift?
- Is the staff friendly and respectful of patients?
- Are continuing education and training a priority?
- Specifically, what staff medical services are provided (i.e., physician, nursing, physical therapy, respiratory care, and occupational therapy)?
- What is the patient-to-nurse ratio?
- Is nursing care provided 24 hours a day?
- What are the credential requirements for the nursing staff?
Licensure and certification:
- Is the facility licensed by the state?
- Is it licensed to provide Medicare and Medicaid coverage?
- Which services are included in the standard rate? Are other services provided for additional fees?
- What are the facility's Medicare and Medicaid policies?
- Is a physician available for emergencies?
- Are personal physicians allowed to follow patients at the facility, or does a facility-appointed physician treat residents?
- Does the facility have arrangements with a nearby hospital should an emergency occur?
- Is emergency transportation available?
- Is there a well-rounded program of social and recreational activities for groups and individuals? For example, does the facility offer outdoor outings, arts and crafts classes, movie outings, exercise classes, reading clubs, and the like?
- Does the facility stay active and connected with the surrounding community?
- Are outside trips and activities planned regularly?
- Are meals provided at the facility, and what are the meal plan options?
- Does a licensed dietitian approve all menus?
- Can the facility accommodate those persons with special dietary restrictions?
- For persons wanting to take some meals in privacy, is there a small kitchen or kitchenette available in the individual room or apartment?
- Does the facility provide chaplain services?
- Are housekeeping and laundry needs available? If so, are they included as part of overall fees or provided at an extra cost?
- Is transportation available for trips to the local shopping center, grocery store, library, and bank?
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