Care Management for the elderly

The Role of Family and Care Workers
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"As you get older, three things happen. First, your memory goes...and I can't remember the other two."

Trust Norman Wisdom, the indefatigable English actor and comedian responsible for this joke, to distill the challenges of aging into a memorable sound bite. Said challenges can get to the point where some degree of assistive care is unavoidable.

The need for geriatric care is quickly increasing as the population of the elderly rises quickly around the world. In 2000, just 11 percent of the global population was aged over 60 years; by 2050, the proportion will be 22 percent, according to The Lancet.

The onset of care can be gradual, such as in cases of dementia, or sudden, as in cases of stroke. The care trajectory may then proceed in a linear fashion, with increasing responsibilities as the need for care increases, or form an inverted 'U' as the person cared for regains function and becomes more self dependent. The trajectory can also be nonlinear, as is often the case with caring for cancer patients.

The primary caregivers are often family. Other carers usually get involved when the level of care or expertise needed exceeds what the family can provide. Caregivers, family and otherwise, play several roles in the context of elderly care.

Assistance with Day-to-Day Tasks
Virtually all caregivers assist the elderly with day-to-day tasks such as housework and general home maintenance, money management, shopping, laundry, meals and transportation. Caregivers also provide assistance with showering, walking, feeding, getting to the toilet and other self-care and mobility tasks. For older adults with more pressing needs, caregivers provide assistance with tasks such as medical appointments and medication management. Caregivers also provide round-the-clock supervision and hands-on assistance for individuals with severe impairments.

Providing Social and Emotional Support
Providing social and emotional support is another important aspect of the caregiving role. Because care recipients may be unable to reciprocate in part or full, this support generally differs from the type that characterizes typical relationships. Some of the challenges that caregivers experience in this context include poor or no communication, intimacy problems, frustration with role reversal, anxiety, depression and feelings of loneliness. Because providing social and emotional support while receiving little to none in return can be stressful, carers often seek social and emotional support themselves in the course of caregiving.

Providing Medical Care
As the November 2016 publication of 'Families Caring for an Aging America' notes, the homes of many elderly care recipients are increasingly turning into de facto clinical care settings. This is due to a convergence of two trends; ongoing efforts to shorten hospital stays and nursing home placements, and an increasing array of options for meeting healthcare needs in non-hospital settings. 

Caregivers are therefore increasingly performing an array of tasks, at home and in other non-hospital settings, that most people associate with infirmaries. These include inserting catheters and certain other medical procedures; monitoring medical equipment such as feeding tubes; observing the condition of their charges; and managing acute conditions such as dehydration and delirium.

Care Coordination
Elderly care involves a large and often confusing array of entities - healthcare providers, employers and payers, to name a few. Determining which of these entities provide solutions for the need at hand and then creating an appropriate care ecosystem is one of the most important roles that caregivers play. Care coordination involves a number of tasks, including making appointments, communicating with healthcare providers, ordering medications and handling insurance issues.

Decision Making and Surrogacy
Caregivers often work with care recipients to help them make and execute decisions. The nature of this kind of assistance depends on the extent of the care recipient's impairment. Where the impairment is severe, the decision may be more directive than participatory. Aged individuals with mild or moderate impairment may only require advice or guidance. Some of the factors that caregivers weigh when making decisions for - or with - care recipients include goals, preferences, values and needs. Where necessary, family members can use a range of legal tools, such as powers of attorney, care agreements and living wills, to define the preferences of the care recipient and the extent of the caregiver's decision making authority.

Given the gravity of proxy decision making, most care recipients prefer to have family members as surrogates. In some cases, family members take up the role after being appointed by a court. Apart from health-related decisions, surrogates may also make legal and financial choices for their charges.

Elderly caregiving is broad in scope. Caregivers assist their charges with self-care and household tasks such as bathing and home maintenance. Carers also provide medical care and emotional and social support. They coordinate the entities involved in providing care, and help care recipients to make decisions. While caring for the elderly is, admittedly, demanding, it is also emotionally satisfying and can provide a profound sense of purpose in life.