Right Service, Right Place, Right Time; Part I

At some point, every caregiver comes to a crossroad.  They begin to wonder whether they can continue to provide all of the assistance needed, or should they seek some support from professional agencies.  This is a difficult decision for a variety of reasons, but the primary reason is what I might call the “independence conundrum.”

Caregivers want to preserve, as much as possible, a sense of autonomy and independence for the person for whom they provide care.  At the same time, they want to insure that the person has the assistance and security s/he needs.  Unfortunately, these are competing values.  As soon as we increase assistance and security, we have to give up some amount of autonomy and independence and vice versa.  The goal for a caregiver is to find the perfect balance, and that is not an easy task—thus the conundrum. 

When is it time to add services?  What is needed and how much?  Can this be managed at home or would another setting work better?  How do you maximize care while minimizing the loss of independence? These are important questions, but the answers are not always readily apparent.

We need to begin with a thorough, objective assessment of the individual’s functional abilities.  In other words, with which tasks does s/he need assistance and what is s/he able to perform independently?  Once you have a realistic list of needs, you can determine the intensityhow much help they need with each activity, and the frequencyhow often do they need help.

No two people are exactly alike, but we all fall somewhere on a continuum from totally independent to totally dependent.  Consider the routine activities of daily living like driving, shopping, cooking, paying bills, and also the personal care activities like dressing, bathing, grooming, eating and using the bathroom.  Can the person perform these duties completely on their own?  Can they get by with reminders or cues?  Do they need to be supervised?  Does someone need to set things up for them? Does someone need to help them or does someone need to complete the entire task for them?

Frequency of care will fit somewhere between occasional/intermittent help and continuous/around the clock assistance and monitoring. Do they need help on a weekly basis (such as shopping or paying bills)? Or, is the need for daily assistance (with dressing and grooming for example)? Do some care needs occur at varying times through the day and night (eating, using the bathroom, taking medications)? Once we determine the amount and the frequency of assistance, we are in a better position to determine what services are needed, when to start, and where is the best location.

I happened to be present once when a new caregiver asked a more experienced caregiver when he knew it was time to seek formal help with his loved one.  The answer came back: ”When you can’t take it anymore.”  That was a response from a loving, caring, heroic husband about his decision to get help with his wife.  While I value the advice of a dedicated caregiver, I suggest that this might not be the best criteria to make this decision.  I recommend that caregivers start to think about available resources before they reach the point of exhaustion.

When considering adding formal services for a family member or friend, caregivers will find that there is a wide variety of options. It may be helpful for seniors and caregivers to separate the continuum of senior services into its various components. The first distinction we can draw is between In-Home (or Community-Based) Services and Residential (or housing) options.  In Part II, we will explore these options further and discuss the benefits and considerations of each.

This blog is part of a two part series that is feature in the ADRC's Newsletter. Stay tuned for PART II next week!