Care Planning 101
List of Needs
The first step in organizing a rational care plan is writing out a detailed list of needs. As the days and weeks pass several questions usually crop up.
- What are the needs and preferences of the person requiring care?
- What kinds of care are needed to allow him or her to remain in the community?
- Are you going to be the main or only caregiver?
- What time can you spare?
- How are you going to manage if attention is needed round the clock?
- Will you have to give up your job?
- Should the care receiver stay in his or her own home, live with you or move into a care home or sheltered housing?
- How can your usual arrangements be changed to help the person stay at home or become more independent?
- If external help is needed, is there enough money to pay for it and whom do you ask?
- How can adequate care be given to the person in need without denying attention to others such as a partner or children?
- Do you as the carer feel tired or frustrated from caring for another?
In answering these questions you are developing the basis of a care plan which includes your own needs. None of these questions have easy answers and will be different for everyone. Caring for an impaired person may create stress which could affect your ability to continue giving the necessary level of care for the months and years ahead. Such stress might be physical, financial, environmental and/or emotional in nature.
Types of stress
Providing physical care to an impaired person can be very tiring. General homemaking and housekeeping activities such as cleaning, laundry, shopping, and meal preparation require energy and can be exhausting especially if added to existing responsibilities in your own home.
Personal care needed for supervision of medicines and the daily hygiene routines can also be stressful, particularly if there is challenging behaviour or incontinence. Lifting and transferring individuals from bed to bath to chair is not only tiring, but also can result in serious injury to either the carer or the impaired person or even both. In some instances there is the additional responsibility of maintenance of equipment such as wheelchairs or hospital beds.
Caring for an impaired person has many financial aspects. For those services which cannot be provided by family, hard decisions will have to be made about getting them and working out how they will be paid for. When money is limited, many families help with these costs of care, but it may be a burden. Never assume you have the legal right to spend another person's money even if it is all for their own benefit.
The proper home setting has to be chosen. If the person needing care wants to stay in their own home, modifications such as railings and ramps may have to be installed. If they can't stay at home, alternative arrangements have to be looked into, such as moving in with a friend or relative or specialized housing or care homes. If remaining at home, some major adjustments in living arrangements and patterns of daily living will be necessary.
Giving personal care up to 24 hours a day can cause social stress by isolation from friends, family and a social life. You may find yourself becoming too tired or unable to have a night out even once a week, or once a month. This may result in a build-up of anger and resentment toward the person receiving care, as they are seen as the cause of the lost social life.
All of these factors often result in tremendous emotional stress. Compounding these sources of stress are the difficulties in time management, juggling many responsibilities, and feeling the pressure of increased dependency.
For family members providing care, 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 "putting in to a home" or even death of the care receiver. This
desire is frequently and swiftly followed by feelings of guilt. All of these
can be felt, then denied because they seem socially unacceptable. Carers need
to be assured that, in fact, these feelings are very common but rarely spoken
There are resources to help you but they are not always easy to find.
Sources of help:
Through Family or Friends
First make a detailed inventory of any resources individual family members and friends can contribute, including the assets of the impaired person needing the care. These include time available, skills, space, equipment, the strengths of the person needing care, and by no means least - money. Gather all the willing members of the family and work out a plan for giving help. This should involve defining and agreeing upon which jobs will be done by who and on what days.
In some areas there are organizations who can arrange this. A person who has similar care responsibilities can care for both impaired individuals together one day a week in exchange for you providing the care on another day. Another scheme involves home sharing with a carefully selected candidate in exchange for help with care giving duties.
When family or volunteer help is not enough agencies can provide staff or respite care. Social or medical services or private companies can arrange this. The cost may be covered by insurance or your health service provider. Sometimes the service charges are based on the income of the client. Every agency has its own fee structure and you are strongly advised to ask about their charges before arranging for service.
For people who are physically and/or mentally frail this offers a range of therapies and support activities. Fully qualified nursing, rehabilitation, assistance with daily living, social work services, lunch and transport, are provided in hospital, normally one to five days per week.
A few city based charities can arrange for heavy duty housecleaning, minor home repairs, gardening, installing safety devices, and making houses wind and watertight.
Volunteer companions visit isolated and homebound individuals for conversation, reading, letter writing, and general light errands. Some can provide escorts on trips away from home.
Assessment and Special Care Units:
Specialized units for geriatric and disability care are set up in some hospitals to provide coordinated multi-disciplinary diagnostic services to patients.
Meals on Wheels
Some areas offer home delivered meals to the frail or disabled housebound. Some volunteer organizations ask for a contribution, while others such as Social Services make a fixed charge for delivering either a hot or microwavable meal.
Personal Care Assistants
Are employed to give personal care only to individuals at home (These services can be free if prescribed by a doctor or in Scotland.) They assist with eating, dressing, oral hygiene, bathing, colostomies, administering medications, etc., but household tasks are normally done by home care assistants depending on the contract.
Home Care Assistants
Sometimes the personal care assistants return later in the day to do domestic chores such as shopping, laundry, light cleaning, dressing, and making snacks. HCA's can help by supplementing efforts made by family, or taking over when family carers need a break.
They can be hired through home health care agencies, Social Services, and religious groups and organizations. Some agencies provide bonding and training for their homemakers while others only give out a list of names and phone numbers, in which case references have to be checked and a formal contract of employment drawn up - see your legal adviser for more details.
Hospital and Surgical Supply Services
Supply houses rent or sell medical supplies and equipment like hospital
beds, canes, walkers, bath chairs, oxygen and other equipment. Consult your
Yellow Pages, look for specialized pharmacies or mail order companies.
These usually include cleaning, shopping, laundry, and meal preparation.
Housing assistance programs exist to help in the search for senior housing, shared housing, and finding emergency shelters, such as Homeshare.
These feed many older adults as a group in a senior centre, community centre, or school. A midday meal is provided, containing one third of the recommended dietary allowance, usually for a voluntary contribution. Additionally, some centres provide recreational and educational activities.
Occupational therapy, or OT, is restorative, to enhance or restore skills necessary for daily living. It should be provided by a qualified occupational therapist who is referred by your doctor.
Physical therapy, or PT, is rehabilitative therapy to maximize mobility. It should be provide by a qualified physical therapist, usually recommended by your doctor or hospital.
Respite Care Services
Respite care programs provide temporary and in some instances up to twenty four hour care to give relief to the primary carer. The care may be provided in the person's home, at an adult day care centre, or a residential home.
Skilled Nursing Services
These specialized services are provided for specific medical problems by trained professionals through local home care agencies. Your doctor must prescribe nursing services.
Speech therapy is provided by a qualified speech therapist to overcome certain speech and communication problems. The doctor usually recommends this.
Social Day Care
Provides supportive but not rehabilitative services in a protected setting for a part of the day, one to five days a week. Services can include recreational activities, social work services, a hot meal, transport, and occasionally, health services.
Friendly telephone calls are provided by agencies or volunteers offering reassurance, contact and socialization. Telephone reassurance can be a lifeline for older people who must be left at home alone during the day.
Transport or ambulance services offer travel by car or specialized vans to and from medical care. Community agencies and service providers such as Red Cross, Cancer Society, and LifeLine are but a few.
Last updated 25-02-2013