Elder Care
Basic Information

Elder Care

One of the biggest decisions a family may have to make is to determine how to provide care for elderly parents or relatives (e.g. elders) when those elders are no longer able to live independently. Families resolve this complex and emotionally charged issue in a variety of ways. Some families find ways to provide elders with sufficient assistance such that they are able to safely remain in their own homes. Other families move their elders in with them so as to personally provide care. Still other families find that placing their elder into a care facility is the best solution for all involved.

Finding appropriate and affordable elder care and assistance is challenging. Determining exactly what type of care will best fit elders' needs is a time consuming process that often requires consultation with medical and eldercare professionals. Locating affordable appropriate and reliable care options is also time consuming. Different types of care are available in different places, w...

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What are warning signs that an elder might need help?

  • There are many warning signs an elder may display that indicate they require assistance with activities of daily living.
  • The following short list highlights some of the more common signs to watch for.
  • Physical Problems:
    • Sensory problems, such as lost hearing, sight, or smell
    • Walking problems, such as difficulty walking or recent falls
    • Chronic health problems, such as Diabetes, Heart Disease, etc.
    • Trouble performing activities of daily living (ADLs) such as cooking, cleaning, shopping, dressing, bathing, and driving or using public transportation
  • Cognitive or Brain Problems:
    • Confusion
    • Memory or Attention problems including forgetting to take or mixing up medications
    • Financial problems including not paying bills on time, or not being able to account for spending when this was not previously an issue
    • Language problems
    • Dementia (brain damage from a condition such as Alzheimer's Disease)
  • Mood or Emotional Problems
    • Depression
    • Loss of interest in activities and relationships that used to be important
    • Social withdrawal
    • Personality changes, such as becoming moody, depressed, irritable, or angry

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What types of eldercare are available?

  • In the United States eldercare can be broken down into two major categories: family-provided care and professionally-provided care.
  • There are six types of professionally-provided care including:
    • in-home licensed or unlicensed care
    • adult day programs
    • independent living facilities
    • assisted living facilities
    • continuum of care facilities
    • dementia facilities
  • There are two types of family-provided care, but many variations are possible.
  • Each care arrangement offers advantages and disadvantages and may be appropriate depending on elders' needs and desires and the needs and limits of the family.

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When is it not safe for an elder to remain in their home alone?

  • It can be unsafe to leave elders at home alone if they:
    • Can no longer manage vital tasks of daily living, such as going to the bathroom, preparing meals, getting themselves from place to place, etc., in an independent manner for whatever reason.
    • Require medical care that they cannot self-administer (such as Dialysis care), or if memory or physical impairments make it impossible for them to reliably manage care, such as administering daily shots or medications.
    • Have physical impairments that stop them from managing tasks of daily living. For example, they are wheelchair bound and cannot get groceries or visit the doctor without assistance.
    • Have moderate memory impairments or other cognitive impairments which make it difficult for them to remember whether they have left the stove on or have locked their doors properly or had taken medications.
    • Have severe memory or other cognitive impairments that result in their being unable to maintain personal safety. For example, the elder wanders into other people's homes or down the street, the elder becomes confused or paranoid, etc.
  • The nature of an elder's impairments are not always clear or obvious and it is a good idea that elders be evaluated by a medical doctor and by a social worker experienced with coordinating elder care needs.

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What legal and financial items should be part of an eldercare plan?

  • A good elder care plan should address elders' legal and financial situations as well as their care needs.
  • A will is a legal document that allows a person to specify how their property should be divided and how custody of their children should be handled upon their death.
  • A healthcare directive (also known as a living will or advanced healthcare directive) is a document that enables a person to legally record their wishes concerning whether 'heroic' or extended medical care measures should be taken to prolong their lives in the event they are incapacitated and unable to speak on their own behalf.
  • In a Durable Power of Attorney for Healthcare a trusted family member or friend can be named as a "healthcare proxy" and then has the power to make healthcare decisions on behalf of the person creating the document when the person is unable to do so on their own.
  • A conservatorship is a court arrangement allowing an individual power over the financial affairs of an elder that is only allowed to exist when an elder is judged no longer capable of managing their own affairs.
  • The Durable Power of Attorney for Finance is a legal document that authorizes a person to have the legal authority to act on behalf of another person with specific regard to managing their finances.
  • It is important to make sure that beneficiaries are appropriately named and up to date on financial assets, including retirement accounts (pensions, 401k accounts, etc.), life insurance plans and other assets.
  • Elders approaching retirement age (generally 65-68 years of age depending on year of birth) should file for Medicare and social security benefits.
  • It may be wise to explore the purchase of a long term care insurance policy, and/or supplemental medical insurance policy that may help pay for needed care facilities and treatments that Medicare will not.
  • A trust is a legal device into which elders' assets can be contributed and can be set up in various ways so as to pay out a small income to the elder during his or her lifetime, and then disburse the remainder of the assets to beneficiaries upon the elder's death.

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What are the steps involved in identifying eldercare options?

  • Elders and their families should begin by making a list of the things that are most important to them with regard to the type of eldercare environment they want and need.
  • This list might include the types of assistance the elder requires and the importance of different aspects of care facilities (such as newness, appearance, activities, transportation, availability of care, social and recreational activities, etc.).
  • For each aspect of care, it will be helpful to note whether a skilled healthcare worker is required to administer that care, or if instead the care could be provided by an unskilled family member or hired aide.
  • Also important to note are preferences (if any exist) regarding care facility characteristics, such as visiting hours, security services, and overall cost of care.
  • Once the elder and family have identified important care items, they are then able to search for facilities or in-home providers who offer those options.
  • Families seeking a care facility can ask for references and referrals from other elders, local doctors and social workers, the religious community, neighbors, associations, and friends.
  • After identifying potential care facilities, the next step is to screen them to see that they fit the desired requirements, conduct interviews and site visits, and check references.

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How can the family successfully transition into eldercare?

  • Elders often perceive a loss of valued independence when this transition occurs because their daily routines must change to accommodate the needs of their care providers, rather than themselves.
  • The elder may have to adjust to having someone share their personal space and structure their daily activities, which can be very frustrating for elders used to living alone and setting their own schedules and routines.
  • Elders may also feel shame at the thought that they now require help to get by.
  • Elders that are moving into a care facility can experience a loss of personal space, identity and possessions, as well as the disruption of long time relationships with neighbors and friends, in addition to the loss of control over scheduling meals, activities and health services.
  • These elders too are likely to experience shame feelings and significant grief and may also build up feelings of resentment towards their family members for not working harder to keep them independent.
  • Because the transition into care is stressful, it is helpful if it occur in stages, over a period of several years, rather than all at once. For example, it may initially include a home health worker in the elder's home, followed by transition into an independent living or assisted living facility before finally moving into a nursing home if a health condition worsens and 24-hour care is required.
  • Family members can commit to visiting the elder on a regular basis, which gives both parties something to look forward to and reduces the likelihood that the relationship between elders and family members will suffer.
  • It is important that families make sure their elders know that they can always contact them to let them know that care is not adequate or should be adjusted or changed.
  • The family needs to keep in mind that an elder's feelings of loss, frustration and anger are fairly normal occurrences that do not need to be taken too personally.

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What are the warning signs of eldercare abuse?

  • Eldercare is inherently stressful, and not all people involved in elder care are able to maintain a patient and compassionate attitude towards their work at all times while providing care.
  • Families should be alerted to the possibility that elder abuse can occur, and should remain watchful for actual signs of elder abuse.
  • It is surprisingly easy to overlook signs that elder abuse is occurring as elders may feel too ashamed, defeated, or intimidated to report abuse to family members.
  • Elders may also be too out of it to know that they are being abused.
  • Signs to watch for that may indicate elder abuse include:
    • personality changes (angry, depressed, moody, defensive, etc.)
    • confusion
    • excessive tiredness
    • changes in personal appearance of the home and living environment
  • Family members who notice any of these signs should talk to their elders, as well as to a social worker or care plan provider and the court or law enforcement officers who can put a stop to the abuse.

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