Broaching the subject of long-term care with an elder or senior can be daunting. But a solid assessment of the elder's needs, and an open and frank discussion about those needs, is the first step to making sure the elder gets the right care when he or she needs it.
Both elders and their loved ones may be reluctant to start the conversation because it is such a sensitive topic. Elders may worry about giving up control or becoming a burden. And loved ones may worry about insulting or challenging the elder. Within the family there may be anxiety, guilt, and wide differences of opinion about what care is needed and who should provide it. However, there are gentle, respectful ways to approach the conversation. Here are some tips.
To get the discussion underway and stay on the right track, it is often best to look outside the family. An unrelated person can sometimes soothe ruffled family feathers, present a neutral opinion, and offer solutions the family might not know about. Also, you and your family members may find it easier to reveal fears and other feelings to an outsider than to an involved family member.
Here are some people who can help you begin to evaluate long-term care needs:
Because a specific physical or mental condition often leads to the need for long-term care, one of the first things to do is get professional advice both about the need for immediate care and about likely changes in the condition over time.
Talk first with your primary care physician; he or she may refer you to a geriatric specialist for further consultation. If you are not completely comfortable with the physician's assessment, seek a second opinion.
Another excellent resource to help you assess medical and personal care needs is a geriatric screening program. Local hospitals have them, as do community and county health centers. If you have trouble finding a geriatric screening program, check with the county social service agency or local Area Agency on Aging, or call the senior referral number in the white pages of the phone book.
You will also have to figure out what sort of personal, non-medical care is needed and what aspects of daily life the elder can still manage without outside assistance. The need and ability to care for oneself is not simply a matter of physical competence. Often, it depends just as much on personality and emotional state. So don't just consider what kind of care is needed and whether providers are available and affordable. The ultimate decisions should also depend on how important it is to the elder to remain in control of his or her own life.
Some people fiercely hold on to personal independence and privacy. For these people, it may be important to stay at home and receive only minimal outside assistance (if they also have the ability to organize, manage, and pay for individual programs to meet their specific needs).
Others may be willing to have an outside agency organize a more comprehensive care program, as long as they or their family members remain in primary control of daily life. For these people, an agency-directed program of home care in a family residence or in secured housing, perhaps combined with adult daycare, may be the best option, especially if family members are willing to give additional assistance.
Still other people prefer the security and ease of complete care organized and provided by others. For them, a residential care facility may be best, even though they may not physically require the high level of care offered there.
To learn more about the varying levels of long-term care, read Nolo's article Choosing and Paying for a Long-Term Care Facility or get Long Term Care: How to Plan and Pay for It, by Joseph Matthews (Nolo).