I need to make a care plan for my loved one. Where do I start?

By, Bryan Ford, PhD, MSW

​Caring for another human being can be one of the most rewarding accomplishments of your life. It can also be very challenging and at times, overwhelming. It disrupts our lives, forces us to change our schedules and habits; just when we feel our lives are already busy enough. Yet, how you approach care planning can be just as important as what you do.

Actively caring for another person has the potential to change your life in ways you never imagined. Caring for someone else is one of life's greatest teachers because you will learn much about yourself and those around you.

Many caregivers put pressure on themselves to do everything "perfectly." This can often result in feelings of caregiver guilt.  Don't feel that you have to be perfect, just do your best. The aim here is to improve the quality of you and your loved ones’ lives. If you are starting to develop a care plan, here are five areas that you should focus on: Health, Emotional, Legal, Portfolio (financial and insurance), and Social Issues (HELPS). These HELPS tasks are the gleaned from research to get you started. 

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Health Issues

Where do I find good health information on the internet?

One of the best resources on the internet to explore evidence-based health topics is the National Institutes of Health website for senior health: https://www.nia.nih.gov/health.

Understand a Geriatric Medical Assessment and Find a Physician

A geriatric medical assessment is a complete assessment of an older person’s health, and well-being, and living situation, social and mental health. In many cases, a doctor can do a limited geriatric assessment. However, doctors will focus primarily on medical issues and at times, mental issues.
 
On the other hand, a full assessment uses an entire team of specialists (Including any professionally licensed individual working with your loved one, which includes nurs­es, social workers, psychiatrists, physical therapist, occupational therapists, etc.). It should include a full physical, review of medications, a mental and cognitive evalua­tion, home evaluation, and social history assessment.

Finding a Physician

Locate a physician that specializes in geriatric medicine and make an appointment for a full geriatric medical assessment. Talk to your loved one about seeing a specialist. If they are unable to make the call, this is a great opportunity for you to begin to get involved in their care solu­tions.
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How do you find a physician that specializes in geriatric medicine?

• Ask the current family doctor or specialist if they do full geriatric medical as­sessments.
• Ask the current family doctor or specialist about getting a referral for a geri­atrician.
• Call your local Area Agency on Aging (or AAA) or state physician association. 

Emotional Issues

Addressing emotional and spiritual issues is crucial. There is the poten­tial for this experience to either be very peaceful or intimidating. Unlike many of the other care tasks, these discussions and decisions may appear at first to be subjective and undefined. There are some guidelines and sugges­tions that can make the journey smoother for those making it daily. Ideally, the outcome would be based largely on a predetermined agreement, leaving everyone satisfied.

Some of the things to be considered:

• Ask them to explain their beliefs and how they view aging and death. Assess the spiritual condition and beliefs of a senior.
• Make peace with the finality of death.
• Create a video or oral history of your senior’s life. You will find it much better than a simple written biography – especially when trying to bridge to younger generations in your family.
• Investigate the nature of religious programs for seniors available in their home community.
• Seek a greater understanding of end-of-life services (hospice vs. palliative care) by reviewing resources and talking with experts.
• Identify the wishes for funeral and burial or cremation. If plans have been made, locate the documentation.
• Establish a reliable point of contact of at least one member of senior’s church, synagogue, mosque, or religious organization.
• Talk about the mental health concerns and seek out professional mental health council. 

Legal Issues

​An elder law attorney can help you with many of the aspects of care that you will face in the coming months and years. In some cases, the attorney will have a Social Worker and/or an RN on staff to help with some of the social aspects of caring for your senior. Some of the issues you need to address with an Elder Law Attorney are the advantages and disadvantages of completing:

• Will
• Durable Power of Attorney
• Trust/Revocable Living Trust
• Joint Ownership & Tenancy
• Living Will
• Do Not Resuscitate Orders
• Health Care Proxy
• AND Make sure to identify an easily accessible, secure location for these legal documents when they are needed.

Additionally, many local Universities, community organizations, and the local Area Agencies on Aging provide elder law workshops and even provide free legal counsel to those in need. A university with a law school is a great place to begin your search. 

Portfolio/Financial Issues

The financial and health insurance status of people with dementia vary greatly, though caregivers should pay attention to these issues regardless of their loved one's income level. If appropriate, speak to a trusted financial advisor about financial and insurance issues.
 
A trusted financial adviser can assist you with a variety of finance issues senior living. In some cases, estate planning and advising may be included in the services of an elder law attorney or he/she may have recommendations. Some of the issues to be addressed:

• Identifying assets, liabilities, income, and expenses of your senior.
• Check social security benefits for accuracy.
• Review a current credit history and make sure spouses (and if applicable, children) have access to joint or separate credit.
• Determine the full extent of the health and life insurance coverage.
• Determine the full extent of the Medicare and Medicaid entitlements.
• Explore the costs of long-term care scenarios (such as: long-term care insurance, health savings accounts, etc.…).
• Organize financial records and place them in an accessible, secure location.

Additionally, it would be advantageous to assist your loved one in making a list of household valuables and designating which family member or friend gets which item. 

Contact Your Local Area Agency on Aging (AAA)

The local AAA is a great community resource. Established by the Older Americans Act (OAA) of 1965, this federal network of agencies is located across the United States and many states may have several, given the need of that community. An AAA can assist you with most things related to senior care, including finding trusted health care, finding, and speaking with an Ombudsman, Medicare assistance, housing issues, and transportation.

Although many local AAAs now have websites, it would be worth the time and effort to find a contact person that you can call when you need a quick answer. Also, they can keep you up to date on community events and seminars that are being sponsored by your community AAA. Local AAAs understand the state budget and policy changes concerning seniors and are equipped to help you navigate the system to get the resources you need. 

Locate a Geriatric Case Manager

A Geriatric Care Manager can help you identify community resources and make plans for the eventualities of senior care. Some of the issues that a Geriatric Care Manager can do for you are:

• Conduct care-planning assessments to identify problems and to provide solutions.
• Screen, arrange, and monitor in-home help or other services, including assistance in hiring a qualified caregiver for home care.
• Provide short- or long-term eldercare assistance for those engaged in local or long-distance caregiving.
• Review financial, legal, or medical issues and offer referrals to geriatric specialists.
• Provide crisis intervention.
• Act as a liaison to families at a distance, overseeing care, and quickly alerting families to problems – especially important when families are engaged in long distance caregiving for a loved one.
• Assist with moving an older person to or from a retirement complex, assisted care home, or nursing home.
• Provide consumer education and advocacy.
• Offer eldercare counseling and support. Some PGCMs also provide family or individual therapy, finance management, conservatorship, or guardianship assistance, and/or caregiving services. 

The Takaway

Everyone's experience in care planning will be different based on their individual needs and available resources. Although this isn’t a complete list of things you may encounter when assisting a loved one, hopefully, this provides you a place to start and an understanding of the important areas to explore. 

Author

Dr. Bryan K. Ford, LICSW, is a gerontological social worker and mental health specialist at the Birmingham VA Medical Center and an Adjunct Faculty member with the School of Social Work at the University of Alabama. His expertise is in care planning for older adults and care transitions for older patients being discharged from the hospital.