What is an Advance Directive?
None of us, but especially seniors, is immune to serious illness or injury. When these conditions are so severe that death is imminent, it is important that doctors, family, and friends know your wishes in those situations. One way to share your wishes is through an advance directive.
Advance directives are a legally binding document that expresses your wishes in the event of serious illness or injury. These documents can be quite detailed or quite general. One detail is what you want done in each specific medical possibility. For example:
- What do you want done if you stop breathing?
- What do you want done if you develop inoperable cancer? What about tumors?
- Do you want breathing machines or feeding tubes used?
These documents empower someone to make decisions about your medical care if you are unable to make these decisions yourself.
It makes sense to speak with the people you appoint. Let them know your wishes. Only appoint people who are willing to accept the responsibility of making medical decisions for you when are no longer able to make them for yourself. Also be sure and discuss your wishes with those close to you such as your family or friends.
Such documents must follow the laws in your state in order to be legally binding. It is best to have one or two people witness and sign the document. In order for these documents to be effective, your doctor and hospital must have copies.
Do I Need One?
It is important for senior citizens to prepare these documents. However, any of us at any age may encounter a life threatening illness or injury. If you have strong feelings about what you want done in these situations, you need to have these wishes written down in a legally binding document.
What is a Living Will?
A living will is a type of advance directive. It is a document outlining explicit instructions regarding medical treatment and life-sustaining procedures if you are permanently unconscious or terminally ill. Usually, a doctor (or even two) will have to certify that you are in either of these states before the living will comes into effect. Since modern medicine now has the ability to prolong life indefinitely, it is necessary to prepare a living will when you are still healthy in body and mind.
What is a Durable Power of Attorney for Health Care?
A durable power of attorney for health care names someone to manage your health care and make all medical treatment decisions for you when you are not able to. This person is usually called a “healthcare proxy” or a healthcare agent.”
Your chosen representative can make decisions such as consenting or refusing treatment, choosing doctors, selecting medical care facilities, and accessing medical records. This durable power of attorney usually does not give explicit instructions to the healthcare agent. This is another reason why it’s important to have an advance directive that provides this person with your wishes.
What is a Do Not Resuscitate Order?
Do not resuscitate orders or DNRs tell doctors and hospitals what you want done should your breathing or heart stop functioning. Examples of treatment that you can decline include CPR, artificial respiration, medicine to keep your heart functioning, artificial nutrition, or specific surgeries.
If you fill out a DNR, your doctor should put the order in your medical records. Without a DNR order, hospitals will typically do what they can to resuscitate someone whose heart has stopped. DNR orders are especially important for seniors with a heart condition.
Resources for Preparing an Advance Directive
Sometimes your medical facility will have these forms on hand for you to express your wishes. You will sign the document and have it witnessed right there in the hospital, long term care facility, or doctor’s office. The doctors and nurses caring for you want to make sure that your decisions are honored.
Another option is to contact your state bar association or state government office for the proper forms.
You can also hire an attorney who is knowledgeable in health care directives. Working with an attorney helps ensure that your directive meets the state legal requirements. It does no good to prepare a health care directive if it is not legally recognized.
Another option for obtaining a health care directive is purchasing software that allows you to fill in your information and print the document. By searching online you can find online services that will guide you through preparing the directive.
It may be unpleasant to think of serious illness and death. Detailing your wishes in advance will relieve some stress from you and your family in these situations.
What’s A Caregiver?
A caregiver or home health aide is an individual that gives personal care to patients in a large variety of settings, although their role may vary greatly from one setting to another. Caregiving often takes place in the patient’s home, but may also be available in nursing homes, assisted living facilities and even hospitals. Often the patient is elderly, but sometimes an illness necessitates the need for a paid companion in the home to assist an adult or care for a child.
What Does A Caregiver Do In The Home?
Essentially, the main purpose of a home care helper is the responsibility they shoulder for assisting their patients with their physical and cognitive health. The variety of duties performed by the caregiver depends on the needs of the patient.
Some of the more common duties in the home environment include:
- Grooming assistance for brushing teeth, bathing, shaving, nail care and toileting as required.
- Monitoring medications and reminding patients to take medications.
- Assisting the patient with exercise, which may include simply providing help with walking around the house or moving in place.
- Helping the patient maintain their memory.
- Deciding the number of meals that are required to meet the patient’s nutritional needs.
- Preparing meals, then, cleaning up the items related to the meals.
- Performing necessary grocery shopping or errands with or without the patient.
- Check foods in the patient’s pantry for expiration dates.
- Providing conversation and companionship.
- Light housekeeping duties, such as dusting and vacuuming, making beds, doing laundry, and maintaining sanitation.
- Accompanying the patient to doctor appointments as necessary.
- Notifying doctors of any significant change in the patient’s condition.
More serious home situations may be supervised by a Senior Helper RN, who should complete a customized plan of care and supervise the home health aide.
Approximately 90 percent of dependent patients use the services of a home health care service or a family member to keep the patient at home, rather than in a nursing home. Patients who have mild to moderate cognitive impairment still want to be involved in decisions concerning their care and their life. A physician will often set the boundaries to ensure the responsibility for medical decisions do not fall on the shoulders of the home companion.
When is Caregiving Needed?
There are some simple ways to assess when a loved one might need to have in-home care. Does the person:
- Have trouble with their normal movement around the house such as getting from the bedroom to bathroom?
- Need medical assistance such as cleaning wounds or administering insulin?
- Need help with normal daily activities such as bathing and getting dressed?
Obviously, a person affected by dementia or Alzheimer’s disease needs help in the home. Changes in eating habits, personal hygiene, social habits and any safety issues that might occur in the home all need to be evaluated.
Hiring a personal companion for your loved one can also help relieve the stress on family members, and it assures the family members that their loved one is receiving proper care. This help can be critical if the family member doesn’t live near the loved one.
Is Caregiving Available Outside the Home?
Most seniors would like to have caregiving take place in their own home. There are situations, however, when the person who is ill will receive more appropriate care in an institution.
Caregivers working in an assisted living facility or nursing home, like home caregivers, assist patients with their activities of daily living. The health aide can also play an important role in helping patients experience meaningful leisure activities, which helps keep the patient’s mind active. Demonstrating compassion for those suffering from Alzheimer’s disease or dementia is essential. Often the companion works with pets, particularly dogs, cats or birds, as these pets can provide a great deal of pleasure for the patient. Sometimes caregiver working hours in these facilities can be irregular and include weekends or holidays.
Caregiving can be difficult work, whether the patient is a senior citizen, a parent, a spouse or a child with special needs. Family members are often caregivers, which can be quite stressful as they are on-call 24 hours a day, seven days a week. In these cases good caregiver resources may involve support groups, which can be quite helpful.
Caregiver resources should include information on the role of Medicare for patients. Specific classes that can provide useful training are often available to empower the companion or home care helper.
Resources are available at the following sites:
http://caregiver.org/caregiver/jsp/home.jsp Family Caregiver Alliance home page
http://www.caregiving.com/ A community of family caregivers sharing stories, support and solutions
http://www.caregiverresource.net/ Caregiver Resources.
http://www.caregiverslibrary.org/home.aspx National Caregivers Library full of useful information in all areas of caregiving
http://www.nlm.nih.gov/medlineplus/homecareservices.html U.S. Government resources about Home Care Services
http://www.medicare.gov/campaigns/caregiver/caregiver.html Information about caregiving from Medicare
http://womenshealth.gov/publications/our-publications/fact-sheet/caregiver-stress.cfm#c Specific information about caregiver stress