HOW DO I KNOW WHEN MY LOVED ONE NEEDS LONG TERM CARE SERVICES
Family members provide an estimated 90% of long-term care in Indian Country. Taking care of an elder is a continuation of an ancient custom of extended family and lifelong care for family. But that tradition may now be colliding with new realities as more Native people live on their tribe’s reservation, have more chronic health problems and are less connected with tribal traditions and supports.
Many people think of nursing home care as the only form of Long-Term Care, LTC. There is a continuum of care that includes home and community care (congregate meals, adult day care, home visitations, and transportation assistance), senior housing, assisted living, and nursing home care. Some Indian communities provide this continuum of care, but there are many gaps, which vary by community.
LTC provides an array of medical, personal, and social services to support frail elders who need feeding, toileting and transferring from bed to chair. Instrumental Activities of Daily ADLs (IADLs) include activities such as shopping and meal preparation, housework, transportation, and managing bills and medications.
The care can be provided in an elder’s home, or in an institution such as a nursing home or assisted living facility. The LTC system strive to include cultural value of the people served. Home and community-based services are preferred by elders and their families over the institutional care.
Evaluating a Senior’s Ability to Age in Place
To determine if an elderly person can continue living at home, take a good look at all aspects of their present housing situation and how each one affects their safety and quality of life. An in-person visit offers the most accurate evaluation, which should combine elements of a functional assessment to identify impairments in activities of daily living (ADLs) and instrumental activities of daily living (IADLs) as well as a home safety assessment. The following are suggested topics and questions:
Medication Management
Do they remember to take their medications at prescribed doses and times? Have they had any hospitalizations or health issues due to skipped doses or multiple doses? If you aren’t sure, look for signs of mismanagement, such as expired medications or pill bottles that are spread out in different rooms with no apparent structure or routine.
Meal Preparation
Can they cook for themselves? Are they eating balanced meals? Are they able to safely operate kitchen appliances? Have there been any incidents where they have forgotten a meal in the oven, accidentally left the stove on or started a fire?
Safety & Mobility
Do they have difficulty getting around the home or taking stairs? Have they fallen in the home? Do they have a plan in place to summon help in case of an emergency? If mobility is an issue, can the home be equipped with safety devices like grab bars, an emergency response system and other tools to ensure safety? If they do not use a mobility aid for added stability, would they be open to using one?
Personal Hygiene
Can they bathe themselves, groom adequately and launder their clothes and linens? Are they bathing frequently enough? A generally unkempt appearance, body odor and soiled clothing are clues that a senior is unable or unwilling to care for themselves properly.
Transportation
Are they still driving? Are they safe behind the wheel or have they gotten in car accidents or gotten lost while driving? Do they have alternate means of transportation for doctor’s appointments, grocery shopping and other errands?
Socialization
Are they isolated from others most of the time? Do they have friends? How often do they get out of the house? Are they showing signs of depression?
Home Management
Is the house clean or in general disarray? When visiting in person, take a peek in each room (including bathrooms) to get a feel for their level of cleanliness. Keep an eye out for stains on furniture and carpets, unusual odors, and spoiled food in the refrigerator.
Financial Management
Are they paying their bills on time? Are there stacks of unopened mail, unpaid bills or late payment notices lying around? Are there signs that they’ve been spending excessively? Do they get calls from telemarketers or creditors?
Knowing When to Intervene with Aging Parents
It’s important to recognize that, even if a loved one is experiencing difficulties in some of the areas discussed above, it doesn’t necessarily mean that they need to move to a long-term care facility. For example, in cases where household chores and meal preparation are a challenge, supportive services can be brought into the home. A cleaning service, meal delivery service or a few hours of in-home care can ensure these needs are met.
For some seniors, social issues may be the priority. They may not necessarily need assistance with activities of daily living but could benefit from a new living arrangement. If they can no longer drive, have an increasingly limited social life, or show signs of loneliness and depression, senior living might be the answer. Residents in independent living communities and assisted living facilities need only step outside their apartment to engage in activities, socialize with their peers and catch a ride to the doctor.
In some cases, a comprehensive assessment may reveal hazards associated with a senior’s current living situation and serious changes in their mental and physical health. Poor money management can make them more vulnerable to financial elder abuse, a burned pot left on the stove could easily lead to a house fire and unresolved mobility issues could result in a life-changing fall. It is up to you to objectively look at their situation, be realistic about the implications of what you find and take proactive steps to work with your loved one to ensure their wellbeing.
Cultural Sensitivity
An assessment of an individual is the entry point to older adult services and must be conducted in order to determine Medicaid eligibility. This can be quite difficult if performed by a non-native that does not understand the culture or language. For example, in many Indian cultures it is considered rude to ask personal questions, especially about bathing and toileting.
If the tribe has a lot of LTC services that it delivers and provides, then people are more apt to use those services than those provided outside of the tribal service structure. By utilizing tribal LTC services, cultural, language, terminology and trust issues can be avoided.
