Susie was a client who reached out for my help with her mother. “My mother started showing signs of dementia, and we didn’t want her to live by herself. She loves her 23-year old grandson, so he moved in with her. The plan was that he would help her around the house and keep her company.”
Susie felt she had a great plan that addressed her mom’s wish to stay at home. But in reality, the grandson was at school all day and was out with his friends on the weekends. Although he helped with yard work and with a few chores around the home, his grandmother Judy was by herself most of the time. Many of Judy’s needs went unaddressed: grocery shopping, meal prep, transportation to medical appointments, showering assistance, and having constant company.
To help Susie keep her mom at home, I suggested that we create a care plan.
What is a care plan?
“Aging in place” means keeping a loved one at home as long as possible prior to moving into a senior care community. The advantage: staying in your own familiar environment and benefiting from personal care. The disadvantage: the family must become care providers, but they often lack the knowledge necessary to do so.
A care plan, by its name, is a custom plan that helps the family address the needs of the person they care for. It identifies loved ones’ care needs and points to appropriate solutions. It is invaluable in preventing conflicts between family members by helping in countless ways: improving time management, decreasing stress, saving money, and keeping your loved one safe at home as long as possible.
How do I create a care plan?
It’s beneficial to have only 1-2 people in charge of creating and implementing your care plan.
1. Gather information
this should be done both directly and indirectly. This can be done directly by asking your loved one what things they have difficulty doing by themselves. You can also gather information indirectly by simply observing: is there expired food in the refrigerator? Are there piles of unopened mail? Is the dirty laundry basket overflowing? Does their home smell unpleasant?
2. Identify care needs
Based on the issues you’ve identified, you can start addressing what they need help with. These care needs may be few in number: assistance with yard work and grocery shopping, as well as transportation to medical appointments. It’s possible that their care needs will be much more extensive: help with dressing, bathing, cooking, cleaning, and laundry; money management; medication administration; night-time care; and socialization.
3. Find solutions
How are you going to provide the appropriate care?
Pool your community resources
1. First, identify all possible helpers: family members, friends, or members of a congregation.
2. Next, find out what kind of help they are able to provide. Not everyone feels comfortable helping with a shower, and not every person is capable of mowing the lawn. Some can help once a day while others once a month.
3. Finally, assign each person a task they are responsible for.
Hire help
Hired help can be a great option for your family as long as finances permit. The person you care for may even be eligible for support from the state, either through Medicaid or the VA (through the Aid and Attendance program for veterans and their surviving spouse).
4. Implement
Once you have a list of your care solutions, create a schedule. Who will provide what, and when? It’s important that the person who creates the care plan is also in charge of implementing it. It may need some adjustment in the beginning until it runs smoothly. Be patient, and don’t be afraid to keep tweaking your schedule.
5. Monitor
A care plan is not set in stone. It changes all the time. Many unplanned factors can affect your care plan:
• a care provider may feel more stressed than they anticipated, and be able to contribute less time than expected.
• If a care provider is away for vacation, you’ll need to fill the gap
• Care needs may be added as the physical ability or cognition of your loved one decline.
6. Start again
Every so often, you’ll need to repeat steps 1-5, in order to gather new information and stay aware of any changes that occur. Continue to go through the process of updating your care plan.
A care plan sounds like a big responsibility
Yes, once you take over the responsibility of managing your loved one’s care, you are in your role of care provider 24/7. You are now responsible for the well-being of your loved one. While it can certainly be very rewarding to watch your loved one thrive, it can also be very stressful.
Some companies provide case management; they can take this responsibility off your shoulders. Depending on the financial resources of you or your loved one, you can utilize their services.
When a care plan is not enough
Many people are able to stay at home without ever needing to move to a senior care community. When their care needs can be provided at home, and their finances can support this decision, there is not always a need to move them from home.
But at times, a loved one’s care needs exceed what a family can provide on their own. For instance, providing full-time home care is beyond most people’s financial ability.
When, or if, this care plan is no longer able to address all of your loved one’s care needs, it may be time to consider moving to a senior care community.