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Elderly care

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See also: Caregiver, Home care, Family caregivers, Carers rights movement, Caregiving and dementia, and Long-term care

Elderly care, or simply eldercare, is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, nursing homes, hospice care, and In-Home care. Because of the wide variety of elderly care found globally, as well as differentiating cultural perspectives on elderly citizens, the subject cannot be limited to any one practice. For example, many countries in Asia use government-established elderly care quite infrequently, preferring the traditional methods of being cared for by younger generations of family members.

Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. It is an important distinction, in that the design of housing, services, activities, employee training and such should be truly customer-centered. It is also noteworthy that a large amount of global elderly care falls under the unpaid market sector.[1]

Cultural and geographic differences

The form of elderly care provided varies greatly among countries and is changing rapidly.[2] Even within the same country, regional differences exist with respect to the care for the elderly.[3] However, it has been observed that the global elderly consume the most health expenditures out of any other age group, [4] an observation that shows worldwide eldercare may be very similar. We must also account for an increasingly large proportion of global elderly, especially in developing nations, as continued pressure is put on limiting fertility and decreasing family size.[5]

Traditionally, elderly care has been the responsibility of family members and was provided within the extended family home. [6] Increasingly in modern societies, elderly care is now being provided by state or charitable institutions.[6] The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home.[6] Although these changes have affected European and North American countries first, they are now increasingly affecting Asian countries as well.[7]

In most western countries, elderly care facilities are residential family care homes, freestanding assisted living facilities, nursing homes, and Continuing care retirement communities (CCRCs).[8] A family care home is a residential home with support and supervisory personnel by an agency, organization, or individual that provides room and board, personal care and habilitation services in a family environment for at least two and no more than six persons.[9]

Gender discrepancies in elderly care

According to Family Caregiver Alliance, the majority of family caregivers are women[10]:

“Many studies have looked at the role of women and family caregiving. Although not all have addressed gender issues and caregiving specifically, the results are still generalizable [sic] to women because they are the majority of informal care providers in this country. Consider: • Estimates of the percentage of family or informal caregivers who are women range from 59% to 75%. • The average caregiver is age 46, female, married and working outside the home earning an annual income of $35,000. • Although men also provide assistance, female caregivers may spend as much as 50% more time providing care than male caregivers."[10]

In the developed world

United States

According to the U.S Department of Health and Human Services[11] the older population—persons 65 years or older—numbered 39.6 million in 2009.[11] They represented 12.9 percent of the U.S. population, about one in every eight Americans.[11] By 2030, there will be about 72.1 million older persons, more than twice their number in 2000.[11] People 65-plus years old represented 12.4 percent of the population in the year 2000, but that is expected to grow to be 19 percent of the population by 2030.[11] This will mean more demand for elderly care facilities in the coming years. There were more than 36,000 assisted living facilities in the United States in 2009, according to the Assisted Living Federation of America [12] in 2009. More than 1 million senior citizens are served by these assisted living facilities.[12]

In the United States, most of the large multi-facility providers are publicly owned and managed as for-profit businesses.[10] There are exceptions; the largest operator in the US is the Evangelical Lutheran Good Samaritan Society, a not-for-profit organization that manages 6,531 beds in 22 states, according to a 1995 study by the American Health Care Association.[13]

Given the choice, most elders would prefer to continue to live in their own homes (aging in place).[14] Unfortunately, the majority of elderly people gradually lose functioning ability and require either additional assistance in the home or a move to an eldercare facility.[14] The adult children of these elders often face a difficult challenge in helping their parents make the right choices.[15]

One relatively new service in the United States that can help keep the elderly in their homes longer is respite care.[16] This type of care allows caregivers the opportunity to go on vacation or a business trip and know that their elder has good quality temporary care, for without this help the elder might have to move permanently to an outside facility. Another unique type of care cropping in U.S. hospitals is called acute care of elder units, or ACE units, which provide "a homelike setting" within a medical center specifically for the elderly [17].

Some United States companies, like Senior Helpers, Home Instead Senior Care, Home Helpers, Professional HealthCare At Home, Visiting Angels, All Valley Home Care, Home Care Assistance, Medi Home Private Care, Concerning Aging [18] and Comfort Keepers, offer long-term, in-home care for seniors.

Information about long term care options in the United States can be found by contacting the local Area Agency on Aging or elder referral agencies such as A Place for Mom.

Canada

In Canada, such privately-run for-profit facilities also exist, but they must compete with government-funded public facilities run by each province's or territory's Ministry of Health. In these care homes, elderly Canadians pay for their care on a sliding scale based on annual income. The scale that they are charged on depends on whether they utilize “Long Term Care” or “Assisted Living.” For example, commencing in January 2010 seniors living in British Columbia’s government subsidized “Long Term Care” (also called “Residential Care”) will pay 80% of their after tax income unless their After Tax Income is less than $16,500. The “Assisted Living” tariff is calculated more simply as 70% of the After Tax Income.[19]

Australia

Due to Australia's ageing population, the issue of aged (elderly) care has been highlighted as a key concern for the next 20 years.[20] KPMG released a report supporting a model of Aged Care Levy to assist in relieving the burden on providers of Aged Care services.[21] Aged Care recipients in Australia are subject to rebates and assistance from the Australian Federal Government provided they are assessed by an Aged Care Assessor (ACAT) [22] Their care can fall into a number of categories including high care, low care and veterans home care.

In 2010 reports stated that only 40% of Australian Aged Care Providers are able to make a profit [23] with the rest having to eat into borrowings to break even.

In the developing world

Nepal

Due to health and economic benefits, the life expectancy in Nepal jumped from 27 years in 1951 to 65 in 2008. [24] Most elderly Nepali citizens, roughly 85 percent, live in rural areas.[24] Because of this, there is a significant lack of government sponsored programs or homes for the elderly. Traditionally, parents live with their children, and today, it is estimated that 80 percent of the elderly do.[24] This number is changing as more children leave home for work or school, leading to loneliness or mental problems in Nepali elderly.[24]

The Ninth Five-Year Plan included policies in an attempt to care for the elderly left without children as caretakers[24]. A Senior Health Facilities Fund has been established in each district.[24] The Senior Citizens Health Facilities Program Implementation Guideline, 2061BS provides medical facilities to the elderly, and to those that are poverty stricken, free medicine and health care in all districts.[24] In its yearly budget, the government has planned to fund free health care to all heart and kidney patients older than 75.[24] Unfortunately, many of these plans are overly ambitious, which has been recognized by the Nepali government.[24] Nepal is a developing nation and may not be able to fund all of these programs after the development of Old-Age-Allowance, or OAA. OAA provides a monthly stipend to all citizens over 70 and widows over 60.[24]

Several charitable organizations have since opened in Nepal, with roughly 1500 elderly citizens living in them.[24] Most of these are not government sponsored and are volunteer staffed.

Thailand

Thailand has observed global pattern of an enlarging elderly class: as fertility control is encouraged and medical advances are made, births shrink and lives age.[5] The Thai government is noticing and concerned about this trend, but tends to let families care for their elderly members rather than create extraneous policies for them.[25] As of 2011, there are only 25 state sponsored homes for the elderly, with no more than a few thousand members of each home.[25] Such programs are largely run by volunteers and are questionable on the basis of quality of care, considering there is not always a guarantee care will be available. Private care is very difficult to follow, often based on assumptions. Because children are less likely to care for their parents, private caretakers are in demand.[25] Volunteer NGOs are available but in very limited quantities.[25]

While there are certainly programs available for use by the elderly in Thailand, questions of equity have risen since their introduction.[26] The rich elderly in Thailand are much more likely to have access to care resources, while the poor elderly are more likely to actually use their acquired health care, as observed in a study by Bhumisuk Khananurak.[26] However, over 96 percent of the nation has health insurance with varying degrees of care available.[26]

India

India's cultural view of elderly care is similar to that of Nepal's. Parents are typically cared for by their children into old age, most commonly by their sons.[27] It should be noted that in these countries, elderly citizens, especially men, are viewed in very high regard. Traditional values demand honor and respect for older, wiser people.[27] India is facing the same problem as many developing nations in that its elderly population is increasing tremendously, with a current estimate of 90 million over the age of 60.[28]

Under its Eleventh Five-Year Plan, the Indian government has made many strides similar to that of Nepal. Article 41 of the Indian Constitution states that elderly citizens will be guaranteed Social Security support for health care and welfare.[28] A section of the 1973 Criminal Procedure Code, alluding to its traditional background, mandates that children support their parents if they no longer can themselves.[28] NGOs, however, are prevalent in Indian elderly care, providing homes and volunteer care, but governmental policies and organizations are more popular.[28]

Medical (skilled care) versus Non-Medical (social care)

A distinction is generally made between medical and non-medical care, care provided by people who are not medical professionals. The latter is much less likely to be covered by insurance or public funds. In the US, 67 percent of the one million or so residents in assisted living facilities pay for care out of their own funds.[29] The rest get help from family and friends and from state agencies. Medicare does not pay unless skilled-nursing care is needed and given in certified skilled nursing facilities or by a skilled nursing agency in the home. Assisted living facilities usually do not meet Medicare's requirements. However, Medicare does pay for some skilled care if the elderly person meets the requirements for the Medicare home health benefit. [30]

Thirty-two U.S. states pay for care in assisted living facilities through their Medicaid waiver programs. Similarly, in the United Kingdom the National Health Service provides medical care for the elderly, as for all, free at the point of use, but social care is only paid for by the state in Scotland, England, Wales and Northern Ireland are yet to introduce any legislation on the matter, so currently social care is only funded by public authorities when a person has exhausted their private resources, for example, by selling their home.

However, elderly care is focused on satisfying the expectations of two tiers of customers: the resident customer and the purchasing customer, who are often not identical, since relatives or public authorities rather than the resident may be providing the cost of care. Where residents are confused or have communication difficulties, it may be very difficult for relatives or other concerned parties to be sure of the standard of care being given, and the possibility of elder abuse is a continuing source of concern. The Adult Protective Services Agency — a component of the human service agency in most states — is typically responsible for investigating reports of domestic elder abuse and providing families with help and guidance. Other professionals who may be able to help include doctors or nurses, police officers, lawyers, and social workers.[31]

Improving mobility in the elderly

Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing segment of the U.S. population.

Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as reduced strength or poor balance. It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to improve their split times. People in both groups perform best when they measure their progress and work toward specific goals related to strength, aerobic capacity, and other physical qualities. Someone attempting to improve an older adult’s mobility must decide what impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options. Today, many caregivers choose to focus on leg strength and balance. New research suggests that limb velocity and core strength may also be important factors in mobility.[32]

The family is one of the most important providers for the elderly. In fact, the majority of caregivers for the elderly are often members of their own family, most often a daughter or a granddaughter. Family and friends can provide a home (i.e. have elderly relatives live with them), help with money and meet social needs by visiting, taking them out on trips, etc.

One of the major causes of elderly falls is hyponatremia, an electrolyte disturbance when the level of sodium in a person's serum drops below 135 mEq/L. Hyponatremia is the most common electrolyte disorder encountered in the elderly patient population. Studies have shown that older patients are more prone to hyponatremia as a result of multiple factors including physiologic changes associated with aging such as decreases in glomerular filtration rate, a tendency for defective sodium conservation, and increased vasopressin activity. Mild hyponatremia ups the risk of fracture in elderly patients because hyponatremia has been shown to cause subtle neurologic impairment that affects gait and attention, similar to that of moderate alcohol intake.[33]

Elderly tourists in countries affected by malaria are almost ten times more likely to die of the disease than younger persons. [34] This study based in the U.K. found that 4.6 percent of those infected with the disease died from it.[34]

Legal incapacity is an invasive and sometimes, difficult legal procedure. It requires that a person file a petition with the local courts, stating the elderly person lacks the capacity to carry out activities that include making medical decisions, voting, making gifts, seeking public benefits, marrying, managing property and financial affairs, chosing where to live and who they socialize with. Most states' laws require that a minimum of two doctors or other health professionals, provide reports as evidence of such incompetence and the person must be represented by an attorney. Only then can the individual's legal rights be removed and legal supervision by a guardian or conservator be initiated. The legal guardian or conservator is the person to whom the court delegates the responsibility of acting on the incapacitated person's behalf and must report regularly his or her activities to the court.

A less restrictive alternative to legal incapacity is the use of "Advance Directives"; powers of attorney, trusts, living wills and health care directives. The person who has these documents in place, should have prepared them with their attorney when that person had capacity. So, if the time comes when that person lacks capacity to carry out those tasks laid out in the documents, the person they named (their agent) can step in to make decisions on their behalf. The agent has a duty to act as that person would have and in their best interest.

See also

References

Public Domain This article incorporates text from this source, which is in the public domain: A Profile of Older Americans: 2010, Department of Health & Human Services

  1. ^ "Unpaid and Paid Care: The Effects of Child Care and Elder Care on the Standard of Living," Kim et al. 2011
  2. ^ "The Elderly, Women's Work and Social Security Costs," Sundstrom, 1982
  3. ^ A Senior Companion, LLC 2009
  4. ^ "Health and Elderly Care Expenditure in an Aging World," 2000
  5. ^ a b World Population Aging: "World Population Aging, 2009"
  6. ^ a b c Elder Care: "Elder care: is legislation of family responsibility the solution?" Ting et al. 2009
  7. ^ Global Networks: Transnational mobilities for care: rethinking the dynamics of care in Asia, Huang et al. 2012
  8. ^ [Medical Care for the Elderly in Other Western Countries, Kane 2008]
  9. ^ "Family Care Homes," Piedmont Triad Council of Governments
  10. ^ a b c FCA: Family Caregiver Alliance
  11. ^ a b c d e Aging Statistics, U.S Department of Health and Human Services, June 2010
  12. ^ a b ALFA: Assisted Living Federation of America
  13. ^ AHCA 2012
  14. ^ a b Age in Place: Age in Place, 2012
  15. ^ Gross, Jane (July 2008). "Faced with Caregiving, Even the Experts Struggle". New York Times. Retrieved 2008-07-26. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  16. ^ "Caregivers Catch a Break with Respite Care". BestAssistedLiving.com. September 2008. Retrieved 2008-10-01. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  17. ^ Acute Care for Elders Project, 2011
  18. ^ Concerning Aging 2011
  19. ^ Elder Care BC, "Assisted Living Vs Long Term Care", ElderCareBC.com
  20. ^ "WLB Grey Matters Articles Writings Thoughts". Retrieved 2010-07-28.
  21. ^ "CEO Calls for Aged Care Levy". Retrieved 2010-07-28. [dead link]
  22. ^ "Aged Care Glossary". Retrieved 2010-10-25.
  23. ^ "More than half... operating at a loss". Retrieved 2010-07-10). {{cite web}}: Check date values in: |accessdate= (help)
  24. ^ a b c d e f g h i j k Nepal: "Status Report on Elderly People in Nepal," 2010
  25. ^ a b c d Thailand: Intergenerational Family Care for and by Older People in Thailand, 2011
  26. ^ a b c Thai Aging: Health Equity in Thai Aging, Khananurak
  27. ^ a b India: Care and Support for the Elderly in India
  28. ^ a b c d HelpAge: HelpAge India, 2009
  29. ^ [http://assets.aarp.org/rgcenter/post-import/fs62r_assisted.pdf AARP Assisted Living in the US, 2000
  30. ^ "How to Pay for Senior Care". VidaSeniorResource.com. August 2008. Retrieved 2009-03-30. {{cite news}}: Cite has empty unknown parameter: |coauthors= (help)
  31. ^ Maria M. Meyer and Paul Derr, "What to Do When You Suspect Elder Abuse," Caring.com, Senior Care and Elder Care, December 2008
  32. ^ Bean, Jonathan. “Three Big Risks For Older Adults: Walking, Climbing Stairs and Rising from a Chair - Evidence-based Rehabilitative Care for Older Adults.” CIMIT Forum. November 6, 2007.
  33. ^ Sandhu, Harminder S. et al. "Hyponatremia associated with large-bone fracture in elderly patients." Int Urol Nephrol (2009) 41:733-737,
  34. ^ a b Malaria: [http://group.bmj.com/group/media/latest-news/elderly-are-almost-10-times-more-likely-to-die-of-malaria-than-younger-tourists BMJ, 2012
  • Thomas, Brian. "Cost of Care". Cost of Care. www.elderpoint.com. Retrieved 5 April 2012.

Further reading

  • Eliminating Barriers to Mental Health Treatment: A Guide for Massachusetts Elders, Families and Caregivers", Massachusetts Association of Older Americans, 3rd Edition, 2008.
  • Aged Care Terminology Glossary (Australia) http://www.bethanie.com.au/index.php?page=glossary
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