Elder Care.

Elder Care addresses the needs of the frail elderly who make up 5% of the population over 65 years of age. In other words, of the approximately 45 million seniors in the United States in 2003, 2.25 million were considered frail elderly. Frailty means the person is no longer capable of performing one or more of the six activities of daily living (ADL's) without the assistance of another person.. These ADL's include: bathing, dressing, grooming, eating, transferring, and toileting.

This group, although small in percentage of the entire elderly population, utilizes the largest portion of healthcare resources including inpatient medical hospitalization, home care, and long-term care in nursing homes and other residential care facilities. Elder Care services are very important because currently 80% of the care provided to the frail elderly in this country is provided by family members.

What services are available to elders?

Elder Care is like an umbrella of care and services for the frail elderly. These include a broad range of services including:

Which care options are most useful for elders?

Even though you may be aware that these services are available, it can be most difficult to determine what kinds of help or services could prove most useful and to locate how to obtain that care. It must be determined in each particular situation whether home care or senior center-based socialization or placement in an assisted living facility is the best choice. Fortunately, there are well-trained, well-versed professionals in the aging services community who can help consumers learn of available services and assist them through the care option and access process. Some of these professionals include agency-based and medical social workers, discharge planners in hospitals, and professional care managers.

Where can financial help be found?

Financing of services, both in the home and in facilities, is a major problem for the frail elderly and their families. Both the elderly and their families are startled when they learn how limited and specific are the medical and care provisions of Medicare-covered services. For instance, just because the Medicare handbook states that 100 days of nursing home care is covered does not mean that the particular circumstances of a loved one's current illness is eligible for this level of coverage. While most of long-term nursing home care is paid for by Medicaid (Medi-Cal in California), and State programs for frail, low-income/ low-asset elderly, the bulk of in-home care often must be paid for out-of-pocket, and is generally not covered by any insurance program.

What medical conditions affect the elderly?

There are many medical conditions that may result in frailty, and several stand out as most directly impacting the individual's day-to-day abilities to function normally. The most glaring of these is dementia in its many forms (i.e., Alzheimer's disease, vascular dementia, etc.). Other serious conditions affecting function include strokes, Parkinson's disease, chronic obstructive pulmonary disease (COPD) and emphysema, near or total blindness, diabetes and advanced heart disease.

What end-of-life options are available for elders?

Life planning, especially end-of-life issues, is a critical consideration when dealing with progressive chronic illness. Decision-making is a vital area to address is care giving. While the frail elderly are capable of being of sound mind, a designed spokesperson should be named via proxy or power of attorney to ensure the frail elderly person's wishes are carried out even after they can no longer be considered qualified to make clear decisions for themselves. While the chronically ill frail elderly is clearly capable to making decision concerning end-of-life treatment, life support, and other decision such as who they trust to make their decisions known and ensure they are carried out, conservatorship, proxy, or power of attorney should be established legally. Up to 50% of persons 85 years of age or older develop dementia. Before this dementia has progressed to the point that "sound mind" may not be valid if challenged in court, it is best to establish hospice options and palliative care options the elderly may desire or wish to avoid.

How can caregivers be supported?

Caregiver concerns are a large area of consideration in Elder Care. Since 80% of the care provided to the frail is given by families, it is crucial that these caregivers are supported during their months or years of care giving. This support may take the form of:

How does depression affect the elderly?

Moderate to severe depression often accompanies physical decline and frailty. As many as 70% of institutionalized elderly experience significant depression. The incidence in community settings is approximately 18% in persons over 65, as opposed to 8% in the general population. Some estimates of frail elderly living in independent settings have found a 30% or higher incidence. Depression is a medical condition that affects not only quality of life, but also the ability of people to take care of themselves. They may not get out of bed, or they may not eat or groom themselves as a result of their depression. It is a condition that is usually easily improved with new treatments. But it is often untreated in the elderly, especially the elderly who is cared for at home as the condition may not be recognized and in the elderly depression can have dire consequences.