List of Needs

The first step in organizing a rational care plan is making a list
of needs. As family members or friends care for an impaired elderly
person, several questions present themselves:

__ What are his/her needs?

__ What kinds of care are needed to allow the elderly/impaired care-
receiver to remain in his/her own home, live with the children or
other relatives or move to other surroundings (retirement
apartments, residential care, intermediate care, skilled nursing
facility or other)?

__ How can living arrangements be changed to help the person stay in
the home or become more independent?

__ If outside services are needed, does the impaired person have the
resources to pay for them? How can they be obtained?

__ How can care be given to the person in need without denying
attention to others (spouse or children) for whom the caregiver also
has responsibility?

__ Do you as the caregiver feel tired or frustrated from caring for
an older person?

In answering these questions you are developing an important *List
of Needs* of the impaired elderly person, and bringing into
perspective the caregiver's needs as well. The questions do not have
easy answers and the solution may vary in every situation. The care
of an impaired older person can create stress that affects the
ability of the caregiver to continue giving necessary levels of
care.

Types of Stress

The stress experienced may be physical, financial, environmental
and/or emotional in nature.

Physical Stress:

Providing physical care to an impaired older person can cause
physical stress. General homemaking and housekeeping activities such
as cleaning, laundry, shopping, and meal preparation require energy
and can be tiring, particularly when added to existing
responsibilities in one's own home. Personal care required for the
supervision of medications and the maintenance of hygiene can also
be stressful, particularly in situations of acting-out behaviors,
incontinence (loss of bladder or bowel control), colostomies, or
assistance with bathing. Lifting and transferring individuals with
limited mobility is not only tiring, but also can result in injury
tothe caregiver or the impaired person. In some instances there is
the additional responsibility of maintenance of equipment such as
wheelchairs or hospital beds.

Financial Stress:

The care of an impaired elderly person has many financial
dimensions. For those services that cannot be provided by family
members (medical, pharmaceutical, therapeutic, etc.), decisions will
have to be made as to where service will be secured and how they
will be paid. When money is limited, many families assist with the
cost of care, causing financial burdens on all family members.

Environmental Stress:

The proper home setting has to be chosen. If the care-receiver
elects to remain in his/her ownhome, modifications such as railings
and ramps may have to be installed. If the person cannot remain in
his/her own home, alternative arrangements must be sought, such as
moving in with a friend or relative or specialized housing
(retirement hotels,senior apartments, residential care homes,
intermediate carefacilities, or nursing homes). If the care-receiver
is to remain in the home, some major adjustments in the living
arrangements and patterns of daily living will be necessary.

Social Stress:

Providing personal care up to 24 hours a daycan cause social stress
by isolating oneself from friends,family and a social life. The
caregiver may find him/herself becoming too tired or unable to have
*an evening out* even once a week, or once a month. What can result
is a build-up of anger and resentment toward the very person
receiving the care, as the care-receiver is the cause of the lost
socialization.

Emotional Stress:

All of these factors often result intremendous emotional stress.
Compounding these sources of stress are the difficulties in managing
one's time, juggling multiple responsibilities, and feeling the
pressure of the increased dependency. For family members providing
care, the various forms of stress can result in different feelings.
Anger, resentment and bitterness about the constant
responsibilities, deprivation and isolation can result. This is also
a time when many of the unresolved conflicts from parent-child
relationships resurface and can intensify, causing anxiety and
frustration. There might even be the unspoken desire, at times, to
be relieved of the burden through institutionalization or even death
of the care-receiver. This desire is frequently and swiftly followed
by feelings of guilt. All of these can be felt, then denied because
they seem unacceptable. The person giving care needs to be assured
that, in fact, these feelings are common even though they may not be
expressed. There are resources that can help caregivers. The
remainder of this book will address those resources, such as joining
a caregiver support group, using community resources and above all,
caring for yourself the caregiver.