Aging and Long Term Care ( 3 Hours) > Chapter 5 - Long-Term Care

Chapter 5 - Long-Term Care

V. Long Term Care

As a result of diminished physical and mental capacities, long-term care becomes a necessity for many older people. This care can be provided in different settings and from different sources including the elderly moving in with family members or vice-versa, paid home healthcare nurses and skilled nursing facilities (nursing homes). The decisions regarding long-term care are difficult. It is a sign to the older person that they are no longer fully independent or self-sufficient. There are also emotional issues regarding whether family members or hired professional personnel will provide care, and what level of care is necessary. The decision to place the elderly person in a nursing home can be devastating. Family members often feel guilt, while the elderly person may feel unloved and rejected. Symptoms of depression, anger, resentment and denial may be present.

A. Family Care

Should family members decide to either move in with the elderly person, or the elderly person move in with the family, there will be some significant home life adjustments that will be made. As a result of their frustration of losing their independence, the elderly person may become demanding and critical of the caregiver. Sometimes they can become abusive, even physically.

The family now has another person to care for who is sometimes even more demanding than children. The elderly may depend primarily, or even exclusively, on the family for social interaction and may need help with various personal needs and hygiene. Besides feeling frustrated, this can also be very embarrassing to the elderly person.

In these situations, helping family members create and practice healthy styles of communication can go a long way in reducing frustrations. It is also important to link caregivers and the elderly to resources. There are senior centers where the elderly person can go during the day to enjoy interaction and age appropriate activities. There are also community caregiver support groups that can provide ideas and the emotional boost that is needed from time to time.

B. Wellness of Caregivers

The following is retrieved from the Department of Health and Human Services Administration on Aging.
It presents helpful information for practitioners who provide services for those providing long-term care:
Department of Health and Human Services
Administration on Aging
Ensuring the Health and Wellness of Our Nation's Family Caregivers
December 16, 2003
10:00am to 12:00pm Washington, D.C

The Deputy Secretary of Health and Human Services Claude Allen hosted a town hall meeting to highlight the important role of health promotion and disease prevention activities in ensuring the health and wellness of one of long-term care's everyday heroes: our nation's family caregivers.

Family caregivers are a critical source of care to older persons with disabilities and chronic health problems. The unpaid and informal care they provide is an essential source of help for disabled elders in the community. If the work of family caregivers had to be replaced by paid home health care staff, research shows a significant cost to the nation of $45 billion to $94 billion per year.

It is generally recognized that caring for an older person with a disability or chronic condition is burdensome and stressful to many family caregivers and contributes to psychiatric and physical morbidity. Accordingly, about a third of these caregivers describe their own health as "fair to poor." Recent research findings suggest stress associated with family caregiving can result in increased risks of infectious diseases, such as colds and flu, depressive symptoms, and chronic diseases, such as heart disease, diabetes and cancer. Family caregiving, when accompanied by emotional strain, has also been found to be an independent risk factor for mortality among older adults caring for loved ones.

Researchers have also shown that family caregivers are less likely than peers of the same age to engage in health-promoting behaviors that are important for chronic disease prevention and control. Given that the demands of caring for a loved one may compromise caregiver health and functioning and increase caregivers' risk of developing physical health problems, there is a pressing need to encourage family caregivers to engage in activities that will benefit their own health, well-being, and longevity.

In response to these finding, the Department of Health and Human Services saw this town hall meeting as an opportunity to:
  • highlight the important contribution of the people on the "front lines" of caring for the elderly and those with disabilities;
  • recognize these everyday heroes for their "can-do" attitudes and generosity toward their family members, friends, and neighbors;
  • acknowledge the importance of health promotion and disease prevention activities for family caregivers;
  • introduce examples of family caregivers who are "living well" because of health promotion/disease prevention activities; and
  • speak on the importance the Department places on encouraging the health and well-being of America's caregivers.
Mr. Donald "Mac" Showers, Ms. Katryna Gould and Mr. Bill Kays, who are former and current caregivers, were on hand to deliver testimonies of their caregiving experiences and also, discuss the positive impacts that health promotion activities have on their quality of life with Deputy Secretary Allen.

These caregivers provided the audience with some valuable lessons learned including:
  • It is necessary to care for the caregiver as it is to care for a loved one.
  • Get adequate rest and exercise.
  • Have a sense of humor.
  • Acknowledge your own poor and adverse health.
  • Do not ignore your own health. If you do not take care of yourself, in the long run, you will not be able to be a good caregiver for someone else.
  • Recognize when you are no longer able to care for your loved one.
  • Do not be ashamed to ask for help.
  • Seek balance in your life as a caregiver by taking time out four your own needs and interests.
  • Consider joining a support group. Such groups can be extremely valuable in providing a safe place to share personal experiences and feelings with others who are in similar circumstances.

Researchers and representatives from organizations that provide support for family caregivers were also on hand to highlight the reasons that might contribute to the physical and emotional strain that family caregivers experience. Some of these reasons could include:

  • Internal sources of stress that come with providing care to a chronically ill relative;
  • External sources of stress such as transportation and financial pressures associated with caregiving (on average, caregivers spend 11% out-of-pocket for services not covered by Medicare);
  • Chronic stress in never knowing what challenge will come next; and
  • Barriers to health promotion activities may include lack of time, respite care, depression, guilt and denial.

The panelists also emphasized ways in which family caregivers can ease some of their caregiving burden and facilitate more engagement in health promotion and disease prevention activities. Some of these might include:
  • Use the opportunities when taking a loved one to the doctor to address concerns and/or ask questions about your own health.
  • Prevent adverse health by getting immunized and obtaining routine screenings.
  • Also be mindful of your own nutrition.
  • Do not try and do everything by yourself. Ask for help from others and utilize local resources, such as the Eldercare Locator at 1-800-677-1116.
  • Quality respite services can allow family caregivers to have a break from their current pressing challenges and give them some much needed time to themselves.
  • Be aware of the all of the programs and services available to ease the burden of caregiving, such as the National Family Caregiver Support Program.

An excellent link for caregivers is here:

C. Skilled Nursing Facilities

A difficult decision is placing the older person in a skilled nursing facility. These facilities are paid for through personal savings of the elderly and after those have been exhausted, Medicare funding. Nursing homes provide scheduled activities and potential social interaction and necessary medical care. However, they are often not very pleasant places to live.

As a result of care problems over the years, a myriad of regulations have been placed on nursing homes, having an adverse affect on some services. Often the nursing home personnel spend most of their time required documentation which leaves them little time to have meaningful interaction with the patients. Many patients, because of ambulatory issues, are at the mercy of these personnel. Nursing home staff sometimes have difficulty providing services other than the bear minimum required by regulations.

In addition to these issues, being placed in a nursing home becomes isolative from the community and family. They no longer have their own home, apartment kitchen bathroom or bedroom. Privacy is minimal. Freedom of movement and activity are curtailed. It can be a very difficult situation. Some Medicare funding, including Medicare Part B, allows for the provision of psychological services for those exhibiting the need for such services. This may include behavioral problems, depressive symptoms, anger, anxiety and adjustment disorders. Along with specific symptom interventions, these services provide the patient with someone to sit down and listen to them and to show positive regard for them. This in itself can be revitalizing to the patient.

The rate of nursing home residence among people age 65 and over, by age group per 1000:
  65 and over 65-74 75-84 85
1985 54 13 58 220
1995 46 10 46 199
1997 45 11 46 192
1999 43 11 43 183

Source: Center for Disease Control and Prevention, National Center for Health Statistics, National Nursing Home Survey

D. Hospice Care

Another important decision that the caregivers often need to consider is the alternative of hospice care. The following guidelines provided by the United States Administration on Aging (AoA) are helpful for the practitioner when advising clients on the use of hospice care:

National Family Caregiver Support Program Resources

U.S. Department of Health and Human Services Administration on Aging

Caring for Someone in the Last Years of Life


Helping to care for someone who may be nearing the end of his or her life can be a surprising, challenging, and rewarding experience. Whether you are a friend, family member, loved one, co-worker, or paid caregiver, the care that you provide does make a difference.

The last years of life are a time of many changes. The changes taking place in the life of the person for whom you care may raise questions and concerns about how best to meet their needs. Information and support is available. Your local hospice can help you understand and prepare for these changes.

When To Consider Calling Your Hospice:

  • When you have questions about what to expect physically, emotionally and spiritually as the end of life approaches
  • When you need information about resources that can help you manage your responsibilities as a caregiver
  • When you have questions about how to have sensitive conversations about treatment choices, living arrangements, and personal care
  • When you want help with preventing and managing symptoms related to an illness or its treatment
  • When you want guidance in finding the opportunities for hope, comfort, and meaning that are part of this important time of life
  • When you are experiencing feelings of loss, sadness, or grief associated with the illness or death of a loved one
Hospice Programs Can Offer You:

  • Support as you make decisions about treatments and options for care
  • Information about advance directives, such as living wills, that can help communicate choices about care
  • Medical treatment that aggressively seeks to prevent, assess, and treat symptoms of discomfort and disease progression
  • Comfort-focused (palliative) care provided by coordinated teams of professionals that include nurses, home health or certified nursing aides, social workers or counselors, chaplains, physicians, and trained volunteers
  • Care that is guided by your goals and priorities
  • Bereavement support to help you find comfort and hope

Hospices serve their communities by being a resource for meeting end of life needs. You can rely on your hospice for help in dealing with the practical, physical, emotional, and caregiving issues that are part of the last years of life. Hospice is not about giving up. It is about comfort, well-being, and quality of life. Anytime you need information from an experienced team of caregivers, contact your local hospice. They are here to help.


Question No.11. Because of the clear need, long-term care decisions are easy to make:

a. True
b. False Question No.12.Alternatives for Long-Term care include:

a. Moving in with family members
b. Hiring professional caregivers
c. Skilled nursing facilities
d. All of the above

Question No.19. A critical source of care to older persons with disabilities and chronic health problems are:

a. Family caregivers
b. Friends
c. Therapist
d. None of these

Question No.20. Comfort-focused (palliative) care provided by coordinated teams of professionals that include nurses, home health or certified nursing aides, social workers or counselors, chaplains, physicians, and trained volunteers is:

a. Assisted-living facilities
b. Health Maintenance Organizations
c. Hospice
d. None of these
Aging and Long Term Care ( 3 Hours) > Chapter 5 - Long-Term Care
Page Last Modified On: December 4, 2015, 08:33 PM