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The Watering Hole - Conversations on 21st. Century religion.

Elder Needs

What do the elderly need from us


 
Abstract

One of the most difficult challenges people face in life is the security and care of the elderly. It's sometimes controversial, and creates heated arguments in families. It is guilt producing. It sometimes brings feelings of rejection. Every situation is different, so there are no "standardized" or "right/wrong" answers. Sometimes the elderly can and should remain in their homes. Sometimes the elderly should go and live with relatives. Sometimes they can and should go to a facility. But we should always be aware of the full set of real needs that people have, no matter where they are in life.


What do the elderly actually need?

As people age they gain experience, and lose physical abilities. Many aging parents today live with their children, and they often find a new role assisting with family childcare. Many live on their own, and prefer to remain independent as long as they possibly can. Others go to assisted living facilities where they can get the minimal assistance they need 24 hours a day and be with their peers. And as people age, they often exceed the abilities of their family to support their needs, and go to skilled nursing facilities.

No matter where aging parents live, their living conditions are never idealistic or optimum. They often aren't "happy" anywhere. This leaves their children in anguish, wondering what they should be doing for them. We all have to remember that things always change in, whether they were good times or bad times, and we can never go back to what was. Mostly the elderly remember the good times in what was, and want them back. We don't have magic wands to make it so.

What do people need

In a very abstract sense, their needs are about the same as everyone else, until their very last dying day.

  • To feel that your basic needs for food, housing, clothing, familiar surroundings, etc., are there for you. (Security)
  • To love, be loved, and feel like you belong in your circle of friends and family. (Love)
  • To feel like you are able to take care of yourself, are independent, in control of your life, and can get around on your own. (Independence)
  • To feel esteemed (appreciated, competent, validated, accomplished, recognized, successful, listened to and assisted, not damaged, and in control of your life) (Esteem)
  • To feel like you are making a contribution (assisting, giving advice, doing your part, work) (Contributing)
  • To feel like you are achieving your individual potential. (Contributing at your level of competence, and growing, and learning)
  • To feel you have rewards and pleasure. (Pleasure)
  • To feel creative (for some)

All of these are actually very important to everyone. When any one of these needs is troubled, they usually show up in the person's behavior (things they do, acting out, the way they think and act, attitude, demeanor). As people age, the need for esteem is usually replaced by making a contribution, unless people are damaged from verbal or physical abuse, but sometimes comes back when people feel useless (lose job, divorce, empty nest, financial problems, retirement, growing old, physical incapacity, etc).

In old age, people who have felt very deficient in attaining their needs for most of their life, whether it's true or not, may take this as a time to satisfy them. They may feel entitled to "say what they want," or to be taken care of, or to have a second childhood.

When talking to and working with the elderly, you might remember that they have these needs, just like everyone else, and try to help them feel like they need to feel. When they feel like they are not competent, not independent, not a contributing person, not living up to potential, and not in control of their own life," their feelings and self-talk make them want to isolate themselves and "crawl into a hole." They withdraw from others, get depressed, feel anxious, become overly dependent (as they doubt their own abilities), etc.

You can counter that kind of self-talk with things like, "We're helping you to stay independent and in control." Of course they may reject that when they hear it, but it has an effect.

As people age, they may slowly lose the ability to fulfill these needs. Life can be ugly, or sweet, and is usually what the person makes of it. We had one elderly parent who really liked the nursing home, having visited it many times in rehabilitation, but when she committed herself, made up her mind she wouldn't like it. We had an uncle who purposely starved himself to death. We had another elderly parent who grew senile at home and finally passed before having to go anywhere. We had one elderly parent who enjoyed doing what she had a life-long love of doing, but was never really happy being there... or anywhere, even with relatives.

I visited with many elderly in one congregation. Many were in facilities. Many were alone at home. The ones at home typically were lonely and didn't eat.

Next: Remaining at home

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Remaining at home

As people become infirm and less able to take care of themselves, or lonely, we often think the best thing for them would be to take them into our own homes or put them in assisted living. In reality, what many of them want is simply to remain in their own home and have that sense of independence that comes with it, and be in surroundings that are familiar and loved, often where fond memories have lodged that place in their heart. I've known people who were legally blind, infirm, widowed and alone, in their nineties, who remained in their own homes, and continued to work in their gardens and supply fresh garden produce to their neighbors. The elderly can often manage better than we think they can, and would prefer to live and die in their own homes.

Sometimes it is better to just have them come and visit for a while... and sometimes see how well they would fit with your family. To help them in their own home, there are emergency call devices that they wear around their neck, by which they can alert a rescue service if they fall and are unable to get themselves back up. Many elderly join call groups that call each other every morning so that no one can lie for hours without assistance. A myriad of tools for communicating, reaching, walking, getting in and out of chairs, or off the toilet, getting regular meals delivered or with others, etc., are available for assisting the elderly.

The most difficult question that arises is senility. As people age, they often lose the ability to think sharply, and lose short term memory. They can't remember if they took their pills that morning, or if they ate lunch. They don't have much appetite, and eating has usually become a social function, so that without someone to eat with they often forget. They won't remember doctor's appointments. They typically are unable to do much about home repairs, so if the home is falling apart and they don't even know it. They may need additional assistance from someone at this point, or to go to your home or a facility at this point.

I highly recommend keeping people in their own homes as long as possible. They are happier there, even if there life potentially might be shortened.

Next: Assisted Living Facilities or your home

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Assisted Living Facilities or your home

In an assisted living facility, the individual can continue with many of life's activities, but is primarily responsible for himself and his own care. They usually have to be able to get themselves up, dress themselves, and walk themselves to all activities. (No wheelchairs, no skilled nursing needs.) Some facilities have apartments and allow cooking, but some are only shared rooms with no cooking. Some facilities will do more for them.

In most facilities, the nursing staff will take care of some doctor ordered procedures, such as dispensing medicine and treating certain skin conditions, and arrange for transportation to medical visits. You have to keep in mind that the staff won't monitor the person's weight, monitor reactions to medications, note minor changes in the person's condition, or do any skilled nursing treatment. They typically will not allow any over the counter medication, not even vitamins. They are typically not skilled nursing facilities.

In these facilities, the individuals are responsible for doing everything themselves, and for getting skilled nursing help, or a family member has to monitor them for changes and help them with medical treatment.

For some, assisted living facilities are great. They get to spend a lot of time with their peers - people who think, feel, and are interested in, similar things. They may have the flexibility to come and go as they please, even drive, take part in group and arranged activities, and continue their daily lives, but they get fed three decent meals a day and get assistance when they need it.

For others, assisted living is not home, and they often have roommates that they don't want, and food that doesn't taste like home cooking. They don't like it.

Payment for these facilities can often be done by a combination of Medicare, Medicaid, resident financing, and family financing. The States have been cutting back on the amount of funding they will do, since 2001. With each financial bind the US gets into, the more aid is cut, making it very difficult for many people to get into assisted living facilities.

Can you take the person into your home?

Yes and no. Yes if you like the company of the person, and he likes yours, and your home is flexible. Guilt may make you feel that you have to. Guilt often leads to resentment that shows, and sometimes even to abuse born of frustration. Taking an elderly person into your home isn't as glorious and noble as some would make it out to be.

Families often have intractable personality conflicts with the elderly person, and a psychologist and religious figure may not be any help. There is often nothing for the person to do in the family home. There is often discord in the home that the elderly would be much better off not witnessing daily, because it keeps them depressed. Having the person in your home often disrupts their ability to associate with people their age, so they are lonely and feel isolated from life, and they will typically feel like an intruder into your life, a fifth wheel, and a bother. They won't feel comfortable having visitors over. They will become depressed because they don't have anything to contribute to life. Children may resent their presence because of the new restrictions, and it often shows. They usually need more exercise than they can or will get in a small home with no activity, which means their fitness is likely to deteriorate and they will be less healthy.

You may have to modify your home so that the person can get in and out on a ramp, have assistance in the bath room, have stair openings blocked so the person can't fall, and get children and adults to pick up items that they normally might leave on the floor as trip hazards. Doctor's appointments are frequent and endless, and you get to provide transportation in the middle of the day, and accompany them for hours on end. Ambulance trips may be regular occurrences. The person's diet may be different than your own eating habits, for medical reasons and for preference. Smokers will have to stop - it irritates elderly breathing passages much more than younger people with thicker mucus. Noise has to be minimized. The elder person will want their own TV, may blare it loudly, and demand you turn your TV down. It's almost as disruptive as having your first baby.

You have to realize that someone may need to be available 24 hours a day, and take on a bunch of new responsibilities, and this may mean the end of a job, a commitment from someone who wants this time for his or her own life, and a reduction in family income... often at a time when you simply can't afford it.

Many of these problems can be addressed in your home, and happily so. But you should not go into having someone in your home with your eyes closed. It means a lot of changes for a family, which may be acceptable, but could also be a welcome addition for someone alone and aging themselves.

Next: The nursing home or your home

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The nursing home or your home

Possible, but highly improbable. Nursing homes have a difficult task, and an image that matches. When the elderly become infirm, it is very difficult for people to give them the assistance they need in their home. Aging is not a pretty picture, and modern medicine extends life often without extending support and quality.

Nursing homes often have skilled nursing facilities attached to them, which are for skilled care and rehabilitation, which lead to the person resuming their normal life. But many go to the nursing home side when medical complications are permanent. It's a place for people who can't get well, and for the dying. In a nursing home, you have people calling for help, sometimes endlessly, all day and sometimes all night. These people's minds have failed, and the only thing they know is that they are not in their homes and that's what they want... but that is impossible.

Many people in a nursing home sit around in a stupor all day long, with their heads in their laps. They are barely conscious. Their minds may have failed, they may be heavily medicated, or they may simply be bored to death. Those in beds require assistance with body necessities, and they smell that way. Those with their wits about them, who need assistance, may go for hours before getting it when the staff is busy with duties and medical emergencies. It is a depressing place for those whose minds are sound. Medicaid cuts make it impossible for there to be enough staff, and only Medicaid, or private payment, will fund this type of facility. The hours go by for people as if they were in a fugue state, hardly conscious of time or visitors. It's a place where people may lose hope. But often, depressing as it is, it is the only choice.

Your home

In your home, the same people will be calling out day and night for help, and wanting to go home, and wanting you to get them up to go to the bathroom, or change their sheets, immediately. Thier presence requires someone to be at home 24 hours a day, 7 days a week, to assist them. You will be unprepared to administer any life saving procedures, or to recognize when vital signs have gone haywire. You will have to learn how to attend to their medical needs, such as medication, shots, wound care, and other things that skilled nurses do.

You will have to learn how to cleanse, bathe, dress, feed, move, and in all other ways assist someone who can't walk, but has to go to doctors appointments, eat, go to the bathroom, etc. They often require specially controlled diets. Since the elderly frequently have no strength at different points in the day, you have to be able to support their weight, move them, break their falls, and pick them up off the floor if they do fall. You will find that you can't do this by yourself - unstable people are just too unwieldy to move by yourself, particularly without injuring them, even if you are capable of lifting 150 or more pounds.

Commonly the elderly at this point are having problems with their minds. Portions of their brains are impaired from strokes, cell death, medication, etc. They often "aren't themselves." In earlier years they would have been able to restrain their affection and their anger, but now often aren't. They don't have anything to think about but themselves and their own needs. The sweet person you knew hasn't really changed, but their mental faculties and ability to censure themselves has. It is very hard to live with someone who is demanding, angry, stubbornly resistant, and seems to resent and even hate you 24 hours a day, but is still completely dependent on you for their every need. But for some, they actually become very sweet and docile, and wonderful to have around.

It's often a thankless job. You may find it very difficult to keep a "loving attitude" toward your relative, give up your life for them, and to chore for them endlessly without resentment. But it is what you have to do. There are care-giver support groups. Before going this route, you should do it with your eyes open and decide if you are physically, mentally, and emotionally able to do this, often with minimal or no support from others. If you are a spouse of an elderly person, you will require frequent assistance from another person during each day, and even some if the person is bedfast.

Next: Summary

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Summary

Aging can be a time that tries people's souls, whether the aged person, the caregiver, or just the person who lives with them. People's needs don't really change much, but our ability to take care of our needs, from going to the bathroom to the need to paint a picture, almost always declines with age. Collectively we are often much better able to address these needs than we are individually. Giving care can break people and relationships. Those who are aging, and those who are giving care, should always look for the collective ways to address needs, such as senior citizen center food and activities, going places and doing things as an elderly group, visiting, caring for each other through phone calls and assistance, etc.

Caregivers should seek advice, special training, get the right tools, and find support. No one can give care 24 hours a day. They really should find someone else to help with the duties.

We also have to realize as we lose abilities, life is rarely ideal again... not that it every was just like our memory. The end of life picture may take us to places we don't really want to be, but for our own sake and others, we may have to go there, and we should not make others feel guilty or resent it - we should make them feel comforted about it. Ideally we can have a spouse who takes care of those end of life things for us, but too often we simply become unmanageable.

Whatever we decide, we have to remember that we all have needs, love each other, be tolerant of each other, be slow to anger, don't take things personally, never be spiteful or vengeful, but to do all things out of love.

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Reference

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