Nov. 14, 2003

Former First Lady Rosalynn Carter is often quoted as saying, "There are only four kinds of people in this world -- those who have been caregivers, those who currently are caregivers, those who will be caregivers and those who will need a caregiver.

One out of four households (22.4 million households) is involved in providing care to a person age 50 or over. Five million caregivers provide care for someone age 50 and over with dementia and 75 percent of the family caregivers are female.

What defines a family caregiver? If your answer is "yes" to any of the questions asked below, you are a family caregiver:

* Are you driving mom to her doctors' appointments?

* Are you doing all the shopping for dad?

* Are you spending your weekends cleaning your grandparent's house and paying their bills?

* Are you increasingly worried about your parents' or grandparents' health, their driving skills and that they are living alone?

* Are you noticing that your spouse acts confused, has memory problems or his/her chronic health problems are getting worse?

* Are you providing assistance to your spouse, and doing more around the house, including those tasks that your spouse had always done before?

How will you know when to help? Many older people may seem perfectly capable of managing their own lives and homes, but often they are reluctant to admit they need help. You can look for clues in your conversations with them, or talk to their close friends and neighbors. Some of the signs that may indicate a person is in need of some extra assistance are:

* Increased requests for your time or assistance

* Recurring memory lapses

* A marked change in behavior patterns

* Lack of interest in life or feeling "down"

* Inadequate meals and nutrition

* Unopened or piled-up bills

* Frequent falls

* Unsafe driving

When assessing a family member's need for care, it is important to be discreet and kind, and try to keep the person's dignity in mind. When mutual love and trust exist, the family member will know you have his or her best interest in mind.

Look at the following areas. Can he/she do them alone? Do they need help, or can they no longer do them at all?

* Grocery shopping

* Meal preparation

* Laundry

* Bathing/grooming/dressing

* Housekeeping

* Driving

* Managing medications

* Doctors visits

* Finances

* Mobility/walking

* Mental functioning

* Behavior in social situations

* Maintaining a social life

* Safety awareness

Seek input from your family member's doctor. It's a good idea to have your family member's medications reviewed and current health problems explained to you. Be honest about the concerns you have and keep in mind your loved one's safety should be your primary concern.

Consider holding a family meeting to include everyone who will be part of the care team, as well as the person that will receive the care. You may find it helpful to prepare an agenda and/or have an outside facilitator present.

Address the daily care needs and write down who will do what and when. When you have the cooperation and assistance from others, you may be able to manage caring for a family member for some time. There will come a time, however, when other questions have to be asked.

* How much work can you miss in order to provide care?

* What financial help may be available from family members?

* Should the ill person move into your home with you?

* What are the fears about death and dying?

* Who will make the legal decisions (e.g., financial, medical, hiring a caregiver, etc.)?

* Who will help with emotional support to the primary caregiver and provide respite care?

* How long are you able to be a caregiver?

* Does the ill or in-need family member need to be in an assisted living facility or nursing home?

At this point it may become necessary to begin looking for community care options. Ask specific questions that address the needs you have identified. Write down all the information. Identify the resource(s) that will best meet your needs.

* Information and referrals/case management services

* Nutrition services (Meals on Wheels, senior centers)

* Medical emergency alert systems

* Adult day care (social)

* Adult day health care (social services, PT, OT or for dementia care)

* Transportation services

* Home care

* Respite care

* Support groups

* Resources from books and the Internet

* Hospice care

Asking for help is a difficult, yet crucial thing to do. No one person can provide care for an adult 24 hours per day, seven days per week. Seek productive solutions.