The “Single” Boom: Problems and Solutions for LTC (McKnights online)

Posted by Dr. El - April 30, 2012 - Younger residents - 2 Comments

Here’s my most recent article in McKnight’s Long-Term Care news online:

The “Single” Boom: Problems and Solutions for Long-Term Care

According to recent reports, one-third of the baby boomers who will be arriving at the doorstep of long-term care are unmarried. Many of them have no children. Just as our healthcare system relies on unpaid family caretakers, LTC relies on close family members who help our residents through their stays.

The demographic trends, however, suggest we need to prepare for increasing numbers of residents without close relatives.

Below are four ways we can expect this shift to impact our residents, and suggestions for how we can adapt to this change:

1. Lack of POAs, healthcare proxies or legal guardians

The Problem: Currently, most residents have someone available in their lives to make medical and legal decisions on their behalf. This trusted helper is able to collect the documents necessary to apply for Medicaid, for example, or to sell a home for the resident.

Typically, family members are informed of the need to sign or gather paperwork, and the nursing home awaits the documents. They generally arrive with or without further prompting, allowing for successful completion of the transactions.

In the absence of an involved family member, these essential activities are virtually impossible for a resident to accomplish independently from inside the nursing home, no matter how robust their condition. Residents, who often make a sudden trip from home to hospital to nursing home, generally don’t have important phone numbers, access to legal papers, Internet connectivity, or the wherewithal to make arrangements on their own, from afar, in the middle of a health crisis.

As we begin to see increasing numbers of elders in this situation, it will become apparent that what we are viewing is not an individual problem, but a systems problem.

The Solution: As a system, we’ll need more court-appointed powers of attorney, proxies and guardians available to our residents, as well as a greater emphasis on obtaining advance directives and community supports. Streamlining the process of obtaining these assistants will make life easier for everyone, and can be accomplished using some of the methods below:

 When assessing social supports upon admission, we can educate residents about the need for assistance in navigating their healthcare. It’s important to plant the seed early in admission because we can expect this idea to meet with resistance as residents struggle to maintain their independence. We can explain that obtaining helpers is not a reflection of a personal failing, but is unavoidable in a complicated healthcare system.

 We can offer increased independence via discussion of advance directives, which allow residents to make their own decisions regarding their healthcare.

 We can discuss with residents who among their family, church, and community members might be willing to assist them with their care and begin outreach toward potential helpers. Offering prepared pamphlets or other educational materials about what is involved in taking on a specific caregiving task will allay the concerns of those considering a helper role and reduce the burden on the social work staff communicating the information.

 Within our facilities, we can increase our connections to the local community. There we might find church volunteers, for example, who would be willing to take an active role in the lives of our residents, such as signing a back-up agreement for home healthcare or becoming a legal guardian.

 We can help residents create a personal caregiving team by connecting more distant relatives or friends who may be able to offer only limited assistance, but together meet the needs of the resident.

• We can increase the number and training of social workers in our centers, so they can take on the additional tasks required to address the above suggestions in a manner that enhances the reputation of the facility.

2. Lack of errand-runners

The Problem:  A LTC facility often becomes the resident’s entire world, but not all of their needs can be met within the walls of the facility. A major and important function played by family members is that of procurer of outside items. Currently, residents rely on their family members to bring them home-cooked foods, clothing or items from the community, such as a favorite lotion or shampoo.

Residents without family or friends have come to rely on the kindness of strangers, like their roommate’s daughter, or the friendly aide who makes a grocery store run on her lunch break. This lack of control over formerly simple tasks leads to frustration and depression. Chores such as fixing a watchband become monumental in a nursing home. Using generic toothpaste instead of the brand enjoyed for 70 years can be a twice-daily reminder of lost independence.

Again, what appears to be an individual problem is actually a systems problem within each setting. An increase in the number of single residents will propel us to adjust the way we handle resident needs.

For more, visit McKnight’s Long-Term Care News online: The “Single” Boom: Problems and Solutions for Long-Term Care