Family Influences

Chapter 6

Family Influences

1

Families play a significant role in the lives of most older persons.

85% of all senior citizens will need in-home assistance at some point in their lives.

78% of in-home care is provided by unpaid family members and friends.

Most of the care for the older adult is provided in the home environment.

Role and Function of Families

2

Demographic and Social Trends That Affect Family Support

Increasing aging population

Living arrangements

Disability and activity

Decrease in birth rate

Increase in employment of women

Mobility of families

Increase in number of blended families

Older adult providing as well as receiving support

State of the senior housing industry

Caregiver workplace issues

3

Common Late-life Family Issues and Decisions

Most common issues and difficult decisions families face include:

Changes in living arrangements

Nursing facility placement

Financial and legal concerns

End-of-life health care decisions

Vehicle driving issues

Family caregiving

4

Family members struggle with allowing a person to be as independent as possible and creating a more secure environment.

Older person views loss of independence as “being closer to the grave.”

As long as they have the mental capacity to make decisions, they cannot be forced to accept help.

If an older adult is resistant to accepting other living arrangements, nurses can help families ask crucial questions and use the answers to guide the older adult to accepting a safer alternative.

Changes in Living Arrangements

5

They are more options available than long-term care facilities including assisted living and continuing care retirement community.

The decision to move an older family member into any type of care facility is difficult.

Decision is filled with guilt, sadness, anxiety, doubt, and anger—even when the older person makes the decision.

Talk with family members about the potential benefits of a care facility.

Care Facility Placement

6

Paying for long-term care

Nurses should know about the community resources that are available and the eligibility requirements.

Financial and legal plans are necessary when the older adult has been diagnosed with Alzheimer’s disease or related disorders.

Durable power of attorney

Financial and Legal Concerns

7

A useful tool to help with end-of-life planning is “Five Wishes”:

The person I want to make health care decisions for me when I cannot

The kind of medical treatment I want or do not want

How comfortable I want to be

How I want people to treat me

What I want my loved ones to know

End-of-Life Health Care Decisions

8

Older drivers are more likely to get into accidents, receive traffic violations, and suffer serious injury or fatality.

Factors that contribute to increased risk are as follows: Loss of hearing acuity, loss of visual acuity, limited mobility and increased reaction time, medications, dementia, or mental impairment.

Families may need assistance assessing a person’s driving ability and following a recommendation that their relative should limit or discontinue driving.

Issue of Driving

9

Primarily provided by the adult children of the older adult (daughters and daughter-in-law)

Types of family caregiving: Routine care, backup care, circumscribed care, sporadic care, dissociation

More families are faced with long-distance caregiving.

Family member with Alzheimer’s disease will require increasing levels of support and assistance as the disease progresses.

Caregiver’s may feel a sense of failure when placement is necessary.

Caregiving is stressful.

Family Caregiving

10

Few families are prepared to cope with the physical, financial, and emotional costs of caregiving.

If the caregiver is employed, work relationships may be compromised.

Many caregivers express frustration regarding the inequality of the contributions of their siblings.

Caregiving can also be regarded as a beneficial opportunity where the caregiving situation demonstrates love and commitment.

Challenges and Opportunities of Caregiving

11

Caregivers may be unprepared for their new role so attending an educational program may help

Caregiver information needs

Understanding the family member’s medical condition

Improving coping skills

Dealing with family issues

Communicating effectively with older persons

Using community services

Long-term planning

Education to Support Family Caregivers

12

To provide caregivers with the confidence that they need to do a task or take an action

It is critical to give caregivers an opportunity to practice skills in a learning environment that is nonthreatening and psychologically safe.

Discuss the barriers caregivers may confront in the real world and ways to overcome these barriers.

Share printed information.

Goals of Caregiver Education

13

Allow caregivers planned time away from their caregiving role.

Benefits to the patient may include interactions with others in a similar situation; safe, supportive environment; and activities that will match their needs and abilities.

Care receivers benefit from caregivers being more refreshed after a break.

Nurses can educate on and encourage respite care.

Respite Programs

14

Lack of awareness

Apprehension

Caregiver attitudes

Timing

Finances

Care receiver resistance

Energy required to use the program

Program inflexibility and bureaucracy

Barriers to Access and Use of Respite Services

15

Caregivers get advice.

Gain knowledge about their older relatives’ medical conditions and problems.

Share experiences and feelings.

Develop new coping strategies.

Learn about community resources and care alternatives.

Caregiver Support Groups

16

Beliefs about what is best often differ, creating family dissension so a meeting should be held early.

Everyone who is concerned/affected by decisions should be involved, including the older person.

Hold in a neutral setting.

Create a feeling of support and confidentiality.

Acknowledge everyone has a different relationship, and perspectives.

Family Meetings (1 of 2)

17

Give everyone the chance to express themselves and offer suggestions.

Keep the meeting focused on current concerns.

Focus on the positive things family members do, and encourage everyone to be honest about their limitations.

Prepare a written plan about decisions made, what each person will do, and when he or she will do it.

Family Meetings (2 of 2)

18

Quick Quiz!

Being a caregiver for an older adult is challenging. Name three things that nurses can do to help and support the caregiver in this role.

19

Answer to Quick Quiz

Possible answers:

Educate them in understanding the older adult’s medical problem.

Give them a list of community services.

Inform them of respite care options and encourage their use.

Offer to hold a family meeting to help siblings express concerns and manage their roles.

Provide written materials.

20

Identify who is the patient and who are the family members.

Assess the family, relationships, and dynamics.

Roles, loyalties, and obligations

Dependence and independence

Caregiver stress

Working With Families of Older Adults: Considerations and Strategies

21

Help family members communicate their concerns honestly and positively.

21

Planning requires anticipating negative situations like dependency, disability, incapacity, and death, and exploring actions to be taken.

Critical time for discussion is when a family member shows signs of deterioration or has been diagnosed with a degenerative disease like Alzheimer’s.

Talk about “what ifs.”

Express good intentions and a willingness to listen.

Help family members communicate their concerns honestly.

Advanced Family Planning

22

A person who is excluded from decision making is more likely to become angry, demanding, helpless, or withdrawn.

Involvement in decision making provides greater assurance that a person will accept and adapt to a change, even if the change is not the person’s preferred choice.

Involve the Older Person in Decisions

23

Families experience many emotions when faced with difficult decisions and caregiving: Grief, frustration, anger, resentment, embarrassment, or guilt.

Family members may need to adjust their perception of the ill person.

Feelings, beliefs, and attitudes influence behavior, so address the belief systems and feelings of family members.

Deal with feelings of guilt since it reduces objectivity and the ability to make decisions that are best for everyone.

Nurses can discuss and reinforce the “goodness of intent” underlying their actions when the actual action taken may turn out not to be the best choice.

Consider Feelings

24

Take care of yourself.

Maintain contact with friends.

Caregiving to adults very stressful.

It is okay not to love the older person who needs care.

Asking for help is a sign of strength.

Caregivers have a right to set limits and to say no.

Taking regular breaks early in caregiving is not selfish.

Make caregiving decisions based on the needs of everyone involved.

Moving a family member into a care facility can be the most loving step to take.

Caregivers should focus on what they have done well―and forgive themselves.

Ten Important Things to Share With Caregivers

25

Recommend this six-step model to help families problem solve:

Gather information

Formulate options

Evaluate options

Create a plan

Implement the plan

Reassess

A Decision Making Model for Families

26

CASE STUDY: Family Member with Alzheimer’s Disease

A woman went to the physician with severe stomach pains.

Family Influences