Chapter One
Preparing for Home Care
Before you begin caring for a loved one at home, it's a good
idea to consult with the other members of the caregiving
team-such as doctors, nurses, therapists, social workers, and
family members-to identify and develop an effective strategy.
This strategy is referred to as a care plan. Each family's situation
is unique, and family members will need to work together to
develop the best plan to deal with their unique situation. The
plan should be flexible enough to meet the continually changing
needs of the person who is being cared for. You may have to
learn through trial and error what works best for you. Although
it is not always possible to predict the exact course of an illness
or how a person will recover, it is a good idea to discuss expectations
and potential problems in advance with all members of
the home healthcare team. This will help you to develop a support
network and the best care plan possible. Consider the following
when developing your care plan:
How long the illness is expected to last
How the person's condition might improve or worsen
Whether it is possible for the person to fully recover from
his or her condition or illness
Whether rehabilitation therapies-such as physical, occupational,
or speech therapy-will be needed to promote
recovery and who will provide these services, if necessary
The specific medical emergencies that might occur and
how these emergencies should be handled
Caregiving adjustments you will need to make, such as
changes in a person's medication or need for therapy
Setting Priorities and Goals
The best time to begin planning the transition from hospital
care to home caregiving is shortly after a person has been
admitted to the hospital. This is a good opportunity for you to
determine the needs of your loved one, create a care plan, identify
potential caregivers, assign caregiving responsibilities, and
address the needs of the caregiver. Typically, a hospital social
worker, primary care nurse, or case manager will be available to
guide you through this transition and help you plan strategies
for successful home caregiving. This will allow you, once your
loved one leaves the hospital, to concentrate on providing the
best care possible for him or her.
You might find it helpful to create a log or journal about your
care plan to keep track of new developments or changes in your
loved one's needs. Consider the following questions when
developing your care plan, tailoring your answers to your
unique situation:
What types of care will your loved one require and what is
the best way to provide them?
Will he or she require 24-hour care?
If you need to monitor health indicators such as blood pressure
or blood glucose level, or administer and adjust medications,
who will train you to perform these tasks? And whom
can you contact for advice and assistance?
Who will be part of your caregiving team and what roles will
they play? You may need the services of a variety of people,
such as doctors, specialists, visiting nurses, therapists, and
home health aides.
What type of care is available, and from which agencies? Is
the care effective and dependable, and what are the costs?
Will you need any special equipment, such as that used to
provide oxygen or intravenous feeding? Find out what
equipment you need, who will train you to operate it, what
type of maintenance it requires, and who will provide maintenance
for it.
Will physical changes have to be made to the person's home
to enhance his or her mobility and safety? For example, you
may need to have ramps, railings, or electric lift chairs
installed on stairways. Grab bars and handrails help make it
safer to use the toilet or bathtub.
Will the person need specialized equipment to help him or
her perform daily tasks? Various useful devices, such as a
handheld "reacher" that can help a person grasp objects that
are out of reach, are available from drugstores and medical
supply companies.
Will pets in the home create any special problems? Experts
acknowledge that pets are often regarded as family members,
but some pet-related routines and behaviors may need to be
adjusted to prevent accidents. For example, you might install
a child safety gate to keep a dog from getting in the way of a
person who is learning to use a walker.
What are the person's likely transportation needs? You may
be able to use your own car or van or you may need to use a
specially equipped van. Transportation services are available
at reasonable cost in many communities; ask your doctor or
nurse for recommendations or check your phone book.
In most families who are caring for a loved one, a spouse,
parents, siblings, or children provide most of the routine care,
with assistance from various healthcare professionals and under
the supervision of a doctor. Do not worry if you have had no
practical experience as a caregiver. Caregiving requires common
sense and a caring approach that most people are able to provide,
and any basic caregiving skills that you do not have already
will be easy to learn. Caregivers rarely need special skills, but if
you do, you can be trained to perform even difficult tasks effectively.
People who have experienced firsthand the challenges
and rewards of home caregiving emphasize self-education as the
key to providing quality care. Learn as much as you can about
your loved one's illness or condition:
Attend discussions with physicians and other members of
your loved one's healthcare team. Write down questions and
take notes or tape-record sessions with care instructors.
Learning how to handle a serious illness or injury requires
taking in a lot of new information that you may not easily
understand or remember. If you feel your questions are not
being addressed in these meetings, schedule a separate meeting
to resolve them.
Consider consulting a private clinical social worker, gerontologist
(aging specialist), or other appropriate care provider.
These people are trained to navigate the complex healthcare
delivery system. They can come into your home, evaluate
your family's needs, and help you get the support you need,
such as a physical therapist, a household helper, or even a
hospital bed. They may also be able to help you make a decision
about a nursing home in your community that meets
your loved one's needs.
Use the services offered by local and national support groups
and organizations, community outreach programs at nearby
hospitals and other healthcare facilities, and help hot lines.
Consult your local public library, bookstores, and the Internet
for additional information and resources.
The basic goal of caregiving is to keep your loved one as clean,
comfortable, and content as possible. Keep in mind that when
a person is seriously ill, even the smallest problems may be
upsetting and can seem overwhelming. By keeping things running
smoothly, you enable your loved one to rest and remain
optimistic.
Planning and Arranging the Room
When planning your loved one's room, consider how ill he or
she is and how long you are likely to be caring for him or her.
Arrange the room to make it as comfortable and convenient as
possible for both the person who is being cared for and his or
her caregivers. Here are some helpful tips:
In a two-story house, it is probably better for a person to stay
on the first floor. This will help keep him or her from feeling
isolated and will eliminate a lot of trips up and down the
stairs for you. This arrangement will also help prevent
potentially serious falls.
Place a single bed in the room so that it is accessible from
both sides; making the bed and moving the person in bed
will be easier. If possible, place the bed near a window so the
person can see outside and feel more connected to the rest of
the world. If you need a hospital bed with side rails, you can
rent one from a medical supply company.
Use a bedside table to keep medications, water, tissues, a
whistle or bell (to call for assistance), and any other important
items within easy reach.
If the person can get out of bed but cannot get to the bathroom
easily, you will need a commode (a portable chair that
contains a removable bedpan). You can rent or buy one from
a drugstore or medical supply company or, in some communities,
borrow one from a local health agency or volunteer
organization. If the person is confined to bed, keep a bedpan
(and a handheld urinal for a male) near the bed at all times.
Be sure that the temperature in the room is comfortable and
the air circulation is adequate. You may want to leave a window
open slightly to bring in fresh air or use a small fan to
keep the air moving, but be careful to keep the room free of
drafts.
(Continues.)
