Elderly care or simply eldercare is the fulfillment of the special needs and requirements that are unique to senior citizens. This broad term encompasses such services as assisted living, adult day care, long term care, nursing homes, hospice care, and In-Home care.
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The form of elder care provided varies greatly among countries and is changing rapidly. Even within the same country, regional differences exist with respect to the care for the elderly.
Traditionally elder care has been the responsibility of family members and was provided within the extended family home. Increasingly in modern societies, elder care is now being provided by state or charitable institutions. The reasons for this change include decreasing family size, the greater life expectancy of elderly people, the geographical dispersion of families, and the tendency for women to be educated and work outside the home. Although these changes have affected European and North American countries first, it is now increasingly affecting Asian countries also.[1]
According to Family Caregiver Alliance, the majority of family caregivers are women:
“Many studies have looked at the role of women and family caregiving. Although not all have addressed gender issues and caregiving specifically, the results are still generalizable [sic] to women because they are the majority of informal care providers in this country. Consider: • Estimates of the percentage of family or informal caregivers who are women range from 59% to 75%. • The average caregiver is age 46, female, married and working outside the home earning an annual income of $35,000. • Although men also provide assistance, female caregivers may spend as much as 50% more time providing care than male caregivers.”” [2]
In most western countries, elder care facilities are residential family care homes, freestanding assisted living facilities, nursing homes, and Continuing care retirement communities (CCRCs).
A Family Care Home is a residential home with support and supervisory personnel by an agency, organization, or individual that provides room and board, personal care and habilitation services in a family environment for at least two and no more than six persons.
In the United States, most of the large multi-facility providers are publicly owned and managed as for-profit businesses. There are exceptions; the largest operator in the US is the Evangelical Lutheran Good Samaritan Society, a not-for-profit organization that manages 6,531 beds in 22 states, according to a 1995 study by the American Health Care Association.
Given the choice, most elders would prefer to continue to live in their own homes (aging in place). Unfortunately the majority of elderly people gradually lose functioning ability and require either additional assistance in the home or a move to an eldercare facility. The adult children of these elders often face a difficult challenge in helping their parents make the right choices.[3]
According to the U.S Department of Health and Human Services [4] the older population—persons 65 years or older—numbered 39.6 million in 2009. They represented 12.9% of the U.S. population, about one in every eight Americans. By 2030, there will be about 72.1 million older persons, more than twice their number in 2000. People 65-plus years old represented 12.4% of the population in the year 2000, but that’s expected to grow to be 19% of the population by 2030. This will mean more demand for elderly care facilities in the coming years. There were more than 36,000 assisted living facilities in the United States in 2009, according to the Assisted Living Federation of America [5] in 2009. More than 1 million senior citizens are served by these assisted living facilities.
One relatively new service that can help keep the elderly in their homes longer is "respite care".[6] This type of care allows caregivers the opportunity to go on vacation or a business trip and know that their elder has good quality temporary care, for without this help the elder might have to move permanently to an outside facility.
Some United States companies, like Senior Helpers, Home Instead Senior Care, Home Helpers, Professional HealthCare At Home, Visiting Angels, All Valley Home Care, Home Care Assistance, Medi Home Private Care and Comfort Keepers, offer long-term, in-home care for seniors.
Information about long term care options in the United States can be found by contacting the local Area Agency on Aging or elder referral agencies such as A Place for Mom.
In Canada, such privately-run for-profit facilities also exist, but they must compete with government-funded public facilities run by each province's or territory's Ministry of Health. In these care homes, elderly Canadians pay for their care on a sliding scale based on annual income. The scale that they are charged on depends on whether they utilise “Long Term Care” or “Assisted Living”. For example, commencing in January 2010 seniors living in British Columbia’s government subsidized “Long Term Care” (also called “Residential Care”) will pay 80% of their after tax income unless their After Tax Income is less than $16,500. The “Assisted Living” tariff is calculated more simply as 70% of the After Tax Income.[7]
Due to Australia's ageing population, the issue of aged (elderly) care has been highlighted as a key concern for the next 20 years.[8] KPMG released a report supporting a model of Aged Care Levy to assist in relieving the burden on providers of Aged Care services.[9] Aged Care recipients in Australia are subject to rebates and assistance from the Australian Federal Government provided they are assessed by an Aged Care Assessor (ACAT) [10] Their care can fall into a number of categories including high care, low care and veterans home care.
In 2010 reports stated that only 40% of Australian Aged Care Providers are able to make a profit [11] with the rest having to eat into borrowings to break even.
A distinction is generally made between medical and non-medical care, and the latter is much less likely to be covered by insurance or public funds. In the US, 86% of the one million or so residents in assisted living facilities pay for care out of their own funds. The rest get help from family and friends and from state agencies. Medicare does not pay unless skilled-nursing care is needed and given in certified skilled nursing facilities or by a skilled nursing agency in the home. Assisted living facilities usually do not meet Medicare's requirements. However, Medicare does pay for some skilled care if the elderly person meets the requirements for the Medicare home health benefit. [12]
Thirty-two U.S. states pay for care in assisted living facilities through their Medicaid waiver programs. Similarly, in the United Kingdom the National Health Service provides medical care for the elderly, as for all, free at the point of use, but social care is only paid for by the state in Scotland, England, Wales and Northern Ireland are yet to introduce any legislation on the matter so currently social care is only funded by public authorities when a person has exhausted their private resources, for example by selling their home.
Elderly care emphasizes the social and personal requirements of senior citizens who need some assistance with daily activities and health care, but who desire to age with dignity. It is an important distinction, in that the design of housing, services, activities, employee training and such should be truly customer-centered.
However, elderly care is focused on satisfying the expectations of two tiers of customers: the resident customer and the purchasing customer, who are often not identical, since relatives or public authorities rather than the resident may be providing the cost of care. Where residents are confused or have communication difficulties, it may be very difficult for relatives or other concerned parties to be sure of the standard of care being given, and the possibility of elder abuse is a continuing source of concern. The Adult Protective Services Agency — a component of the human service agency in most states — is typically responsible for investigating reports of domestic elder abuse and providing families with help and guidance. Other professionals who may be able to help include doctors or nurses, police officers, lawyers, and social workers.[13]
Impaired mobility is a major health concern for older adults, affecting fifty percent of people over 85 and at least a quarter of those over 75. As adults lose the ability to walk, to climb stairs, and to rise from a chair, they become completely disabled. The problem cannot be ignored because people over 65 constitute the fastest growing segment of the U.S. population.
Therapy designed to improve mobility in elderly patients is usually built around diagnosing and treating specific impairments, such as reduced strength or poor balance. It is appropriate to compare older adults seeking to improve their mobility to athletes seeking to improve their split times. People in both groups perform best when they measure their progress and work toward specific goals related to strength, aerobic capacity, and other physical qualities. Someone attempting to improve an older adult’s mobility must decide what impairments to focus on, and in many cases, there is little scientific evidence to justify any of the options. Today, many caregivers choose to focus on leg strength and balance. New research suggests that limb velocity and core strength may also be important factors in mobility.[14]
The family is one of the most important providers for the elderly. In fact, the majority of caregivers for the elderly are often members of their own family, most often a daughter or a granddaughter. Family and friends can provide a home (i.e. have elderly relatives live with them), help with money and meet social needs by visiting, taking them out on trips, etc.
One of the major causes of elderly falls is hyponatremia, an electrolyte disturbance when the level of sodium in a person's serum drops below 135 mEq/L. Hyponatremia is the most common electrolyte disorder encountered in the elderly patient population. Studies have shown that older patients are more prone to hyponatremia as a result of multiple factors including physiologic changes associated with aging such as decreases in glomerular filtration rate, a tendency for defective sodium conservation, and increased vasopressin activity. Mild hyponatremia ups the risk of fracture in elderly patients because hyponatremia has been shown to cause subtle neurologic impairment that affects gait and attention, similar to that of moderate alcohol intake.[15]
In almost all cases in which elderly persons are declared mentally or physically incompetent to adequately take care of themselves, state laws require that a minimum of two doctors, or other health professionals, vouch for evidence of such incompetence. Only then can legal supervision by a loved one or caretaker be initiated, including power of attorney, guardianship and conservatorship. If doctors' corroboration cannot be obtained by interested parties, then other proof must be proffered to support the case for incompetence, including outstanding bills and financial debt, or substandard living conditions that would be deemed unsafe or hazardous to the elderly person(s).[16]
This article incorporates public domain material from the United States Government document "A Profile of Older Americans: 2010, Department of Health & Human Services".