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General Management Strategies Tips from: Physical Therapist | Occupational Therapist | Social Worker
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Tips for Social Workers working with Clients Who Have Dementia Authored by:
With a B.A. degree from Washington University in St. Louis, Diana obtained her Master of Social Work degree from the George Warren Brown School of Social Work at Washington University in St. Louis and has practiced over thirty years in medical Social Work specializing in geriatrics and in rehabilitation. She is an LCSW-approved supervisor, granted by the Texas Board of Social Work Examiners and is a master trainer in the Chronic Diseases Self-Management program.
Psychosocial Factors in Dementia Caregiving “Of the older persons receiving paid and unpaid assistance, 95% have family and friends involved in their care. Paid home care is the exception, not the rule, for the great majority of older persons with disability.” ( www.aoa.gov ) More than 22.4 million persons are informal caregivers – providing unpaid help to older persons who live in the community and have at least one limitation on their activities of daily living. These caregivers include spouses, adult children, and other relatives or friends. Fifty per cent of elderly who have a long-term care need but no family available to care for them are in nursing homes, while only 7% who have a family caregiver are in institutional settings. ( www.aoa.gov ) Women provide the majority of informal care. The average caregiver is age 46, female, married, and working outside the home earning an annual income of $35,000. ( www.caregiver.org ) The number of men serving as caregivers is increasing; currently nearly four in ten caregivers are men. ( www.caregiving.org/04finalreport.pdf ) Caregivers can take advantage of a vast array of information including newsletters, support groups, books and videos, as well as the Internet. Newsletters:
Support Groups:
Books and Videos:
Internet:
Personal Stories:
Living Arrangements Community services may provide needed help to enable a person with Alzheimer's Disease to live at home. Services may include Meals on Wheels, transportation assistance, housekeeping or chore service. Adult day care, senior citizens' center activities and congregate meals may also support the at-home living arrangement. There is no national resource for assisting middle-class families with the costs of in-home or day care. However, under certain circumstances, Medicare will pay for home health nursing, physical therapy, occupational therapy and personal aide. This is usually for a limited number of visits under the orders of a physician. Medicare does not pay for “custodial care”. Medicare rarely pays for respite care for people with Alzheimer's. Eligibility requirements and available services through Medicaid vary from state to state. Sometimes a family is unable to care for a person with Alzheimer's Disease at home. A number of living arrangements can be considered including assisting living facilities, nursing homes, personal care homes. Assistance in learning about local living arrangement options and funding resources is available from the Alzheimer's Association, the state Office on Aging, hospital and clinic geriatric social workers, geriatric case managers, and from the state Department of Human Services. Medicare is not designed to pay for nursing home care. In some limited circumstances, it may cover rehabilitation after an acute-care hospital stay. Medicaid and an individual's own funds are usually the available sources of payment for nursing homes. Resources:
Financial/Legal The time may come when a person with Alzheimer's Disease is unable to take legal or financial responsibility for himself. The time to prepare for this eventuality is before the person becomes too confused to understand and to make decisions. Critical conversations may focus on care preferences, end-of-life decisions, financial planning. Financial planning may include making a will and appointing a Power of Attorney. Planning may also include making a living will and appointing a Power of Attorney for healthcare decisions. These latter two documents are known as Advance Directives. Resources:
Ethnocultural Hispanic Americans may be two times more likely than Caucasians to develop Alzheimer's Disease by age 90. African Americans may be four times more likely than Caucasians to develop Alzheimer's Disease by age 90. African American caregivers compared to Caucasians are less likely to be a spouse of the elder and are more likely to be an adult child of the care recipient. Numerous studies have reported that the majority of African American caregivers are actively managing more than one person and may be responsible for the well-being of children and other family members. African American caregivers may be less knowledgeable about dementia assessment centers. In Hispanic families, caregiving is delegated to female family members. Studies suggest that caregivers who are attempting to live in both Anglo and Latino cultures experience more role strain, depression and guilt about the caregiver role than those who are primarily rooted in traditional Latino beliefs and role expectations. Hispanic caregivers and patients may be reluctant to use formal health care services since few agencies have bilingual and bicultural staff. Resources:
For research references: Resources | For more information: Useful Links |
Last Modified: July 2004
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