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Forming a Plan

Forming a care plan is an ongoing process. Even before you have all the results of medical, functional, psychological and rehabilitation assessments, the caregiver and support team can develop an informal plan to guide early decisions about care.

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 This initial plan will ensure that:

    • the primary caregiver, support team and care recipient understand the recipient's strengths and can work to support these.
    • everyone understands the directions that caregiving might take at this point.
    • lines of communication are initiated between the primary caregiver, support team, and recipient.
    • potential resources can be researched.

Although the initial plan will need to be updated as the team learns more about the care recipient's strengths and challenges, it is a helpful starting point.  There are several tasks involved in planning and it can be helpful to assign these to individuals who are most able, reliable, willing, qualified and available to carry them out.  It can be useful to engage as many members of the care team as possible up front in order to set a collaborative tone for future problem solving.

Tasks can include:

Gathering up and organizing important documents. Organization makes life simpler and less stressful. By collecting and centralizing important information, the caregiver, the recipient, and the support network will be well-prepared and by having this material available whenever it is required. The types of information to be collected include individual and family data, medical information, financial and banking information, personal property details, legal and estate information and funeral arrangements. A helpful checklist of important information to collect can be found at http://www.caregiverslibrary.org/Portals/0/ChecklistsandForms_CaregiverDocumentOrganizer.pdf

Research placement and home care options.  Even if the care recipient prefers to remain in the home and that is a viable choice for now, it can be useful to know what housing options may be available in the near future.  In addition there are a wide range of in-home services in Larimer County that support independent living, including home maintenance, companion services,  non medical and medical home care, occupational and physical therapies and technological solutions to health and safety issues. If the recipient is facing a terminal illness, hospice services can provide invaluable information, support and palliative care.  Know what your options are — for now as well as later.  

Identify and contact potential members of the extended care team.  A plan is only as good as the ability of the care team to execute it. Before creating a plan of care, it is useful to take a good look at the resources available.  While not all family members, friends or social networks may be able to participate in a significant way, it is possible that individuals may be able to manage small tasks to take some of the burden of care from the primary caregivers.

Secure sound medical diagnoses and a good understanding of each of them.  Accompany the care recipient to all medical appointments. Be sure to ask questions, do the research and help with treatment decisions.  It is useful to have a power of attorney for health care or, at the very, least a statement (release of information) signed by the care recipient  allowing medical professionals to release information upon request.  A separate release is needed for each medical office involved. Each medical provider can provide their own release form.

See that financial affairs are in order.  This includes understanding what assets are available to pay for care. If significant assets are involved, it is important to confer with an estate attorney (along with the care recipient of course) who understands the prospects for using those assets to cover major medical expenses.  If there are few assets, you will want to explore the requirements for Medicaid eligibility.  An estate attorney experienced in geriatric law can help you.  In addition the Larimer County Office on Aging funds the Senior Law Project which provides one free (donations encouraged) consultation with an attorney regarding such issues as Medicaid readiness. Questions about private insurance can be referred to an insurance specialist.  The University of Colorado Health's Aspen Club and Banner Seasons Club can help navigate Medicare plans for their members.

Once this pre-planning homework is done, the support team can update the initial care plan and create one that most effectively addresses care needs and uses available resources most efficiently.  With the proper information at hand, it may be clear to the care team what the most reasonable plan might be.  That may well be the case if the planning starts early and addresses fairly straightforward needs.  In cases involving more complicated challenges, advice from a professional is desirable; consider assistance from the following sources:

  • A care consultation from the caregiver support program of the Larimer County Office on Aging.
  • The Larimer County ARCH program can provide an in-home assessment, information and referral, some follow up to see that a plan of care is working.
  • A professional geriatric care manager can work with a care team to develop a plan, help finding and engaging resources to implement it, facilitate ongoing communication among care team members and anticipate ongoing changes in plan to address evolving needs.

 

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Cyndy Luzinski
Dementia-Friendly Communities
8403 Castaway Drive
Windsor, CO 80528
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