Flexibility and Continuity of Care Required for the “Best Care” in Any Setting 08 21 12

Flexibility – ability to accommodate changes in care needs.  08 21 12

When choosing a care setting you need to consider the fact that your care needs will likely change many times over the next several years.   You will get sick and recover with a net outcome of progressive aging.  Aging, unfortunately is progressive.   We do what we can to reduce it and to maximize quality of life as we start to need assistance but we often lose sight of the role of the direct care team as a big part of providing the quality of life, continuity of care and flexibility in care options.   What you need to look for is a care setting that can accommodate your needs now when you are relatively well with caregivers and staff who can interact with you as friends, family members and well known persons.


If you have a care giver that sees you just a few minutes a day or once a week for a shower they are not really interacting with you on a continuous basis and they will be less likely to sit and talk with you about day to day events. If the caregivers know you, know who visited, called, emailed you over the last few days you can see that all the direct physical care they offer will come with a much higher degree of compassion, trust, and understanding and social interaction since the care giver can remind you of those visits that make you smile so much.  When you choose a care setting look for one with caregivers who can be part of the resident’s life, care, now when you are at a higher level of function and as the care needs evolve.

Flexibility is part of continuity of care.  There is overlap in these terms.  When you are choosing a care setting because you feel you are starting to need some back up people around to help consider the staff and how they interact with the senior in addition to looking for other seniors, peers, as the main source of social integration.  If the senior can’t initiate and maintain their own social calendar in their own home it is likely they will have some difficulty meeting, friending and then relying on others frail seniors to be their friends.  Having friends and peers is needed but also consider the possibility of having staff who are more like friends, more interactive, as part of the social system.  Having that type of staff when you are well initially and as you need more help can drastically improve communication, sense of quality of care, for the resident and families who are not able to be there day in and day out.  If you under value this aspect of care when you need minimal assistance and you value having other frail senior as the main social system that system has a high degree of failing and leading to stress.   You need both highly interactive staff you can rely on and who can adapt and adjust to whatever your level of social needs are as well as other seniors or peers who you can interact with in structured activities.


If you, the family, are planning to be the main caregiver, social support person, you might consider keeping them at home since it will be easier for you to be there day in and day out.  However, if providing direct care to a parent is becoming to stress full to your own family life you might consider looking for a consistent, live in, or more integrated staff to allow flexibility in social, emotional, and physical care as those needs change over the next few years.  Otherwise,  expect to be faced with finding a new, higher level of care, every 6 months as the care needs evolved.  Also expect frequent calls since while you hope the other frail seniors and your parent will “just find a social connection and shared activities” that most likely will happen at a limited level.  Then they will continue to rely on you as a main social and management  system.  That is why it is so important to meet the owner and administrator and management team of what every care option you choose.  Assisted living, out patient home care WHERE THE DOCTOR, YOUR DOCTOR, is the team leader.  If you are relying on the CNA to be the team leader it is likely her very limited medical training will have many large gaps in the care plan.  She may not know what the medications are, what side effects there are, how to get them, how to deal with insurances, or how to deal with the complex system of specialist doctors.  Moreover, the owner of the home care company is likely just a staffing person with limited medical or case management skills as well.   While Home Care sounds appealing since they have the word home in the title in fact that is only 1/2 of the continuity of care.  The other half is for the skill people the Doctor, Administrator, and more medical skill people.    Family is always important but finding a flexible staff who can work with the family to bridge that social gap is a part of flexibility in care.   Having the caregiver, the doctor or Administrative staff allows the family to be family and to focus on what they do best be family.    Most care setting claim they can provide many levels of care however, you need to look very closely at the care system from top administrator and owners down to the direct care givers and med tech’s so you can compare which systems are likely to offer the greatest flexibility and continuity of care as the social, emotional and physical care needs change with aging.
Flexibility and continuity of care are required eliments of care in any “care” settings — Assisted Living, where Assisted is a synonym for Care, Home Care, Hospice Care, Dementia Care, Alzheimer’s Care, Memory Care, Respite Care, Residential Care, Nursing Home Care or any other care setting.By Shawn McGivney MD, RFA

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Shawn McGivney MD, RFA




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