Care of the Elderly: The

¶ … Care of the Elderly: The Responsibility of Family It is a fact of life that people are living longer lives than ever before in human history. Because of advances made in medicine and knowledge about lifestyle choices, the older population is growing and living to increasingly older ages. With this, some unfortunate effects are following, including the economic burden of health and old age, long-term care for the aged, the frail, and the ill.

Many older people are also suffering from debilitating diseases such as Alzheimer's disease and other forms of dementia. Although these are not exclusive to the aged, such conditions are certainly more prevalent in old age. Hence, while human life expectancy has increased dramatically, it is also the unfortunate case that, more often than not, old age is often accompanied by a myriad of health conditions and difficulties, which require long-term and often intensive care.

While the tradition has been to provide institutionalized care for such persons, the financial burden upon general society has increased as a result of the increased population of older people in need of such care. Hence, alternatives have been investigated, including the potential of family members to care for persons with debilitating conditions who need intensive help with their everyday activities.

The question is, however, is this a viable alternative to institutionalized care, and would the financial burden of older age care truly be mitigated by requiring families to be more directly involved? Other considerations also include the emotional burden that this would create for families, as well as such families' ability to be gainfully employed while also providing adequate care for their older family members. Simonazzi (2009) affirms that long-term care has been an increasing demand among human societies as a side-effect of increased life expectancy.

This demand has potentially detrimental effects on cost efficiency in terms of resource availability and financial sustainability. In Europe, there has been a shift away from institutional care to home and community care systems, on the basis of the fact that these care systems are far less expensive than institutional care, while also providing older persons with a greater sense of belonging and well-being, according to the general assumption.

To encourage these systems to become more prevalent, support has been provided in the form of cash transfers and other support programs to help families better care for their infirm older relatives. On the other hand, the caring activities provided by families more often than not need to occur on a more or less constant basis as a result of the needs of the older persons involved. Hence, it places a time, stress, and generally emotional burden upon the family members whose duty it is to provide such care.

In a traditional marriage between a man and a woman, for example, the caring duty would often fall to the woman, in addition to household and child rearing duties. This could create conflict between such as a woman's desire to participate in the labor market and have a career. Some women, for example, choose to establish a career before entering marriage or starting a family. These decisions are effectively removed if the burden of elder care is placed upon them, even with monetary compensation and other forms of support.

This, in turn, could lead to increased levels of frustration within these women, a lack of self-determination and well-being. This could increase social and psychological problems such as depression. By association, the lack of workplace participation among roughly half of the population could also have severe long-term economic consequences, even though the ultimate effect is a relief of economic burden upon the healthcare system.

Hence, such systems will need to be investigated for the actual relief that they bring to overburdened care systems as well as to families who do not in fact have the funding to pay for long-term care for elderly family members. Another potential feature of home-based care giving is the employment of informal care givers to help with the family's care duties.

This also has potentially severe implications in terms of not only wages, but also the potential for elderly abuse or neglect, which could be either intentional or unintentional, the latter being the result of untrained care givers. What these concerns imply is that home care might not be the simple and ideal alternative to expensive institutional care that it may appear to be.

Before encouraging such a trend or including it as part of policy in a country, its integration in and reliance upon the labor issues, emotional stability, and personal financial burden should be taken into account. Hence, although it appears that home care for elderly persons is the ideal solution to a burdened institutional care system, it is not necessarily the case. One might focus the start of an investigation into this matter on the general effect that certain types of care in fact have on the recipients of care.

Are older persons who are cared for by family members in fact happier than those in institutional care? Again, a number of factors make this a complicated matter for discussion and debate. One regular criticism against institutional care and in favor of at-home family care is that older persons in institutions are often "forgotten" or abandoned by their family members, which has a detrimental effect upon their well-being.

In addition to the high cost of such care, this creates an emotional burden for caregivers as well as those in their care. This is an issue addressed by Gaugler (2005), who focuses his investigation upon those in institutional care and the effect of family contact while housed in these institutions. As an extra dimension, the author also focuses on the tendency of family members to pay regular visits or, conversely, the neglect to do so.

Although the general assumption tends to be that family members would "forget" those who enter into institutional care, Gaugler's literature review suggests otherwise, with the majority of family members continuing to visit at least once per week for at least 30 minutes at a time. Activities that such family members engage in is emotional support in the form of talking to their loved ones, bringing them gifts and other items that they need or request.

This testifies to the loyalty and love that continue after loved ones have been entered into institutional care. Gaugler (2005) concludes that such visits offer vital psychosocial support while staff members at the institutions offer daily clinical care. Another important factor to keep in mind is the rise of a more "inviting" aspect to institutional care, where older persons are housed in a type of community care setting. Such settings may include social gathering places, shops, gyms, and pools, functioning as a type of retirement village.

Staff is then in continual attendance to meet the needs of inhabitants, while family members visit as their schedules allow. This provides a type of hybrid between family care and institutional care, where older persons can still feel that they are part of a community while at the same time experiencing the security and safety of trained personnel to care for them. Gaugler (2005) therefore concludes that the general trend is for family members to continue visiting their loved ones after institutionalization.

In terms of the emotional aspect, then, this is more ideal than home care, where institutions take the burden of day-to-day care while the family can relieve staff by providing emotional and psychosocial support. This, however, leaves the financial burden on the system and on families who need to fund their elders' care. In the same aspect, Verbeek et al. (2010) investigate the viability of the increasing policy change towards home care as opposed to institutional care for persons with dementia and related conditions.

According to policymakers who favor home care, people with dementia should be enabled to remain in their homes and family settings for as long as possible, while institutionalized care should also be set up to resemble the home as closely as possible. In their work, the authors' aim is to investigate the true effect of the home setting, as opposed to institutionalization, on the well-being of those with dementia. According to the authors, current institutional care focuses on the overall well-being of those with dementia.

Specifically, this means the promotion of values such as preserving autonomy, allowing residents to continue their own lifestyle as much as possible, and promoting a generally acceptable quality of life within these institutions. Such values are supported by means of integrated care programs, person-centered care, and a focus on the individual needs of residents. As mentioned above, these concerns have led to the construction of homelike care settings, where groups of residents are housed in a type of retirement care community.

This type of living arrangement has been implemented in Sweden, Japan, and the United States, in the form of group living, group homes, and the Green House project, respectively. In these settings, small groups of residents -- no more than 10 per group -- live in a house where they receive care from trained staff. The emphasis is on normal, everyday activities provided for residents. According to the authors, however, little research has been conducted to investigate the actual effect of such activities and settings upon residents.

The assumption is that such settings have a better effect that traditional institutions, but there is little empirical research to support this. Hence, Verbeek et al. (2010) conducted a study to compare small-scale living with regular care in nursing homes in the Netherlands. Interestingly, they found no significant difference between the quality of life experienced by residents in traditional institutional settings and those in small-scale living facilities. Furthermore, there was also no significant difference in the job satisfaction levels of nursing staff between both types of institution was found.

Another important aspect, namely neuropsychiatric symptoms and agitation were also significantly similar for both institution types. According to the authors, a difference was found in the satisfaction level of family care givers. Those in small-scale living facilities were found to be less burdened and more satisfied with nursing staff contact than those in traditional style wards. In terms of the general effect of the different settings upon the well-being of residents, there seems to be much less difference between the small-scale care setting and the regular setting of traditional institutions.

The greatest differences are within the satisfaction levels experienced by family care givers and individual nursing staff members. When therefore considered in terms of their effect upon residents, those receiving care, and those who are presumably the most important component of dementia care, it appears that physical setting makes little difference to well-being when all other things are equal. This is an important finding and a potential focus of future research not only for dementia care, but for elderly care in general.

In terms of emotional well-being Lyness (2009) focuses on the general effects of aging, one of which is the rise in the rate of depressive conditions. These in themselves are a problematic healthcare concern, especially in the light of an increasingly aging society. Again, the effect of healthcare setup and institutionalization, as well as the effect of family involvement, make rich grounds for research to find effective ways of mitigating the harsher effects of aging.

If seen in the light of the above, this does not necessarily mean that home or family care is better than institutional care for the elderly who are dependent upon others for their daily care and activities. Depressive symptoms can be as prevalent in a home type setting as in an institution. When considered in terms of the psychosocial support that visiting family members can provide, residents in institutions might even be less prone to depression than those in home settings.

Indeed, in a home setting the lack of expertise and general fatigue in family members might be the cause of problems such as abuse or neglect, which would certainly be conducive to the depressive effect. Youngmee and.