Four Stages of Care

There are four stages of caregiving, but not all caregivers go through each stage. Where are you as a caregiver? 

Stage 1 -- Basic Care

-- easy, casual assistance for common tasks, activities and issues 

 
Stage 2 -- Intermediate Care

-- more involved assistance for common tasks, activities and issues; greater dependence on the family caregiver 


Stage 3 -- Advanced Care

-- very "hands on" caregiving, with much time spent providing physical care and dealing with related issues 

Stage 4 -- End-of-Life Care

-- intense caregiving that involves providing "comfort care" to loved one
 
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Basic Care 

-- You usually spends 4-8 hours a week providing care
-- The care is uncomplicated and straightforward
-- You act as a helpful companion
-- Your loved one is still active and independent, but has some limitations
-- The need for care may be temporary
--There are simple solutions to common problems
-- This is a mutually cooperative relationship because care needs are manageable by both loved one and caregiver 

Common Tasks

-- Your loved one may need help with big physical tasks
-- You may occasionally drive for your loved one
-- You may accompany a loved one to important medical appointments
-- Your loved one may need assistance with grocery shopping and other errands
-- You may provide assistance and physical support after surgery or during illness
-- You may organize activities and home duties to make things easier for your loved one 
 
Common Issues 
-- Your loved one has an awareness of dependence, even on a temporary basis
-- He or she may experience frustration with current limitations
-- Your loved one is looking for a balance between needing help and providing for self 
 
Caregiver Goal
 
-- Encourage your loved one to remain independent and focused on the positive things he or she can still do 
 
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Intermediate Care

-- You provide more than 8, but less than 15 hours of care a week
-- Physical limitations interfere with your loved one's normal activities
-- You arrange care around your loved one’s needs
-- Your loved one has a greater need for monitoring, communication, reassurance
-- The balance of the relationship begins to shift from cooperative to dependent 

Common Tasks 

-- The family caregiver is the care coordinator
-- You and/or other family members do routine driving around town for your loved one
-- Your loved one needs help with meals and other household activities
-- You accompany your loved one to medical appointments, tracking medical issues and records, prescriptions, treatments
-- You coordinate and/or monitor care in the home
-- You spend more time organizing, overseeing, or completing household tasks and responsibilities for your loved one 

Common Issues 

-- Your loved one has a growing awareness of increasing dependence
-- He or she may express fear of the future
-- Your loved one may be concerned about becoming a burden
-- Decreasing physical abilities interfere with everyday life
-- Your loved one may experience increasing frustration when trying to overcome obstacles 

Caregiver Goals 

-- Keep your loved one as independent as possible
-- Find ways to address the physical limitations
--Address the emotional aspects
-- Create your resources list
 
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Advanced Care 

-- You provide more than 15 hours a week – it's labor intensive
-- Your loved one has a greater need for hands-on physical care
-- He or she has a higher level of dependence on the family caregiver
-- Palliative care and pain management can help reduce symptom discomfort
-- Safety often becomes an issue for your loved one
-- You benefit from utilizing resources to help you provide better care 

Common Tasks 

-- Family caregiver is the care manager
-- Your loved one needs help with most activities
-- There is a greater need to assist with mobility, especially if your loved one is unsteady
-- You often have to take over the physical management of the household
-- Medication management is important -- you may have to take over dispensing prescriptions and supplements, to insure patient safety
-- You may be in charge of coordinating in-home care services
-- You are likely to provide greater assistance in making decisions 

Common Issues 

-- Your loved one may experience increased depression
-- He or she may have less tolerance for frustration
-- Fatigue  (physical, mental, and emotional) may limit your loved one's activities
-- You can observe progressive physical deterioration
-- There is greater risk of injury in the home from falls, burns, accidents
-- Your loved one may experience an increase in serious health problems that require routine and emergency medical treatment 

Caregiver Goals 
 
-- Address the changing physical, mental, and emotional needs of your loved one
-- Use your resource list to get the kind of assistance you need to be a good caregiver
-- Take care of your own health -- don't ignore symptoms
-- Take respite time to recharge your batteries
 
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End-of-Life Care 

-- You are likely to provide and/or coordinate around-the-clock caregiving
-- Hospice team comes to the home to provide treatment and to instruct you in care
-- You, as the family caregiver, work with the hospice team
-- This is a very emotional time for family and friends
-- Directed comfort care and pain management can ease suffering for your loved one
-- There are often rapid physical changes, and medical treatment is likely to change with each
-- Rest is important for your loved one and you may see a significant increase in sleeping 

Common Tasks 

-- You are the hospice coordinator, working under the direction of the hospice team
-- Your goal is provide your loved one with the best comfort care possible
-- Medication and nutrition management for the dying patient are critical
-- You are likely to provide physical assistance for most or all activities
-- You can help loved one finish unfinished business
-- You are likely to keep family and friends directly informed of loved one’s condition, or work with a family member to do so 

Common Issues 

-- Many families experience depression, anger, sadness during hospice care
-- Your loved one may feel frustration with or denial of impending death
-- He or she may have fears of how death will come and what will happen to the family afterwards
-- The family may feel uncertainty and dread as your loved one's health begins to spiral downward
-- Your loved one may have extreme fatigue due to the physicality of death
-- Physical pain, discomfort and muscle atrophy may result from the body's deterioration
-- In preparing for death, your love one may physically and socially withdraw 

Caregiver Goals 

-- Provide physical, mental and emotional comfort
-- Coordinate with the hospice team and family
-- Take respite time, especially because you need to accept the reality of hospice care
-- Accept that the death of your loved one is not a failure of your care 

When the End Comes…. 

-- Gather your family and friends together
-- Understand that your emotions will be strong
-- Reach out to each other and share your grief and your memories
-- Honor your loved one



Copyright Sara M. Barton 2013-2014



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