It is important that the recipient of care feels safe and comfortable with whoever is providing the care services listed.  Often one person can do many of these tasks, which builds a good rapport and fosters an improved quality of life. 

• • Companionship 

• • Cleaning

• • Errands

• • Exercise

• • Home maintenance

• • Meals

• • Medical support

• • Mobility

• • Personal hygiene

Companionship 

Companionship and social interaction is crucial to staying healthy at all ages.  As we age, our friends, older family members, and siblings die, leaving one needing companionship more.  Loneliness is a serious problem for those at the end of their lives.  For more information on loneliness and aging, click here.

Caretakers can support the development of relationships with their loved ones and help them to feel supported and valued. With the right approach, seniors can be made to feel less isolated through companionship efforts and initiatives.

Suggestions to improve companionship

Communicate openly and encourage others to do so also.  Try to get the person to discuss their feelings, and also their limitations.  Sometimes too much socialization can overwhelm and greatly reduce quality of life.  Only the recipient of care can tell you what the need and can tolerate.   

• • Sometimes it is easier to get a neutral party to enter such dialogue.  Parents may not want to burden their children, or they may be proud and not want to show their weakness.  

• • It is also good support them as they learn what it is they would like to experience as they transition to ever increasing levels of dependence and ultimately death.  Discussions can progress as the person continues to decline.  Discuss ways you can help them realize their desires.  Perhaps a new hobby done other others. 

• • Be sure to be sensitive to their situation and their mental and physical state. If struggling with dementia or other mind-altering conditions, it might be difficult to interact with new people.  This adds an increased demand on those close to the recipient of care. 

• • Set a schedule for appropriate companionship.  This can be tricky when juggling appointments and personal care schedules.  Make sure visits with companions are not too long but provide adequate time for socialization.  Long visits can exhaust the recipient of care.   SeniorSynCare can help with that. 

• • Hire a companion from a service that provides companionship.  Do an internet search on “finding a companion for an elderly person” and you will see a list of companies in your area that provide this service. Ask if the companion can also do other tasks such as house keeping and errands. 

• • Use technology to increase interactions, such as helping them make phone calls to or video chat with loved ones who may not be able to visit in person. Make sure that those interacting directly with the recipient of care know how to use these technologies.

Cleaning

Seniors have a harder time cleaning the house and doing laundry.  Keeping their place free of clutter is important as seniors are more likely to trip over things left about.  If you cannot find a friend or family who can keep the house both clutter free and sanitary, it will be important to hire a cleaning lady.  

Check in your location, or the location of the recipient of care, to see what services are available.  Hired cleaning can be hired individually or through a service.  While you may pay more for a service, they are usually bonded and take care of all the human resource tasks. 

Often a cleaning person can also act as a companion while they do time lagging tasks like laundry.  

Errands

Mobility is quite limited for those reaching the end of their lives.  No errands are quick errands.  Depending on the ease at which the elderly person can get in and out of vehicles, it is often much easier and more pleasurable for all involved for somebody to run errands.  This includes shopping, picking up mail, dropping off donations, etc. 

Things to consider:

• • Groceries

• • Hair appointments

• • Picking up medication

• • Post office runs

• • Banking and bill paying

Exercise

Increased pain, limited range of motion and decreased strength and energy makes getting enough exercise difficult.  It may seem counterintuitive, but people who are not yet at the final days and hours of life require enough physical and mental stimulation to maintain a decent quality of life. Moving is important for digestion, reducing physical pain, increasing oxygen uptake for ease of breathing, good sleep, mental acuity, etc. Click here for more information.

Exercise regimes should be tailored to each individual.   The family physician should be consulted and the appropriate supports for physical activity implemented.  Personal Support Workers can provide this service in addition to friends and family.  

Mental Stimulation

There are many ways to stimulate the mind and improve cognitive skills.  Individual needs and interests vary, and the extent of the benefits is dependent on several factors.  However, there are several ways that one can keep the mind occupied.  

• • Staying  connected with family and friends.  The best way to stay mentally agile and healthy is to engage in conversation.  It is also essential for mental and emotional health.  SeniorSynCare can help.

• • Listening to music. Music helps with cognition and can help with memory recall (if listening to a song with emotional significance). Purposefully listening to music lyrics and processing them helps the mind stay active. 

• • Working and puzzles and playing board games is good for the brain, and the mood.

Home maintenance

For people who rent, this is not much of a problem.  Seniors who own their homes often lapse on proper home maintenance.  Furnaces do not get checked, air conditioner filters do not get replaced, roofs do not get repaired, the list goes on.  When something catastrophic happens, it is noticeable, but the small things (like paying the home insurance) can get overlooked.  

There are companies that offer property management, which may be helpful if family and friends are not able to take on this task. 

Things to consider:

• • Roof

• • Snow clearing

• • Turning off outdoor water in winter months

• • Leaf raking

• • Furnace maintenance and regular filter changing

• • Appliances remain in working order (toaster, oven/stove, dishwasher, refrigerator, washer/dryer, vacuum system)

• • Window washing

• • Sump pump in basement

SeniorSynCare can help with scheduling.

Meals

Seniors tend to have more trouble with their digestion leading to inadequate nutrition intake, which can lead to deficiency related issues.  We need fewer calories, but more nutrients.

Studies show that many seniors decrease their intake of healthy foods, such as fruits and vegetables and increase their intake of carbohydrates and sweets.  This causes a diet that is low in antioxidants, which can increase the aging process.  Genes also express differently as we age which affect how our systems absorb food.  Finally, the older we get, the less stomach acid we produce, and this can lead to poor absorption of key nutrients (B12, iron, calcium and magnesium). 

Food must be enjoyable and cost effective.  Sharing meals with friends and families can be a great support and increase the positive association with eating.  It is also good to experiment with different foods and food groups.  Diversity of food choices leads to a healthy diet, but they must be easy to chew and swallow.  As we get older our swallowing reflexes decline. 

Some interesting facts: 

• • The average adult loses 3-8% of their muscle mass each decade after age 30.

• • Diverticular disease affects 50% of people over age 50 in Western countries and less than 0.2% of people in Japan and Africa

• • Human and animal studies have shown that the gut tends to absorb less calcium with age which is likely caused by vitamin D deficiency

• • 20-30% of people over age of 50 have reduced ability to absorb vitamin B12 from their diet

• • Older people are more prone to dehydration as thirst receptors become less sensitive to water changes making it harder to detect thirst
    •  
    • • Dehydration is a major cause of delirium

• • Studies have found that older people have lower levels of hunger hormones and higher levels of fullness hormones, which means they get hungry less often and feel fuller more quickly

• • Aging can affect your sense of smell and taste, which means foods are less appealing

Getting good food.  Having prepared food easily available increases the independence of recipient of care.  There are several food services that offer such meals to seniors.  Alternately, a support person (companion or PSW) can prepare meals and feed the recipient of care.  They can also make sure the groceries are purchased accordingly. 

Medical Support

Getting the recipient of care to and from appointments and ensuring that the proper medicine is always in stock in the home must be considered.  People with limited mobility may need special driving services.  

Dentists, medical specialists, eye doctors, hearing clinics, and general physicians are all part of the community of care. 

Be sure that somebody who is lucid with a good memory (most likely the PoA) is at each appointment so that notes can be taken and follow up care properly provided.  It may be a good idea to take videos for procedures that may need to be repeated at the home (such as how to put in hearing aids or change a particular bandage). 

Most jurisdictions have support services, some by Province or State, others municipally, such as Para-Transport.  

SeniorSynCare can help with coordination where videos and doctor’s notes can be directly stored for community dissemination.

Mobility

Mobility is the largest challenge for end-of-life care.  Getting in and out of bed can be as challenging as washing one’s hair.   Some people require 24-7 supervision if they have a tendance to try to move about when they are not quite capable.  Falling can cause severe results such as broken limbs, skin wounds (old skin is not as elastic or thick as younger skin and has a harder time healing), muscle can be pulled or strained.  

An occupational therapist can provide an in home evaluation of what is needed to ensure safety in the home.  This can get expensive depending on the individual.  Once mobility is too hampered, it may be worth considering Assisted Living.  Some people hire an au pair, or have a person move in to provide oversight.  

Note: Nobody can provide full time care on their own.   Human labour codes generally dictate that people cannot work longer than 12 hours, and require at least a day, sometimes two after each 5-6 day period.  If somebody needs 24-7 supervision, it will require a team of scheduled people cycling through the home. 

Personal Hygiene

This is closely linked to lucidity and mobility.  Bodies need cleaning, as do teeth and hair.  Nails need trimming.  There will come a time when one will no longer be able to perform these tasks on their own.  

To consider:

• • Bathing (includes showers, baths, and sponge baths)

• • Nail care

• • Tooth brushing

• • Going to the toilet and proper clean up

• • Changing bed sheets and ensuring clean towels

Use SeniorSynCare to keep track.

Spiritual Needs

Our own fragility and mortality tends to create heightened spiritual needs in those nearing the end of life.  Religion and existentialism factor in as we get older.  

For those with an existing spiritual community, it will be important to keep them connected.  Spiritual leaders can help ensure that the person gets these needs met. 

For those who have no spiritual community, open discussion and becoming informed on things like what happens after death.

For more information see Spiritual Needs at End of Life.

Scheduling 

All these services must be communicated and coordinated. SeniorSynCare is here for you