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Posted: Monday, January 25, 2016

Making Caregiving Decisions: A Difficult Task

If you’re a person who is in charge of caring for another person, you’re very likely juggling numerous tasks all at once. From appointments to medications to moral support, you’re basically on 24 hours a day, seven days a week for whatever needs he or she may have, and it doesn’t include all the things you have to do to keep your own life going, too. Sometimes, though, the hardest thing a caregiver can be tasked with doing is making decisions for his or her loved one. Some decisions are simple and straightforward. Other decisions require consideration of multiple potential outcomes. Naturally, you’ll want to do the right thing – or at least the best thing – for your loved one at all times, so those decisions can be overwhelming.

Blount Memorial Hospital licensed clinical social worker Edward Harper says making tough decisions can become a routine affair for a caregiver. “Caregivers are confronted on a daily basis with making decisions for those for whom they are providing care,” he said. “The decision-making ability of the caregiver can sometimes be compromised due to a sheer lack of critical distance from the situation and their sense of duty to preserve the remaining abilities of the person receiving care. This sense of preserving honor, dignity, and sameness, while admirable, can be a major roadblock to making timely and productive decisions for the person requiring care,” Harper explained. “It prolongs the default course of action that can promote a situation either remaining unchanged or degrading it to a point of crisis,” he added.

Harper says sometimes it can be difficult to know when to step in and begin making those decisions in the first place. “It can be tough for a caregiver to identify when the person receiving care has reached a state where there is significant loss of capacity to warrant stepping in and making decisions for that person,” he said. “Naturally, it’s common for the person who has lost significant intellectual capacity not to recognize this loss, but it can be frustrating to the caregiver for the person receiving care to insist that he or she still can do things without help. Caregivers frequently are at an impasse in these circumstances,” he added.

Harper explains that there are specific areas of the brain associated with the ability to continue performing usual tasks, as well as the ability to adapt to performing new ones. “This type of intellectual loss of capacity is termed as a loss of ‘executive function,’ stemming from impairment to the frontal lobe of the brain that is responsible for new thoughts, problem solving, adaptability and response to older stimulations in new ways,” Harper said. “When people appear to be losing cognitive flexibility, but still are able to carry on with other basic daily living routines, he or she is relying on another part of the brain – the parietal lobe – which stores all the information, responses and routines that individual is accustomed to. A person experiencing memory or cognitive impairment is able to perform routine tasks because he or she still has access to ‘instrumental skills.’ This can make decision making hard because the person appears to have more capacity than they actually do, and sometimes he or she may fight the caregiver for control simply because the sheer scope of the matter at hand is elusive to him or her,” he explained. “This puts the caregiver in a no-win situation, complicated by the desire to honor and respect his or her wishes, as well as a fear of disapproval and reprisal,” he added.

However, Harper says there are steps you can take to ease these decision-making tensions. “The first intervention is to execute a set of power of attorney orders for finance and health care,” he said. “These two documents go a long way in providing comfort and direction when making decisions for others. These documents are created when a person’s intellectual capacity is intact and indisputable. If you do not have a power of attorney for finance and health care, now is the time to contact an attorney or visit a reputable internet site that allows you to construct the documents. Without them, no one is authorized to speak or act on your behalf,” he said. “The second and most-effective way to make decisions for another person is to base each decision on safety and security. You want to say to yourself: ‘Is it safe for the person to continue the usual pattern of behavior or is a change needed?’ Answer ‘yes’ or ‘no,’ and try to think in black and white, excluding gray areas. Basing each decision on safety reduces the mental clutter and pacifies some of the anxiety about the criticism of your motivation for making a decision,” he said. “Reaching a decision on a situation is a positive intervention even though a caregiver may not be able to evoke immediate change or action in the matter. Reaching that decision and having a plan is empowering,” he added.

Blount Memorial Senior Services can assist caregivers with making difficult decisions. Free caregiver consultations and caregiver support groups are available. For information about caregiver services, call Blount Memorial Senior Services at 865-977-5744.

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