1. Chapter 35 Family Caregiving

2. Introduction Aging is a family affair
Impact of an individual's aging process has a ripple effect on the entire family unit
Families are absorbing more complex responsibilities over longer periods of time
Nurses need knowledge of family structure, roles, and relationships to be effective

3. The Older Adult’s Family
Almost every individual is part of a family unit
Many families today do not reflect the stereotypical nuclear family
Diversity of family structures
Need to explore the family unit for all “significant others”
Persons beyond traditional thinking

4. Identification of Family Members
Look for those individuals who fulfill family functions
Modified family functions that address the needs of the older adult
Questions that can facilitate the identification of persons who perform family functions
Include all persons providing care in the development and evaluation of the care plan

5. Question Is the following statement true or false?
When interviewing older adults, it is important to explore all persons who are “significant others” to an individual and fulfill a family role.

6. Answer
True
Rationale: When interviewing older adults, it is important to explore all persons who are “significant others” to an individual and fulfill a family role, regardless of whether they are unrelated or reside in different households.

7. Family Member Roles
Determined as a result of socialization processes, family needs, and expectations
Decision-maker
Caregiver
Deviant
Dependent
Victim
Impact of role

8. Question
Which of the following statements best describes the deviant family member role?
One who is granted responsibility even though that person is not geographically close
One who provides direct services and manages the home
One who is seen as the “scapegoat” and provides a sense of purpose for family members
One who depends on other members of the family for economic support

9. Answer
C. One who is seen as the “scapegoat” and provides a sense of purpose for family members
Rationale: The deviant, as a family member role, is described as the “problem child” who has strayed from family norms and may be the family scapegoat or may provide a sense of purpose for family members who “rescue” or compensate for this individual.

10. Family Dynamics and Relationships
Can have positive or negative effect
Need to explore the following issues:
How family members feel about each other
The manner of communication
Attitudes, values, and beliefs
Links with organizations and the community

11. Family Dynamics and Relationships (cont.)
Majority of older adults have regular contact with their children
Most older adults want to live in their own residence
Grandparenting
Sibling relationships
Older couples
Relationships in old age

12. Scope of Family Caregiving
Most home care is provided by family members
Statistics
Types of assistance provided to older family members
Provision of assistance is usually a subtle and gradual process

13. Protecting the Health of the Older Adult and Caregiver
The family chain is only as strong as its weakest link
Health of all family members must be maintained and promoted
Maintaining older persons’ independence facilitates normality in family relationships
Sound health practices to prevent disease and disability are crucial

14. Protecting the Health of the Older Adult and Caregiver (cont.)
Older adults themselves are often caregivers
Physical, emotional, and social health of caregivers must be assessed on a regular basis
Caregivers’ TLC:
Training, Leaving, Caring
Middle-aged daughters as caregivers

15. Question Is the following statement true or false?
Caregivers need to care for themselves through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, stress reduction, and health management.

16. Answer
True
Rationale: This is the “C” component of caregivers’ TLC. Caregivers need to care for themselves through adequate sleep, rest, exercise, nutrition, socialization, solitude, support, financial aid, stress reduction, and health management. The gerontological nurse should review the TLC needs of caregivers during every contact to unsure their continued effectiveness.

17. Family Dysfunction and Abuse
Many factors can threaten the healthy functioning of the family unit
Nurses must have the knowledge to identify and intervene when necessary
Forms of family dysfunction
Characteristics of families experiencing dysfunction

18. Family Dysfunction and Abuse (cont.)
Abuse statistics
Profile of the older adult at risk for abuse
Abuse occurs in all types of families
Types of abuse
Older adults may be reluctant to report or admit abuse

19. Family Dysfunction and Abuse (cont.)
Subtle clues of abuse
Elder Mistreatment Assessment Instrument
Nursing management of abusive situations
Assess the degree of immediate danger
Support for the abused person
Good family history
Care of the family

20. Rewards of Family Caregiving
A caring, interested family is one of the most valuable resources an individual can possess in old age
Caregiving can add a unique depth and meaning to the family
Opportunities for relatives to learn more about each other
Gratification in giving back to the aged