Characteristics to Qualify Patients of Long-Term Care
Those people requiring the assistance of a caregiver generally fall into 3 categories: Acute care patients, chronic care recipients and younger individuals with permanent mental impairment requiring supervision.
Acute Care
Acute care is often a rehabilitative recovery from a hospital stay or it may be a recovery from a serious illness or injury. With acute care, the individual is typically under the formal supervision of a nurse, physical therapist or nurse's aide. Recovery can be at home but is more likely to be in a hospital rehab wing or skilled nursing facility. Recovery time is usually a matter of a few weeks or months after which the person–even if not completely whole-- is typically capable of not needing a caregiver to function normally.
Acute conditions that may require the assistance of a caregiver might be recoverable brain damage or spinal cord injuries and orthopedic traumas or elective orthopedic surgery, especially to the back or feet, which are slow to heal. Other serious injuries from accidents may also require formal or informal caregiving. Serious acute circulatory conditions such as a heart attack, mild stroke or infectious diseases of the heart or blood vessels may require a caregiver. Cancers, especially the types affecting the abdominal cavity, may require a caregiver before death or recovery occurs. And many severe infectious diseases may result in a recovery period where the patient is too weak and needs a caregiver.
Chronic Care
Certain diseases, disorders, accidents or injuries result in disabilities that last longer than a few weeks or months. Many of these become permanent problems and although the disabled person may eventually adapt to take care of himself, a caregiver is often needed. The location of where this care is given, either in the community or in an institution and whether the care is provided by informal or formal caregivers is dependent on the nature of the disability and the ability of the caregiver. The constraints on the ability of the informal caregiver are the amount of time needed to care for the disabled, the need to balance a job with the demands of caregiving, the need for medical supervision of the disabled person, the physical demands of moving the disabled and finally the issue of the dignity and privacy of the caregiver and the disabled over changing dirty diapers or helping in the bathroom with toileting and bathing. Often an informal caregiver will attempt to provide this care perhaps out of love or a sense of obligation, but a better solution for everyone involved might be the use of a formal caregiver such as a home health agency or an assisted living facility. The nature of the disability also dictates who gives care and where. Many informal caregivers attempt to cope with care beyond their ability or expertise. Added to this pressure is the fact that the disabled person is often reluctant to give up the familiar environment of the home in favor of what might be better care and a more stimulating environment in an assisted living facility or a nursing home.
Chronic conditions resulting in permanent care might include permanent spinal cord or brain damage, disabling strokes, advanced congestive heart failure, various dementias such as Alzheimer's Disease, Parkinson's Disease, emphysema, various hereditary disorders such as Huntington's Disease, advanced diabetes, obesity-induced joint failure, disabling amputation, chronic disabling pain caused by injury or diseases such as pancreatitis, advanced osteoarthritis especially of the back, advanced osteoporosis with stress factors, AIDS and a host of slow-acting incurable cancers. Many of the above problems are more prevalent with advanced ages and as a rule caregiving is a problem associated with aging. But many people of all ages often develop disabling conditions requiring care. And many of these are progressive forms of auto-immune disorders such as type I diabetes, rheumatoid arthritis, multiple sclerosis, scleroderma, lupus, ALS, muscular dystrophy, myesthenia gravis, and many more.
Mental impairment developed early in life
Many of the roughly 5 million persons between the ages 18 to 65, requiring caregivers, are mentally impaired due to mental retardation, autism, Down's Syndrome, mental illness or severe depression. Many will live an entire lifetime needing supervision and because they have such a long-term need their numbers tend to skew the data for age-related caregiving. Although no studies are available showing the incidence of first-time caregiving–number of people per 10,000 needing care each year for the first time–this incident rate would probably be very low for young-aged individuals and high for the old-aged. For people over age 65, the average need for care is probably only 2 to 4 years before recovery or death. With the aged there is a constant turnover of new cases replacing those who die or recover. With the mentally impaired, the need for care may drag on for scores of years. There is less turnover due to death or recovery and these unfortunate people tend to accumulate in number. Although many of these people are cared for at home under supervision of their family, many more are cared for in special facilities licensed for this type of care. Both formal and informal caregivers are supported by government programs to help relieve the financial burden this type of caregiving can impose.
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