Supporting someone who is older and frail can sometimes involve taking steps to ensure that the individual is able to live safely, comfortably and as independently as possible. These needs can often change over time as their health deteriorates and having early conversations about future care and plans will support the transition if or when the time is right.
These can be difficult conversations, but it’s good to have them as soon as possible, by listening to the person you care for about their wishes for care, treatment and future plans it can help them feel more involved in the decisions and allow them time to plan for an adjustment. This can include accessing equipment to help with daily tasks, introducing carers to help with personal care or knowing if and when to consider alternative care arrangements, such as residential care options.
This section shares some ideas to support you to have positive conversations with the person you care for about their care and future plans.
Being independent can help people to keep healthier for longer – both physically and mentally. It can also give people a sense of purpose and pride, so it’s good to encourage the person you care for to be as independent as possible.
The level of independence will vary from person to person, but where possible:
- encourage the person you care for to do as much for themselves as is possible
- ask for their opinions and involve them in decision-making, for example if you’re choosing a care agency or arranging to have home adaptations
- borrow, hire or buy equipment that can support them to stay independent (read our guide on ‘Equipment and technology to help someone live independently at home’)
- encourage them to do what they are safe to do. That might mean doing part of a task, even if they cannot do it all. For example, they could plan meals, even if they’re unable to cook.
It’s a very good idea to set up a Lasting Power of Attorney for the person you care for. Having this in place means that if they are unable to make their own decisions as a result of reduced mental capacity, someone they trust has the authority to do so on their behalf.
This is particularly helpful if they’ve been diagnosed with a condition such as dementia, or another condition that may affect capacity to make decisions. That way, if there comes a time when they can’t make decisions, plans are already in place.
It’s only possible to set up an Lasting Power of Attorney if the person still has mental capacity. That means they have the ability to make and understand the consequences of their decisions.
There are two types of Lasting Power of Attorney:
- Health and welfare Lasting Power of Attorney: This allows the named person to make decisions about the person’s healthcare and personal welfare if they can’t themselves. That might include things like care or medication.
- Property and financial affairs Lasting Power of Attorney: This allows the named person to have financial control, meaning they can make decisions about buying or selling a property, or paying the mortgage.
We explain these options in detail in our guide ‘Lasting Power of Attorney’.
Moving into sheltered accommodation or residential care is a huge step – and one which can bring up difficult emotions for everyone involved. The person you are supporting may feel like their independence is being taken away, or as their carer there may be feelings of guilt. These are normal emotions and other carers suggest were possible to include the person you care for in conversations about where they will move to and plan the transition together. This can help them to feel more positive and confident about their next steps. For example, talk about what items they want to take with them or visit the home or look at photos of the home together before they move in.
You can read more in our guide on ‘Supporting someone with the move into residential care or supported living’.
It’s hard to talk about death – especially if it’s with someone you are close to and caring for. But while even broaching the subject can be difficult, the conversations that follow may end up being comforting, both for you and the person you care for.
Talking about how the person would like to experience the end of their life, as well as what they’d like to happen afterwards, can give you confidence if you have to make difficult decisions. It can also be reassuring for the person you care for to know that their wishes have been heard, written down, and will be carried out.
If it’s too hard for you, maybe another family member or close friend could have these conversations. It might be easier for the person you care for to speak to someone a step removed, in case they’re worried about upsetting you. Or if talking about it is just too much, you could encourage them to write down their wishes.
This is to help the person you care for to experience the end of their life in the way that they want. You can talk with the person and their medical team to record things like where they’d like to be at the end of their life, what kind of emotional, spiritual and social support they want, and how symptoms can be controlled and any pain managed.
If the person you are supporting were to become unwell suddenly you may feel a lot of pressure to make decisions about their future care plans and clinical needs. Resuscitation Council UK suggests that everyone should hold a document called Recommended Summary Plan for Emergency Care and Treatment or ReSPECT. This is a document in which the person you care for can record preferences for their clinical care in emergency situations, if they are unable to make decisions or express their wishes. Their medical team can then use this document to guide treatment decisions.
Having a will in place will make sure the person’s money, property and possessions go to the people and causes they want them to. Age UK shares lots of information on how to make a will.
These might include whether they want to be buried or cremated, where they want their ashes scattered, and if there are any songs, prayers or poems they would like. While this can be very hard to talk about, it can take some of the pressure off you having to make decisions like this at a difficult time.
We share more information in our article ‘How can I help someone who is near the end of their life?’
Often planning for the future and having discussions around the future can be daunting and perhaps something both of you are not emotionally ready to do. However, as we have read above, by having open discussions, it allows everyone involved to make plans in advance, so when the time comes you are all reassured that any decisions, actions or care plans are being done in the best interests of the person being cared for.