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Elder care and the five stages of aging

By Sheila Avari, BrighterLife.ca

Comments (5)

These days, everyone has a story about caring for an elderly family member. From waiting with Dad at the doctor’s office, to staying overnight to administer Mom’s medication, to visiting your spouse at the long-term care home, the spectrum of care is broad. Elder care is posing mounting pressure on family caregivers, who are contributing billions of dollars worth of unpaid care each year.

Elder care and the five stages of agingPeople are burning out from taking care of a sick or elderly family member, says Dr. Mark Frankel, president and CEO of Taking Care Inc., an organization dedicated to helping caregivers navigate the elder-care system. Its self-service website and call centre receive a combined 20,000 to 30,000 inquiries annually. “We get most calls from family members carrying the load, caring for a parent or spouse,” says Frankel. “They’re frustrated, exhausted and stretched, and they need support.”

Going into long-term care is not an isolated event; it is usually a gradual process with many stops and bumps along the way. As people age, they may experience chronic health problems resulting in a variety of functional challenges or disabilities. They and their family caregivers shift from one strategy to another, coping with what can be a trying experience. As the stages of care progress, the choices and sources for that care become more complex, and often more expensive.

To help families understand and be better prepared for the main needs and issues along the long-term care continuum, Frankel has developed the following five-stage framework:

Stage 1

Seniors are still self-sufficient and able to manage chronic health problems and disabilities. Usually they don’t require or even accept special support from family members, preferring to be as independent as possible.

Stage 2

Independence turns to interdependence. Seniors begin accepting care from family members with cooking, house cleaning, shopping and banking, but are reluctant to accept formal care just yet. “Seniors often see formal caregivers as a beginning in the decline in their independence,” Frankel explains. During this stage, Frankel often advises families to begin considering seniors’ residences designed for independent living, which feature 24-hour security, suites, meal plans, cleaning services and laundry.

Stage 3

Seniors become more dependent on others for practical chores such as meal preparation, cleaning, shopping and transportation. They may also begin to need some limited direct help or stand-by assistance with personal care items such as dressing, bathing and grooming. There are a wide variety of care options; live-in and live-out personal support workers provide one-to-one care. Assisted living or retirement homes become options if both personal care and social activities, such as group dining or recreation programs, are desired.

Stage 4

The responsibility for providing care at home can send some families into an exhausting spiral of crisis management. “Families call us saying they went to Mom’s fridge and all the food was rotten, or Dad’s been leaving the stove on,” says Frankel. “The health and personal care needs of a senior can outstrip the family’s capacity to help. Formal home care may be insufficient or too expensive and the family goes from crisis to crisis.”

Stage 5

Frankel’s final stage of long-term care occurs when families are forced to admit their elder family member into a nursing home. Skilled nursing care and extensive personal care help the senior continue to live with dignity and allow the family to continue providing social and emotional support, while still tending to their own responsibilities.

Whatever the care, the funding is all on you, Frankel warns. Long-term care homes are not part of the Canada Health Act and government-subsidized care is very limited. “Everyone is discovering that the hard way,” he says, adding that families unprepared financially to cover costs of assisted living homes often end up bearing the responsibility of care at home.

Understanding Frankel’s stages of aging has become particularly important as Canadians live longer than ever before. They reinforce why planning for retirement requires both important lifestyle and life stage choices.


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connor on

Having Grandma in the home to help with meals and childcare is peachy if Grandma is healthy. If Grandma is in the home because she needs full-time care, she may not be able to cook or care for children; she may not be able to even care for herself. And what if you don’t have an extended family? My SO and I are both only children: my aunts and uncles are in no condition to help; they need help themselves. And what if Grandma is not a nice person, to put it mildly? You may be fortunate in your family members, but some of the rest of us aren’t: I personally am dealing with a selfish manipulative witch who only opens her mouth to complain and has a whine that makes fingernails on a blackboard sound like Beethoven’s Ninth. She only opens her mouth to demand something else be done for her and to tell you what’s wrong with what you just did, and then she bemoans the fact that no one wants to socialize with her. An hour with her and it takes you the next twenty-four to recover from the urge to hang yourself. If you and the rest of the Peters’ family would like to take over, send me your address. My bet is that you’ll do a high-speed rethink of your ‘the younger generation is just totally selfish’ position.
My advice to people who are concerned about needing care when they’re elderly: start becoming the kind of person someone would want to take care of right now so that when you need help, those traits will be habitual to you. Then, when you do need care, your children will be glad to do it, and when you do need full-time professional care, your children will be visiting on a regular basis.

Carolyn Peters on

My first comment is about the previous comment……is it just a coincidence that Mr. Landry sells insurance?

My real comment is this: I was born in 1943 & grew up in an extended family. When my aunts & uncles & my parents could afford to rent an apartment, & then buy houses, we all lived within few blocks of each other & my grandmother lived in our home. We helped each other. When my mother was working, my grandmother & my aunt took care of me & my brother. If my aunt was sick, my mother & my grandmother would bring in meals. No one had to rely on the government or paid caregivers or longterm care because everyone pitched in to help one another……& that’s how it has been for hundreds of years. But now we are in the “me” generation, which is more interested in using the fourth bedroom for “an office”, ie the computer room, than for a lone or aging parent. The nuclear family has “forgotten” some of their familial responsibilities & is much “poorer” for it. Having grandma in the home could mean a home-cooked dinner on the table, no more latch-key kids, and a wealth of knowledge. An old but true saying: “Many hands make the load lighter.” If you reach out, you will grasp a helping hand.

    Tim Landry on

    I sell insurance because I see how it helps people and how not having it – MY OWN BROTHER – hurts people. I have a question – other than insurance, tell me how you can pay UNEXPECTED bills. I watched my brother survive a car accident – a head-on collision at a combined speed of 120 mph – only to get hepatitis C from the blood transfusions which saved his life. I listened to a woman who came to visit her mom who lived above us in our apartment building yelling at her mom “I wish you would die”. She did not mean it but her mom had dementia of some sort and HER son had advanced MS. Carolyn – after 44 years in our industry I have heard all the negatives – but I have also seen all the positives. I also remind you that the “nuclear family” now tends to live far apart – and that women who were the traditional caregivers now work outside the home and are not in the same position to provide care – plus the incidence of divorce has risen a TOUCH.

Tim Landry on

The largest threat to everything women have accomplished in the last 40 years is looming ahead of us. Women – rightly or wrongly – have always been the caregivers in our society and they are already spending more time looking after aged relatives than they spend looking after their own children. The government CANNOT take this one on. Government money comes from taxes. I was born in 1945 and we had 42 taxpayers per retiree. We are about to reach TWO. There is no way the government can collect enough taxes to look after us – so we need to prepare. The biggest threat to our retirement is not economic downturns or interest rate drops. The biggest threat to our retirement is our health. 1 in 3 males now age 65 will eventually need care. Females age 65? ONE IN TWO!. Seriously investigate Long Term Care Insurance. It is what will keep you OUT of the Long Term Care facility you dread . it will allow you to be a customer – not a patient.

    Laura D. on

    I would love to have long term care insurance but can’t afford it. I can only have a part-time job due to health issues and caring for three children plus a parent in assisted living who has been in hospital as much as home for the past year and a half. My parent also lives two hours away. My other parent is even further away and I can’t afford to visit more than once or twice a year. I can’t move closer to them because children have to be close to their father too, besides the expense of changing / finding another job and moving. What does one do?

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