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Helpful tips for family caregivers

Does my relative have "capacity"?

If your older loved one is showing signs of cognitive decline, it may be time to find out whether they still have “capacity.” This medical term refers to their ability to make decisions while weighing the consequences. It means your relative can understand an issue, appreciate how it applies to them, reason through the options, and express a choice.

Capacity is clinically assessed by a healthcare professional, often one with a background in psychology. In cases of moderate to severe cognitive impairment, a physician may use their own clinical judgment to determine whether someone has capacity. But further evaluation is in order if there is any uncertainty. Or if the older adult struggles with some types of decisions but not others.

When evaluating your relative, the clinician may consider the following:

• Legal standard. What type of capacity is being evaluated, as defined by the law? For example, financial decision making, a safe-driving decision
• Functional elements. What abilities does this type of decision making require?
• Diagnoses. Are any medical or psychiatric conditions affecting those abilities?
• Cognition. What does a cognitive assessment show?
• Emotions. What emotional or psychiatric factors are at play? For example, depression or anxiety
• Values. What does the person value? What are their preferences? How might these considerations influence their decision making?
• Risk. What is at stake in this type of decision?
• Capacity enhancement. Could psychosocial supports improve the person’s ability? A new medication? Occupational therapy?
• Clinical judgment. Considering all factors, does the older adult have the capacity to make this type of decision?

If there are doubts about your relative’s capacity, seek legal counsel from an elderlaw attorney. These professionals can help you with next steps. A clinical assessment of capacity can be used in a larger process of determining whether the older adult is still legally able to make decisions.

Making your home safe for older guests

As the holidays near, it’s not too soon to check your home for hazards to visitors. Older adults often have impaired balance and vision. This makes them prone to trips and falls, especially in new surroundings. And fragile skin and bones can mean double trouble if someone does take a spill.

Home entry. Early darkness and wet or icy walkways can create a fall risk. Check that outdoor lighting illuminates every step. Make sure stairs have a sturdy handrail and nonslip surfaces.

Living/dining areas.

• Clear the floor! Store away toys, piles of books. Avoid slippery wax floor finishes and tape downrea rugs. Create wide paths.
• Eliminate extension cords from walking areas or tape them down.
• Be mindful of fire hazards. If you’re plugging in an extra heater, place it at least three feet from anything flammable.
• Review seat height. Seating that is low, angled back, or lacks side arms can pose problems for elders. Add a firm cushion to raise the seat.

Indoor stairs. If your guest must use stairs, make sure they are well lit and without glare or strong shadows. Consider nightlights, and point out where light switches can be found. If the stairs are wooden, consider adding nonslip tape.

Bedroom.

• Install nightlights to light the path to the bathroom. Also provide an easy-to-reach bedside lamp.
• Check bed height. If it’s too high, provide a platform step. If too low, add risers. (Risers are sturdy plastic “cups” that raise each leg of a bed. Also useful for couch or chair.)

Bathroom/kitchen.

• Clear the floor! Remove throw rugs. Ensure pet bowls and toys aren’t underfoot.
• Avoid scald burns. Put red electrical tape on hot water knobs as a reminder to take caution. (Turning the water heater down is no longer recommended because bacteria can breed at lower temperatures.)
• Prevent slipping by placing a large, nonskid mat in tub or shower. A shower chair makes for a safer shower. Check the thrift store or borrow a neighbor’s.

Alternatives to traditional burials

Talking with an aging loved one about their wishes for their body after they die may feel uncomfortable, awkward, or even taboo. Yet avoiding the topic doesn’t change the fact that at some point a choice will have to be made. Discussing the options now is important. Your relative may even find comfort in planning their final resting place—one that aligns with their own values and vision. It’s another way to honor their voice and the life they lived.

The options are more numerous and creative than many people realize. There are many alternatives to burying bodies and putting cremains in crypts. Depending on your relative’s beliefs, budget, and state laws, you might explore these options:

• Placing cremated remains in a favorite location in nature or under a tree, or made into personalized memorial pendants or other keepsakes
• Green burial, natural organic reduction, or alkaline hydrolysis for environmentally conscious choices
• Burial in a national cemetery for veterans
• Organ, tissue, or whole-body donation to a medical school to advance medical care and research
• Burial at sea, or in some states, on private family property
• A “living funeral,” a gathering of family and friends before their death for a mutual sharing of stories and appreciations

As you help your loved one explore these options, ask questions to help you both clearly understand what is important to them. Decide on a budget and explore possible resources or benefits. For example, you might consult a professional who is familiar with local laws, to learn any limits on choices. Former service members may be eligible for a burial allowance through Veterans Affairs.

Once a final decision has been made, make sure your relative puts it in writing so there can be no confusion. Instead of someday wondering, “What would they have wanted?” you’ll have the reassurance of knowing they are being honored as they wished.