Home-Based Care & Mental Health

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In the New York Times blog The New Old Age Paula Span examines the challenges for elders who seldom leave their homes while receiving home care assistance. Highlighting a report from JAMA Internal Medicine, the numbers are significant showing that almost two million Americans over 65 rarely leave their homes, while six million are categorized as “semi-homebound.” This introduces various issues that can impact quality of life within the home environment. Primary among them is feelings of isolation and a decline in interest in everyday activities. Span describes the day-to-day routine of Solange DeLaPaz, a 67-year-old woman struggling with pulmonary disease, and how her routine has dwindled to an occasional 10-minute outing with her caregiver. DeLaPaz’s condition prohibits her from the activities she once took part in. In the post she says that although she misses participating in certain things such as going to church, she has regular visitors and maintains communication with family members. Unfortunately, this isn’t the case for everyone as Span describes some situations as “imprisonment” based on the findings.

Formal studies aside, anyone can imagine the ways in which a limited lifestyle would be sapping on one’s mental health. Not surprisingly, depression affects a large percentage of those homebound or semi-homebound though the root causes vary. Individual circumstance plays a significant role in the psychological well being of older persons. Those who are able to venture outdoors on a consistent basis, with the help of their home care aids, are less likely to suffer from chronic depression. Additionally, the nature of someone’s illness is a determining factor of their activity level. Other studies have shown that those residing in assisted living facilities have more accessibility to outside activities. Another key challenge for millions in the aging demographic is quality of care, which correlates to their living situation. When resources are compromised it contributes to the restrictive environment, which is why family relationships are of equal importance to medical care.

Those with family member(s) who visit or contact them on a regular basis has positive measure on their homebound circumstances relieving feelings of isolation and emotional disconnection. For professional caregivers it is incumbent upon those filling this role to understand how psychosocial aspects are interconnected with physical health. Often psychological health takes a back seat to the ongoing medical needs, and this is something that requires collective attention within the palliative care industry. In addition to depression, dementia is serious issue that can be traced to decreased activity and other forms of withdrawal. A better understanding of the interplay between quality of life and cognitive impairments will offer clearer perspective on how we go about caring for those with long-term illness and who wish to remain in familiar surroundings. The VCM philosophy adheres to this integrated perspective and places equal emphasis on the psycho-spiritual requirements of long-term care.


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