Lesson 1

Providing Care and Support to Elderly Persons

Get Ready

Have you ever experienced taking care of your Grandmother or Grandfather or an elderly
relative? Bathing, feeding, giving medications, or taking body temperature? If you have, and have
found the experience worthwhile and interesting, then caregiving is the right career for you.
Being a home caregiver is a beginning opportunity to have your skills in taking care of elderly
persons.
This lesson will give you helpful insights on what caregiving is all about

Get Ready

Caregiving is the act of taking care and giving support to an elderly or sick person at home
so that he/she receives all the attention at the same time retain his/her sense of independence and
privacy.
The primary purpose of caregiving is to give help and support to any person who is ill or
suffering from an injury whether he/she is a child, adult, or an elderly, in order to be healthy and live
independently.
It does not only help patients recover from any illness within the comfort of their homes, but
also helps decongest hospitals; thus, improving services.
A good and better caregiver must have the knowledge of careful planning, good self care, and
knowledge of what help is needed and what is available.

Establishing and Maintaining an Appropriate Relationship with the Elderly

The development tasks of old age relate more to the individual’s personal life than to the lives
of others. Elderly people are expected to adjust to decreasing strength and gradually failing health.

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This often means marked revisions in the roles they have played in the home and outside. They are
also expected to find activities to replace the work that consumed a major part of their time when
they were younger.
Meeting social and civic obligations is difficult for many older people as their health fails and as
their income is reduced by retirement. As a result, they are often forced to become socially inactive.
Failing health and reduced income likewise require the establishment of new living arrangements,
which are often radically different from those of their earlier years.
With grown children being involved in their own family affairs, the elderly people cannot expect
more time with their companionship. This means that they must establish affiliations with members
of their own age group if they are to avoid the loneliness that upsets the elderly people.
Some elderly people feel useless and unwanted, they develop feelings of inferiority and
resentment–feelings that are not conducive to good personal and social adjustments.
Respect the decision of the patient or elderly person to keep some of his/her personal conditions
or things private and confidential.
Rights of the Elderly People:
1. Right to be protected, and to safeguard his/her strength and weaknesses
2. Freedom to make decisions about his/her own life
3. Right to be given quality care
4. Right to be in a safe and healthy environment
5. Right to worship, according to his/her religious belief

In home care, the elderly person or patient feels secured and private; members of the family
can give full attention without restrictions on visitors. The manner of giving care is more personal,
with love and concern. Home caregiving encourages a patient to feel competent and independent in
making decisions for himself/herself.
Basic psychological needs of an elderly person includes the following: the need to be esteemed,
the need to be valued, accepted, and recognized as an individual, and the need for security and
privacy. One can help maintain the person’s self-esteem by encouraging as much as possible his/her
independence and by using his/her proper name and title. There are some elderly people who feel
annoyed and humiliated by being referred to as “grannies.” In such cases, there is a need to adjust
your approach, take into account the person’s age, background, physical, and mental condition and
depending on how well you know him/her.
The caregiver should be good in conversing with the elderly person, giving the latter a chance to
express out his/her feelings. Talking about experiences and other interesting topics help the patient/
elderly person feel that he/she has someone to talk to – a friend or a companion. The caregiver should
avoid conversation about bad and unpleasant experiences of the elder person or patient so that he/
she would not be depressed. In conversing with the elderly person, the caregiver should be more of a
listener than a talker. He/She should make the conversation as pleasant as possible but never let the
elderly person/patient be tired due to long conversation.

Providing Appropriate Support to the Elderly People

Every person has basic human needs; and the elderly person has the right to be provided with
all the care and support including their interest in recreational activities.
Elderly men and women tend to remain interested in the recreational activities they enjoyed
in early adulthood, and they change these interests only when necessary. Changes consist mainly
of a gradual narrowing down of interests, rather than a radical change in pattern, and shift toward
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more sedentary forms of recreation. Some changes in recreational activities are made as a result of
necessity, not by choice.

Common conditions responsible for changes in recreational activities are:

1. Health – as health gradually fails and as physical disabilities such as poor eyesight set
in, the individual requires an interest in recreational activities that requires minimum
strength and energy and can be enjoyed at home.
2. Economic Status – reduced income after retirement may force the cutting down on, or
elimination of recreational activities, such as going to the movies, that costs money.
3. Education – the more formal education a person has, the more intellectual recreational
activities, such as reading, should be cultivated. Because this requires little energy, it can
be enjoyed in old age.
4. Marital Status – elderly people who have been accustomed to engaging recreations with
their spouses must make radical changes in their patterns after the loss of a spouse. When
he/she is left alone, he/she may have to cultivate new recreational interest.
5. Living Conditions – elderly person who live in a home for the aged have recreations
provided for them that are suited for their physical and mental abilities. Those who live in
their homes or with a married child have fewer opportunities for recreation, especially if
their economic status is poor or if failing health or transportation problems prevent them
from participating in community-sponsored recreation activities.

Recreation covers any activity that is found to be

refreshing and renewing. Recreation must be carefully
planned and designed to suit the elderly person’s need.
This will depend on the elderly’s age and sex, as well
as his/her health. It is important to know what his/her
interest and what facilities are available for him/her.
Common recreational activities of older people
include reading, writing letters, listening to the radio,
watching television, visiting friends and relatives, playing
cards, going to the theater or movies. Radio and television
demand no physical activity and every effort should be
made to avoid interrupting the older person during his/her favorite programs. There are also older
people who love music and so a record player should be made available. Others are basketball,
football or boxing fanatics. Some find comfort in participating in broadcast religious services; others
take part in civic, political, and spiritual activities. As health condition permits, some elderly people
even join cultural and educational activities.
With their advancing age, most people suffer from increasing social loss or social disengagement
– a process of mutual withdrawal of the aged from the social environment. This is expressed in a
narrowing down of the sources of social contact and a decline in social participation.
Women, as a rule, retain friendships longer than men, mainly because their friends, for the most
part, come from the neighborhoods, while the men’s friends are largely work associates who lived in
different areas and who are not brought together by their common interest in work after retirement.
Many retired men are forced to rely on their wives for companionship and to play “homebody” roles.
The elderly person can participate in social activities like visiting friends, joining tours, playing
mahjong with friends, attending social gatherings, or family gatherings except when such obstacles
as poor health, economic privations, or family responsibilities prevent them from doing so.

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 Although it is popularly believed that people turn to religion
as life draws to a close, there is little evidence to support this
belief. While elderly people may become more religious as death
approaches, or if they are seriously disabled, the average elderly
person does not necessarily turn to religion in the sense that it
becomes a new interest or a new focal point of attention. Most
elderly people carry on the religious beliefs and habits formed
earlier in life. They usually join different religious organizations and
attend different spiritual activities.
The attitude of most older people towards religion is
probably most often that which they grew up or which they have
accepted as they achieved intellectual maturity. Women continue to participate in church activities
more than men do because of the opportunities they offer to social contacts. Whatever the reasons
for interest in religion, attendance at church and participation in religious organizations, there is
evidence that these contribute to good adjustment in old age.

Providing Assistance to the Elderly People to Maintain Safe and Healthy Environment
An elderly person or patient cannot select his/her environment unlike healthy people who can
choose their own safe place. Hence, he/she is not in a position to make adjustments or go elsewhere
because of danger and discomfort. He/She has to depend upon others to provide a safe immediate
environment. Whether confined in bed at home or in the hospital, his/her surroundings is of great
value to him/her. The general atmosphere of the room is crucial to the elderly person/patient’s
comfort and recovery.
The location of the room must be in a safe environment especially if the movement of the
elderly person is restricted. The room should be immaculately clean. An elderly person has a low body
resistance to infections and diseases. It is essential to keep the room free from pathogenic organisms
or germs which may aggravate their health. The room must be comfortable, well-ventilated, and
well-lighted. It must be conducive to rest and relaxation. It should be aired once or twice a day, open
the window to allow fresh air to enter. Place the bed near the window if there is a garden outside.
Curtains and windows hold control on the amount of light entering the room and these provide
privacy. A quiet room gives the elderly person time to rest his/her mind and should be of considerable
distance from noisy street. To a sick elderly person, every sound is magnified and can cause headache
or irritability. The radio and television receiver should be timed down. Too many visitors can be tiring.
Limit the number of visitors and the length of their stay, but be tactful about this.
The location and furniture of the room should be considered for the elderly’s well-being and
convenience for the caregiver. It is better to have a room at the first floor with a toilet or near the
toilet. The bed must be firm, the mattress must not be sagging and must support the soft parts of the
body. The room should have plenty of space around the bed for facility in movement and placement
of essential equipment. The room needs a table drawer within the reach of the elderly or sick person
from the bed. The bedside table must have a lamp with light of moderation brightness. An armchair
is needed for placing the bed linen or for visitor use. Always have a clear pathway between the bed
and the door or between the bed and the toilet (if there is any) to avoid any body tripping over. For a
bath, have a ready chair or stool which the elderly person or patient may use.
Orderliness in the room is a must. It means that needed articles are placed in their proper places.
Things needed by the elderly person or patient must be within his/her reach so that he/she will not
lose his/her balance or fall off from the bed. Never leave unnecessary objects beside the table except
those that will not cause accidents. Remove medicines on the table. The elderly person or patient
may repeat the dosage, forgetting he/she has already taken the same. Medicines are placed in a safe
place separate from other things. It should be labeled properly. If possible, note the prescribed time
when to take them.
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Providing Assistance with the Elderly’s Personal Care
Taking care of an elderly person requires accurate and intelligent decision-making skills for
the caregiver. One of the most important tasks as a caregiver is to attend to the elderly’s comfort.
It is important to analyze the extent of help needed by an elderly person to attend to his/her daily
personal routines.

Below are the activities in which they may require assistance:

1. Assistance in washing and bathing – if the person is mobile
enough, he/she can bathe in the bathroom with the help
of bathing aids. If he/she is confined in bed, he/she
can bathe in the bed. A daily bath is ideal, though it is
important as well to check how often he/she normally
bathe. Some elderly are nervous of bathing. In this case,
a good washing can be just
as adequate. When bathing in
the bathroom, make sure the bathroom is warm and the windows are
closed. Gather together soap, washcloths, towels, talcum powder, and
any clean clothes that may be needed. The caregiver may offer him/
her help with getting in and out of the bathroom. Persons who need a
lot of help should use a bath seat. Bear in mind that, the elderly needs
to work at other times. Washing his/her hands and face often refreshes
a person and makes him/her comfortable. He/She should also wash
hands after using a bedpan or commode, or after going to the lavatory.

2. Shaving – a man who shaves regularly will find it uncomfortable and

embarrassing when stubble grows. If he is unable to shave himself,
then the caregiver must do it for him. The caregiver must first assess the
person’s condition and judge how much help he needs. Ask him what
kind of razor he normally uses and find out in which direction he shaves
because the bristles grow according to the direction of shaving. Going
against the normal may causes pulling and soreness.

3. Caring for the nails – the caregiver will notice if the person’s nails need
attention while bathing him/her. A nail brush is used to keep the nails
clean and should be cut regularly. The fingernails should be cut or filed
to the shape of the finger, while toenails should be cut straight across.
It is common for elderly to have very hard and thick nails. The help of a
podiatrist is invaluable in these cases.

4. Caring for the eyes – in normal health, the eyes are kept moist and clean by an imperceptible
film of fluid, which flows across the eyeball and drains into the nose.
During illness, the eyes may become dry, sore, and even infected. If this
happens, you must bathe the eyes to keep them clean. Help the person
into a comfortable position and tell him/her what you are going to do.
Wash your hands, arrange the towel under his/her face. Dip soap into the
water or saline solution, squeeze it gently, and swab the eyes from the
nose outwards. Discard the swab. Repeat the procedure until both eyes
are clean. Dry the surrounding skin with clean, dry swabs. Use each swab
once only. This is important in order to prevent cross infection.
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5. Caring for the mouth – food particles left in the mouth after each meal
begin to decompose if not washed and cleaned. Harmful bacteria will
flourish and multiply having an unpleasant
taste and feeling in the mouth. These bacteria
can cause tooth decay or mouth infections. The
healthy person cleans his/her teeth regularly.
Patients confined to bed are unable to care for
their mouth without assistance. In these cases,
the caregiver has to provide them with the
means to clean their teeth at regular intervals. In
the case of a child, get him/her the habit of cleaning his/her teeth twice a day. Try and restrict
his/her intake of sticky and sweet food.

6. Caring for the hair – Elderly, ill or disabled people find it enjoyable
when they go to a barber shop or salon for a haircut or shampoo.
They find it refreshing to keep hair short in an easy-care style. If
you find it difficult to wash hair in a tub or shower, you can use
the kitchen sink. Brush and comb the hair at least twice a day and
arrange it in a simple style that is easy to manage and pleases the
person. Check the hair if it is not infected with lice. Lice multiply
quickly by laying eggs. The eggs are called nits and stick to strands
of hair. Lice can spread from one person to another, especially
in crowded conditions. Ask the other members of the family for permission to examine their
heads. Once you found an infected head, treat the condition, then examine their hair regularly
to check that there is no recurrence.

7. Choice of clothing – choice of clothing is a very personal thing. Let a person who has some
level of confusion, arranged two or three choices of clothes and let him choose what to wear.
If illness or disability makes it necessary to adapt clothing for a specific need, most people
appreciate help. The caregiver should also know what special clothing is available for his/her
particular disability. In helping the person select the right clothing for his/her condition, tact
is just as important as the choices itself. Be careful not to cause embarrassment by suggesting
items which are out of the person’s personal choices.

8. Dressing and undressing – it is wise to encourage the person to do as much for himself/herself
as he/she can. This may be a lengthy process if he/she is blind, has lost a limb or is paralyzed
as a result of an injury or stroke. Dressing and undressing are an important part of the elder’s
days. Every achievement is a step towards independence. Allow the person plenty of time for
dressing and undressing and encourage him/her to rest at intervals.

9. Eating and drinking – food and drink are necessary to

life and health. Everyone enjoys good food attractively
served and gives a great deal of pleasure. Even the sick
person whose appetite is not great will often respond
to the right kinds of food served to him/her in the right
quantity and at the right time. The caregiver should
understand the basic principles of good nutrition.
He/she should know the basic nutrients needed in a
balanced diet and in what food they are found. If the caregiver is concerned with preparing

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 and serving food to an elderly person, this knowledge will help
him/her to prepare balanced meals according to their needs. If
the meals are presented attractively so they look appetizing, then
the caregiver has a good chance of overcoming any reluctance of
the elderly to eat caused by the loss of appetite. The nutrients in
food are used by the body –
a) to provide energy movement
b) to provide heat so that the body temperature remain stable
c) to provide for normal growth
d) to replace cells as they wear out or are destroyed by illness
It is important for everyone to get enough fluids each day. Adults
need at least 6 to 8 glasses of fluids each day in different forms such as
water, fruits, vegetables, juices, milk, and soups. The kidneys of an older
person may need more fluids to function properly if he/she is taking some
medications that can dehydrate a person.

10. Comfort and mobility – helping the person to move and maintain a comfortable position is
one of the most important tasks of a caregiver. If the person is unable to move or if his/her
movements are restricted, it is up to the caregiver to choose the most suitable
position in bed for him/her. The caregiver should know how to lift and move
him/her without causing him/her any pain and without straining the caregiver’s
back. The elderly who gets up and moves around should
be encouraged to do so, but do not forget that even the
relatively mobile person may need help. Many patients
recovering from a serious illness or an operation need help
at first with walking and moving about. Elderly person
may also need help to a greater or lesser degree, like the
paralyzed and handicapped. It is important to try and judge
how much help the individual person needs, and to make it possible to him/
her without making him/her more dependent than necessary. Whenever an
elderly needs to be moved, the caregiver must think carefully about both
the needs of the elderly and of his/her own needs.

Listening to the Elderly’s Preference to Maximize His/Her Well-being

Several basic principles of home caregiving should be observed in the handling of an elderly
person. The first is hygiene. This is important to protect the elderly and the caregiver from infection.
Washing one’s hands before and after tending the elderly reduces the spread of bacteria.
The attitude of those around the elderly has a decided effect on his/her well-being. A cheerful
attitude encourages and supports the elderly and promotes his/her cooperation. It is also important
to encourage the elderly to express his/her feelings about his/her care and about receiving help from
others. It is difficult to be so dependent on others when one is sick or disabled. Listening to what
the elderly says about that dependency and the type of care he/she would like to have, enables the
home caregiver to understand what the elderly is feeling. With this knowledge, the caregiver can
be sympathetic and tolerant when the elderly seems demanding and uncooperative. Being open
to the elderly’s choices concerning his/her care, asking him/her when he/she would like to wake up
in the morning, how to do his/her exercises, being flexible enough to accept his/her choices, and
resourceful enough to incorporate them cheerfully into the daily routine, all of these form significant
parts of home care.

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Providing Assistance with the Elderly’s Personal Needs
A working knowledge of the characteristics of the elderly provides the basis for working with
them satisfactorily. Acquisition of functional information and skills in handling the physical and
emotional needs of the elderly and those with disabilities prepare one to assume the responsibilities
of caring for them effectively.

Characteristics of the Aged Person

1. Changes in appearance – seen in the head, trunk, and limbs region.
2. Changes in Physiological functions – changes in the functioning of the organs, decrease
vascularity of the skin, reduced metabolic rate, and lessened muscular vigor.
3. Changes in sensory function – decline in ability to see, hear, smell; marked changes in
taste, sense of touch become less as the skin becomes drier and harder; and decline in the
sensitivity to pain.
4. Decrease in mental alertness – mental decline accompany physical deterioration.
5. Changes in motor abilities – move more slowly, become awkward and clumsy, and
decrease in strength and energy.
6. Decline in social activities – less active role in social and community affairs as well as in
the business and professional world.
7. Role change – feeling useless and unwanted so they develop feelings of inferiority and
resentment.
8. Changes in interest – decrease in personal interest, self and appearance, clothes and in
money.

In addressing the concerns and needs of the elderly, it is important to assess how much
assistance they need and make the help available without encouraging needless dependence. The
caregiver should help the elderly be as independent as his/her health permits. Involving the elderly
in his/her own care reassures him that he/she is in control of his/her own life. This is important when
much of his/her physical life may be severely altered or limited. If the elderly is unable to participate
in his/her own care, the caregiver can help him exert some control over his/her life by mutually
arranging procedures which reflects the elderly’s wishes regarding his/her care. This perspective is
best achieved at home, where the elderly can gain confidence in his/her physical and mental abilities
and learn to cope with the limitations of his/her condition.

Basic Needs of an Aged Person:

1. To be in safe environment
2. To move and maintain a comfortable position
3. To keep his/her body clean and well-groomed and protect his/her skin
4. To select suitable clothing and dress and undress
5. To eat and drink adequately
6. To eliminate regularly
7. To sleep and rest
8. To maintain normal body temperature
9. To breathe normally
10. To communicate with others and express emotions, needs, and fears
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 11. To work at something that provides a sense of accomplishment
12. To play or participate in various forms of recreation
13. To learn, discover or satisfy the curiosity that is part of normal development and health
14. To worship according to his/her faith

Appropriate Assistive Devices for Providing Assistance to the Elderly

1. Aids to Bathing
a) A handrail or a bath seat may help a frail or elderly person to bathe alone. For a heavy
disabled patient, a hoist can be used. This is a device to lift people into the bath. The
correct type must be recommended by a competent therapist who will also teach how
to operate it. Bath seats help a person who finds it hard to get down to the bottom of the
bath.

b) A non-slip mat placed in the bath is held firm by suction

pads.

c) The elderly who find it hard to sit down in the bath may prefer a shower with a seat or a
shower attachment.

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2. Aids to Dressing
a) An elderly person who is weak or arthritic can continue dressing by
using a dressing stick made from an old coat hanger. The V-notch pulls
straps over the shoulder; the rubber thimble clings to fabrics.

b) A stocking aid has a plastic frame and the stocking is slipped over it. This
allows the toes to be inserted while the handle enables stocking and
the frame to be pulled up the leg.

c) The long-handled shoehorn helps people who cannot bend down to

their feet.

d) The reacher performs the same function as regular reachers but is

of adjustable length. It has a mechanism at the top of the handle,
which operate the jaws at the bottom.

3. Aids to Eating and Drinking

a) A person who only uses one arm may find a deep bowl
helpful or a plate guard especially when these are used with
a combined knife and fork or a pusher spoon.

b) For a person with arthritic hands, light but thick handled cutlery is easier to grasp. It can
be improvised by padding ordinary cutlery with foam rubber.

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 c) A spike board makes it possible for someone with the use of
only one hand to butter bread or peel potatoes.

d) For people without the strength to open stiff jar lids, special
gadgets exist which only requires a little pressure.

e) For a feeding cup for a helpless patient, you may improvise with a baby’s feeding cup, a
teapot, or a glass with an angled straw.

f) A non-slip tray with a handle makes it possible for a frail

person with the use of one arm to carry several items at
once without spilling everything.

4. Aids to Waste Elimination

a) Raised toilet seats and toilet risers raise the height of the toilet seat, like a raised plastic
toilet seat; a removal arm and hand support; and a strong well-mounted handrail.

5. Aide to Mouth Care

a) Make the handle bigger with a sponge, rubber ball or adhesive tape for a person who has
difficulty grasping a toothbrush.
b) It is easier to use an electric toothbrush than a normal brush.

6. Aids that Can Help with Transfer

a) Transfer belt is placed around the patient’s waist to help him transfer or walk. It is made of
sturdy webbing with a buckle on it. A regular belt with a clasp will also do.

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 b) Transfer board is used to slide a patient from one place to another. It is good for a patient
who could use his/her arms to move quickly from one side to the other.
c) Lift cushions is a powered recliner that can lift and tilt forward. It helps a patient to stand
easily and lower himsel/herself into a seated position.
d) Lift chairs is a portable device placed on the seat of a chair and can function thus the use
of electricity or air compressor. This will help a patient with lesser, upper and lower body
strength to gently put himsel/herself into a chair and help him/her when standing.

7. Aids to Comfort in Bed

a) When a person is sitting up his/her back needs to be supported, and a backrest reduces
the pillows required –

1) A backrest can be improvised by using a kitchen chair in

conjunction with pillows.

2) The standard backrest is widely available for use in the

home.

3) A triangular pillow offers excellent support and is much

appreciated by sufferers from backache.

4) A backrest which looks like the back of a sofa chair with

arms provides extra support for the arms.

b) It is necessary to support the person’s feet to prevent him/her from skipping down the
bed. In a long illness, a foot support is also used to keep the foot at right angles to the leg.
A soft footrest can either be a bolster or a pillow wrapped in a sheet.
c) Orthopedic boards – persons with back problems find it difficult to lie comfortably on a
soft bed. The bed can be rigid by one long board, or a series of boards, placed across the
base under the mattress.

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8. Aids to Walking
a) A cane with a rubber tip is ideal for an elderly who only need a little support
or a boost to confidence.

b) The use of walker is ideal for someone who has to support

some of his/her weight on his/her hands.

c) Tripods and quadrupeds are adjustable in height. They provide balanced

support for those who need it.

d) In a case of permanent disability or condition such as breathlessness. It

may be possible to install a stair lift which the person can stand or sit to
ride up and down the stair.

e) The wheelchair is used by disabled person. A temporarily

incapacitated person or a frail elderly person may have to use it
for a while.

9. Aids to Incontinent
a) Urinals for men are used at night when the patient cannot be
moved.

Female urinals are small and light. They can be slipped between a
patient’s legs without her hips needing to be raised off the bed.

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 b) Fitted incontinence pants are made of a soft material with a
waterproof pouch on the outside and suitable for men and women.
The urine passes straight through the pants to be absorbed by a pad
placed in the pouch, so leaving the skin dry.

c) Stretch incontinence pants are light, open-stretch pants designed to

fit any patient. Across the pants are two woven – in blue bands which
hold a plastic-backed pad firmly in place. These pants can be used at
night.

d) Underpads are made of layers of absorbent material backed by

waterproof material. Pads are especially used at night.

e) The protective sheet is a waterproof sheet to cover the mattress.

It should be placed beneath the bottom sheet, and securely
tucked around the bed to completely protect it against moisture.
The sheet may be left for 12 hours. It never feels really wet, just
dump when saturated. It looks and feels pleasant and can be
frequently laundered.

f) A catheter may be used to give the patient more independence.

It may be inserted into the bladder and left in position. The urine
drains into a bag strapped to the leg or supported by a wrist belt.
The bag is emptied periodically.

10. Aids for Fall Prevention

a) Slippers that are not slippery
b) Stainless bars in bathrooms to provide support and stability
c) Wheelchair with anti-roll back device to stop it from rolling away when the patient stands
or sits into the chair
d) Floor mats with anti-slip material on the bottom
e) In the event of a fall, a hip protector is necessary to protect the hips from injury
f) Cushions are also important in case a patient rolls out of bed. These are placed at the side
of a bed.
g) Alarm to signal when the patient leaves a bed, wheelchair, or toilet unattended

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Attending to the Elderly’s Personal Hygiene
Hygiene refers to the process of making oneself clean and healthy. It is also what keeps and
promotes the health of people around you.
In giving care to the elderly, the caregiver must be constantly alert to the need for cleanliness.
The elderly’s environment should always be cleaned, because old people have low body resistance
to infection. The room must be comfortable, well-ventilated and well-lighted. It must be conducive
to rest and relaxation.
The care giver has the responsibility to attend to the personal hygiene of the older person in
order to make him/her feel comfortable. The proper hygienic living has an effect upon the body itself
and on the personality of the person.
Hygiene includes many good benefits:
1. Always keep oneself clean and presentable
2. Having a good night sleep (7 to 8 hours sleep)
3. Eating a well-balanced diet
4. Taking a bath daily
5. Wash hand frequently especially when taking food
6. Brush teeth and floss daily
7. Regular dental check-up
8. Having a regular elimination
9. Exercise daily to keep oneself fit

The caregiver must attend to the personal necessities of the elderly. Although personal care
is personal, the caregiver must assist the elderly person in doing his/her personal activities. Use as
much as possible the same routines he/she is used to.

Personal necessities cover the following:

1. A daily bath is ideal. It serves many purposes for the person. It cleans the skin, stimulates
circulation of the blood and provides movement and exercise.
2. Proper care of the skin is by means of cleansing baths, cream, and oils. A clean skin has a self-
disinfecting power while dirty skin harbors bacteria.
3. The face should be cleaned with tepid water and bath soap daily.
4. The hair should be washed or shampooed at least once a week with plenty of water. The
scalp needs vigorous rubbing so as to remove dirt. Both the hair and scalp should be dried
immediately by rubbing with a clean towel.
5. Keeping the hands clean is indeed a problem as no other part of the body come frequently in
contact with infective organisms. So, wash the hands with soap and water after going to the
toilet, before eating, or handling food and every time they become dirty.
6. Laundering – laundry can be done daily or weekly or on schedule. Before doing the laundry,
the caregiver should segregate items according to colors and by delicate materials. When the
clothing is already dry, iron, fold and place them in their proper drawer or closet.

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 Lesson 2
Providing Care and Support to People with Special Needs

Get Ready

Have you experience taking care of a person with special needs? If you had an experience
caring a non-disabled person, knowing what to expect from a person with special needs will give
you confidence that you can do it.
In this lesson, you will learn about the different kinds of disabilities that a person may have. It is
important to understand their condition and provide them with quality care and support.

Read and Learn

People with special needs refer to persons with disabilities. Some of these disabilities are:
blindness or vision impairment, hearing impairment, speech impairment, inability impairment,
psychiatric disability, specific learning disability, and other health impairments, that who by reason
thereof, need special education and related services.
1. Blindness or vision impairment does not affect the ability to talk, to think, and to hear,
but non-verbal communication is largely inaccessible to him/her. He/She has to adapt
to a new way of life. His/Her hearing and sense of touch must develop, he/she may learn
Braille and other new skills.
2. Hearing impairment – a person with hearing impairment makes it hard for him/her to
communicate. He/She may hear at a functional level with the use of an amplification

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 device such as a hearing aid. They can also use combination of lip reading and sign
languages.
3. Speech impairment – this affect the ability to speak. There are some gadgets like an
electronic mail that does not require the person to speak and others are computers that
provide an alternative voice for people who cannot speak.
4. Mobility impairment – this impairment affects the upper and lower body. The lower body
impairment may require the use of wheelchairs, walkers, and canes. The upper body
impairment results in limited or no use of the hands.
5. Psychiatric disability – people with this disability are not always considered mentally ill.
They may need to be provided with unique on-the-spot accommodations to prevent
them from exhibiting behaviors that are not proper in a certain situation in the work
environment.
6. Health impairments – there are some health conditions wherein the medications required
may affect memory or energy level of a person. There are some that are chronic and
constant while others are occasional like allergies and require flexible and variable
accommodations.
7. Specific learning disabilities – people with this disability usually have average to above
average intelligence. There are also some who find it difficult to work on written or
reading information in a given amount of time. They also find it difficult to demonstrate
their knowledge and understanding of certain instructions or ideas.

Establishing and Maintaining Appropriate Relationship with People with Special Needs
The home caregiver may be any member of the immediate family, a relative, or a close friend
who has the time and commitment to care for a person with special needs. It is best to designate
one person as the primary caregiver to avoid confusion and insures that medication is properly
administered and necessary schedules for treatments are followed.
As a caregiver of a person with special needs, you will be faced with challenges that you have
not experienced before and it can be difficult to know where to start and what to do. An important
advice is to establish a routine. A routine is a daily performance of specific activities of a person done
in the same manner over time. Some people are likely to rely more and more on routines to keep
themselves organized.
In order to be able to establish a bond with the person with special needs, routine is a powerful
tool which can help foster bonds. Bonding is important because a relationship based on trust and
mutual respect will be a successful union, and the person will feel secured and comfortable.
A caregiver must find as much as possible about the person in his/her care. He/She has to know
the patient’s routines, personal habits, likes and dislikes. He/She should not impose his/her own
routines on the person he/she is caring. The caregiver must be prepared to compromise.
The caregiver must know the person’s interest, strengths and needs from interacting with
him/her everyday and seeing him/her in a variety of activities and recreations. Having a good
understanding of the disability, its possible impacts and available equipment and devices can be very
helpful. In spite of the disability, the person must learn how to socialize, just as speaking, moving, and
thinking.
1. Talk with the person with disability about different situations that may happen in day to
day interactions with others like how to start a conversation, how to meet new people,
how to request for a favor, and how to answer and manage when encountering conflict
or criticism and when he/she is asked about his/her disability.

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 2. Encourage friendship, tell him/her the qualities that are necessary to have friends and
how to be a good friend to others.
3. Encourage the person to participate in various activities that interest him/her and fits
his/her disability. These activities will help in developing skills, confidence, and new
relationships.

Responsibilities of a Caregiver
1. Records information of the person with disability, both his/her physical and emotional health.
This will serve as basis for the specialist who will diagnose the disabilities of the person.
2. Follows strictly the doctor’s order such as dosage and time of medication.
3. Practices proper basic principles of caregiving such as safety, sanitation, and proper hygiene.
4. Permits families and friends to participate in looking after the patient with disability so that he/
she will feel connected with his/her family.
5. Recognizes and considers the patient’s comfort in his/her room. By keeping the room clean and
neat, it will create a relaxing environment and the patient will feel he/she is properly cared for.
6. Keeps the surroundings quiet and free from disruption specially when sleeping.
7. Gives a balanced and nutritious food for the patient to give sufficient energy.
8. Is alert and has control in terms of emergency
9. Always maintain the care, respect, and support toward the person with disability.

Normally, the duties and responsibilities of a caregiver are related to the patient’s needs that he/
she cannot perform due to illness or disability. An example of which is a patient suffering from a hand
problem and the patient cannot eat and drink without the assistance of a caregiver. The caregiver will
provide the help needed by the patient. Other duties of the caregiver are prescribed by the doctor.

Individual Differences of People with Special Needs

People with special needs must be treated appropriately for their individual differences, rights,
interest, and decision-making. Every person is different depending on his/her disability.
1. It is important to remember that in communicating with a person who is blind, the
disability does not affect his/her ability to think or to hear.
a) To converse with a person who is blind speak in a normal
tone, touch the person lightly on the arm or
address him/her by name.
b) Orient him/her in the place where you intend
to meet and talk.
c) A person who is blind and cannot relate
to hand or facial gestures, use descriptive
words instead of vague languages when
conversing.
d) Use expressions that are commonly used by blind people.
2. There are people who cannot talk as a result of a stroke. The hearing is not affected, but
cannot tell what he/she wants; he/she can speak but not capable of saying the right word.
After exerting much effort still the word is inappropriate. Literally, the patient has to be
taught to speak again. This requires patience on the part of the caregiver and perseverance

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 on the part of the patient. In the early stages, pictures, cards or from magazines can be
useful. When the patient has a need that he/she cannot express, show him/her a solution
of pictures, he/she can then point to the pictures the things he/she needs.
3. The deaf patient’s inability to hear makes it hard for him/her to communicate. Deafness is
common among the elderly, hearing fails gradually. A hearing
aid may help but it is not useful as it may seem because it
magnifies all sounds, including background noise. A specialist
to teach lip-reading and non-verbal signs may be of help.
While talking, never turn your back on a deaf person. Try and
use the lower tones of your voice range as these are readily
heard. Always include the patient in your smiles and gestures
whenever possible.

Encourage People with Special Needs to Communicate Ideas, Feelings, and Preferences
There are many ways that can help a person enhance the skills to let people know about his/her
disability and conditions that might be needed in certain situations.
1. Talk with a person with disability about ideas for managing various situations. Help him/
her learn about his/her needs and how to express those needs. For example – if a person
has hearing impairment, he/she can be provided with hearing aids if that will make it
possible for him/her to participate fully or express his/her needs; he/she can also explain
that it is easier to understand what someone is saying when there is less noise and he/she
can see the face of the person talking to him.
2. It is important for a caregiver to show a disabled person how to learn the positive and
effective ways of asking help or expressing a need by watching you.
3. Give the person opportunities to practice what to do in various situations. See to it that
he/she practices in a safe, non-threatening environment. Encourage him/her to develop
plans for any kind of situation that fits him/her.
4. When the person likes to do something by himself/herself, encourage him/her to let you
know if he/she needs help. Urge him/her to try new activities if safety is not at risk. Even
if the result is not perfect, the person may gain confidence and independence.
5. Maintain a positive approach. Accept and believe in his/her abilities. Your reaction
towards his/her disability can affect his/her self-esteem.

Providing Appropriate Support to People with Special Needs

Every person whether non-disabled or with disability has a basic human need and right to
be treated with respect and dignity. People with disabilities require extra effort physically and
emotionally. There are many ways to support a person with special needs.
1. The caregiver must learn about the disability and so with the person with disability.
The specialist can tell the patient about his/her disability and then allow him/her to ask
questions.
2. Discuss with the specialist the specialized equipment and devices that can enhance the
disabled person’s skills and help him/her with everyday activities.
3. The family should take a positive approach toward the disability and ideas about the
possibilities for the patient.
4. Share your own experience with the person with special needs. Talk about how it is
important to work on areas they find difficult as well as develop their strengths. Explain

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 that a person whether with disability or not, have things that they are good at and there
are things they find harder to do.
5. It can help if you can reach out to families who have relations with similar disabilities for
help and support and can serve as guides.
6. Families of people with special needs can find organization dedicated to a specific
disability for support.

Examples of support for an individual with disability:

a) A person with hearing impairment may have difficulty understanding the speaker if he/she
speaks quietly, rapidly, and unclear.
• Speak normally and direct to the person with hearing impairment when conversing with
him.
• Talk directly to the person and not the interpreter when using an interpreter.
• Pictures or drawings and gestures can be used to help in communicating with the person.
• Adequate lighting facilities should be available in communicating with the person with
hearing impairment.
• As much as possible include the person with hearing impairment in group conversation.
b) Encouraging greater mobility – patients recovering from a serious illness or an operation need
help at first with walking and moving about. Elderly patients may also need help to a greater
or lesser degree, as may the paralyzed and handicapped. It is important to try and judge how
much help the individual patient needs and make it available to him/her without making him/
her more dependent than necessary.
Patients recovering from a stroke that has temporarily paralyzed one side of the body need
special help.

• In helping him/her to walk, stand at a weaker side. Support him/her with

one arm around the waist from behind and the other hand under his/her
armpit.

• In helping him/her to go upstairs, you may need to steady the

patient on the stairs by taking his/her arm on the side opposite
the banister or wall.

• The patient who needs to visit the doctor or hospital for

treatment may need help with getting in and out of the car,
especially if he/she is arthritic, or partially paralyzed.

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 • If the patient is using a wheelchair
or walker, consider this device as an
extension of his/her body.

The person with disability has lost one of his/her vital aids to recovery. Whatever the disability,
the aim of care is the same, to allow the person to live as full and as active a life as possible while
maintaining his/her self-respect and encouraging his/her independence.
A caregiver must keep in mind that person with or without disability are more alike than
different and that each has unique skills and abilities. He/she must be positive in helping the patient
and expect that they are there to succeed in participating in some learning activities.
In providing support to people with needs, it is important to consider that the patient is in
a safe and healthy environment. The comfort of both the patient and the caregiver is vital. For the
patient, a well-kept, clean, and organized room creates a relaxed and controlled atmosphere where
the patient can rest. A clean, well-made bed with the correct support for the patient in both sleeping
and sitting-up positions will give the patient the comfort necessary for the sleep and rest so essential
to his/her recovery. Keep the environment in good shape, giving attention to order, housekeeping,
and proper waste disposal everyday.

Assist in Maintaining Well-being of People with Special Needs

Home caregiving places the focus on the patient, his/her needs, and well-being. In the home,
a patient can be cared for as an individual rather than as an illness or injury. The care of the family
encourages both physical and psychological health. The family has the opportunity and the time to
confer with the patient and gain an understanding of the patient’s emotional and physical needs. In
meeting those needs, family members acquire a sense of contributing to the health of the patient.
This will make certain that the entire responsibilities do not fall on a single family member, and
that the proper amount of time is devoted to the care of the patient. Together the family, caregiver,
and the patient need to develop strategies to foster the highest possible level of well-being for all
concerned.

Rights and Privileges for Disabled Persons under the “Magna Carta for Disabled Persons”
1. Disabled persons are part of Philippine society; thus, the State shall give full support to
the improvement of the total well-being of disabled persons and their integration into
the mainstream of society. The State shall adopt policies ensuring the rehabilitation, self-
development and self-reliance of disabled persons. It shall develop their skills and potentials to
enable them to compete favorably for available opportunities.
2. Disabled persons have the same right as other people to take their proper place in the society.
They should be able to line freely and as independently as possible.
3. The rehabilitation of the disabled persons shall be the concern of the government in order to
foster their capacity to attain a more meaningful, productive and satisfying life.
4. The State also recognizes the role of the private sector in promoting the welfare of disabled
persons and shall encourage partnership in programs that address their needs and concern.

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5. To facilitate integration of disabled persons into the mainstreams of society, the State shall
advocate for and encourage respect for disabled persons. The State shall exert all efforts to
remove all social, cultural, economic, environmental, and attitudinal barriers that are prejudicial
to disabled persons.
(Source: Magna Carta for Disabled Persons –– Republic Act 7277)

Practice and Encourage Self-Expression to Assert Self-esteem, Accomplishment, and

Achievements
As convalescence progresses and the patient begin to be up and about, a walk in the garden
creates an interest and sense of achievement. After a long illness a walk as far as the corner or around
the block is a tremendous boost to the patient’s morale. A short car ride can also be very pleasant,
especially if the driver uses a little imagination.
If a patient has interest in gardening, he/she will enjoy gardening programs on radio and
television and will gladly read gardening books. He/she will appreciate a vase of flowers from his/her
own garden or an indoor plant to tend. If patients are severely handicapped, or need activities to get
stiff limbs moving again, the occupational therapist will give help and advice.
In certain circumstances following an illness or an accident, an adult may have to relearn many
things. He/she should be encouraged, so that he/she may discover what he/she can do and gain
enough confidence to extend himself further still. The patient who had an stroke may have to learn
to speak again, to feed himself with only one hand and chew his/her food with a part of his/her face
which he/she cannot control. He/she may have to learn to walk with a paralyzed leg and struggle to
relearn many simple skills he/she mastered as a young child.
The man who has lost an arm in an accident not only has to master the skills of everyday living
but may have to be retained at his old job or learn to do a new one. The patient with spinal damage
must learn to propel a wheelchair, relearn the skills of driving with hand controls and adapt his daily
living to wheelchair height. These are just examples of circumstances making relearning necessary.
To be successful in cases of severe handicap, physical reeducation requires a team approach.
The patient’s family and his/her friends can all help in giving the care. Give praise for trying the task
especially when his/her abilities are limited and appreciate what he/she has done.
(Source: Lagala, Ellen Caring for the Sick, p. 149)

Assisting People with Disabilities to Identify and Meet Their Needs

It is important to analyze the extent of help or support needed by a person with disability in
his/her activities. Below are activities in which they may require assistance:
1. Personal hygiene
2. Grooming and dressing
3. Preparing and serving suitable meals
4. Maintaining an attractive living quarters
5. Administering medicine
6. Preventing accidents through proper safety measures
7. Providing assistive devices that can help in his/her activities
8. Assisting him/her in his/her exercises and need for fresh air

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Upholding the Dignity, Privacy, and Personal Choice of People with Special Needs
Caregiving can bring changes to the life and relationship with the patient and family members.
An open and honest communication will be necessary to explore all the changes that goes with
caregiving. Everyone has the right to be treated with respect and dignity and does not change when
a person becomes sick or disabled. Listen to his/her concerns.
There are patients and families who are very private. A family with mentally ill person wants
to protect the patient by keeping his/her condition confidential. A good caregiver should respect
the wish of the family to keep in private the condition of the patient. Ensure that privacy is available
whenever the patient requires it, particularly if you are attending to his/her personal needs or if he/
she wishes to talk quietly with a friend, lawyer or priest.
In making decisions, involve the patient with regards to his/her condition and welfare. Even if
he/she needs a great deal of care, don’t forget that he/she is an adult and not a child and should be
trusted as an adult. Respect the right of the person to make choices. Let him/her decide for himself as
long as it is safe for his/her condition. In case an individual difference comes along, explain your side
in a courteous way, but do not try and force your side upon the person.

Fulfilling the Physical, Social, Intellectual, and Emotional Needs of People with Special Needs
Physical needs include being able to breathe, to eat and drink, to rest and sleep, and to be safe
in a stable environment. As you plan a daily routine for the patient, you take account of these needs.
Make sure he/she is washed, fed, gets enough sleep and stay secure in familiar surroundings. If he/
she finds the environment unfamiliar and unsettling, you need to do as much as you can to make
him/her feel comfortable and at ease.
Social Needs – whether young or old, the patient needs companionship. Visitors are always
welcome, but they can tire the patient. Try and assess the patient’s condition to decide how much
visiting is advisable and discuss your opinion with the family.
Radio and television can provide companionship. The set should be placed where they can
be seen easily, heard without difficulty and switched off when not required. The set should have a
remote control to make it easier for the patient to switch off or on. The caregiver should ensure that
she is available to respond to the patient’s needs.
Intellectual needs – The brain needs regular workouts and the mind kept active. A person can
keep a healthy and active mind by enjoying and engaging in stimulating conversation being active in
social life, doing brain activities like reading a variety of reading materials, playing educational games
like scrabble, crossword puzzles and word games, writing letters, and creating new hobbies. If the
activities are too stressful and difficult for the patient, change it to some easier activities that he/she
will enjoy.
Emotional needs – It is important for the patient to feel that he/she is emotionally supported.
He/she may feel lonely and isolated due to his/her condition. The caregiver should be alert to the
patient’s feelings of insecurity if his/her illness has been for long time and has left him/her severely
incapacitated. Apprehension, fear, depression, and frustration are often experienced by disabled
people which often stems from the limitations and dependence imposed by an illness or injury. In
support, the caregiver should listen attentively to what the patient is saying and what he/she wants.
Try to make him/her feel that you really care about him/her as a person.

Assisting People with Special Needs in Maintaining an Environment that Enables Maximum
Independent Living
A good caregiver has a fairly good knowledge of the behavior of a patient. Due to the condition
of the sick person, he/she becomes difficult to please, sensitive, gets irritated easily, often complains,
and sometimes makes unnecessary demands.
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 Illness or disability contributes to the patient’s difficult behavior. Emotional and physical
changes he/she is experiencing may cause the changes in his/her personality and behavior. Side
effects of medication, depression, dehydration may also contribute to the physical problems of the
patient. The important action to do is to consult the patient’s doctor to know the reason for his/her
difficult behavior especially if it comes on suddenly for the patient.
If you can’t control the patient’s behavior, then control yourself in dealing with his/her difficult
behavior.
1. Be calm, balance, and patient with yourself
2. Do the best you can and don’t blame yourself
3. Don’t feel bad, focus on his/her difficult behavior
4. When difficult to handle, you have some options like asking him/her for politeness or
leaving the room
5. Stand up for yourself or avoid build up of resentment or angry feelings

Developing Strategies in Dealing with Difficult Behavior

1. If a caregiver feels being abused emotionally, verbally, or physically, get help immediately. Call
the attending physician and ask the medical reason for the difficult behavior.
2. When a patient who needs help refuses to accept it, be patient and understanding. Tell him/her
to prepare his/her own care plan and ask him/her when he/she wants things done. Tell him/her
that he/she has the final say in deciding about his/her care.
3. If the patient becomes easily irritated, angry, demanding, and always complaining, don’t take
the anger personally. Ask him/her why he/she feels so bad. Offer him/her help to make him/her
feel better. Respect his/her demands even if they are petty demands but are important to him/
her.
4. A patient with anxious behavior may worry about small details of his/her condition and
medications. Use gentle touch to calm him/her and assure him/her that things are under control.
Give him/her some positive statements that he/she can repeat again and again. Distract his/her
attention so he/she can focus on something else, to stop the thoughts that causes the anxiety.
5. If the patient has a disrespectful behavior, calm yourself and take a deep and relaxing breathe.
Let the patient know what he/she has done and how you felt. Tell him/her politely how you
wish to be treated. Ask him/her what is wrong and listen to what he/she has to say behind the
disrespectful actuation or words.

Developing Strategies to Meet the Requirements in Their Nursing

Needs
1. Comfort and mobility. One of the important tasks as a caregiver is
to attend to the patient’s comfort. If the patient is unable to move
or if his/her movements are restricted, it is up to the caregiver to
choose the most suitable position in bed for him/her. You should
know how to lift and move him/her without causing him/her pain
and without straining your back. Prolonged bed rest is known to be
harmful, the patient is likely to develop bedsores. Because of the
risk, you should turn the patient regularly and help him/her to take
gentle exercises.
The patient who can get up and move around should be encouraged to do so; but do not
forget that even the relatively mobile patient may need help.

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2. Helping the blind patient to eat. The blind patient is often able to
feed himself/herself with encouragement and a little thoughtful
preparation, so be careful not to limit his/her independence.
Cut the food up into bite-sized pieces and arrange it around
the plate. You can then tell him/her that the potatoes are at 1
o’clock, the meat at 4 o’clock and so on. If he/she cannot feed
himself, try and avoid saying ‘next’ or ‘open’ when each mouthful
is ready; instead, tap his/her chin when you want him/her to open his/her mouth. This leaves
you free to chat.
3. Shaving – a man who shaves regularly will find it both uncomfortable and embarrassing when
stubble grows. If he is unable to shave himself, then you must do it for him. Before you start,
assess the patient’s condition and judge how much help he needs. Ask
him what kind of razor he normally use, switching from an electric to a
safety razor will cause him discomfort for several days. Also find out in
which direction he shaves. The bristles grow according to the direction of
shaving, so going against the normal may cause pulling and tenderness.
Plan your care according to how much the patient can do for
himself. Protect him and the bed with towels. Wash and dry his face in
the usual way.

Remember These
1. As a caregiver of a person with special needs, you will be faced with challenges that you
have not experienced before and it can be difficult to know where to start and what to do.
2. Every person whether non-disabled or with disability has a basic human need and right
to be treated with respect and dignity.
3. Whatever the disability, the aim of care is the same, to allow the person to live as full and as
possible, while maintaining his/her self-respect and encouraging his/her independence.
4. It is important for the patient to feel that he/she is emotionally supported. He/she may
feel lonely and isolated due to his/her condition.
5. The stress of an illness or disability can lead to a patient’s behavior becoming difficult.

Check Your Understanding

A. Fill in the blanks with the correct word/words. Choose your answer on the box on the next
page.
1. People with special needs refer to persons with __________.
2. __________ impairment does not affect the ability to talk, to think and to hear.
3. Mobility impairment affects the _______ and _______.
4. A ________ is the daily performance of a specific activity done in the same manner.
5. Every person with special need is different depending on his/her ________.

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