Long-term Care Services; Then and Now

Long-term care includes nursing home facilities as well as home care agencies and assisted living facilities. Who uses long-term care services? Why do they use them?
Mainly the elderly (considered age 65 or older) population uses long-term care services; however, there are those who are younger and mainly physically or mentally handicapped. However, those who use long-term care services are those who require additional assistance or recovery time. Examples of some situations in which an individual needs long-term services would be someone who is recovering from/adjusting to chronic diseases/injuries and disabilities, both mental and physical. There are those individuals who are younger that have developed chronic illnesses that has left them needing the care of skilled, licensed personnel and is more extensive than their family can provide.
How has long-term care changed in recent years?
Years ago family would care for the elderly once they reached a point in their lives when they needed additional assistance and care and became unable to care for themselves. Facilities were used mainly for elderly people, those who were mentally ill, or those who were poor and had no place to go. Today long-term care facilities are used for individuals of any age, in any financial class who need professional help in performing their ADLs (activities of daily living) for a longer length of time than a hospital is able to provide. Many times these facilities are used as rehabilitation facilities where people can go for strengthening and assistance in order to reach their ultimate goal of returning to home.

Should Mary's family members authorize the double-hip replacement?
Taking into consideration Mary’s age, I do not feel as though her family members should authorized the double-hip replacement. Mary has advancing memory loss and her dementia has been bad for some time. She is not able to get around on her own, so the idea of putting Mary though the surgery, which at this stage of Mary’s life can be extremely life threatening, is not practical. Mary’s family should opt for pain management for Mary, especially since the extensive recovery post hip replacement surgery is not something Mary will be able to endure, if Mary were to make it through surgery given her heart condition.
What factors should be considered?
There are many factors to be considered when Mary’s family thinks about putting her through the surgery and then recovery of double-hip replacement. First, there is the financial burden it will cause, both with surgery and then post recovery time and rehabilitative services that will be required, ultimately at an outside facility other than the hospital. There is also the consideration of Mary’s health. Her current age and health status weigh against Mary making it through any kind of surgery, especially one this extensive which often results in large amounts of blood loss. Also, there may not be a surgeon willing to consider doing surgery on Mary because of her age and medical conditions. She would need to be cleared by many different medical services prior to surgery, and she may not get that clearance, but there would still be the financial burden associated with attempting to get clearance. Will the hip replacement benefit Mary in any way? She is already not getting around on her own, and with her dementia, it makes it unlikely that she will be able to provide care for herself.