Neighborly Support and Health Care, Co-Care Agreements
What neighbors may do and should not do for neighbors who need health care support
One of the most difficult things to determine is where to draw the line when neighborly support and health care, particularly when it is more than a temporary need. These guidelines were initially developed at Takoma Village Cohousing to clarify expectations of community residents, their family members, and those considering living in cohousing who require on-going health-care needs.
A few years ago one of our residents began needing multiple interventions each day. Not only was it much more care than we could provide, but we began to question what kinds of care we should not be providing. The resident’s family lived nearby, but they continued to be unaware of the need. This case of accelerating decline followed closely on a neighbor suddenly needing support during cancer treatment. We expected to provide short-term support but it extended to several years. In addition, providing meals for one or two became meals for four or five as family members moved in temporarily to help with care.
In both cases we gradually slipped into a level of support that was unsustainable, creating feelings of guilt and inadequacy. Having guidelines that established appropriate expectations on both sides would have avoided this.
Fortunately, we had several residents who were medical, psychiatric, and religious professionals with experience in long-term health care. They helped assemble guidelines on what we could do and also what we shouldn’t be doing. Long-term Takoma Village resident Sharon Villines posted the list to Cohousing-L where it was discussed and amended. She has been shepherding it since then and has updated it several times. If you have suggestions, please send them to her so it remains current.
Guidelines for Neighborly Support vs Health Care in Cohousing, Co-care Agreements
These guidelines were developed at Takoma Village Cohousing in consultation with medical, psychiatric, and religious professionals living in cohousing who had experience in long-term health care. They are intended to help clarify expectations between neighbors, family members living at a distance, and those considering living in cohousing who have special needs. It includes both recommendations and cautions.
When presenting cohousing as a caring community that encourages aging in place, it becomes important to distinguish between what is sustainable on a temporary basis and what can be provided on a continuing basis. And when neighborly support becomes health care that needs dedicated care.
Neighborly support includes:
1. Picking up medications at the pharmacy, but not administering medications.
2. Shopping, but not being sole shopper.
3. Bringing in some meals, but not becoming the cook or meal server.
4. Accompanying, along with an aid, to a medical appt but not daily transportation.
5. Not providing intimate body care or bathroom functions.
6. Not assuming responsibility for making appointments or arranging for health care providers
7. Not changing bandages or other health care devices
Neighbors in cohousing can provide helpful services but not critical services or services that create a dependency. Neighbors should not expect support for themselves in activities that would interfere with the normal household functioning of others on a continuing basis, or that would cause harm to the patient or liability to the neighbor if not done or not done properly.
——— By Sharon Villines, Takoma Village Cohousing
Tags: co-care agreements, Legal