What is support?

Every one of us needs and uses support. Put simply, a support is any activity that assists people in successfully completing a goal or task. That could be setting an alarm for your kids so they make it to school on time or cooking your mother a meal. Support can come from things, too. For example, when you go to the grocery store, you need a way to get there, carry your food, pay, and get back home.

Supports are everywhere, and they are deeply interconnected. In this guide, we are going to discuss what types of supports caregivers use and how to identify them. Consider how much time you spend driving an elderly or disabled family member or friend to their appointments. Think about the number of meals you make for them or the hours you invest cleaning their homes. These are all supports.

If you feel unseen, unappreciated, or alone in this role, you are not. According to one study, over one in six Americans working full- or part-time also spend time in a caregiver role – and that excludes parents or guardians of children.

Providing support is not effortless. It impacts your life in many, far-reaching ways. Your time is worth compensation, and the first step toward securing the recognition you are owed is understanding the types and extent of the care you give.

Identifying the support you give

Maslow’s hierarchy of needs can help us better understand what support looks like in the context of your unique situation. Maslow’s hierarchy of needs is a five-tier model of human needs, typically represented as levels within a triangle. We must satisfy the needs on the lower level before we can move to higher-level needs.

On the base of the triangle are physiological needs – the things required to keep us alive. For example, air, food, clothing, shelter, and warmth. As a caregiver, you may be responsible for helping your person achieve one or more of their physiological needs.

One step up is our safety needs. This includes things like emotional and financial security, property, social stability, and freedom from fear. Then, we have love and belongingness, followed by esteem needs and self-actualization needs.

Similar to Maslow’s hierarchy of needs, ‘activities of daily living’ or ADLs offer another way for us to identify the type of support we are giving. You may already be familiar with ADLs, but in short, they are the basic activities we need to complete to keep ourselves alive and well, such as:

• Dressing
• Personal hygiene
• Moving from one place to another, such as from bed to the bathroom
• Grooming
• Toileting

In addition to ADLs, we have instrumental activities of daily living or IADLs. These tasks are more complex and not essential for survival. In most cases, these tasks are the first a person losing independence will require support for. They include:

• Grocery shopping
• Meal preparation
• Housework and laundry
• Medication management
• Financial management, such as paying bills on time

Take a moment to consider the tasks you provide support for. Which level of Maslow’s hierarchy of needs do they fall within? Are they ADLs or IADLs? With a clear view of the type of support you offer, you can begin to unpack how that support unfolds in your day-to-day interactions.

Understanding the five types of support

Not all support activities are created equally. There’s a big difference between reminding John to get dressed and dressing him yourself. Dig down even further, and there’s a difference between reminding John to get dressed and reminding him to put on his underwear, pants, shirt, socks, and shoes. It’s not just type but also quantity or number of times a support is required to complete a task that matters.

As we move through the five types of support, we will look at examples and ground these in the principles and values of person-centered care. What is important for someone and what is important to someone are not always the same thing. Let’s get started.

Observation

The first and least involved type of support is observation. You observe that John can dress himself, so you know he is capable of that task. Observation may seem like an obvious or unnecessary step to mention, but it plays a vital role in determining how much support you need to give or how much support a person requires to thrive.

Why? If you didn’t write it down, it didn’t happen. It’s the oldest adage in healthcare. If you don’t observe a task from start to finish, you might not know the process, effort, ease, or struggle behind that task.

For example, let’s say John walks into an assessor’s office to ask for support. He is fully dressed and looking sharp, so the assessor assumes John doesn’t require support to dress himself. In reality, however, you, the caregiver, had to remind John to put on his underwear, pants, shirt, and so on.

For John to get the support he needs to achieve his ADLs – and for you to claim the compensation you deserve – observe and note the level of support John does or doesn’t need so that the assessor has the complete picture.

In addition, through the lens of person-centered care, observation gives us crucial information about how the patient prefers to do a particular task. People are taught to do things differently, and there’s no ‘right’ way to make minestrone or tie our shoelaces. Observation also gives the person the opportunity to be independent.

Gestures

The next type of support is gestural. Let’s go back to our dressing example. If John is getting dressed but needs you to point out where his shoes are, that’s gestural support. Or let’s say John requires a little more support than that – he needs you to point to each drawer and each piece of clothing. Understanding the amount of support needed is equally as important as understanding the type.

In addition to gestures like pointing, you may use environmental gestures to support a person who is elderly or disabled. For example, perhaps John is responsible for putting away the dishes after the dishwasher has run its cycle. If you have observed that John forgets to do this, you might open the dishwasher to trigger John’s memory. Then, when he sees the dishwasher filled with clean dishes, he knows to put them away.

Gestural prompts are precursors to verbal prompts and can effectively enable a person to maintain a higher degree of independence.

Verbal prompts

Most people don’t enjoy being told what to do, but sometimes verbal prompts are the only way to help a person achieve their ADLs. One technique that helps us maintain a person-centered focus is swapping demands for questions. For example, you leave the dishwasher open, but John doesn’t put the dishes away. So instead of saying, ‘John, please put the dishes away,’ you ask, ‘John, can you please put the dishes away?’

It’s a minor adjustment, but one that empowers John to make his own decisions about his time – he maintains his autonomy. In response, John might say, ‘Sure, I’ll do it now.’ But he also has the opportunity to say, ‘I’ll do it soon, but I’d like to finish this chapter of my book,’ or, ‘I can do it, but I might need your help.’

One quick note: if you are caring for someone who has hearing impairments, sign language is considered a verbal prompt – not a gestural prompt.

When evaluating your use of verbal prompts, pay attention to the number of times you offer a hint or repeat yourself. Again, this is crucial information when documenting the support you give, as it takes a lot longer to say the one instruction four, five, or more times before it’s understood than to say it once. It also takes a lot longer to give step-by-step instructions – take out the cups and put them in the cupboard, and then take out the forks and put them in the drawer – than giving one overarching instruction – ‘Can you please put the dishes away?’

Physical assistance

If verbal prompts aren’t successful because the person is refusing or unable to physically complete the task independently, we move on to physical assistance. Physical assistance occurs anytime you touch someone, something, or perform a physical task that helps the person you are caring for accomplish a goal.

When evaluating physical assistance supports, consider how often you initiate an action and when one action becomes another. Let’s use going to the bathroom as an example. When we physically assist someone, the first touch might be transferring them from the wheelchair to the toilet. The second touch might be pulling down their pants, and the third wiping. A person might need all three touches or just one – it’s essential to make this distinction.

Finally, physical assistances are supports initiated by the person you are caring for. For example, if they say, ‘I need to use the bathroom, so can you please help me?’ they recognize the need and understand the steps required to meet that need. The same applies if someone expresses their hunger and needs you to make a meal or if they are ready for bed and need help moving into their bedroom.

If a person cannot physically complete a goal and fails to recognize why that goal is necessary, the support moves into the fifth and final category: completing the task for them.

Completing the task for them

At times, people will refuse care. It can be frustrating, disheartening, and tiresome, particularly if that goal is integral to the person’s health and safety. If you take the initiative and complete a task for the person you are caring for, you have performed the fifth and most involved type of support.

Regardless of our stage of life, most of us don’t enjoy being told what to do, let alone forced to do it. That’s why grounding your approach to support in the values of person-centered care is more crucial in this stage than any other.

Here’s an example of what that might look like in practice. Let’s say John is refusing to take a shower – it’s not something that’s important to him. You know that going to the cinema once a week is important to John. Instead of forcing John to shower, you can reason with him by connecting the importance of showering with something that matters to him. Showering is essential if John wants to go out and do the things he loves – that way, John can decide to shower cooperatively because he sees its value.

More is not always more

Effective, person-centered support requires us to evaluate the types and extent of support we give the person we care for. But even well-intentioned support can have adverse repercussions if the person doesn’t need it.

For example, if you offer verbal prompts but have never tried to achieve the same goals with gestural prompts, it may be worth giving that a go. Or, if you have been helping a person achieve their ADLs through physical assistance, it’s worth considering whether you can lower the number of required touches. Does the person you care for need help putting on all of their clothing, or just their shoes and socks, which are out of reach?

A person cannot demonstrate their independence if they haven’t had the opportunity, and person-centered care promotes independence and ensures the cared-for person maintains their dignity and autonomy every step of the way. Sometimes that means incorporating more support, and other times that means carefully removing or altering support.

Communicating support needs where words fail

Communication is vital in a successful caregiver relationship – not only between the carer and cared-for but also with family members, assessors, doctors, providers, and regulatory agencies. Using the above five categories, you can document the type of care required and ensure both you and the person you care for are getting their needs met.