Navigating the Maze of Senior Care
Finding Good Care for Your Parents and Loved Ones
By Melissa Sprouse Browne
When a loved one needs some extra help in his senior years, there are many ways to solve those issues. The range of care needed can go from just a little assistance with the activities of daily living, including things such as dressing, bathing, transferring, medication reminders and light housekeeping to complete and total skilled care. There are things you need to know as your family member progresses along the continuum of care to insure the best possible outcome.
Getting help is advisable when the time comes. Let’s first talk about how to choose a home health or non-medical companion agency and the differences in medical and non-medical services.
There are many situations when you will find it helpful to bring in a professional care provider. There are times when you can’t handle it all by yourself and even a short break can help you recharge. This type of break is usually called respite care. There are other situations where your parent needs care beyond your capabilities or comfort level that a professional can offer. Or, you may have work obligations and can’t be there all the time, yet your parent needs help on an ongoing basis. Not living close by is another great reason to call in help from an outside agency.
The first thing to learn is the difference between medical and non-medical providers. A medical home health agency can administer medication, perform therapy (physical, speech and occupational), deliver nursing services and, in most cases, accept payment from Medicare and Medicaid should their agency be properly registered and licensed. Other components of medical home health include intermittent home health aides, social services, certain medical supplies and equipment. You may not need the full range of medical services and will want to also consider a non-medical home health provider. Usually, a medical service provider will not provide custodial care, which is the term used by insurance and Medicare/Medicaid for companionship or sitter services.
A non-medical home care company will offer an assortment of services, which may include any or all of the following: companionship/sitter services, medication reminders, light housekeeping, laundry, diet monitoring, meal preparation, transportation, hands-on assistance with activities of daily living, errands, socialization activities, grocery shopping and basic exercise. For a non-medical service, the line is drawn at medication administration. The medicine can be put within reach of the patient, but cannot be physically administered.
When you’re thinking of evaluating home care agencies, determine if you need a medical or non-medical provider. Consider consulting with your parent’s doctor to make the proper determination. Once you’ve decided on a level of care, it’s time to start looking for agencies.
There are lots of ways to get names of qualified providers. First, you can get a list from your local hospital. Your doctor’s office should also be able to help you find providers, too. Certainly the internet will also be a great help in finding home health agencies in your area. Set up a comparison chart, which you can do simply on notebook paper, or by creating a spreadsheet. Create a list of questions to ask, so you can compare apples to apples. Your chart might include the following:
Agency Name and Phone Number.
Duties/tasks they perform.
Medical or Non-Medical care.
Rate per hour.
Is there a minimum number of hours required per visit?
Is there a minimum number of hours required each week?
Are they bonded and insured?
Are there references you can call?
How long has the company been in business?
How are emergencies handled?
Is staff available 24/7?
How are patient rights and privacy protected?
What input does the family have in the care plan?
Who can be called for questions or complaints?
For medical care, will the agency stay in contact with your parent’s doctor?
What happens if someone doesn’t come when scheduled?
Costs vary for home health services, particularly medical home health. Typical costs for a home health aide (non-medical care) average between $18 - $22 per hour, and less skilled aides providing companionship or sitter services average between $16 - $19 per hour.
You may be considering hiring a private individual to provide care for your parent. Be careful to not run afoul of the law. You’ll need to establish either an employer/employee relationship or set up the workers as independent contractors. Be sure to confirm the person is eligible to work in the United States and report wages at the end of the year. Caregivers working for an agency will have been vetted through a criminal background check, verified for work eligibility, checked for tuberculosis and trained. A private individual won’t have any of these safeguards in place. The right home health aide is a wonderful addition to your caregiving routine. Don’t settle for anyone less than the best.
One of the biggest misconceptions is the belief that Medicare pays for long term and nursing care. Medicare pays for a very short timeframe for in-patient care in a nursing or rehabilitaton facility.
Medicare doesn’t pay for around-the-clock care, prescriptions, meals delivered to the home, any homemaker services or personal care provided by home health aides when this type of care is the only care needed.
When it’s clear home care isn’t feasible, you’ll want to begin the process of evaluating the choices in care settings. The levels of care are usually categorized as independent living, assisted living and skilled nursing care, often with sublevels of each type. A continuum of care community will have all three levels (or four, if memory care if offered) and allow the resident to progress from one to the other as his abilities and circumstances change. Furthermore, you are expected to enter the continuum of care cycle at the independent living stage. Community care and group homes are another option for senior care in some locales.
Understanding the distinctions between care levels is vital to placing your parent in the right environment. Alzheimer’s/dementia care can be found in both assisted living and skilled nursing care settings. Assisted living doesn’t have a hard and fast definition, but the Assisted Living Federation of America defines assisted living as “a combination of housing, personalized support services and health care designed to meet the individual needs of persons who need help with the activities of daily living, but do not need the skilled medical care provided in a nursing home.”
Skilled nursing care is full medical care provided in a clinical setting by credentialed medical professionals. Skilled nursing facilities are also referred to as nursing homes and are residential care facilities where residents receive skilled nursing services twenty four hours a day. Residents are patients who cannot take care of their own personal and medical needs.
When you’re ready to begin your search for the right residential care community, there are many considerations. First, any place you consider needs to have an unannounced walk through. Walk around by yourself and give a five senses inspection – how does it look, smell, sound and feel. If the first thing you notice is a strong urine smell, turn around and leave. This is no place for your parent.
Vary your visits between days, evenings and weekends. Weekend staff levels are usually lower, so it can give you a good idea of how low they allow their staffing levels to be and what effect it has on the residents. If you can ask for the resident to staff ratio, you’ll have a picture of the type of attention your parent can expect. Listen for residents crying out or buzzers going off for long periods of time without anyone attending to them, which is a bad sign.
You’ll want to go into the cafeteria or dining hall. The best time to go is lunch or dinnertime. Go back on a planned visit with the staff and ask to have a meal so you can judge for yourself the quality of the food being served.
Ask what steps have been taken to prevent patients with dementia from wandering off or getting hurt. A properly stimulating environment for memory care is as important as security, so look for outdoor gardens and places for dementia residents to enjoy life without risk.
Having a parent with dementia means you need to ask additional questions about how certain behaviors are handled. If the staff’s answer to challenging behavior is only medication, be concerned. Properly trained staff are often able to redirect residents into a more productive behavior without escalating the issue.
After you’ve done the walk-throughs, if your search is for skilled nursing care, go online to www.medicare.gov to see a comparison of nursing homes in your area.
How do you know if your parent is a candidate for hospice? One of the most prominent hospital systems in our area developed a checklist to help determine if hospice care is a viable alternative for care. If you have noticed the following symptoms, then your parent should be evaluated by his or her primary care physician:
Decrease in appetite.
Decreased interest in surroundings.
Decreased interactions/withdrawal from others.
Decreased level of activity.
Progressive loss of function.
Decreased participation in self care.
Loss of continence.
Progressively worse or difficult to control symptoms of a chronic disease (i.e. increased pain, difficulty breathing, swelling, etc.).
Frequent hospital stays.
You may be wondering what hospice is exactly. It’s care designed to be supportive of people in the final phase of a terminal illness and focuses on helping patients be comfortable and as free from pain as possible. The term pallative care is often used, and means providing specialized relief from the symptoms of a disease to improve quality of life. Pallative care does not seek a cure, but rather offers assistance in symptom management. Hospice programs are usually home-based, but services may be provided anywhere.
Hospice care helps people die with dignity. As a Medicare covered benefit, the doctor must certify the patient is likely to die within six months if the disease continues on its current course.
In the past, hospice was associated primarily with cancer patients. However, people with other types of life limiting illnesses are appropriate candidates for care, including those with dementia, stroke, heart disease, Parkinson’s Disease, COPD, kidney or liver failure, or any other serious condition.
Hospice becomes the controlling healthcare team, providing medical professionals, equipment, medication and supplies, counseling for the patient and family members and bereavement services for up to a year afterwards.
With hospice providers, they employ people just like other companies. So, there is a possibility of receiving less than stellar care. If you’re unhappy with a caregiver or any aspect of service, you should make your feelings known to the hospice provider’s administrator. Fortunately, the majority of those working for a hospice are good people who care, which is want you want for your parent or loved one in the last days.
Melissa is the author of The Caregiver’s Training Program: What You Need to Know to Take Care of Your Parents in their Golden Years.